Prevalence of noncalcified coronary plaque on 64-slice computed tomography in asymptomatic patients with zero and low coronary artery calcium

Iwasaki, Kohichiro; Matsumoto, Takeshi; Aono, Hitoshi; Furukawa, Hiroshi; Samukawa, M

doi:10.1016/s0828-282x(10)70419-0

Cited by 25 publications

(22 citation statements)

References 34 publications

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“…In a study of patients with a zero coronary artery calcium score, 11% had evidence of noncalcified plaque on CT coronary angiogram. 41 A prior study demonstrated that reduction in Lp-PLA 2 reduces progression of necrotic core volume but not total atheroma volume in human coronary atherosclerotic plaque. 42 Our findings suggest that Lp-PLA 2 identifies characteristics of vulnerable plaque not associated with traditional measures of subclinical disease.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort: The multi ethnic study of atherosclerosis

et al. 2015

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Objective Prospective studies reporting a positive association of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and activity with incident cardiovascular disease (CVD) have included primarily white individuals. We evaluated associations of Lp-PLA2 and first-time cardiovascular events in a healthy multi-ethnic cohort characterized by presence or absence of baseline subclinical atherosclerosis. Methods Lp-PLA2 mass and activity were measured at baseline in 5456 participants in the Multi-Ethnic Study of Atherosclerosis. Individuals were characterized for presence of baseline subclinical disease (coronary artery calcium score>0 or carotid intima-media thickness value>80th percentile) and followed prospectively for development of CVD events (coronary heart disease, ischemic stroke, and cardiovascular death). Results 516 incident CVD events occurred over median follow-up of 10.2 years. In adjusted Cox proportional hazards models, each higher standard deviation of both Lp-PLA2 activity and mass was associated with an increased risk of cardiovascular events; hazard ratios (HR; 95% confidence intervals (CI)) 1.12 (1.01–1.26) for Lp-PLA2 activity and 1.10 (1.01–1.21) for mass. Associations did not differ by subclinical disease status (p-value for interaction 0.99 for Lp-PLA2 activity and 0.32 for Lp-PLA2 mass) and there was no confounding by subclinical atherosclerosis measures. Associations of Lp-PLA2 activity but not mass were weaker in Chinese participants but there were relatively few events among Chinese in race-stratified analysis. Conclusion In this multi-ethnic cohort, Lp-PLA2 was positively associated with CVD risk, regardless of the presence of coronary artery calcium or a thickened carotid-intimal media.

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Section: Discussionmentioning

confidence: 99%

Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort: The multi ethnic study of atherosclerosis

et al. 2015

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“…Motoyama, et al reported that the appearance of low attenuation plaque on multidetector CT was an independent predictor of acute coronary syndrome events for a 2-year followup period 17 . Noncalcified plaque may be present in the absence of coronary artery calcification: in a Japanese study, the prevalence of noncalcified plaque was 11.1% in patients with no coronary artery calcium and 23.4% in patients with mild coronary artery calcium 18 .…”

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confidence: 99%

Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

et al. 2012

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Objective A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE. Methods Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software. Results The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant. Conclusion Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

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“…Early studies focusing on CCTA alone have often defined NCP as any discernable object within the vessel wall with enhancement greater than the wall structures but less than the lumen,(26, 40, 41) effectively defining NCP as any plaque that is not completely calcified. Recent SCCT guidelines have recommended subdividing plaque type into calcified, non-calcified, or mixed.…”

Section: Plaque Characterization With Cctamentioning

confidence: 99%

“…However, in symptomatic patients this percentage is much higher, suggesting that there are at-risk population subsets that would benefit from NCP screening. (26) In fact, elevated NCP burden is present in almost all patients who present with ACS. (38, 39, 54) A study by Motoyama et al found that culprit lesions were comprised of NCP in 79% of ruptured lesions causing ACS, whereas stable lesions causing typical angina were comprised of NCP in only 9%.…”

Section: Plaque Characterization With Cctamentioning

confidence: 99%

Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden

Kwan

Cater

Vargas

et al. 2013

Curr Cardiovasc Imaging Rep

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Coronary computed tomographic angiography (CCTA) is emerging as a key non-invasive method for assessing cardiovascular risk by measurement of coronary stenosis and coronary artery calcium (CAC). New advancements in CCTA technology have led to the ability to directly identify and quantify the so-called “vulnerable” plaques that have features of positive remodeling and low density components. In addition, CCTA presents a new opportunity for noninvasive measurement of total coronary plaque burden that has not previously been available. The use of CCTA needs also to be balanced by its risks and, in particular, the associated radiation exposure. We review current uses of CCTA, CCTA’s ability to measure plaque quantity and characteristics, and new developments in risk stratification and CCTA technology. CCTA represents a quickly developing field that will play a growing role in the non-invasive management of cardiovascular disease.

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Prevalence of noncalcified coronary plaque on 64-slice computed tomography in asymptomatic patients with zero and low coronary artery calcium

Cited by 25 publications

References 34 publications

Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort: The multi ethnic study of atherosclerosis

Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort: The multi ethnic study of atherosclerosis

Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden

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