Prognostic Value of Plaque Volume in Patients With First Diagnosis of Coronary Artery Disease

BackgroundPericoronary adipose tissue attenuation (PCATa), derived from coronary computed tomography angiography (CCTA), is a novel marker of inflammation in the coronary arteries. Patients with type 2 diabetes mellitus (T2DM) are at elevated risk of coronary artery disease (CAD), potentially due to systemic inflammation. This study evaluated whether baseline PCATa predicts changes in plaque composition and burden over 12 months.MethodsThis prospective longitudinal study included 200 participants with T2DM, who had neither symptoms nor a prior diagnosis of CAD (mean age 61 ± 9.4 years, 72% male). PCATa was measured at the baseline scan along the proximal 40 mm of each major coronary artery, and the values were averaged to calculate the participant-level PCATa. High PCATa levels were determined using the validated cut-off of -70.1 Hounsfield units. Compositional plaque changes were quantified as the differences between baseline and 12-month scans, and plaque burden was calculated as the normalized atheroma volume. Multivariable regression analyses assessed the associations between baseline PCATa and compositional plaque changes and evaluated risk factors, including high PCATa, in predicting non-calcified plaque burden progression.ResultsPlaque compositional volumes and burden increased over 12 months, while PCATa remained stable. After multivariable adjustments, baseline PCATa was significantly associated with changes in total plaque volume (β = 0.005, p = 0.005), non-calcified plaque volume (β = 0.006, p = 0.007), total plaque burden (β = 1.7, p = 0.007), and non-calcified plaque burden (β = 2.0, p = 0.006), but not with calcified plaque volume or burden. High baseline PCATa was observed in 44 participants (22%) and was the only independent predictor of non-calcified plaque burden progression (odds ratio 3.5, p = 0.002).ConclusionsBaseline PCATa is significantly associated with increases in total and non-calcified plaque volumes and burden over 12 months in participants with T2DM without symptoms or known CAD. High PCATa levels uniquely predict non-calcified plaque burden progression, suggesting that PCATa may serve as a marker for subclinical atherosclerosis progression. This warrants further investigation into PCATa for cardiovascular risk assessment, particularly in high-risk populations such as individuals with T2DM.Trial registrationTrial registration: NCT06644651.Graphical abstractPCATa = Pericoronary Adipose Tissue attenuation. T2DM = Type 2 diabetes mellitus. CAD = Coronary Artery Disease. N = numbers. CCTA = Coronary CT angiography. Created in BioRender.Research insightsWhat is currently known about this topic?Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) share inflammatory mechanisms.Individuals with T2DM face a two- to four-fold increased risk of CAD compared with those without T2DM.Pericoronary adipose tissue attenuation (PCATa) is a novel marker of coronary inflammation.What is the key research question?Can baseline PCATa predict compositional plaque changes over 12 months in T2DM without known CAD?What is new?Baseline PCATa relates to higher total and non-calcified plaque (NCP) volumes after adjustment.Baseline PCATa associates with increased total- and NCP burden after multivariable adjustment.High baseline PCATa (> -70.1 HU) independently predicts NCP burden progression.How might this study influence clinical practice?PCATa may be a marker for subclinical atherosclerosis progression.

