Relationship between Coronary Artery Calcium Score by Multidetector Computed Tomography and Plaque Components by Virtual Histology Intravascular Ultrasound

Abstract

The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 ± 132 µL vs 171 ± 114 µL vs 195 ± 149 µL vs 321±182 µL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 ± 6.6 µL vs 11.0 ± 10.3 µL vs 15.6 ± 13.6 µL vs 36.6 ± 18.2 µL, P < 0.001, and 14.8 ± 18.2 µL vs 19.5 ± 18.9 µL vs 22.5 ± 19.1 µL vs 41.7 ± 27.9 µL, P < 0.001, and 6.4 ± 5.3% vs 11.0 ± 6.2% vs 14.0 ± 6.5% vs 20.0 ± 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.

Association of Coronary Artery Calcification with MDA-LDL-C/LDL-C and Urinary 8-Isoprostane in Japanese Patients with Type 2 Diabetes

“…The level of 8-OHdG is increased in patients with diabetes, and it has been reported that 8-OHdG is a biomarker of the patients with early stage diabetic complications (18). There was no significant association between the urinary 8-OHdG and the CACS in our study, possibly because a higher CAC is found in the patients with advanced stages of atherosclerosis (19).…”

High Calcium Score Predicts Severity of the Culprit Lesions in Patients with Acute Coronary Syndromes

“…It was suggested that CAD patients with high calcium score have more vulnerable plaque components [8,11] (such as higher burden with calcium or presence and extent of the necrotic core within the plaques) than those with low calcium score [4,10,12].Our study results showed that patients with acute coronary syndrome and high calcium score had low attenuation voluminous plaque. Diff erent cut-off value of plaque density: 30 HU, 60 HU, 100 HU showed the same change if we assessing patients with calcium score below or above than 400, 600, 1000: the culprit lesion plaque mainly is composed by low attenuation (<30 HU) substance, the p value being statistical signifi cant in all three groups.…”

“…It has been also shown that voluminous plaques together with other features like: positive remodeling index, spotty calcifi cation, presence of low density, are good markers for characterization of a vulnerable plaque. Other authors [4] showed in their comparative study of vulnerable plaque analysis with IVUS and MDSCT a good correlation between vulnerable plaque characteristics and coronary calcium score. Th e plaque burden was significantly higher in patients with calcium scoring above 400, as well as the external elastic membrane volume, total atheroma volume, percent atheroma volume, absolute dense calcium and necrotic core areas.…”

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

“…It has been shown that a PR on CCTA is associated with higher percentages of necrotic cores within the plaque on IVUS and that the percentage of the necrotic core by IVUS is significantly higher in plaques with SC identifi able by CCTA compared to non-calcifi c plaques. 8,9) However, although these studies have demonstrated an association between the presence of different 10) In most ACS cases, CCTA plaque quantifi cation demonstrates a mixed composition of the coronary plaques, containing variable proportions of a lipid-reach core with a low CT density (with mean attenuation values reported in a range between 11 and 99 Hounsfi eld units (HU)), a fi brous component with higher CT densities (with mean attenuation values reported in a range between 77 and 121 HU), and calcium. [11][12][13] While many studies published on the topic of CT plaque characterization have demonstrated the presence of a low-density core (LDC) containing lipid-reach atheroma in the culprit lesions, 14,15) quantitative assessment of this LDC is almost totally lacking in all these studies.…”