Calcified Plaque Volume Research Articles

Impact of calcified plaque volume on technical and 3-year outcomes after transcarotid artery revascularization

ObjectiveWe sought to quantify the percent calcification within carotid artery plaques and assess its impact on percent residual stenosis and rate of restenosis in patients undergoing transcarotid artery revascularization for symptomatic and asymptomatic carotid artery stenosis. MethodsA retrospective review of prospectively collected institutional Vascular Quality Initiative data was performed to identify all patients undergoing transcarotid artery revascularization from December 2015 to June 2021 (n = 210). Patient and lesion characteristics were extracted. Using a semiautomated workflow, preoperative computed tomography head and neck angiograms were analyzed to determine the calcified plaque volume in distal common carotid artery and internal carotid artery plaques. Intraoperative digital subtraction angiograms were reviewed to calculate the percent residual stenosis post-intervention according to North American Symptomatic Carotid Endarterectomy Trial criteria. Peak systolic velocity and end-diastolic velocity were extracted from outpatient carotid duplex ultrasound examinations. Univariate logistic regression was performed to analyze the relationship of calcium volume percent and Vascular Quality Initiative lesion calcification to percent residual stenosis in completion angiograms. Kaplan-Meier analysis examined the relationship between calcium volume percent and in-stent stenosis over 36 months. ResultsOne hundred ninety-seven carotid arteries were preliminarily examined. Predilation was performed in 87.4% of cases with a mean balloon diameter of 5.1 ± 0.7 mm and a mean stent diameter was 8.8 ± 1.1 mm. The mean calcium volume percent was 11.9 ± 12.4% and the mean percent residual stenosis was 16.1 ± 15.6%. Univariate logistic regression demonstrated a statistically significant difference between calcium volume percent and percent residual stenosis (odds ratio [OR], 1.324; 95% confidence interval [CI], 1.005-1.746; P = .046). Stratified by quartile, only the top 25% of calcified plaques (>18.7% calcification) demonstrated a statistically significant association with higher percent residual stenosis (OR, 2.532; 95% CI, 1.049-6.115; P =.039). There was no statistical significance with lesion calcification (OR, 1.298; 95% C,: 0.980-1.718; P = .069). A Kaplan-Meier analysis demonstrated a statistically significant increase in the rate of in-stent stenosis during a 36-month follow-up for lesions containing >8.2% calcium volume (P = .0069). ConclusionsA calcium volume percent of >18.7% was associated with a higher percent residual stenosis, and a calcium volume percent of >8.2% was associated with higher in-stent stenosis at 36 months. There was one clinically diagnosed stroke during the follow-up period, demonstrating the overall safety of the procedure.

Comparison of Calcified Plaque Volume in Coronary Arteries using Filtered Back Projection and Intelli IP Advanced at CT-scan 128 Slice

Calcified plaque has a major effect on increasing plaque volume which can increase the risk of Coronary Artery Disease (CAD). The use of Filtered Back Projection (FBP) on CT-scans still has flaws in terms of image quality that can result in errors in the calculation of plaque volume. Intelli IP Advanced is hitachi CT-scan’s Iterative Reconstruction (IR) type and can improve image quality compared to FBP. The purpose of this study is to find out the comparison of calcified plaque volume in coronary arteries using FBP and Intelli IP Advanced. This study used 38 samples of coronary artery blood vessels that had calcified plaque and reconstructed using the reconstruction of FBP and Intelli IP Advanced algorithms (Levels 1-3). Plaque calculation is done automatically using aquarius intuition edition application on CT-scan Hitachi SCENARIA 128 Slice. The results in this study found significant differences (p < 0.05) in calcified plaque volume results with the use of FBP and Intelli IP Advanced algorithm reconstruction (Levels 1-3). However, significant differences are found only in algorithm reconstruction pairs (Intelli IP Advanced Level 1 and Level 3) that have a p < 0.05. The conclusion is that IR affects the volume value of calcified plaque.

The value of quantitative plaque analysis based on coronary computed tomography angiography in predicting the percutaneous coronary intervention outcome of chronic total occlusion lesions.