Background Individuals with type 2 diabetes mellitus (T2DM) have a two- to fourfold increased risk of coronary artery disease (CAD). This increased risk is partly attributed to shared inflammatory pathways involved in the pathogenesis of both conditions. Pericoronary adipose tissue attenuation (PCATa), measured by coronary computed tomography angiography (CCTA), reflects the inflammatory activity within the coronary arteries and shows potential as a biomarker for cardiovascular risk assessment. Purpose This study investigated whether a participant-level baseline PCATa predicts changes in compositional plaque volumes and burden over a year in asymptomatic individuals with T2DM, who had neither symptoms nor a prior diagnosis of CAD. Methods This prospective longitudinal study included 200 asymptomatic participants with T2DM. Participants underwent CCTA scans at baseline and after one year to measure PCATa and quantify compositional plaque volumes and burden. PCATa represents the adipose tissue located within a radial distance from the outer coronary vessel wall equivalent to the vessel diameter, with an attenuation range of -190 to -30 Hounsfield units (HU). PCATa was measured along the proximal 40 mm of each coronary vessel, and the values were averaged to calculate participant-level PCATa. High PCATa were determined using the validated cut-off of -70.1 HU. Changes in plaque compositional volumes were quantified from the differences between baseline and one-year CCTA, and compositional plaque burden was calculated as the normalized atheroma volume. Multivariable linear and logistic regressions evaluated baseline PCATa associations with compositional plaque changes. Results Participants mean age was 61 ±9.4 years, 72% were male, and the mean body mass index was 30.5 ±4.5 kg/m². Over a years follow-up, compositional plaque volumes and burden increased, while PCATa remained stable. After multivariable adjustments, baseline PCATa was significantly associated with changes in total plaque volume (β=0.005, p=0.005), non-calcified plaque volume (β=0.006, p=0.007), total plaque burden (β=1.7, p=0.007), and non-calcified plaque burden (β=2.0, p=0.006). No significant associations were observed between baseline PCATa and changes in calcified plaque volume or burden. High baseline PCATa (> -70.1 HU) was observed in 44 participants (22%) and was the only independent predictor of non-calcified plaque burden progression (odds ratio 3.5, p=0.002). Conclusions Baseline PCATa was significantly associated with increased total and non-calcified plaque volumes and burden over a year in asymptomatic participants with T2DM. High PCATa predicts non-calcified plaque burden progression, suggesting that PCATa may serve as a marker for subclinical atherosclerosis progression. This supports further investigation into the role of PCATa in cardiovascular risk stratification, particularly in high-risk populations such as T2DM.Central Figure Changes in plaque compositions by PCATa

Plaque quantification from coronary computed tomography angiography in predicting cardiovascular events: A systematic review and meta-analysis.

We aim to evaluate the relationship between quantitative plaque characteristics detected by dual-source computed tomography angiography (DSCTA) and myocardial ischemia as assessed by single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). In this study, 460 consecutive patients with suspected coronary artery disease (CAD) underwent DSCTA and stress/rest SPECT-MPI, and 179 patients with coronary artery plaques were quantitatively analyzed. Quantitative coronary artery plaque measurements including total plaque volume, the volume of non-calcified plaque, calcified plaque volume, low-density noncalcified plaque volume, total plaque burden, calcified plaque burden, non-calcified plaque burden, low-density non-calcified plaque (LDNCP) burden, remodeling index, plaque length, maximum diameter stenosis were provided by the automated software (Release 5.6.5, Circle Cardiovascular Imaging, Canada). Univariate and multivariate logistic regression analysis was performed to assess the correlation between quantitative plaque characteristics and myocardial ischemia to determine if plaque characteristics were independent of clinical risk factors and significant CAD. One hundred and seventy-nine patients (65% males) with suspected-CAD, undergoing DSCTA and stress/rest SPECT-MPI and single vessel ischemia were considered. There were significant correlations between quantitative assessment of plaque features and myocardial ischemia with details as follow: total plaque volume [25.2 (17.8-37.8) vs. 15.6 (10.3-24.9) mm3, P<0.001], calcified plaque volume (1.6±7.1 vs. 2.3±6.4 mm3, P=0.019), non-calcified plaque volume [23.6 (16.6-35.9) vs. 14.6 (10.3-22.8) mm3, P<0.001)], LDNCP volume [4.9 (2.1-8.2) vs. 2.2 (1.0-5.5) mm3, P=0.003], total plaque burden (47.6%±17.1% vs. 36.2%±17.3%, P=0.002), calcified plaque burden (1.5%±5.5% vs. 2.9%±6.9%, P=0.014), non-calcified plaque burden (46.1%±18.8% vs. 33.3%±16.4%, P=0.001), LDNCP burden [12.3% (6.4-17.7) vs. 3.3% (1.6-5.3), P<0.001], remodeling index [1.2 (1.1-1.4) vs. 1.0 (1.1-1.2), P<0.001], plaque length [4.0 (3.2-6.1) vs. 3.3 (2.8-3.8) mm, P=0.009], maximum diameter stenosis [18.1% (10.0-52.9) vs. 12.9% (6.5-18.5), P=0.011]. In a multivariate analysis, low-density noncalcified plaque burden (OR 1.33; 95% CI, 1.16-1.53, P<0.001) remained a significant predictor of myocardial ischemia after adjusting for stenosis ≥50% and gender. The area under curve (AUC) of the model containing LDNCP burden, stenosis ≥50% and gender was 0.875 (95% CI, 0.812-0.938), which was significantly better than the model with stenosis ≥50% and gender (AUC 0.729; 95% CI, 0.633-0.825). Quantitative plaque characteristics detected by DSCTA are independently correlated with the incidence of myocardial ischemia by SPECT-MPI in patients with suspected CAD.

