Distribution matters: Diagnostic value of coronary plaque in distal segments

Abstract

Cardiac computed tomography (CT) has become a valuable tool for quantification of coronary artery plaque, whether calcified or not, because its extent is strongly related to the severity of angiographic obstructive coronary artery disease (CAD) and identifies subjects at increased risk of future coronary events at preclinical stages of the disease. 1 Detrano R. Guerci A.D. Carr J.J. Bild D.E. Burke G. Folsom A.R. Liu K. Shea S. Szklo M. Bluemke D.A. O'Leary D.H. Tracy R. Watson K. Wong N.D. Kronmal R.A. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358: 1336-1345 Crossref PubMed Scopus (2121) Google Scholar , 2 Miller J.M. Rochitte C.E. Dewey M. Arbab-Zadeh A. Niinuma H. Gottlieb I. Paul N. Clouse M.E. Shapiro E.P. Hoe J. Lardo A.C. Bush D.E. de Roos A. Cox C. Brinker J. Lima J.A. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008; 359: 2324-2336 Crossref PubMed Scopus (1492) Google Scholar , 3 Budoff M.J. Dowe D. Jollis J.G. Gitter M. Sutherland J. Halamert E. Scherer M. Bellinger R. Martin A. Benton R. Delago A. Min J.K. Diagnostic performance of 64-multidetector row coronary CT angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary CT Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008; 52: 1724-1732 Abstract Full Text Full Text PDF PubMed Scopus (1697) Google Scholar , 4 Hoffmann U. Bamberg F. Chae C.U. Nichols J.H. Rogers I.S. Seneviratne S.K. Truong Q.A. Cury R.C. Abbara S. Shapiro M.D. Moloo J. Butler J. Ferencik M. Lee H. Jang I.K. Parry B.A. Brown D.F. Udelson J.E. Achenbach S. Brady T.J. Nagurney J.T. Coronary CT Angiography For Early Triage of Patients with Acute Chest Pain: the ROMICAT (Rule Out Myocardial Infarction Using Computed Assisted Tomography) trial. J Am Coll Cardiol. 2009; 53: 1642-1650 Abstract Full Text Full Text PDF PubMed Scopus (456) Google Scholar Early pathoanatomic, 5 Montenegro M.R. Eggen D.A. Topography of atherosclerosis in the coronary arteries. Lab Invest. 1968; 18: 586-593 PubMed Google Scholar histomorphometric, 6 Mautner G.C. Mautner S.L. Froehlich J. Feuerstein I.M. Proschan M.A. Roberts W.C. Doppman J.L. Coronary artery calcium: assessment with electron beam CT and histomorphometric correlation. Radiology. 1994; 192: 619-623 Crossref PubMed Scopus (319) Google Scholar and cardiac CT-based 7 Schmermund A. Baumgart D. Adamzik M. Ge J. Grönemeyer D. Seibel R. Sehnert C. Görge G. Haude M. Erbel R. Comparison of EBCT and intracoronary ultrasound in detecting calcified and non-calcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease. Am J Cardiol. 1998; 81: 141-146 Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar studies found consistent evidence that advanced atherosclerotic lesions are most frequently located at the proximal left anterior descending coronary artery followed by the left circumflex and right coronary arteries. The prevalence of atherosclerotic lesions is lower within distal segments, particularly the left coronary artery. Similarly, the rate of progression of coronary plaque was found to be highest in the proximal left coronary artery, whereas plaque progression was more uniform throughout the right coronary artery. 5 Montenegro M.R. Eggen D.A. Topography of atherosclerosis in the coronary arteries. Lab Invest. 1968; 18: 586-593 PubMed Google Scholar , 8 Schmermund A. Baumgart D. Möhlenkamp S. Kriener P. Pump H. Grönemeyer D. Seibel R. Erbel R. Natural history and topographic pattern of progression of coronary calcification in symptomatic patients: an electron-beam CT study. Arterioscler Thromb Vasc Biol. 2001; 21: 421-426 Crossref PubMed Scopus (122) Google Scholar