Quantitative Coronary Plaque Analysis Predicts High-risk Plaque Morphology on Coronary Computed Tomography Angiography: Results from the ROMICAT II Trial

Overview

Journal Int J Cardiovasc Imaging

Publisher Springer

Specialty Radiology

Date 2017 Aug 14

PMID 28803421

Citations 12

Authors

Ting Liu

Pal Maurovich-Horvat

Thomas Mayrhofer

Stefan B Puchner

Michael T Lu

Khristine Ghemigian

Pieter H Kitslaar

Alexander Broersen

Amit Pursnani

Udo Hoffmann

Maros Ferencik

Affiliations

Soon will be listed here.

Abstract

Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm, 95% CI 1.04-1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10-1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08-2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.

Citing Articles

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study.

Andersen T, Overgaard K, Heinsen L, Mohamed R, Madsen F, Precht H J Cardiovasc Dev Dis. 2025; 12(2).

PMID: 39997471 PMC: 11856177. DOI: 10.3390/jcdd12020037.

Whys and Wherefores of Coronary Arterial Positive Remodeling.

Onnis C, Virmani R, Madra A, Nardi V, Salgado R, Montisci R Arterioscler Thromb Vasc Biol. 2024; 44(12):2416-2427.

PMID: 39479766 PMC: 11594009. DOI: 10.1161/ATVBAHA.124.321504.

Artificial Intelligence-based Coronary Stenosis Quantification at Coronary CT Angiography versus Quantitative Coronary Angiography.

Dundas J, Leipsic J, Sellers S, Blanke P, Miranda P, Ng N Radiol Cardiothorac Imaging. 2024; 5(6):e230124.

PMID: 38166336 PMC: 11163244. DOI: 10.1148/ryct.230124.

Non-Calcified Coronary Artery Plaque on Coronary Computed Tomography Angiogram: Prevalence and Significance.

Alyami B, Santer M, Seetharam K, Velu D, Gadde E, Patel B Tomography. 2023; 9(5):1755-1771.

PMID: 37736993 PMC: 10514817. DOI: 10.3390/tomography9050140.

Coronary Computed Tomography Angiography: Beyond Obstructive Coronary Artery Disease.

Tonet E, Boccadoro A, Micillo M, Cocco M, Cossu A, Pompei G Life (Basel). 2023; 13(5).

PMID: 37240730 PMC: 10223586. DOI: 10.3390/life13051086.

References

Davies M . The composition of coronary-artery plaques. N Engl J Med. 1997; 336(18):1312-4. DOI: 10.1056/NEJM199705013361809. View

Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U . Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014; 11(7):390-402. DOI: 10.1038/nrcardio.2014.60. View

Brodoefel H, Burgstahler C, Sabir A, Yam C, Khosa F, Claussen C . Coronary plaque quantification by voxel analysis: dual-source MDCT angiography versus intravascular sonography. AJR Am J Roentgenol. 2009; 192(3):W84-9. PMC: 3290996. DOI: 10.2214/AJR.08.1381. View

Versteylen M, Kietselaer B, Dagnelie P, Joosen I, Dedic A, Raaijmakers R . Additive value of semiautomated quantification of coronary artery disease using cardiac computed tomographic angiography to predict future acute coronary syndrome. J Am Coll Cardiol. 2013; 61(22):2296-305. DOI: 10.1016/j.jacc.2013.02.065. View

Burke A, Weber D, Kolodgie F, Farb A, Taylor A, Virmani R . Pathophysiology of calcium deposition in coronary arteries. Herz. 2001; 26(4):239-44. DOI: 10.1007/pl00002026. View

Burke A, Farb A, Malcom G, Liang Y, Smialek J, Virmani R . Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997; 336(18):1276-82. DOI: 10.1056/NEJM199705013361802. View

Austen W, Edwards J, Frye R, Gensini G, Gott V, Griffith L . A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975; 51(4 Suppl):5-40. DOI: 10.1161/01.cir.51.4.5. View

Ferencik M, Mayrhofer T, Puchner S, Lu M, Maurovich-Horvat P, Liu T . Computed tomography-based high-risk coronary plaque score to predict acute coronary syndrome among patients with acute chest pain--Results from the ROMICAT II trial. J Cardiovasc Comput Tomogr. 2015; 9(6):538-45. PMC: 4684738. DOI: 10.1016/j.jcct.2015.07.003. View

Hoffmann U, Moselewski F, Nieman K, Jang I, Ferencik M, Rahman A . Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 2006; 47(8):1655-62. DOI: 10.1016/j.jacc.2006.01.041. View

10.

Narula J, Strauss H . The popcorn plaques. Nat Med. 2007; 13(5):532-4. DOI: 10.1038/nm0507-532. View

11.

Lehman S, Schlett C, Bamberg F, Lee H, Donnelly P, Shturman L . Assessment of coronary plaque progression in coronary computed tomography angiography using a semiquantitative score. JACC Cardiovasc Imaging. 2009; 2(11):1262-70. PMC: 2796339. DOI: 10.1016/j.jcmg.2009.07.007. View

12.

Fujii K, Carlier S, Mintz G, Wijns W, Colombo A, Bose D . Association of plaque characterization by intravascular ultrasound virtual histology and arterial remodeling. Am J Cardiol. 2005; 96(11):1476-83. DOI: 10.1016/j.amjcard.2005.07.054. View

13.

Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T . Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009; 54(1):49-57. DOI: 10.1016/j.jacc.2009.02.068. View

14.

Maurovich-Horvat P, Schlett C, Alkadhi H, Nakano M, Otsuka F, Stolzmann P . The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging. 2012; 5(12):1243-52. DOI: 10.1016/j.jcmg.2012.03.019. View

15.

Leipsic J, Abbara S, Achenbach S, Cury R, Earls J, Mancini G . SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014; 8(5):342-58. DOI: 10.1016/j.jcct.2014.07.003. View

16.

Varnava A, Mills P, Davies M . Relationship between coronary artery remodeling and plaque vulnerability. Circulation. 2002; 105(8):939-43. DOI: 10.1161/hc0802.104327. View

17.

Schepis T, Marwan M, Pflederer T, Seltmann M, Ropers D, Daniel W . Quantification of non-calcified coronary atherosclerotic plaques with dual-source computed tomography: comparison with intravascular ultrasound. Heart. 2009; 96(8):610-5. DOI: 10.1136/hrt.2009.184226. View

18.

Seifarth H, Schlett C, Nakano M, Otsuka F, Karolyi M, Liew G . Histopathological correlates of the napkin-ring sign plaque in coronary CT angiography. Atherosclerosis. 2012; 224(1):90-6. DOI: 10.1016/j.atherosclerosis.2012.06.021. View

19.

Virmani R, Burke A, Farb A, Kolodgie F . Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006; 47(8 Suppl):C13-8. DOI: 10.1016/j.jacc.2005.10.065. View

20.

Voros S, Rinehart S, Qian Z, Vazquez G, Anderson H, Murrieta L . Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results.... JACC Cardiovasc Interv. 2011; 4(2):198-208. DOI: 10.1016/j.jcin.2010.10.008. View