To explore the association between baseline Lp (a) levels and high-risk plaques, plaque volume, and plaque progression in patients with diabetes mellitus. Patients with diabetes mellitus and intermediate pretest probability of coronary artery disease (CAD) were prospectively enrolled. All patients underwent baseline coronary computed tomography angiography (CCTA), and patients with recurrent symptoms underwent mid-term follow-up CCTA. Plaque quantification and qualification were performed to compare coronary atherosclerosis features and plaque progression between the elevated and normal Lp (a) groups. In this study, 1694 subjects (mean age: 62.0 ± 7.0 years; 1031 males) were enrolled for baseline analysis, and 246 subjects with repeat CCTA (mean interval of 2.3 ± 0.74 years) were included for follow-up analysis. The total plaque volume, noncalcified plaque volume, low attenuation plaque (LAP) volume, fibro-fatty plaque volume, and fibrotic plaque volume were higher in the elevated Lp (a) group than in the normal Lp (a) group at baseline (all p < 0.001). At follow-up, the elevated Lp (a) group showed a higher mean annual increase in LAP volume than the normal Lp (a) group (3.03 ± 22.26 mm3 vs -3.09 ± 12.22 mm3; p = 0.011). In multivariate linear regression analysis, elevated Lp (a) levels were associated with accelerated LAP volume progression after adjusting for confounders (Beta = 4.50, 95% confidence interval: 0.06-8.93; p = 0.045). Elevated Lp (a) level in patients with diabetes mellitus was associated with high coronary artery plaque burden at baseline and LAP volume progression at follow-up. Question The relationship between Lp (a) levels and coronary artery plaque volume and progression in patients with diabetes mellitus remains unclear. Findings Elevated Lp (a) level was associated with high total coronary plaque volume at baseline and low-attenuation plaque (LAP) volume progression at follow-up. Clinical relevance Elevated Lp (a) level in patients with diabetes mellitus was associated with high coronary artery plaque burden at baseline and LAP volume progression at follow-up, which supports the modulation of LAP level to improve prognosis.

To investigate the association of coronary plaque burden variables derived from coronary computed tomography angiography (CCTA) before patients underwent their first percutaneous coronary intervention (PCI) procedure and major adverse cardiovascular events (MACEs) after PCI. Patients who underwent CCTA before their first PCI were included retrospectively. A radiologist and a cardiologist analyzed CCTA images on a dedicated workstation. The coronary plaque burden variables included total plaque volume, total percent atheroma volume, volumes and fractions of total low-attenuation plaque, total fibrous plaque, and total calcified plaque. The primary outcomes were MACEs, a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unscheduled coronary revascularization. A total of 230 patients were included in the final analysis. During a median follow-up of 4.8 years, 67 MACEs occurred. Total plaque volume, total percent atheroma volume, volumes of total low-attenuation plaque and total fibrous plaque but not their fractions were independent predictors for MACEs. Compared with the first tertiles, the hazard ratio of the third tertile of total plaque volume, total percent atheroma volume, total low-attenuation plaque volume, and total fibrous plaque volume were 2.06 (95% CI: 1.03-4.15), 2.15 (95% CI: 1.02-4.51), 3.04 (95% CI: 1.45-6.36), and 2.23 (95% CI: 1.11-4.46), respectively. Neither total calcified plaque volume nor fraction was associated with MACEs independently. Selected pre-PCI CCTA-derived variables, including total percent atheroma volume, volumes of total plaque, total low-attenuation plaque and total fibrous plaque, were significantly associated with MACEs after PCI, suggesting that CCTA before PCI reveals the residual risk after revascularization. The coronary plaque burden variables derived from coronary computed tomography angiography before percutaneous coronary intervention are independently associated with major adverse cardiovascular events, which could be instrumental in optimizing patient management. Coronary plaque burden is associated with cardiovascular events in patients with coronary artery disease. Selected total plaque burden variables derived from coronary computed tomography angiography before percutaneous coronary intervention were associated with poor prognosis. Routine coronary computed tomography angiography before percutaneous coronary intervention might be helpful in reducing future risks.

