Coronary Atherosclerosis Imaging by Coronary CT Angiography

Vörös, Szilárd; Rinehart, Sarah; Qian, Zhen; Joshi, Parag H.; Vázquez, Gustavo; Fischer, Collin; Belur, Pallavi; Hulten, Edward; Villines, Todd C.

doi:10.1016/j.jcmg.2011.03.006

Cited by 315 publications

(81 citation statements)

References 38 publications

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“…CCTA images underwent 3‐dimensional reconstruction for coronary segment plaque volume analysis using semiautomated software (SUREPlaque, version 6.3.2; Vital Images, Minnetonka, MN) 7, 22, 23, 24. Representative images have been previously published (Supplement 2 in Hauser et al) 15.…”

Section: Methodsmentioning

confidence: 99%

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

Alfaddagh

Elajami

Ashfaque

et al. 2017

JAHA

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BackgroundAlthough statins reduce cardiovascular events, residual risk remains. Therefore, additional modalities are needed to reduce risk. We evaluated the effect of eicosapentaenoic acid and docosahexaenoic acid in pharmacologic doses added to statin treatment on coronary artery plaque volume.Methods and ResultsA total of 285 subjects with stable coronary artery disease on statins were randomized to omega‐3 ethyl‐ester (1.86 g of eicosapentaenoic acid and 1.5 g of docosahexaenoic acid daily) or no omega‐3 (control) for 30 months. Coronary plaque volume was assessed by coronary computed tomographic angiography. Mean (SD) age was 63.0 (7.7) years; mean low‐density lipoprotein cholesterol ≤80 mg/dL. In the intention‐to‐treat analysis, our primary endpoint, noncalcified plaque volume, was not different between groups (P=0.14) but approached significance in the per protocol analysis (P=0.07). When stratified by age in the intention‐to‐treat analysis, younger omega‐3 subjects had significantly less progression of the primary endpoint, noncalcified plaque (P=0.013), and fibrous, calcified and total plaque. In plaque subtype analysis, controls had significant progression of fibrous plaque compared to no change in the omega‐3 ethyl‐ester group (median % change [interquartile range], 5.0% [−5.7, 20.0] versus −0.1% [−12.3, 14.5], respectively; P=0.018). Among those on low‐intensity statins, omega‐3 ethyl‐ester subjects had attenuation of fibrous plaque progression compared to controls (median % change [interquartile range], 0.3% [−12.8, 9.0] versus 4.8% [−5.1, 19.0], respectively; P=0.032). In contrast, those on high‐intensity statins had no difference in plaque change in either treatment arm.ConclusionsHigh‐dose eicosapentaenoic acid and docosahexaenoic acid provided additional benefit to statins in preventing progression of fibrous coronary plaque in subjects adherent to therapy with well‐controlled low‐density lipoprotein cholesterol levels. The benefit on low‐intensity statin, but not high‐intensity statin, suggests that statin intensity affects plaque volume.Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT01624727.

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Section: Methodsmentioning

confidence: 99%

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

Alfaddagh

Elajami

Ashfaque

et al. 2017

JAHA

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“…A higher prevalence of non-calcified coronary plaque on coronary CT angiography (CCTA) has been associated with HIV infection [9–11]. CCTA allows assessment of plaque morphology [12], and can identify plaque characteristics known to be potentially “vulnerable” to rupture [13], thus possibly leading to an increased risk for acute coronary syndromes. High-risk plaque characteristics that are detectable using CCTA include positive arterial remodeling (Figure 1), low attenuation plaque (LAP), and spotty calcifications.…”

Section: Introductionmentioning

confidence: 99%

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

Miller¹,

Haberlen²,

Metkus³

et al. 2015

Atherosclerosis

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Objective Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV−) men. Methods/Results Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40–70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV− and HIV+ men, respectively. After demographic adjustment, HIV+ men had twice the odds of PR [OR 2.01(95% CI 1.20–3.38)], which persisted after CAD risk factor adjustment [1.76(1.00–3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion HIV+ men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+ individuals.

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“…[14, 15] CCTA provides more detailed characterization and measurement of plaque burden beyond calcium scoring and allows identification of plaque subtypes that may carry differential risks for adverse cardiovascular events. [16-19] We hypothesized that HIV-infected men have more epicardial fat than HIV-uninfected controls, and that epicardial fat is associated with subclinical coronary artery atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Brener

Ketlogetswe

Budoff

et al. 2014

Aids

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Objective Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and anti-retroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine if HIV infection is associated with greater epicardial fat and if epicardial fat is associated with subclinical coronary atherosclerosis. Design We studied 579 HIV-infected and 353 HIV-uninfected men age 40 to 70 years with non-contrast computed tomography (CT) to measure epicardial adipose tissue volume (EAT) and coronary artery calcium (CAC). Total plaque score (TPS), and plaque subtypes (non-calcified, calcified and mixed) were measured by coronary CT angiography in 706 men. Methods We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race and serostatus and with additional cardiovascular (CV) risk factors and tested for modifying effects of HIV serostatus. Results HIV-infected men had greater EAT than HIV-uninfected men (p=0.001). EAT was positively associated with duration of antiretroviral therapy (p=0.02), specifically AZT (p<0.05). EAT was associated with presence of any coronary artery plaque (p=0.006) and non-calcified plaque (p=0.001), adjusting for age, race, serostatus and CV risk factors. Among men with CAC, EAT was associated with CAC extent (p=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque. Conclusions Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.

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Coronary Atherosclerosis Imaging by Coronary CT Angiography

Cited by 315 publications

References 38 publications

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

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