Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

Coronary computed tomography angiography (CCTA) has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

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The clinical and pathological features of intraplaque hemorrhage in coronary artery -insights from Japan DCA registry-

European Heart Journal ◽

10.1093/ehjci/ehaa946.1757 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Nakamura ◽

S Torii ◽

T Ijichi ◽

K Jujo ◽

M Hara ◽

...

Keyword(s):

Coronary Artery ◽

Unstable Angina ◽

De Novo ◽

Coronary Intervention ◽

Coronary Plaque ◽

Active Cell ◽

Intraplaque Hemorrhage ◽

Histopathological Analysis ◽

Coronary Syndrome ◽

Clinical Presentations

Abstract Introduction Intraplaque hemorrhage (IPH) is known to play an important role in plaque vulnerability in coronary artery. However, the biological reaction in IPH and clinical features of patients with IPH remain unknown, since most histological studies of IPH in coronary artery were performed on autopsy cases. Directional coronary atherectomy (DCA) enables the direct pathological evaluation of collected tissue from “living” patients. Purpose We aimed to clarify the clinical presentations and histopathologic features of IPH using specimens obtained by DCA. Method This multicentral prospective observational study included consecutive patients who underwent percutaneous coronary intervention for de novo lesions using DCA from June 2015 to February 2018. Histopathological sections that were collected from coronary plaques by DCA were evaluated and classified by the presence of IPH. IPH in DCA specimens was defined as clusters of hemosiderin (Figure A, arrows), erythrocytes (Figure B, arrow heads) and fibrin (Figure C, arrows) within the coronary plaque. A total of 154 de novo lesions from 154 patients were ultimately analyzed, and were divided into IPH group (n=37) and non-IPH group (n=117). Result Clinical profiles of patients in the two groups were comparable, except that unstable angina rather than chronic coronary syndrome was significantly more prevalent in the IPH group (32.4% vs. 16.2%, P=0.04). Histopathological analysis showed a significantly higher incidence of cellular-rich plaque (46.0% vs. 25.6%, P=0.02) and spindle-shaped cells (18.9% vs. 6.0%, P=0.02), which indicate active cell proliferations, in the IPH group. The prevalence of necrotic core was also higher in IPH group compared to non-IPH group (48.7% vs. 13.7%, P<0.01). Conclusion Pathohistological analysis revealed that coronary plaques with IPH had an active cell proliferation, and patients with IPH likely to had clinical presentations of unstable angina. Figure 1 Funding Acknowledgement Type of funding source: None

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Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department

Circulation ◽

10.1161/circ.118.suppl_18.s_597 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Fabian Bamberg ◽

Maros Ferecik ◽

Quynh Truong ◽

Ian Rogers ◽

Michael Shapiro ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Coronary Arteries ◽

Atherosclerotic Plaque ◽

Acute Chest Pain ◽

Coronary Plaque ◽

Plaque Burden ◽

Coronary Syndrome ◽

Coronary Ct ◽

Calcified Plaque

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

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Evaluation of human coronary vasodilator function predicts future coronary atheroma progression

Heart ◽

10.1136/heartjnl-2017-312579 ◽

2018 ◽

Vol 104 (17) ◽

pp. 1439-1446 ◽

Cited By ~ 1

Author(s):

Samuel L Sidharta ◽

Timothy J Baillie ◽

Stuart Howell ◽

Stephen J Nicholls ◽

Natalie Montarello ◽

...

Keyword(s):

Near Infrared ◽

Coronary Plaque ◽

Plaque Burden ◽

Plaque Progression ◽

Independent Function ◽

Lipid Core ◽

Coronary Syndrome ◽

Coronary Vasodilator ◽

Dependent Function ◽

The Relationship

ObjectiveCoronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.Methods33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12–18 months (n=520 segments).ResultsLipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (−0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: −3.03, 95% CI (−5.81 to −0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).ConclusionsEpicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.Trial registration numberACTRN12612000594820, Post-results.

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P360 Site specific phenotype of atherosclerotic lesions according to plaque location within the coronary tree, a CCTA based study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.209 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

D Opincariu ◽

N Rat ◽

A Mester ◽

R Hodas ◽

D Cernica ◽

...

