Frequency and extent of coronary atherosclerotic plaques in patients with zero coronary artery calcium score: assessment with computed tomographic angiography

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to evaluate the frequency and extent of coronary atherosclerotic plaques in patients with a coronary artery calcium (CAC) score of zero and establish the demographic characteristics and the cardiovascular risk factors that affect the formation of atheromatous plaques. MATERIALS AND METHODSCoronary computed tomography (CT) angiography was performed in 288 cases with a CAC score of zero. The plaques that were detected using coronary CT angiography were categorized into two groups: nonsignificant (<50%) and significant (≥50%). Based on the coronary CT angiography results, the patients who had plaque and those who did not have plaque were compared in terms of the demographic characteristics and the presence of cardiovascular risk factors. RESULTSNoncalcified plaques were detected in 50 cases (17.4%) on CT angiography, of which six cases (2.1%) had significant stenosis. The plaques were localized most frequently (38.2%) in the proximal left anterior descending artery. When all the plaques considered 50% of the plaques were localized in the proximal segments, 42.7% were in the mid-segments, and 7.3% were in the distal segments. Hypertension was a significant risk factor for coronary artery disease in both genders, and smoking was a significant risk factor in females. Additionally, diabetes mellitus was a borderline significant risk factor in both genders. CONCLUSIONIn patients with a CAC score of zero, the frequency of noncalcified plaques is too high to be ignored. The distribution of these plaques in the coronary artery is similar to calcified plaque localizations. Patients who have a CAC score of zero and cardiovascular risk factors need to be evaluated with additional tests for the detection of noncalcified plaques.

Association of pericardial fat volume with coronary atherosclerotic disease assessed by CT angiography

“…This cutoff value of coronary stenosis had been used and investigated by several studies to define the severity of coronary stenosis in patients who had undergone multislice computed tomographic coronary angiography. 2,12 CT scan protocol and pericardial fat volume quantification CT coronary angiography was performed with a 64-slice scanner (Aquilion™ 64, v. 4.51 ER 010; Toshiba Medical Systems, Tochigi, Japan) with retrospective electrocardiography (ECG) gating. Before multislice CT angiography, a non-contrast CT was acquired to measure the calcium score according to the Agatston method using a sequence scan with a slice thickness of 3 mm.…”

GOLD stage predicts thoracic aortic calcifications in patients with COPD

“…The present study only addressed calcified plaques. However, noncalcified plaques are of high relevance in vascular disease as demonstrated by Büyükterzi et al (41) in a study with 288 subjects lacking calcified plaques in the coronary arteries, with 17.4% of their patients showing substantial coronary soft plaques, and 2.1% showing significant stenosis on coronary computed tomography. Besides, cardiovascular diseases reflect a broad spectrum of disease entities, such as cardiac diseases of different origin, and atherosclerosis with its diverse manifestations, while these entities are often linked or have common risk factors (42)(43)(44).…”

A high-risk, high-grade proximal left anterior descending coronary artery stenosis in a patient with a zero calcium score

“…While his symptoms were markedly atypical, his intermediate cardiac risk and strong family history of early CAD obligated an evaluation for obstructive CAD. Because of its high negative predictive value for the identification of CAD, [5] its ability to reclassify intermediate risk patients into high and low cardiac risk, [3,4] and its ability to identify other, non-cardiac causes of chest pain, a CCTA with CAC was ordered. Another advantage to this approach over stress test imaging is the ability of CCTA to identify subclinical CAD, not identifiable by stress testing.…”

“…[2] Patients with a zero calcium score are extremely unlikely to have coronary artery disease (CAD). [3,4] However, their risk for obstructive CAD is not zero. [3,4] Cardiac computed tomographic angiography (CCTA), a contrasted scan, is a state of the art diagnostic imaging modality used to evaluate patients with chest pain or other symptoms that may be attributable to CAD.…”

“…[3,4] However, their risk for obstructive CAD is not zero. [3,4] Cardiac computed tomographic angiography (CCTA), a contrasted scan, is a state of the art diagnostic imaging modality used to evaluate patients with chest pain or other symptoms that may be attributable to CAD. Its high negative predictive value and excellent diagnostic accuracy [5] are ideally suited for the evaluation of patients at low to in-termediate risk for CAD.…”