Background:Studies have demonstrated that patients with non-obstructive coronary artery disease (NOCAD) have an increased risk of myocardial infarction and all-cause mortality, particularly due to coronary microvascular dysfunction (CMD). Moreover, the features of atherosclerotic plaque can affect myocardial blood flow (MBF); however, data on these findings remain limited. Therefore, this study aimed to assess the impact of quantitative coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque features on myocardial perfusion and MBF in NOCAD patients measured using dynamic cadmium–zinc–telluride single-photon emission computed tomography (CZT-SPECT).Methods:Based on the CCTA results, a total of 49 NOCAD patients (stenosis <50%, 29 men, mean age 57.4 ± 9.0 years) were included in the study. In addition to estimating stenosis severity, the plaque volume (mm3) and burden (%) were measured using the coronary bed and separately by structural components (non-calcified, soft-tissue, fibrous, calcified). All patients underwent dynamic CZT-SPECT to assess stress and resting MBF and myocardial flow reserve (MFR).Results:Based on the MFR values, patients were divided into two groups: Group 1 consisted of patients with reduced MFR (<2.0, n = 20), and Group 2 consisted of those with normal MFR (≥2.0, n = 29). Not all patients had severe myocardial perfusion abnormalities, as determined by standard myocardial perfusion imaging indexes. Analysis of the CCTA data demonstrated that small volumes and burdens of atherosclerotic plaques were characteristic of patients. Stress was significantly correlated with total plaque volume (Spearman's rank correlation coefficient (ρ) = –0.402) and burden (ρ = –0.374), as well as non-calcified plaque volume (ρ = –0.341) and burden (ρ = –0.314). Rest significantly correlated with total plaque volume (ρ = –0.504) and burden (ρ = –0.432), and non-calcified plaque volume (ρ = –0.471) and burden (ρ = –0.433). Meanwhile, MFR and standard indexes of myocardial perfusion impairment did not exhibit significant associations with quantitative CCTA parameters. Multivariate logistic regression analysis revealed that only total plaque volume (odds ratio 1.01; 95% confidence interval 1.005–1.030; p < 0.001) was an independent predictor of reduced stress-related MBF of less than 1.5 mL/min/g.Conclusions:Total plaque volume, derived from quantitative CCTA data, represents an independent predictor of reduced stress-related MBF of less than 1.5 mL/min/g, as obtained using dynamic CZT-SPECT, even in the absence of obstructive coronary artery disease (CAD).

Increased attenuation of pericoronary adipose tissue (PCAT) around the proximal right coronary artery (RCA) from coronary computed tomography angiography (CTA) has been shown to be associated with coronary inflammation and improved prediction of cardiac death over plaque features. Our aim was to investigate whether PCAT CT attenuation is related to progression of coronary plaque burden. We analysed CTA studies of 111 stable patients (age 59.2 ± 9.8 years, 77% male) who underwent sequential CTA (3.4 ± 1.6 years between scans) with identical acquisition protocols. Total plaque (TP), calcified plaque (CP), non-calcified plaque (NCP), and low-density non-calcified plaque (LD-NCP) volumes and corresponding burden (plaque volume × 100%/vessel volume) were quantified using semi-automated software. PCAT CT attenuation (HU) was measured around the proximal RCA, the most standardized method for PCAT analysis. Patients with an increase in NCP burden (n = 51) showed an increase in PCAT attenuation, whereas patients with a decrease in NCP burden (n = 60) showed a decrease {4.4 [95% confidence interval (CI) 2.6-6.2] vs. -2.78 (95% CI -4.6 to -1.0) HU, P < 0.0001}. Changes in PCAT attenuation correlated with changes in the burden of NCP (r = 0.55, P < 0.001) and LD-NCP (r = 0.24, P = 0.01); but not CP burden (P = 0.3). Increased baseline PCAT attenuation ≥-75 HU was independently associated with increase in NCP (odds ratio 3.07, 95% CI 1.4-7.0; P < 0.008) and TP burden on follow-up CTA. PCAT attenuation measured from routine CTA is related to the progression of NCP and TP burden. This imaging biomarker may help to identify patients at increased risk of high-risk plaque progression and allow monitoring of beneficial changes from medical therapy.

