CT Attenuation Features of Individual Calcified Coronary Plaque: Differences among Asymptomatic, Stable Angina Pectoris, and Acute Coronary Syndrome Groups

Yi, Hana; Lin, Huey Shyan; Wu, Carol C.; Wu, Fu-Zong; Yeh, Chinson; Chiou, Kuan Ran; Mar, Guang Yuan; Wu, Ming Ting

doi:10.1371/journal.pone.0131254

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…A recent clinical CT study that examined the predictive value of both calcium density (standard CAC Agatston score) and plaque calcium density showed that although the CAC score was positively and independently associated with CV disease risk, at any level of CAC volume, CAC density was inversely and significantly associated with CV disease risk (12,33), as we found in our study. In addition, a recent study showed that a CAC score of zero at baseline in an asymptomatic population with no known CV disease was associated with low CAC progression over the 5year period.…”

Section: Calcification and Plaque Vulnerabilitysupporting

confidence: 83%

Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome

Pezel

Sidéris

Dillinger

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAside from the culprit plaque, the presence of vulnerable plaques in patients with acute coronary syndrome (ACS) may be associated with future cardiac events. A link between calcification and plaque rupture has been previously described.AimTo assess whether analysis of the calcium component of coronary plaques using CT angiography, coronary computed tomographic angiography (CCTA) can help to detect additional vulnerable plaques in patients with non-ST elevation myocardial infarction (NSTEMI).Materials And MethodsCross sectional study of consecutive patients referred for NSTEMI from 30 July to 30 August 2018 with CCTA performed before coronary angiography with systematic optical coherence tomography (OCT) analysis of all coronary arteries within 24 h of clinical onset of NSTEMI. Three types of plaques were defined: culprit plaques defined by angiography (vulnerable culprit plaques–VCP) – plaques with a fibrous cap thickness < 65 microns or thrombus in OCT (vulnerable non-culprit plaque–VNCP) – plaques with a fibrous cap thickness ≥ 65 microns in OCT (stable plaque–SP).ResultsA total of 134 calcified plaques were identified in 29 patients (73% male, 59 ± 14 years) with 29(22%) VCP, 28(21%) VNCP and 77(57%) SP. Using CCTA analysis of the calcium component, factors associated with vulnerable plaques were longer calcification length, larger calcification volume, lower calcium mass, higher Agatston score plaque-specific (ASp), presence of spotty calcifications and an intimal position in the wall. In multivariate analysis, ASp, calcification length and spotty calcifications were independently associated to vulnerable plaques. There was no difference between VCP and VNCP.ConclusionsCCTA analysis of calcium component of the plaque could help to identify additional vulnerable plaques in NSTEMI patients.

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Section: Calcification and Plaque Vulnerabilitysupporting

confidence: 83%

Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome

Pezel

Sidéris

Dillinger

et al. 2022

Front. Cardiovasc. Med.

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“…Dense calcification is considered to contribute to worse cardiovascular prognosis in a different manner from spotty calcification, for example, by increasing vascular stiffness and reducing coronary flow reserve [ 29 ]. In fact, contrary to the findings of the non-CKD population [ 11 , 12 ], Bellasi et al have recently reported that the higher CAC density was associated with an increased risk of all-cause mortality in a cohort of 125 prevalent hemodialysis patients [ 30 ], suggesting that clinical relevance of CAC density in patients with kidney disease is different from those without kidney disease. Further follow-up studies are needed to elucidate the relationship between CAC density and cardiovascular prognosis in non-dialysis CKD patients.…”

Section: Discussionmentioning

confidence: 81%

“…In this context, the two previous studies of primarily the non-CKD population examined the CAC density [ 11 , 12 ]. These studies found that the risk of coronary artery disease increased as the CAC density decreased, suggesting that high-density calcified plaques may be protective.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, a recent report from a population-based cohort found that the lower CAC density was associated with a higher risk of coronary artery disease [ 11 ]. Another group also reported that CT attenuation values of calcified plaques were lower in patients with acute coronary syndrome than in those with stable angina [ 12 ]. These observations may be in line with a fact that a low-density spotty calcification is a typical feature of vulnerable plaques [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease

Sakaguchi¹,

Hamano²,

Nakano³

et al. 2016

PLoS ONE

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BackgroundThe Agatston score, commonly used to quantify coronary artery calcification (CAC), is determined by the plaque area and density. Despite an excellent predictability of the Agatston score for cardiovascular events, the density of CAC has never been studied in patients with pre-dialysis chronic kidney disease (CKD). This study aimed to analyze the CAC density and its association with serum mineral levels in CKD.MethodsWe enrolled patients with pre-dialysis CKD who had diabetes mellitus, prior cardiovascular disease history, elevated low-density lipoprotein cholesterol levels, or smoking history. The average CAC density was calculated by dividing the Agatston score by the total area of CAC.ResultsThe mean estimated glomerular filtration rate (eGFR) of 109 enrolled patients was 35.7 mL/min/1.73 m2. The correlation of the Agatston score with density was much weaker than that with the total area (R2 = 0.19, P < 0.001; and R2 = 0.99, P < 0.001, respectively). Multivariate analyses showed that serum magnesium level was inversely associated with the density, but not with the total area, after adjustment for demographics and clinical factors related to malnutrition-inflammation-atherosclerosis syndrome and mineral and bone disorders including fibroblast growth factor 23 (P = 0.006). This inverse association was pronounced among patients with higher serum phosphate levels (P for interaction = 0.02).ConclusionCAC density was inversely associated with serum magnesium levels, particularly in patients with higher serum phosphate levels.

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“…Previous studies have demonstrated that density scores that can be retrospectively derived from the Agatston score and volume score are independently associated with increased coronary heart disease [22,23]. Our previous report also found that the CAC plaque in the ACS group had a lower and homogenous attenuation compared to subjects without symptoms or with chronic stable angina [24]. However, the impact of TRF and CAC burden among the three groups was not well eliminated.…”

Section: Discussionmentioning

confidence: 77%

Lower Attenuation and Higher Kurtosis of Coronary Artery Calcification Associated with Vulnerable Plaque – An Agatston Score Propensity-matched CT Radiomics study

Huang

Lin

Chen

et al. 2022

Preprint

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Background: Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radiomics could reveal. Propensity-score matching of the traditional risk factors and CAC burden between the ACS and asymptomatic groups could radically remove biases and allow exploration of characteristic features of CAC in ACS. Methods: We retrospectively identified 77 patients with ACS who had a CAC scan before percutaneous coronary intervention between 2016–2019. These 77 patients were one-to-two propensity-score matched for traditional risk factors of ACS and AS ranks to select 154 subjects from 2890 asymptomatic subjects. A validation cohort of 30 subjects was also enrolled. Radiomics features of each plaque were extracted and averaged in each person. Conditional logistic regression and area under curve analysis was used for statistical analysis. Results: A higher number of coronary segments involved, lower mean, median, first quartile, and standard deviation of attenuation, and increased kurtosis of attenuation of CAC were associated with the ACS group compared to the control group (p < 0.05 for all). Multivariable analysis showed that the lower median attenuation (OR = 0.969, p < 0.001) and higher Kurtosis (OR = 18.7, p < 0.001) were associated with the ACS group. The median attenuation and kurtosis significantly increase across AS ranks 1 to 4 (p = 0.001). The AUC of kurtosis (0.727) and median attenuation (0.66) were both significantly higher than that of the standard AS (AUC = 0.502) and the number of TRF (AUC = 0.537). The best cut-off of kurtosis at 2.74 yielded an accuracy of 74%, and the cut-off of median attenuation at 196 yielded an accuracy of 68%. The accuracy of kurtosis was 64%, and the accuracy of median attenuation was 55% in the validation cohort. Conclusion: After propensity-matching traditional risk factors and CAC burden, CT radiomics highlighted that lower median attenuation and higher kurtosis were the CAC characteristics of vulnerable plaques. These features improve the understanding of the biomechanics of CAC evolution and enhance the value of CAC scan in ACS risk assessment.

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CT Attenuation Features of Individual Calcified Coronary Plaque: Differences among Asymptomatic, Stable Angina Pectoris, and Acute Coronary Syndrome Groups

Cited by 7 publications

References 33 publications

Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome

Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome

Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease

Lower Attenuation and Higher Kurtosis of Coronary Artery Calcification Associated with Vulnerable Plaque – An Agatston Score Propensity-matched CT Radiomics study

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