Due to the uncertainty of the success of percutaneous coronary intervention (PCI) and the complexity of selecting suitable treatment cases, the interventional outcome of coronary chronic total occlusion (CTO) remains challenging. The purpose of this study was to evaluate the role of quantitative plaque analysis based on coronary computed tomography angiography (CCTA) in predicting the CTO-PCI outcome. We retrospectively included 78 patients with CTO (80 lesions) confirmed by invasive coronary angiography from July 2016 to December 2018. All patients underwent PCI treatment according to standard practice. A total of 47 lesions in 47 patients were successfully treated with PCI. PCI failed in the remaining 33 lesions in 31 patients. The following conventional CCTA morphologic parameters were evaluated and compared between the PCI-success and PCI-failure groups: stump morphology; occlusion length, tortuous course; CTO lesion calcium; bridging collateral vessel; retrograde collateral vessel; the appearance of the occluded distal segment; and quantitative CTO plaque characteristics, including total plaque volume, calcified plaque (CP) volume, noncalcified plaque (NCP) volume, low-density noncalcified plaque (LDNCP) volume, and plaque length. Univariate and multivariate logistic regression analyses were performed to determine independent parameters predictive of CTO-PCI outcomes. The predictive performances were assessed using receiver operating characteristic curve analysis. The blunt stump was the only independent CCTA morphologic parameter to predict the outcome of CTO-PCI [odds ratio (OR): 10.807; P<0.001]. NCP volume (OR: 1.018; P<0.001), CP volume (OR: 1.026; P=0.049), and plaque length (OR: 1.058; P=0.037) were independent quantitative CTO plaque characteristics predictive of CTO-PCI outcomes. The plaque-based model combining NCP volume with CP volume and plaque length had a higher area under the curve (AUC =0.96) than did the morphology-based model that included blunt stump (AUC 0.68) in predicting the outcomes of CTO-PCI (P<0.001). The CCTA-based plaque characteristics, including NCP volume, CP volume, and plaque length, outperformed morphologic parameters in predicting the CTO-PCI outcomes.

Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression.

To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP). A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients' images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software. A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P <0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P <0.001) was significantly better than that based rarely on %DS (AUC=0.61, P =0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P <0.001). Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.

Prediction of optical coherence tomography-detected calcified nodules using coronary computed tomography angiography

Diagnosis of calcified nodules (CNs) is critical in the proper management of coronary artery disease, but CNs can be detected only using intracoronary imaging modalities. This study aimed to investigate the ability of coronary computed tomography angiography (CCTA) in predicting CNs detected using optical coherence tomography (OCT). From 138 patients who underwent OCT-guided percutaneous coronary intervention (PCI) after CCTA evaluation, 141 PCI target vessels were retrospectively enrolled and classified into CN (12 vessels/11 patients; CNs in the PCI culprit lesion) and non-CN (129 vessels/127 patients; without CNs) groups based on the OCT analysis. Retrospective CCTA analysis revealed significantly higher coronary artery calcification score (CACS), calcified plaque volume (CPV), and maximum calcified plaque area (MCPA) of the target vessel in the CN group than in the non-CN group. Receiver operating characteristic curve indicated that CACS ≥ 162 (area under the ROC curve (AUC 0.76, sensitivity 83.3%, specificity 54.2%), CPV ≥ 20.1 mm3 (AUC 0.83, sensitivity 100%, specificity 57.3%), and MCPA ≥ 4.51 mm2 (AUC 0.87, sensitivity 91.7%, specificity 78.3%) were the best cutoff values for predicting CNs. MCPA showed the highest AUC among all the CCTA parameters. In conclusion, CCTA is useful for predicting OCT-detected CNs in PCI target vessels.

Abstract 9401: Impact of Visceral Abdominal Tissue on Coronary Artery Disease as Defined by Quantitative Computed Tomographic Angiography