Keyword(s):

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Coronary Plaque ◽

The European Union ◽

Plaque Composition ◽

Cross Sectional ◽

Coronary Ct ◽

Atherosclerotic Lesions ◽

The Government ◽

Artery Disease

Abstract Funding Acknowledgements Research grant PlaqueImage, contract number 26/01.09.2016, SMIS code 103544, Project funded by the European Union and the Government of Romania Background The coronary CT angiography (CCTA)-based differences in composition, morphology and vulnerability of coronary plaques (CPs), according to their location within the coronary tree, have not been investigated so far. Purpose We sought to perform a comparative analysis between plaques located at different levels within the coronary tree, to identify the differences in plaque composition, morphology, and vulnerability between the three major coronary branches. Methods We conducted a cross-sectional, observational study on 75 patients with stable coronary artery disease who underwent CCTA for assessment of coronary lesions that exhibited at least one vulnerable plaque (VP) in the coronary tree. After image acquisition, coronary plaque analysis was performed with the use of the Syngo.via Frontier (Siemens) software. Plaque analysis also included evaluation of presence of VM: low attenuation plaque – LAP; napkin ring sign – NRS; spotty calcifications – SC; positive remodeling – PR. VP were defined as lesions that presented at least 1 vulnerability marker (VM). In total, 90 coronary VPs located at the level of the left anterior descending (LAD; n = 30), circumflex (CXA; n = 30) and right coronary artery respectively (RCA; n = 30) were identified and analyzed. Results Lesions located in the RCA presented a significantly higher length (LAD - 18.67± 5.49 vs. CXA - 15.48 ±3.73 vs. RCA - 20.47 ± 5.97 mm, p = 0.001), a higher degree of stenosis (LAD - 57.77 ± 8.62 vs. CXA - 54.50 ± 11.25 vs. RCA - 59.63 ± 10.42 mm, p = 0.022), and were more voluminous (LAD - 187.9 ± 86.03 vs. CXA - 146.9 ± 102.4 vs. RCA - 248.1 ± 11.4 mm3, p = 0.0007) compared to those located in the LAD and CXA, but no difference was observed regarding the remodeling (p = 0.180) or eccentricity indexes (p = 0.423). Plaque composition was also significantly different according to plaque location: calcified volume (LAD - 44.07 ± 63.90 vs. CXA - 12.40 ± 19.65 vs. RCA - 33.69 ± 34.38 mm3, p = 0.002), non-calcified volume (LAD - 143.8 ± 76.02 vs. CXA - 134.5 ± 102.2 vs. RCA - 214.4 ± 99.67 mm3, p = 0.002), lipid rich volume (LAD - 14.95 ± 22.69 vs. CXA - 6.44 ± 13.42 vs. RCA -16.07 ± 15.74 mm3, p = 0.0005), fibrotic volume (LAD - 128.9 ± 66.10 vs. CXA - 128.1 ± 91.56 vs. RCA - 198.3 ± 92.34 mm3, p = 0.003). The highest number of VM per plaque was present in the LAD (LAD - 2.2 ± 0.8 vs. CXA - 1.6 ± 0.7 vs. RCA - 1.8 ± 0.6, p = 0.01), as well as highest rate of VPs (LAD – 80%, CXA – 46.6%, RCA – 70%, p = 0.01). No difference was registered between coronary arteries on the presence of SCs (p = 0.670), NRS (p = 0.455), PR (p = 0.833), but LAPs were more frequently located in the LAD (p = 0.0009). Conclusions Coronary plaques located in the RCA were more voluminous and exhibited a higher volume of lipid rich and non-calcified atheroma. However, compared to the RCA and CXA, the left anterior descending artery presented CPs with a more expressed degree of vulnerability, a higher number of vulnerability markers per plaque, and a higher incidence of LAP.

