Coronary computed tomography angiography derived risk score in predicting cardiac events

Uusitalo, Valtteri; Kamperidis, Vasileios; Graaf, Michiel A. de; Maaniitty, Teemu; Stenström, Iida; Broersen, Alexander; Dijkstra, Jouke; Scholte, Arthur J.; Saraste, Antti; Bax, Jeroen J.; Knuuti, Juhani

doi:10.1016/j.jcct.2017.04.010

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…Quantitative plaque analysis has been described in detail previously. 23 In brief, a 3-dimensional coronary tree and its side branches were extracted from the CCTA data set. All coronary vessels >1.5 mm diameter were evaluated and each vessel and segment were automatically labeled.…”

Section: Methodsmentioning

confidence: 99%

Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease

Kuneman

Rosendael

Bijl

et al. 2023

Circ: Cardiovascular Imaging

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BACKGROUND: Pericoronary adipose tissue (PCAT) attenuation has been associated with coronary inflammation and can be evaluated with coronary computed tomography angiography. The aims of this study were to compare the PCAT attenuation across precursors of culprit and nonculprit lesions of patients with acute coronary syndrome versus stable coronary artery disease (CAD). METHODS: In this case-control study, patients with suspected CAD who underwent coronary computed tomography angiography were included. Patients who developed an acute coronary syndrome within 2 years after the coronary computed tomography angiography scan were identified, and patients with stable CAD (defined as any coronary plaque ≥30% luminal diameter stenosis) were 1:2 propensity score matched for age, sex, and cardiac risk factors. The mean PCAT attenuation was analyzed at lesion level and compared between precursors of culprit lesions, nonculprit lesions, and stable coronary plaques. RESULTS: In total, 198 patients (age 62±10 years, 65% male) were selected, including 66 patients who developed an acute coronary syndrome and 132 propensity matched patients with stable CAD. Overall, 765 coronary lesions were analyzed (culprit lesion precursors: n=66; nonculprit lesion precursors: n=207; and stable lesions: n=492). Culprit lesion precursors had larger total plaque volume, fibro-fatty plaque volume, and low-attenuation plaque volume compared to nonculprit and stable lesions. The mean PCAT attenuation was significantly higher across culprit lesion precursors compared to nonculprit and stable lesions (−63.8±9.7 Hounsfield units versus −68.8±10.6 Hounsfield units versus −69.6±10.6 Hounsfield units, respectively; P <0.001), whereas the mean PCAT attenuation around nonculprit and stable lesions was not significantly different ( P =0.99). CONCLUSIONS: The mean PCAT attenuation is significantly increased across culprit lesion precursors in patients with acute coronary syndrome, compared to nonculprit lesions of these patients and to lesions of patients with stable CAD, which may suggest a higher intensity of inflammation. PCAT attenuation on coronary computed tomography angiography may be a novel marker to identify high-risk plaques.

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Section: Methodsmentioning

confidence: 99%

Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease

Kuneman

Rosendael

Bijl

et al. 2023

Circ: Cardiovascular Imaging

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“…In total, 922 consecutive symptomatic outpatients with suspected coronary artery disease and with intermediate pre-test likelihood for obstructive coronary artery disease underwent coronary CTA from 2007 till 2011 at the Turku PET Centre in Finland [ 10 ]. QCTA analysis was not feasible in 153 patients.…”

Section: Methodsmentioning

confidence: 99%

“…All the patients included in the current analysis underwent a coronary CTA and a PET scan with a hybrid 64-row PET/CT scanner (GE Discovery VCT, General Electric Medical Systems, Waukesha, WI, USA). The coronary CTA scan was performed with collimation of 64 × 0.625 mm, gantry rotation time 350 ms, tube current 600–750 mA, voltage 100–120 kV according to patient size and prospective electrocardiographic triggering if feasible, according to the heart rate [ 10 ]. Before the coronary CTA acquisition, a bolus dose of 0–30 mg metoprolol was intravenously injected and 800 μg nitrate were sublingually administered.…”

Section: Methodsmentioning

confidence: 99%

“…After the acquisition, the QCTA image analysis was performed using previously validated software (QAngio CT Research Edition, version 1.3.6; Medis Medical Imaging Systems, Leiden, the Netherlands) by an experienced reader (V.K. holds a level 3 accreditation by the Society of Cardiac Computed Tomography and is reading CT exams since 2013) blinded to the PET data [ 9 , 10 ]. This software automatically extracted a 3-dimensional coronary tree and labelled each vessel and segment based on the American Heart Association 17-segment model [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

