Coronary computed tomography angiography allows detailed evaluation of the coronary atherosclerotic plaque, even before any cardiac symptoms are present. This thesis describes the important... Show moreCoronary computed tomography angiography allows detailed evaluation of the coronary atherosclerotic plaque, even before any cardiac symptoms are present. This thesis describes the important prognostic role that the burden, morphology, composition, and location of coronary plaque has, which allows to intervene at an early stage. Detection of subclinical coronary atherosclerosis allows early treatment and reduction of cardiovascular mortality and morbidity. Show less
Background: We examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS. Methods... Show moreBackground: We examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS. Methods: A total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from the main epicardial vessels and side branches on a 0.5 mm cross-sectional basis. Calcified plaque and non-calcified plaque were defined by above or below 350 Hounsfield units. Patients were categorized according to their age by deciles. Also, coronary artery calcium scores (CACS) were evaluated when available. Results: Patients were on average 62.2 +/- 11.5 years old. On the pre-ACS CCTA, patients showed diffuse, multi-site, predominantly non-obstructive atherosclerosis across all age categories, with plaque being detected in 93.5% of all ACS cases. The proportion calcified plaque from the total plaque burden increased significantly with older presentation (10% calcification in those <50 years, and 50% calcification in those >80 years old). Patients with ACS <50 years had remarkably lower atherosclerotic burden compared with older patients, but a high proportion of high risk markers such as low-attenuation plaque. CACS was >0 in 85% of the patients older than 50 years, and in 57% of patients younger than 50 years. Conclusion: The proportion of calcified plaque varied depending on patient age at the time of ACS. Only a small proportion of plaque was calcified when ACS occurred at <50 years old, while this increased gradually with older age. Purely non-calcified atherosclerotic plaque was not uncommon in patients <50 years. Show less
Background and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three... Show moreBackground and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA > 2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm(3), (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAV(norm)) in mm(3) [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAV(norm), were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed.Results: The study population comprised 1479 patients (age 60.7 +/- 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAV(norm), but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAV(norm)) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex.Conclusions: PAV was less affected by patients body surface area then PV and TAV(norm) and may be the preferred method to report coronary atherosclerotic burden. Show less
Purpose of Review Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have... Show morePurpose of Review Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization.Recent FindingsRecent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs.SummaryBesides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed. Show less