Introduction The effect of human immunodeficiency virus (HIV) and its medications on coronary artery disease (CAD) is controversial. Furthermore, illicit drug use such as cocaine occurs more often in these populations, however its potential modulating impact on CAD poorly understood. Purpose We sought to assess the effect of anthropometrics, serostatus, HIV medications and cocaine use in HIV patients on coronary plaque volumes assessed using coronary CT angiography (CTA). Methods We randomly selected 100 HIV patients without known CAD, but with coronary CTA confirmed coronary stenosis. All major epicardial vessels were segmented. Total plaque volume, low-attenuation non-calcified plaque volume and calcified plaque volumes were quantified from vessel portions which contained coronary atherosclerosis. We used linear regression analysis to assess the association between anthropometric (age, sex, body mass index), traditional risk factors (hypertension, diabetes, positive family history, HDL, LDL, cholesterol, triglycerides levels, years of alcohol and smoking), HIV associated parameters (years of HIV infection, months of protease inhibitor, nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, antiretroviral therapy medication use, hepatitis virus C infection, endothelin 1 levels, CD4 levels and viral load), years of cocaine use and coronary plaque volumes. Results Among anthropometric and traditional risk factors age (β=10.35, p=0.006) and smoking years (β=2.72, p=0.044) showed a significant association with total plaque volume, while all other parameters did not. Among HIV related parameters non-showed a significant association with the total plaque volume. However, the years of cocaine use significantly increased the amount of plaque volume (β=4.51, p=0.024). The amount of low-attenuation non-calcified plaque volume was only associated with the years of cocaine use (β=0.30, p=0.031), while all other parameters were non-significant. The amount of calcified plaque volume was associated with age (β=2.82, p=0.047) and years of cocaine use (β=1.52=0.043). Conclusions Cocaine use significantly increases the amount of low-attenuation non-calcified plaque volume, calcified plaque volume and overall plaque volume in HIV patients. Our results suggest the importance of cocaine use prevention in HIV patients as it increases plaque volumes which have been shown to be associated with poor cardiovascular outcomes. Acknowledgement/Funding This study was supported by grants from the US National Institute on Drug Abuse, National Institutes of Health (U01DA040325).

Objective To analyze the quantitative features of coronary plaque and evaluate its diagnostic performance for myocardial ischemic injury in patient with coronary artery disease. Methods Retrospectively enrolled 109 patients with suspected coronary artery disease, who successively underwent coronary CT angiography(CCTA) and coronary angiography in Shandong Provincial Hospital from June 2018 to September 2019. Elevated myocardial enzyme with segmental wall motion abnormalities (SWMA) in ultrasound was defined as myocardial ischemic injury, with which the subjects were divided into two groups, with and without myocardial ischemic injury (n=75,34) respectively. CCTA images of each target vessel were quantitatively analyzed by automated plaque analysis software to obtain the following indexes: minimal lumen area(MLA), plaque length(PL), total plaque volume(TPV), total plaque burden(TPB),calcified plaque volume(CPV), calcified plaque ratio(CPR), fibrous plaque volume(FPV), fibrous plaque ratio(FPR), lipid plaque volume(LPV), lipid plaque ratio(LPR), napkin-ring sign(NRS), spotty calcification(SC), remodeling index (RI) and eccentric index (EI). Chi-square, Mann-Whitney U tests, logistic regression and area under the receiver operating characteristics were determined. Results For the degree of coronary artery stenosis, MAS% was 85.00% (80.00%, 92.00%) and 63.00% (60.00%, 65.00%) in myocardial ischemic group and without myocardial ischemic injury group, which was statistically significant (Z=-4.32, P=0.001). For the quantitative plaque features, TPV 150.13 (104.44,202.20) mm3, TPB (75.67%±9.90%), FPV 95.73 (66.57, 134.23)mm3, LPV 32.18 (18.93,54.55) mm3, LPR (25.13%±13.71%) in the group with myocardial ischemic injury were larger than those in group without myocardial ischemic injury 109.94 (79.39, 121.67) mm3, 65.37%±6.94%, 67.35 (57.67, 90.11) mm3, 16.64 (13.26, 24.73) mm3, 18.44%±7.09% respectively with statistically significant (Z=-2.59, P=0.010; t=3.11, P=0.003; Z=-2.16, P=0.031; Z=-2.18, P=0.029; t=2.19, P=0.037). In logistic regression analysis, MAS%(OR=1.55,P=0.021) was independent significant predictors of myocardial ischemic injury. The AUC of MAS%, LPV, LPR, TPV, TPB, FPV were 0.84, 0.82, 0.77, 0.72, 0.74, 0.67, respectively, which were all statistically significant (P<0.05). Conclusions In quantitative plaque analysis by coronary CT angiography, MAS%, TPV, TPB, FPV, LPV, LPR were affecting factors of myocardial ischemic injury, in which MAS% was independent predictors. MAS% and LPV have higher diagnostic accuracy in myocardial ischemic injury. Key words: Coronary disease; Myocardial ischemia; Tomography, X-ray computed