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Atherosclerotic plaque characteristics on quantitative coronary computed tomography angiography associated with ischemia on positron emission tomography in diabetic patients

Kamperidis

Graaf

Uusitalo

et al. 2022

Int J Cardiovasc Imaging

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Patients with diabetes mellitus (DM) may show diffuse coronary artery atherosclerosis on coronary computed tomography angiography (CTA). The present study aimed at quantification of atherosclerotic plaque with CTA and its association with myocardial ischemia on positron emission tomography (PET) in DM patients. Of 922 symptomatic outpatients without previously known coronary artery disease who underwent CTA, 115 with DM (mean age 65 ± 8 years, 58% male) who had coronary atherosclerosis and underwent both quantified CTA (QCTA) and PET were included in the study. QCTA analysis was performed on a per-vessel basis and the most stenotic lesion of each vessel was considered. Myocardial ischemia on PET was based on absolute myocardial blood flow at stress ≤ 2.4 ml/g/min. Of the 345 vessels included in the analysis, 135 (39%) had flow-limiting stenosis and were characterized by having longer lesions, higher plaque volume, more extensive plaque burden and higher percentage of dense calcium (37 ± 22% vs 28 ± 22%, p = 0.001). On univariable analysis, QCTA parameters indicating the degree of stenosis, the plaque extent and composition were associated with presence of ischemia. The addition of the QCTA degree of stenosis parameters (x2 36.45 vs 88.18, p < 0.001) and the QCTA plaque extent parameters (x2 88.18 vs 97.44, p = 0.01) to a baseline model increased the association with ischemia. In DM patients, QCTA variables of vessel stenosis, plaque extent and composition are associated with ischemia on PET and characterize the hemodynamic significant atherosclerotic lesion.

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“…for anatomical features at the Dutch core laboratory (Leiden University Medical Center, Leiden, the Netherlands) according to the 17-segment modified American Heart Association model, blinded to clinical and ESS results. 16,17 All coronary segments ≥1.5 mm in diameter were evaluated. Quantitative analysis was assessed using semi-automated validated software (QAngio CT Research Edition version 1.3.6, Medis Medical Imaging Systems, Leiden, the Netherlands) with manual correction if needed.…”

Section: Analysis Of Anatomical Featuresmentioning

confidence: 99%

Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography

Hoogen

Schultz

Kuneman

et al. 2022

European Heart Journal - Cardiovascular Imaging

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Aims Evolving evidence suggests that endothelial wall shear stress (ESS) plays a crucial role in the rupture and progression of coronary plaques by triggering biological signalling pathways. We aimed to investigate the patterns of ESS across coronary lesions from non-invasive imaging with coronary computed tomography angiography (CCTA), and to define plaque-associated ESS values in patients with coronary artery disease (CAD). Methods and results Symptomatic patients with CAD who underwent a clinically indicated CCTA scan were identified. Separate core laboratories performed blinded analysis of CCTA for anatomical and ESS features of coronary atherosclerosis. ESS was assessed using dedicated software, providing minimal and maximal ESS values for each 3 mm segment. Each coronary lesion was divided into upstream, start, minimal luminal area (MLA), end and downstream segments. Also, ESS ratios were calculated using the upstream segment as a reference. From 122 patients (mean age 64 ± 7 years, 57% men), a total of 237 lesions were analyzed. Minimal and maximal ESS values varied across the lesions with the highest values at the MLA segment [minimal ESS 3.97 Pa (IQR 1.93–8.92 Pa) and maximal ESS 5.64 Pa (IQR 3.13–11.21 Pa), respectively]. Furthermore, minimal and maximal ESS values were positively associated with stenosis severity (P < 0.001), percent atheroma volume (P < 0.001), and lesion length (P ≤ 0.023) at the MLA segment. Using ESS ratios, similar associations were observed for stenosis severity and lesion length. Conclusions Detailed behaviour of ESS across coronary lesions can be derived from routine non-invasive CCTA imaging. This may further improve risk stratification.

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Coronary computed tomography angiography derived risk score in predicting cardiac events

Abstract: Comprehensive CTA risk score integrating the location, burden and composition of coronary atherosclerosis predicts future cardiac events in patients with suspected CAD.

Cited by 8 publications

References 24 publications

Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease

Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease

Atherosclerotic plaque characteristics on quantitative coronary computed tomography angiography associated with ischemia on positron emission tomography in diabetic patients

Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography

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