Positive Remodeling on Coronary Computed Tomography as a Marker for Plaque Vulnerability on Virtual Histology Intravascular Ultrasound

Kröner, E.S.J.; Velzen, J.E. van; Boogers, Mark J.; Siebelink, Hans‐Marc J.; Schalij, Martin J.; Kroft, Lucia J.M.; Roos, Albert de; Wall, Ernst E. van der; Jukema, J. Wouter; Reiber, Johan H. C.; Schuijf, Joanne D.; Bax, Jeroen J.

doi:10.1016/j.amjcard.2011.02.337

Cited by 73 publications

(45 citation statements)

References 23 publications

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“…In a subset of 13 patients, IVUS was performed to verify the accuracy of MDCT measurements, and cross-sectional vessel areas measured in MDCT correlated closely to the external elastic membrane area measured in IVUS (1). Kro¨ner et al (2011) studied the association between positive remodeling on computed tomography angiogram (CTA) and vulnerable plaque characteristics on virtual histologic intravascular ultrasound (VH IVUS) images. Forty-five patients underwent computed tomographic angiography followed by VH IVUS.…”

Section: Discussionmentioning

confidence: 99%

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Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Abdeldayem

Ibrahim

Ahmed

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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KEYWORDSRemodeling index (RI); Coronary artery disease (CAD); Left anterior descending (LAD); Right coronary artery (RCA); Left circumflex artery (LCX) Abstract Purpose: To emphasis the role of MSCT utilizing the remodeling index in assessment of positive coronary remodeling which was associated with plaque rupture and vulnerability. Methods and material: Studied group included 35 patients with positive coronary remodeling. One lesion per patient was assessed, either a solitary lesion or the most significant one. All patients were subjected to history taking and radiological evaluation using a contrast-enhanced 64 MSCT then post processed. Assessment of the plaque causing positive remodeling regarding the site, number (single, kissing, or multiple), relative composition and predominant type in H.U. was performed. Specific measurements at the reference and remodeling segment were taken. Calculation of remodeling index was done. Two comparative groups were made between subjects with remodeling index (RI) < 1.5 and RI P 1.5. Results: A strong correlation was noted between lipid plaque area, plaque cross sectional area and multiplicity of plaques with remodeling index (p value < 0.001). There was no correlation between the RI with either the patient coronary risk factors or symptomatology. Conclusion: Previous studies had shown that most acute coronary syndromes were initiated by sudden changes of mildly stenotic lesions, commonly found in positively remodeled vessels. Promising comparative results between MSCT and IVUS allowed consideration of MDCT as a useful tool in the noninvasive detection of potentially threatening coronary lesions. In our study, RI P 1.5 showed a strong correlation between the lipid plaque area, multiplicity of the plaques, and cross sectional area which were prognostic factors for plaque rupture and vulnerability, and thus, early detection of coronary artery disease. Modulation and prevention of positive remodeling by statin could promote to start medical treatment especially in cases where RI exceeds 1.5 and their follow up non-invasively by MDCT to detect reversal of remodeling and response of treatment.

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Section: Discussionmentioning

confidence: 99%

“…In conclusion, lesions with positive remodeling on CTA were associated with increased levels of plaque vulnerability on VH IVUS images including a higher percent necrotic core and a higher prevalence of TCFA. Thus evaluation of remodeling on CTA might provide a valuable marker for plaque vulnerability (14).…”

Section: Discussionmentioning

confidence: 99%

Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Abdeldayem

Ibrahim

Ahmed

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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“…24,25) However, CT imaging is not restricted only to plaque visualization, as it provides additional information regarding plaque burden, composition and remodeling, which are directly correlated with plaque vulnerability. 26) In a prospective study including 1059 patients who were followed for a mean period of 2.3 years after having undergone CCTA, Motoyama, et al demonstrated that specifi c plaque parameters such as PR and low CT attenuation may be associated with a particularly high risk for plaque rupture and the development of an acute coronary event. 27) Another retrospective study demonstrated that culprit lesions present a more positive remodeling (815 versus 12%), more low-density (< 30 HU) plaque components (79% versus 9%), and a higher prevalence of spotty calcifi cations (63% versus 21%), and all of these features were shown to represent signifi cant predictors for ACS.…”

Section: Discussionmentioning

confidence: 99%

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

Benedek

Beáta²,

Benedek

2014

Int. Heart J.

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SummaryThe purpose of this study was to demonstrate the relationship between the presence and amount of a low-density core (LDC) with a CT density < 30 Hounsfi eld units (HU) by coronary computed tomography angiography (CCTA) and IVUS-derived markers of vulnerability in the culprit lesions (CL) of patients with acute coronary syndromes (ACS).In 43 patients with ACS, 105 coronary plaques were scanned using CCTA and IVUS for the quantitative and qualitative assessment of vulnerability markers.The presence of a low attenuation plaque (LAP) was identifi ed in 67.4% of the CL and 29.03% of the non-CL (P = 0.0001). The presence of a LDC > 6.0 mm 3 was signifi cantly correlated with the percentage of the necrotic core (NC) (22.08% versus 7.97%, P = 0.001) and the fi bro-fatty tissue by IVUS (18.68% versus 15.87%, P = 0.02). LDC volumes showed a good correlation with the percentage of the NC (r = 0.7303, P < 0.0001) and the fi bro-fatty tissue in the CL (r = 0.4928, P < 0.0008). Quantitative plaque analysis revealed a signifi cant difference in plaque composition between CL and non-CL in regards to the LDC (18.45 versus 6.5, P < 0.001), the percentage of NC (20.74 versus 18.74, P = 0.02), fi bro-fatty tissue (17.77 versus 15.48, P = 0.002), and fi brotic tissue (51.68 versus 54.8, P = 0.01).VH-IVUS and CCTA plaque quantifi cation showed that the presence of a low-density (< 30 HU) core within the CL of patients with ACS represents a marker of vulnerability and correlates well with other CCTA and IVUS-derived features of vulnerability, particularly the NC of the plaque. (Int Heart J 2014; 55: 22-28)

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“…Ganz im Vordergrund steht dabei die Differenzierung von vulnerablen Plaques, die anhand eines großen nekrotischen Lipidkerns und eines positiven Remodellings sowie einer lumennahen Position des Lipidkerns identifiziert werden kön-nen [13,14,15]. Dies war die Grundlage für die Aufdeckung neuer Mechanismen der Pathogenese der Atherosklerose und der Begleitreaktionen bei Interventionen, die auf Mikroembolisierungen zurückge-führt werden können [16,17].…”

Section: Fortschritte Der Diagnostik Sind Die Treibende Kraft Für Dieunclassified

Fortschritte der Diagnostik sind die treibende Kraft für die Weiterentwicklung interventioneller Verfahren

Erbel

2011

Herz

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Positive Remodeling on Coronary Computed Tomography as a Marker for Plaque Vulnerability on Virtual Histology Intravascular Ultrasound

Cited by 73 publications

References 23 publications

Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

Fortschritte der Diagnostik sind die treibende Kraft für die Weiterentwicklung interventioneller Verfahren

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