P868Temporal remodeling of coronary arteries during progression of atherosclerosis with serial coronary CT angiography using 3D metrics: results from the PARADIGM study

Abstract

Abstract Aim To determine compensatory enlargement and luminal reduction of coronary arteries during the progression of atherosclerosis with serial coronary computed tomography angiography (CCTA) by using volumetric measurements. To date, the impact of coronary plaque progression on temporal remodeling, as opposed to the static remodeling, has only been studied with invasive imaging modalities and primarily two-dimensional areas rather than three-dimensional volumes. Methods In total, 1,245 patients with suspected coronary artery disease (CAD) at 13 sites (61±9 years, 39% women) underwent serial CCTA with interscan interval of ≥2 years. The primary objective was to assess volumetric temporal remodeling, defined as the linear association between the change in coronary plaque, lumen and vessel volume at follow-up CCTA on a per-segment level. Temporal remodeling was determined in strata of low and high baseline plaque burden as well as different coronary segments at baseline. Linear regression analysis and Pearson's correlation coefficients were calculated to assess associations. Results Amongst 1,245 patients with 19,920 segments, the median interscan interval was 3.3 (IQR 2.6–4.8) years. For each 1 mm3 increase in plaque volume, the increase in vessel volume was 0.72 mm3 and the decrease in lumen volume was 0.28 mm3 (Figure 1, both p<0.001). Volumetric temporal remodeling was similar in low versus high PAV [0.70 mm3 vs 0.73 mm3 (p for interaction=0.491)] and left-main arteries versus all other segments [0.78 mm3 vs. 0.72 mm3 (p for interaction=0.336)], but not in proximal versus distal segments at baseline [0.75 mm3 vs. 0.61 mm3 (p for interaction=0.020)]. Figure 1. Volumetric temporal remodeling Conclusion In general, coronary plaque grows approximately 70% outward and 30% into the coronary lumen during the progression of atherosclerosis. Volumetric temporal remodeling is not limited by baseline plaque burden, but is potentially dependent on its location within the coronary artery tree. Acknowledgement/Funding NRF of Korea (Grant No. 2012027176); Dalio Institute of Cardiovascular Imaging and Michael J. Wolk Foundation