scholarly journals Coronary Computed Tomography Angiography to Triage Patients With Non–ST-Segment Elevation Acute Coronary Syndrome

2021 ◽  
Vol 77 (8) ◽  
pp. 1053-1056
Author(s):  
Michelle C. Williams ◽  
Marc R. Dweck ◽  
David E. Newby
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Computed Tomography ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome

scholarly journals Pericoronary Fat Attenuation Index Is Associated With Vulnerable Plaque Components and Local Immune‐Inflammatory Activation in Patients With Non‐ST Elevation Acute Coronary Syndrome

2022 ◽  
Author(s):  
Jia Teng Sun ◽  
Xin Cheng Sheng ◽  
Qi Feng ◽  
Yan Yin ◽  
Zheng Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Intracellular Cytokine ◽  
Coronary Computed Tomography ◽  
Coronary Syndrome ◽  
Pearson's R ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background The pericoronary fat attenuation index (FAI) is assessed using standard coronary computed tomography angiography, and it has emerged as a novel imaging biomarker of coronary inflammation. The present study assessed whether increased pericoronary FAI values on coronary computed tomography angiography were associated with vulnerable plaque components and their intracellular cytokine levels in patients with non‐ST elevation acute coronary syndrome. Methods and Results A total of 195 lesions in 130 patients with non‐ST elevation acute coronary syndrome were prospectively included. Lesion‐specific pericoronary FAI, plaque components and other plaque features were evaluated by coronary computed tomography angiography. Local T cell subsets and their intracellular cytokine levels were detected by flow cytometry. Lesions with pericoronary FAI values >−70.1 Hounsfield units exhibited spotty calcification (43.1% versus 25.0%, P =0.015) and low‐attenuation plaques (17.6% versus 4.2%, P =0.016) more frequently than lesions with lower pericoronary FAI values. Further quantitative plaque compositional analysis showed that increased necrotic core volume (Pearson’s r=0.324, P <0.001) and fibrofatty volume (Pearson’s r=0.270, P <0.001) were positively associated with the pericoronary FAI, and fibrous volume (Pearson’s r=−0.333, P <0.001) showed a negative association. An increasing proinflammatory intracellular cytokine profile was found in lesions with higher pericoronary FAI values. Conclusions The pericoronary FAI may be a reliable indicator of local immune‐inflammatory response activation, which is closely related to plaque vulnerability. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04792047.

scholarly journals Prediction of acute coronary syndrome within 3 years using radiomics signature of pericoronary adipose tissue based on coronary computed tomography angiography

2021 ◽  
Author(s):  
Jin Shang ◽  
Shaowei Ma ◽  
Yan Guo ◽  
Linlin Yang ◽  
Qian Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Adipose Tissue ◽  
Computed Tomography Angiography ◽  
Predictive Models ◽  
Coronary Computed Tomography Angiography ◽  
Plaque Score ◽  
Coronary Computed Tomography ◽  
Coronary Syndrome ◽  
Radiomics Signature

Abstract Objectives To evaluate whether radiomics signature of pericoronary adipose tissue (PCAT) based on coronary computed tomography angiography (CCTA) could improve the prediction of future acute coronary syndrome (ACS) within 3 years. Methods We designed a retrospective case-control study that patients with ACS (n = 90) were well matched to patients with no cardiac events (n = 1496) during 3 years follow-up, then which were randomly divided into training and test datasets with a ratio of 3:1. A total of 107 radiomics features were extracted from PCAT surrounding lesions and 14 conventional plaque characteristics were analyzed. Radiomics score, plaque score, and integrated score were respectively calculated via a linear combination of the selected features, and their performance was evaluated with discrimination, calibration, and clinical application. Results Radiomics score achieved superior performance in identifying patients with future ACS within 3 years in both training and test datasets (AUC = 0.826, 0.811) compared with plaque score (AUC = 0.699, 0.640), with a significant difference of AUC between two scores in the training dataset (p = 0.009); while the improvement of integrated score discriminating capability (AUC = 0.838, 0.826) was non-significant. The calibration curves of three predictive models demonstrated a good fitness respectively (all p > 0.05). Decision curve analysis suggested that integrated score added more clinical benefit than plaque score. Stratified analysis revealed that the performance of three predictive models was not affected by tube voltage, CT version, different sites of hospital. Conclusion CCTA-based radiomics signature of PCAT could have the potential to predict the occurrence of subsequent ACS. Radiomics-based integrated score significantly outperformed plaque score in identifying future ACS within 3 years. Key Points • Plaque score based on conventional plaque characteristics had certain limitations in the prediction of ACS. • Radiomics signature of PCAT surrounding plaques could have the potential to improve the predictive ability of subsequent ACS. • Radiomics-based integrated score significantly outperformed plaque score in the identification of future ACS within 3 years.

scholarly journals Pre‐percutaneous Coronary Intervention Pericoronary Adipose Tissue Attenuation Evaluated by Computed Tomography Predicts Global Coronary Flow Reserve After Urgent Revascularization in Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Yoshihisa Kanaji ◽  
Hidenori Hirano ◽  
Tomoyo Sugiyama ◽  
Masahiro Hoshino ◽  
Tomoki Horie ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Adipose Tissue ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Elevation Acute Coronary Syndrome

Background Impaired global coronary flow reserve (g‐CFR) is related to worse outcomes. Inflammation has been postulated to play a role in atherosclerosis. This study aimed to evaluate the relationship between pre‐procedural pericoronary adipose tissue inflammation and g‐CFR after the urgent percutaneous coronary intervention in patients with first non–ST‐segment–elevation acute coronary syndrome. Methods and Results Phase‐contrast cine‐magnetic resonance imaging was performed to obtain g‐CFR by quantifying coronary sinus flow at 1 month after percutaneous coronary intervention in a total of 116 first non–ST‐segment–elevation acute coronary syndrome patients who underwent pre‐percutaneous coronary intervention computed tomography angiography. On proximal 40‐mm segments of 3 major coronary vessels on computed tomography angiography, pericoronary adipose tissue attenuation was assessed by the crude analysis of mean computed tomography attenuation value. The patients were divided into 2 groups with and without impaired g‐CFR divided by the g‐CFR value of 1.8. There were significant differences in age, culprit lesion location, N‐terminal pro‐B‐type natriuretic peptide levels, high‐sensitivity C‐reactive protein (hs‐CRP) levels, mean pericoronary adipose tissue attenuation between patients with impaired g‐CFR and those without (g‐CFR, 1.47 [1.16, 1.68] versus 2.66 [2.22, 3.28]; P <0.001). Multivariable logistic regression analysis revealed that age (odds ratio [OR], 1.060; 95% CI, 1.012–1.111, P =0.015) and mean pericoronary adipose tissue attenuation (OR, 1.108; 95% CI, 1.026–1.197, P =0.009) were independent predictors of impaired g‐CFR (g‐CFR <1.8). Conclusions Mean pericoronary adipose tissue attenuation, a marker of perivascular inflammation, obtained by computed tomography angiography performed before urgent percutaneous coronary intervention, but not hs‐CRP, a marker of systemic inflammation was significantly associated with g‐CFR at 1‐month after revascularization. Our results may suggest the pathophysiological mechanisms linking perivascular inflammation and g‐CFR in patients with non–ST‐segment–elevation acute coronary syndrome.

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