Quantification of calcium burden by coronary CT angiography compared to optical coherence tomography

Monizzi, Giovanni; Sonck, Jeroen; Nagumo, Sakura; Buytaert, Dimitri; Hoe, Lieven Van; Grancini, Luca; Bartorelli, Antonio L.; Vanhoenacker, Peter; Simons, Philip; Bladt, Olivier; Wyffels, Eric; Bruyne, Bernard De; Andreini, Daniele; Collet, Carlos

doi:10.1007/s10554-020-01839-z

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…The distinct image of CNs on grayscale IVUS are convex luminal surface and irregular luminal surface [ 2 ]. A previous study illustrated that coronary CTA might emerge as a tool to aid in the quantification of calcium burden for procedural planning [ 3 ]. The present study examined the CTA characteristics of plaques with CN.…”

Section: Discussionmentioning

confidence: 99%

“…CTA is a reliable tool for plaque characterization and quantification including calcium [ 3 ]. All coronary CTA data was analyzed using a Vitrea workstation (Vital Images, Minnetonka, Minnesota).…”

Section: Methodsmentioning

confidence: 99%

“…The inclusion criteria were CTA and IVUS were performed to assess native coronary lesions within 4 weeks. Exclusion criteria were: (1) impaired CTA image quality; (2) previous revascularization of target lesion; (3) prior history of coronary artery bypass grafting; (4) patients with liver disease; (5) patients of coronary non-calcified lesions (Fig. 1).…”

Section: Study Populationmentioning

confidence: 99%

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Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Jian²,

Wu³

et al. 2022

BMC Cardiovasc Disord

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Background Calcified nodule (CN) is a type of potentially vulnerable plaque. Its formation mechanism remains unknown. This study was to assess serum marker and computed tomography angiography (CTA) characteristics of CN validated by intravascular ultrasound (IVUS). Methods Patients who underwent coronary CTA followed by invasive coronary angiography and IVUS were retrospectively analyzed. Serum levels of alkaline phosphatase (ALP), gamma-glutamyltransferase, and calcium were collected. Results IVUS detected 128 de novo calcified lesions in 79 patients with coronary artery disease (CAD). CNs were identified in 11.4% (9/79) of patients and 9.4% (12/128) of lesions. Compared with patients with non-nodular calcified plaques, CN patients had higher serum level of ALP (82.00 vs 65.00 U/L, P = 0.022) and total plaque volume (673.00 vs 467.50 mm3, P = 0.021). Multivariable analyses revealed that serum ALP level and total plaque volume were independently associated with the prevalence of CN in CAD patients with calcified plaques. At lesion level, the CN group had a higher frequency of moderate to heavy calcification on angiography (75.00% vs 40.52%, P = 0.017). In terms of CTA characteristics, plaques with CN had a more severe diameter stenosis (79.00% vs 63.00%, P = 0.007), higher plaque burden (85.40% vs 77.05%, P = 0.005), total plaque density (398.00 vs 283.50 HU, P = 0.008), but lower lipid percentage (14.65% vs 19.75%, P = 0.010) and fiber percentage (17.90% vs 25.65%, P = 0.011). Mean plaque burden is an independent predictor of the prevalence of CN in calcified plaques (odds ratio = 1.102, 95% confidence interval: 1.025–1.185, P = 0.009). The AUC is 0.753 (95% confidence interval: 0.615–0.890, P = 0.004). When using 84.85% as the best cutoff value, the diagnostic sensitivity and specificity of mean plaque burden for predicting the presence of CN within calcified plaques were 66.7% and 80.2%, respectively. Conclusions CN had different CTA imaging features from non-nodular coronary calcification. The presence of a CN was associated with a higher serum ALP level and plaque burden.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

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Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Jian²,

Wu³

et al. 2022

BMC Cardiovasc Disord

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“…On the other hand, in comparison with ICA, CCTA offers not only the possibility for assessing calcium distribution but also a roadmap along coronary arteries. Moreover, compared to invasive optical coherence tomography, CCTA provides similar information, despite a systematic overestimation of calcific plaque volume [ 10 ]. In our subanalysis of the SYNTAX III REVOLUTION trial, patients with heavily calcified lesions were significantly older (mean age 69.5 ± 7.9 vs 65.9 ± 9.4) and more often had diabetes (46.2% vs 30.5%).…”

Section: Discussionmentioning

confidence: 99%

Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial

Andreini

Takahashi

Mushtaq

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team’s treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease. METHODS SYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications. RESULTS Overall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived—ICA derived) was lower in patients without heavy calcifications [mean (−1.96 SD; +1.96 SD) = 1.5 (−19.3; 22.4) vs 5.9 (−17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen’s kappa 0.79) or without coronary calcifications (Cohen’s kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%). CONCLUSIONS An overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions.

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“…Stent underexpansion is the most common cause of stent failure in the short and midterm follow-up (19). Preprocedural lesion preparation with evaluation of the calcium arc, length, and thickness is a valuable tool in planning and guiding PCI (20).…”

Section: Importance Of Using Ccta Imaging For Pcimentioning

confidence: 99%

Coronary CT Angiography to Guide Percutaneous Coronary Intervention

Τζίμας¹,

Gulsin²,

Takagi³

et al. 2022

Radiology: Cardiothoracic Imaging

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C oronary CT angiography (CCTA) has become an established first-line noninvasive imaging modality for the evaluation of patients with suspected, but not yet confirmed, coronary artery disease (CAD) (1,2). Current guidelines highlight the high negative predictive value of CCTA to exclude obstructive coronary stenosis (3). Moreover, identification of atherosclerosis at CCTA provides prognostic information that can be used to stratify cardiovascular risk and guide medical therapy (4). Over the last decade, the assessment of the hemodynamic relevance of CAD, as measured by CT-derived fractional flow reserve (FFR CT ), has been validated and introduced into clinical practice to help accurately determine the impact on physiology from each lesion (5) and better identify those patients who may benefit from revascularization or those in whom invasive coronary angiography (ICA) can be deferred (6,7).Beyond diagnostic accuracy, CCTA provides incremental information that can be of clinical value for both guiding referrals for ICA and helping plan coronary interventions. Integration of CCTA in the procedural planning of patients considered for an invasive evaluation could potentially facilitate the course of ICA, enhance diagnostic and therapeutic intervention, and improve clinical outcomes. Importantly, with CCTA being used more routinely in the evaluation of symptomatic patients, the opportunity to expand its use to help plan and guide coronary intervention involves understanding how to use the existing data rather than ordering an additional test. This review provides practical recommendations on integrating CCTA into the planning of percutaneous coronary interventions (PCI).

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Quantification of calcium burden by coronary CT angiography compared to optical coherence tomography

Cited by 19 publications

References 23 publications

Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial

Coronary CT Angiography to Guide Percutaneous Coronary Intervention

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