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Aims: The relationship between AtheroSclerotic CardioVascular Disease (ASCVD) risk and vessel-specific plaque evaluation using coronary computed tomography angiography (CCTA), focusing on plaque extent and composition, has not been examined. To evaluate differences in quantified plaque characteristics (using CCTA) between the three major coronary arteries [left anterior descending (LAD), right coronary (RCA), and left circumflex (LCx)] among subgroups of patients with varying ASCVD risk.
Methods And Results: Patients were included from a prospective, international registry of consecutive patients who underwent CCTA for evaluation of coronary artery disease. ASCVD risk groups were <7.5% (low), 7.5-20% (intermediate), and ≥20% (high). Among the ASCVD risk groups, the three coronary arteries were compared regarding quantified plaque volume and composition. Whole-heart plaque quantification was performed in 1340 patients (age 60 ± 9 years, 58% men). Across low, intermediate, and high ASCVD risk patients, the volume of plaque increased proportionally but was least in the LCx (7.4, 9.0, and 25.3 mm3, respectively) as compared with the RCA (19.3, 32.6, and 67.0 mm3, respectively, all P ≤ 0.006) and LAD (39.9, 60.8, and 93.3 mm3, respectively, all P < 0.001). In each ASCVD risk group, the composition of plaque in the LCx exhibited the least necrotic core and fibrofatty plaque (P < 0.05 vs. LAD and RCA).
Conclusion: Among patients with varying risk of ASCVD, plaque in the LCx is decidedly less and is comprised of less non-calcified plaque supporting prior evidence of the lower rates of acute coronary events in this vessel.
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http://dx.doi.org/10.1093/ehjci/jeac029 | DOI Listing |
JACC Asia
October 2024
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Background: Coronary computed tomography angiography-derived fractional flow reserve (FFR) is a per-vessel index reflecting cumulative hemodynamic burden while coronary events occur in focal lesions.
Objectives: The authors sought to evaluate the additive prognostic value of the local gradient of FFR (FFR gradient) in addition to FFR to predict future coronary events.
Methods: The current study included 245 patients (634 vessels) who underwent coronary computed tomography angiography within 6 to 36 months before the index angiography, of which 209 vessels had future coronary events and 425 vessels did not.
Eur Heart J Cardiovasc Imaging
November 2024
Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Aims: The relationship between coronary artery atherosclerosis and microvascular resistance remains unclear. This study aims to clarify the relationship between total atherosclerotic and vessel-specific atherosclerotic burden and microvascular resistance reserve (MRR).
Methods And Results: In this post-hoc analysis of the PACIFIC 1 trial, symptomatic patients without prior coronary artery disease (CAD) underwent [15O]H2O positron emission tomography, coronary computed tomography angiography (CCTA) and invasive fractional flow reserve (FFR).
J Cardiovasc Comput Tomogr
October 2024
Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy. Electronic address:
Background: Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.
View Article and Find Full Text PDFAcad Radiol
August 2024
Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No.150, Nangang District, Harbin 150081, China. Electronic address:
Rationale And Objectives: To investigate the predictive value of coronary CT angiography (CCTA)-based radiomics for vessel-specific ischemia by stress dynamic CT myocardial perfusion imaging (MPI).
Materials And Methods: Patients with typical angina/atypical angina/non-angina chest pain who underwent both stress dynamic CT MPI and CCTA scans were retrospectively enrolled. The following models were constructed for ischemic prediction using logistic regression and CCTA-derived quantitative and radiomic features: plaque quantitative model, lumen quantitative model, CT-fractional flow reserve (CT-FFR) model, integrative quantitative model, plaque radiomic model, peri-coronary adipose tissue (pCAT) radiomic model, integrative radiomic model, and quantitative and radiomic fusion model.
Int J Cardiol Heart Vasc
April 2024
Royal North Shore Hospital, Australia.
Background: CT coronary angiography (CTCA) is a guideline-endorsed assessment for patients with stable angina and suspected coronary disease. Although associated with excellent negative predictive value in ruling out obstructive coronary disease, there are limitations in the ability of CTCA to predict hemodynamically significant coronary disease. The CAPTivAte study aims to assess the utility of Aggregated Plaque Burden (APB) in predicting ischemia based on Fractional Flow Reserve (FFR).
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