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Characterization of the calcium component of vulnerable coronary plaque in patients with NSTEMI: Prospective comparison between coronary CT and optical coherence tomography

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2019.09.008 ◽

2020 ◽

Vol 12 (1) ◽

pp. 8

Author(s):

T. Pezel ◽

Georgios Sideris ◽

Jean-Guillaume Dillinger ◽

Damien Logeart ◽

Stéphane Manzo-Silberman ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Coronary Plaque ◽

Optical Coherence ◽

Coronary Ct ◽

Prospective Comparison

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Coronary Plaque Structural Stress Is Associated With Plaque Composition and Subtype and Higher in Acute Coronary Syndrome

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.113.001526 ◽

2014 ◽

Vol 7 (3) ◽

pp. 461-470 ◽

Cited By ~ 56

Author(s):

Zhongzhao Teng ◽

Adam J. Brown ◽

Patrick A. Calvert ◽

Richard A. Parker ◽

Daniel R. Obaid ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Plaque ◽

Structural Stress ◽

Plaque Composition ◽

Coronary Syndrome

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Abstract 2004: Usefulness of Coronary CT Angiography in the Early Triage of Patients with Acute Chest Pain

Circulation ◽

10.1161/circ.118.suppl_18.s_655-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Udo Hoffmann ◽

Fabian Bamberg ◽

Claudia U Chae ◽

Ian S Rogers ◽

Sujith K Seneviratne ◽

...

Keyword(s):

Chest Pain ◽

Hospital Admission ◽

Acute Chest Pain ◽

Coronary Plaque ◽

Discriminatory Power ◽

Coronary Cta ◽

Coronary Syndrome ◽

Coronary Ct ◽

Increased Risk

Background: Early triage of patients with acute chest pain in the emergency department (ED) may be improved by rapid noninvasive assessment of coronary artery disease (CAD) by coronary computed tomography angiography (CTA). We sought to determine the usefulness of coronary CTA for the early triage of patients with acute chest pain but an inconclusive initial ED evaluation. Methods: Single center, double-blinded observational cohort study in the ED of a large tertiary academic hospital enrolling 368 consecutive patients with acute chest pain and inconclusive initial ED evaluation (normal initial troponin and an initial ECG without evidence of myocardial ischemia) who were awaiting hospital admission between May 2005 and May 2007. All patients underwent 64-slice contrast-enhanced coronary CTA prior to hospital admission with caregivers and patients blinded to the results of the examination. Diagnostic accuracy and discriminatory power of coronary CTA findings (coronary plaque and stenosis [>50% luminal narrowing]) for acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events (MACE) during 6- month follow-up. Results: Among 368 patients (mean age 53±12 years, 61% male) 31 (8%) developed ACS but no MACE occurred during follow-up. Fifty percent (n=183) of the study population had neither plaque nor stenosis, a finding which had 100% negative predictive value (95% confidence interval [CI]: 98 to 100%) for ACS. In adjusted analysis, the extent of coronary plaque and presence of stenosis were associated with an increased risk for ACS (OR: 1.28, 95% CI: 1.14 to 1.43 and OR: 11.69, 95% CI: 4.4 to 31.0; respectively). Coronary CT findings (no CAD, plaque but no stenosis, and stenosis) discriminated patients at low, intermediate, or high risk of ACS (OR: 8.65, 95% CI: 3.69 to 20.26; AUC: 0.91). Conclusion : Half of the patients with acute chest pain and low to intermediate likelihood of ACS have no CAD and may be safely discharged directly from the ED. Coronary CT has excellent discriminatory power in defining patient risk for ACS.

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Biochemical markers of cardiac diseases

Jugoslovenska medicinska biohemija ◽

10.2298/jmh0403201p ◽

2004 ◽

Vol 23 (3) ◽

pp. 201-211 ◽

Cited By ~ 5

Author(s):

Mauro Panteghini

Keyword(s):

Biochemical Markers ◽

Coronary Plaque ◽

Plaque Instability ◽

Coronary Syndrome ◽

Early Markers ◽

Early Injury ◽

Cardiac Troponins ◽

Rule Out

This article reviews the current contribution of the determination of biochemical markers to clinical cardiology and discusses some important developments in this field. Biochemical markers play a pivotal role in the diagnosis and management of patients with acute coronary syndrome (ACS), as witnessed by the incorporation of cardiac troponins into new international guidelines for patients with ACS and in the redefinition of myocardial infarction. Despite the success of cardiac troponins, there is still a need for development of early markers that can reliably rule out ACS from the emergency room at presentation and detect myocardial ischemia also in the absence of irreversible myocyte injury. Under investigation are two classes of indicators: markers of early injury/ischemia and markers of coronary plaque instability and disruption. Finally, with the characterization of the cardiac natriuretic peptides, Laboratory Medicine is also assuming part in the assessment of cardiac function.

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