To determine the value of combining conventional plaque parameters and radiomics features derived from coronary computed tomography angiography (CCTA) for predicting coronary plaque progression. Clinical data and CCTA images of 400 patients who underwent at least two CCTA examinations between January 2009 and August 2020 were analyzed retrospectively. Diameter stenosis, total plaque volume and burden, calcified plaque volume and burden, noncalcified plaque volume and burden (NCPB), pericoronary fat attenuation index (FAI), and other conventional plaque parameters were recorded. The patients were assigned to a training cohort (n = 280) and a validation cohort (n = 120) in a 7:3 ratio using a stratified random splitting method. The area under the receiver operating characteristics curve (AUC) was used to evaluate the predictive abilities of conventional parameters (model 1), radiomics features (model 2), and their combination (model 3). FAI and NCPB were identified as independent risk factors for coronary plaque progression in the training cohort. Both model 2 (training cohort AUC: 0.814, p < 0.001; validation cohort AUC: 0.729, p = 0.288) and model 3 (training cohort AUC: 0.824, p < 0.001; validation cohort AUC: 0.758, p = 0.042) had better diagnostic performances in predicting plaque progression than model 1 (training cohort AUC: 0.646; validation cohort AUC: 0.654). Moreover, model 3 was slightly higher than model 2, although not statistically significant. The combination of conventional coronary plaque parameters and CCTA-derived radiomics features had a better ability to predict plaque progression than conventional parameters alone. The conventional coronary plaque characteristics such as noncalcified plaque burden, pericoronary fat attenuation index, and radiomics features derived from CCTA can identify plaques prone to progression, which is helpful for further clinical decision-making of coronary artery disease. • FAI and NCPB were identified as independent risk factors for predicting plaque progression. • Coronary plaque radiomics features were more advantageous than conventional parameters in predicting plaque progression. • The combination of conventional coronary plaque parameters and radiomics features could significantly improve the predictive ability of plaque progression over conventional parameters alone.

AimWhether the total coronary atherosclerotic plaque burden is independently associated with myocardial ischemia in non-obstructive coronary artery disease (CAD) is not well established. We aimed to test the association of total plaque burden quantified by coronary computed tomography angiography (CCTA) with myocardial ischemia in patients with chronic coronary syndrome and non-obstructive CAD.MethodsWe included 125 patients (age 62 ± 9 years, 58% women) with chronic coronary syndrome and non-obstructive CAD (stenosis < 50%) by CCTA, who were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. Total plaque burden was quantified by CCTA as the total plaque volume in the main coronary arteries, and positive remodelling was defined as remodelling index > 1.10.ResultsPatients with myocardial ischemia (n = 66) had higher total plaque burden (847 ± 245 mm3 vs. 758 ± 251 mm3, p = 0.049) and higher left ventricular (LV) mass index (42.1 ± 9.9 g/m2.7 vs. 37.3 ± 8.0 g/m2.7, p = 0.004), while age, sex, prevalence of hypertension, diabetes, calcium score and positive remodelling did not differ between the groups (all p > 0.05). In multivariable regression analysis, total plaque burden remained associated with presence of myocardial ischemia (OR 1.02, 95% CI 1.00–1.04, p = 0.045) independent of age, sex, hypertension, diabetes, LV mass index, coronary calcium score and positive remodelling.ConclusionTotal coronary artery plaque burden by CCTA was independently associated with myocardial ischemia in patients with non-obstructive CAD. Whether plaque quantification is useful for clinical management of patients with non-obstructive CAD should be tested in prospective studies.ClinicalTrials.gov: Identifier NCT01853527.

