Subclinical Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography in an Asymptomatic Population

Abstract

Background and ObjectivesPrimary prevention of coronary artery disease (CAD) has become a public health issue, according to increasing awareness of the substantial risks posed by asymptomatic atherosclerosis. The aims of this study were to determine the prevalence and characteristics of subclinical CAD using coronary computed tomography angiography (CCTA), and to evaluate the role of this advanced technology in identifying subclinical CAD in asymptomatic Korean individuals, compared with conventional risk stratification.Subjects and MethodsWe enrolled 4,320 consecutive asymptomatic individuals (61% males, aged 50±9 years), who underwent 64-slice CCTA during a routine health check.ResultsCoronary artery plaques were present in 1,053 (24%) individuals. Significant stenosis (diameter stenosis ≥50%) was identified in 139 (3%) subjects, and most of the significant lesions (87%) were located in the left anterior descending artery. CCTA revealed noncalcified plaques in 5% of subjects with a coronary calcium score of zero (n=801). Although 25% (n=10) of those with noncalcified plaque had significant stenosis, most of them (90%) were classified into low- or moderate-risk groups according to National Cholesterol Education Program risk stratification guidelines. In a young population (age ≤55 years for males, ≤65 years for females), 30% of subjects with significant stenosis were classified into a low-risk group and 60% had low (0 to 100) calcium scores.ConclusionSubclinical CAD in asymptomatic individuals cannot be ignored for its considerable prevalence, CCTA may be helpful in identifying at-risk subclinical CAD in a noninvasive manner, especially in the young and traditionally low-risk population.

Acute coronary syndromes and atherosclerotic plaque burden distribution in coronary arteries among patients with valvular heart disease (BIA-WAD registry)

“…In a retrospective analysis of over 13 000 coronarographies, an isolated change in RCA was found in 6.5% of cases, while a similar lesion was present over five times more frequently in the left artery (34.7%) [14][15][16][17]. Enrico et al in a study of 73,282 deposits in angio-CT scans of coronary arteries presented similar results by showing that nearly half of them were located in the LAD, and every third in RCA and circumflex artery [18][19][20]. The analysis also showed that patients with severe aortic stenosis were less often diagnosed with coronary artery disease, which concerned both patients with ischemic heart disease with and without significant atherosclerotic lesions, as well as with multi-vessel disease, 17.3% (n = 50) vs. 26.5% (n = 69), p < 0.001 (including prior STEMI and NSTEMI), 7.6% (n = 22) vs. 23.5% (n = 61), p < 0.001 (Table II).…”

Specific Characteristics of Coronary Atherosclerosis

“…Косвенным критерием, отражающим степень коронарного атеросклероза, является количество кальция, содержащегося в сосудах сердца, так называемый коронарный кальциевый индекс (индекс Агатстона). Он используется для обнаружения и оценки субклинического атеросклероза даже в отсутствие симптомов у пациентов [28][29][30][31][32].…”

“…Известно, что количество кальция коррелирует с тяжестью атеросклероза у разных пациентов, а также с поражением различных сегментов артерий венечного русла одного и того же индивидуума [33]. Это подтверждается данными компьютерной томографии (КТ) [28][29][30][31][32].…”

“…Септальные ветви обычно оказываются свободными от АСБ. На характер поражения влияют гемодинамические факторы, а также наличие ветвления сосудов с образованием локальных турбулентных потоков [28][29][30][31][32].…”

The Role of Septal Perforators and “Myocardial Bridging Effect” in Atherosclerotic Plaque Distribution in the Coronary Artery Disease

“…The amount of coronary artery calcium correlates with plaque burden and the calcium score roughly reflects the magnitude of coronary atherosclerosis [ 8 ]. According to tomographic studies, higher spatial distribution of calcalcifications and plaques is found in the LAD, then in RCA, circumflex branch (LCx) and the left main stem (LM) in a decreasing order of frequency [ 9 – 13 ].…”