Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia

Feuchtner, Gudrun; Barbieri, Fabian; Langer, Christian; Beyer, Christoph; Widmann, Gerlig; Friedrich, Guy; Cartes-Zumelzu, Fabiola; Plank, Fabian

doi:10.1016/j.jcct.2019.01.010

Cited by 17 publications

(13 citation statements)

References 33 publications

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“…Among those with 30-50% diameter of stenosis, a minority of nadir FFR CT -positive vessels underwent ICA and revascularization. A recent study found that high-risk plaque, increasing lipid necrotic core and non-calcified plaque burden on coronary CTA predict ischemia in non-obstructive lesions [46]. Thus, for those with 30-50% diameter of stenosis, it may be reasonable to reserve FFR CT for those lesions with adverse plaque characteristics or significant atherosclerotic burden.…”

Section: Discussionmentioning

confidence: 99%

Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

Rabbat

Leipsic

Bax

et al. 2020

JCM

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Objectives: In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFRCT) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFRCT could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone. Methods: The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFRCT and 44 control patients who underwent CTA alone. Lesions with 30–90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFRCT. Nadir FFRCT ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded. Results: Using coronary CTA and selective FFRCT, 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFRCT ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30–50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFRCT ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFRCT reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFRCT, no major adverse cardiac events occurred over a mean follow-up of 440 days. Conclusion: FFRCT safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.

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Section: Discussionmentioning

confidence: 99%

Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

Rabbat

Leipsic

Bax

et al. 2020

JCM

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“…Second, less non-calcified plaque burden was observed in those being treated with vitamin D. Higher total plaque burden is a risk factor for MACE and ischemia [19,20], especially when applying a score weighting for the non-calcified plaque burden [21]. Beyond, our study revealed that while stenosis severity score was not different, the proportion of >50% stenosis was slightly higher in those who did not apply vitamin D. However, there was no difference in stenosis severity score (CAD-RADS TM ) and serum 25-hydroxyvitamin D level.…”

Section: Discussionmentioning

confidence: 99%

“…(1) Coronary stenosis severity was scored on a 5-point scale as: (1) minimal (<25%), [27], respectively. Total plaque burden was expressed by the coronary segment involvement (SIS) score [28], and the total mixed plaque burden weighted for the non-calcified plaque component was calculated as previously described [21] (sum of plaque types T1-4 for each segment, G-score) (Figure 1), per-coronary segment (AHA-modified-16-segment classification) [26]. (3) Quantitative High-risk plaque analysis [17,29,30]:…”

Section: Cta Image Analysismentioning

confidence: 99%

“…To our knowledge, no study to date has investigated the effect of vitamin D supplementation on the coronary artery atherosclerosis profile by quantitative coronary computed tomography angiography (CTA), including stenosis severity [16], total plaque burden, and high-risk "vulnerable" plaque characteristics, which represent novel biomarkers for increased cardiovascular risk [17,18] and myocardial ischemia [19,20]. Total plaque burden by CTA is another predictor of adverse cardiovascular outcomes [21].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case–Control Coronary CTA Study

Feuchtner

Suppersberger

Langer

et al. 2021

JCDD

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Background: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case–control cohort study. Methods: 176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: <20 ng/mL; 1: 20–40 ng/mL; 2: 40–60 ng/mL; and 3: >60 ng/mL) and compared with CTA. Results: The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque. Conclusions: In this retrospective case–control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.

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“…Calcified and non-calcified plaque components were defined as hyperand hypoattenuating lesions with > and < 150 HU [10]. The G-score [17] (= sum of plaque types T1-T4 for each segment), as radiologic marker for an increased noncalcifying plaque burden, per coronary segment (AHAmodified-16-segment classification) was calculated. 3) Quantitative High-risk plaque (HRP) analysis [8] & Non-calcified plaque (NCP) was defined as being hypodense as compared to vessel lumen, < 150 HU [18].…”

Section: Coronary Computed Tomographymentioning

confidence: 99%

Coronary atherosclerosis profile in patients with end-stage liver disease prior to liver transplantation due to alcoholic fatty liver: a coronary CTA study

et al. 2020

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Objectives To assess the coronary atherosclerosis profile by coronary computed tomography angiography (CTA) in patients with end-stage liver disease (ESLD) due to alcohol-related liver disease (ARLD) evaluated for liver transplantation (LT), in a retrospective matched case-controlled cohort study. Methods One hundred forty patients (age 60.6 years ± 9.8, 20.7% females) who underwent coronary CTA were included. Seventy patients with ESLD due to ARLD (ESLD-alc) were propensity score (1:1) matched for age, gender, and the major 5 cardiovascular risk factors with healthy controls. CTA analysis included the following: stenosis severity according to CAD-RADS as (0) = no, (1) minimal < 25%, (2) mild 25-50%, (3) moderate 50-70%, and (4) severe > 70% stenosis, total mixed plaque burden weighted for non-calcified component (G-score) and high-risk plaque criteria (Napkin-Ring, low attenuation plaque, spotty calcification, positive remodeling). Results Prevalence of coronary artery disease (CAD) was high (84.4%) in the ESLD-alc group but similar to controls. Stenosis severity was similar (CAD-RADS, 1.9 vs. 2.2, p = 0.289). High-grade stenosis (> 70%) was observed in 12.5% of ESLD-alc patients. High-risk plaques were less frequent in the ESLD-alc cohort as compared to controls (4.5% vs. 37.5%, p < 0.001), and total mixed plaque burden was lower (G-score, 4.9 versus 7.4, p = 0.001). Plaque density was lower in controls (56.6HU ± 3.2 vs. 91.3HU ± 4.5, p = 0.007) indicating more lipid-rich in controls, but higher mixed fibro-calcific plaque component in those with alcohol-related ESLD. Conclusion Patients with alcohol-related ESLD exhibit more mixed fibro-calcified plaques but less plaque with high-risk features and less fibro-fatty plaque burden, while total CAD prevalence is high. Key Points • Patients with ESLD prior to LT have a high total prevalence of CAD and stenosis severity, which is similar to those of healthy controls with an identical cardiovascular risk profile. • Patients with ESLD prior to LT due to alcohol abuse have more calcific but less fibro-fatty plaque and less high-risk plaque. • CTA seems to be a useful imaging technique for risk stratification prior to LT.

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Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia

Cited by 17 publications

References 33 publications

Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case–Control Coronary CTA Study

Coronary atherosclerosis profile in patients with end-stage liver disease prior to liver transplantation due to alcoholic fatty liver: a coronary CTA study

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