Coronary Computed Tomography Angiography Evaluation of Plaque Morphology and Its Relationship to HDL and Total Cholesterol to HDL Ratio

Background Sodium-glucose cotransporter-2 inhibitor (SGLT2i), as a novel oral hypoglycemic therapy of type 2 diabetes mellitus (T2DM), has been proved to benefit cardiac function. However, it remains unknown whether SGLT2i has an impact on coronary plaque characteristics. Purpose The aim of this study was to investigate whether SGLT2i was able to improve coronary plaque composition, burden and inflammation [i.e., fat attenuation index (FAI)] using series coronary computed tomography angiography (CCTA) images among T2DM patients with angina pectoris. Methods T2DM patients presenting with angina pectoris admitted at our center were screened. Eligible patients were those underwent first CCTA within 3 months prior to initiating SGLT2i therapy, and repeated CCTA beyond 6 months after the first CCTA. Those patients not treated with SGLT2i underwent likewise longitudinal CCTA tests were propensity score matching in a 1:1 ratio using age, sex and CCTA time interval. Routine CCTA images were assessed for coronary plaque characteristics using dedicated softwares. Paired or unpaired Student’s t test or Mann–Whitney U test were used for comparing coronary plaque characteristics between series CCTA and patients with or without SGLT2i. The relationships between SGLT2i and changes of plaque characteristics was examined using logistic regression analysis. Results After propensity score matching, a total of 196 T2DM patients with angina pectoris were included (mean age, 60.4±9.2 years; male, 69.9%; SGLT2i treatment, 50%). Time interval between baseline and the last CCTA examinations was 400 (343,496) days. In the SGLT2i group, the non-calcified plaque burden [(39.86±14.30)% vs. (36.84±13.86)%, p=0.002)] and low attenuation non-calcified plaque burden (6.62 [4.11,10.13]% vs. 5.78 [3.40,9.28]%, p=0.042) were significantly decreased between two CCTA images. Whereas, in the non-SGLT2i group, there was no difference with regard to non-calcified and low attenuation non-calcified plaque burden between two CCTA images (all p&amp;gt;0.05). Moreover, changes of total plaque burden and non-calcified plaque burden were higher in the SGLT2i group than the non-SGLT2i group (all p&amp;lt;0.05). Importantly, SGLT2i was associated with total plaque volume (odd ratio=0.594, p=0.024) and non-calcified plaque volume regression (odd ratio=0.619, p=0.042) after adjusting for confounding factors. Conclusion SGLT2i significantly regresses coronary plaque burden, in particularly non-calcified plaque. These findings might explain the observed cardio-protective effect of SGLT2i in large trials.

The aim of this study was to evaluate the differences in plaque composition and burden between normal glycemic status (NGS) and dysglycemia expressed as impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Clinically indicated coronary computed tomography angiography was used to evaluate patients with suspected coronary artery disease (CAD). An oral glucose tolerance test was performed to assess glycemic status. Patients were stratified as NGS, IGT, and T2DM. Plaque volumes were quantified using validated software, with further compositional measurements of low-attenuation, non-calcified, and calcified plaque burden. Of 355 patients with suspected CAD, 220 had NGS, 92 were diagnosed with IGT, and 43 with known T2DM. Low-attenuation plaque volume was significantly higher in IGT (209 mm3, p < 0.02) and T2DM (243 mm3, p = 0.005) compared with NGS (166 mm3). Total plaque burden was similar between all groups, but a significantly greater low-attenuation plaque burden was seen in IGT (p = 0.03) and T2DM (p = 0.02) compared with NGS. The multivariate linear regression model adjusted for clinical risk factors showed that patients with IGT had a greater low-attenuation plaque burden compared with those with NGS (p = 0.03). Interestingly, no significant differences in plaque burdens were observed between those with IGT and T2DM in both univariate and multivariate analyses. Dysglycemia, including impaired glucose tolerance and type 2 diabetes mellitus, was associated with increased low-attenuation plaque burden compared with normal glycemic status. Patients with IGT demonstrated plaque burden similar to patients with known T2DM, underscoring the need for early metabolic intervention.