Introduction: Obesity has long been associated with all-cause mortality and cardiovascular disease (CVD). Visceral abdominal tissue (VAT) has been proposed as an important CVD risk stratification metric and has been shown to correlate with the extent and severity of coronary artery plaque. This study aims to clarify the relationship between the presence and severity of VAT with the presence and severity of coronary artery plaque as defined by total plaque volume (TPV), calcified plaque (CP) volume, non-calcified plaque (NCP) volume, and high risk low-density non-calcified plaque (LD-NCP) using quantitative coronary computed tomography atherosclerosis imaging (AI-QCT). Methods: We reviewed 145 consecutive patients who had undergone CCTA and CT visceral fat analysis for health screening purposes. Atherosclerosis imaging - quantitative computed tomography (AI-QCT) was performed for TPV, percent atheroma volume (PAV), and the presence of stenosis. We segmented atherosclerosis by composition for CP, NCP and LD-NCP. Results: The mean age of the patients was 56.1 ± 8.5 years, 84.0% male. Overall, 3.5% had a history of diabetes, 19% hypertension, 38% dyslipidemia, 8% current smokers, and 34% had a family history of CAD. There was a stepwise progression of the median coronary plaque volume for each quartile of visceral fat including total plaque volume (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm 3 (P=0.0098)), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm 3 (P=0.0032)) and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm 3 (P&lt;0.0001)). Conclusion: Our findings represent the first demonstration of a stepwise progression with regards to visceral abdominal tissue and total plaque volume, non-calcified plaque volume, and, particularly of note, low density non-calcified plaque volume. A stepwise progression as demonstrated here may indicate the future usefulness of VAT in CVD risk stratification and its role in longitudinal preventive care.

Abstract 14387: Early Atherosclerosis on CCTA: Insights From Artificial Intelligence-Enabled Quantitative CT Analysis of Serial Scans From the Paradigm Trial

Introduction: Non-obstructing small coronary plaques are not always appreciated during coronary CTA (CCTA) but may be identified by artificial intelligence-enabled quantitative CT (AI-QCT). It is unclear if these are true early atherosclerotic plaques or false positive findings. Hypothesis: Serial CCTA exams may provide insights into the natural history of these findings, as a plaque appearing in the same anatomical location and demonstrating interval change is likely real. Methods: 399 plaques measuring between 0.1 and 50.0 mm 3 were identified using AI-QCT in 83 patients with serial CCTA exams (N=166 exams) from the PARADIGM Trial. The total volume (TPV), calcified (CP), non-calcified (NCP) and low-density plaque (LD-NCP) volume, and % diameter stenosis of each plaque were recorded. Serial studies were processed in a blinded manner and linked after processing. The presence and change in plaque characteristics were assessed. Results: Overall 345/399 (86%) of small plaques were present in the same location on follow-up (mean interval 3.8 years), including 313/350 (89%) of plaques &gt;2.0mm 3 (Figure 1). Plaques were nonobstructive (&lt;=50%) in 99.5% of initial and 97.5% of follow-up studies. On follow-up, 82% (250/305) increased in size and 293/304 (96%) increased in calcified plaque content. Plaques in statin taking patients demonstrated higher median increase in CP (8.7 vs 4.0 mm 3 , p&lt;0.05) and transformed from all NCP to mixed NCP + CP at a higher rate (59.3 vs 43.9%, p=0.0027 Conclusions: Small coronary plaques depicted with serial AI-QCT are often present in the same location upon follow-up, increase in volume, and develop or increase calcification with statin therapy. While further data regarding the natural history and prognosis of these plaque is warranted, these findings provide a rationale for identifying early coronary atherosclerotic plaques.

Association between Arousals during Sleep and Subclinical Coronary Atherosclerosis in Patients with Obstructive Sleep Apnea.

(1) Aim: We aim to evaluate the association between arousals during sleep and subclinical coronary atherosclerosis detected by coronary computed tomography angiography (CTA) in patients with obstructive sleep apnea (OSA). (2) Methods: This was a cross-sectional study. Consecutive newly diagnosed OSA patients, who underwent coronary CTA examinations within 3 months of the sleep study, were eligible. We used the arousal index (ArI) derived from polysomnography to assess arousals during sleep and a semi-automated plaque quantification software to characterize and quantify the subclinical coronary atherosclerosis. Multiple regression models were used to evaluate the associations of the ArI with the coronary atherosclerotic plaque presence, volume, and composition. (3) Results: A total of 99 patients with OSA were included in the study. In the multivariable models, patients with a high ArI (ArI > 32.2 events/h) were more likely to have coronary plaques compared to those with a low ArI (ArI ≤ 32.2 events/h) (OR: 3.29 [95% CI: 1.284 to 8.427], p = 0.013). Furthermore, the ArI exhibited significant associations with total (β = 0.015), noncalcified (β = 0.015), and low-attenuation (β = 0.012) coronary plaque volume after accounting for established risk factors (p = 0.008, 0.004, and 0.002, respectively). However, no association between the ArI and calcified plaque volume was found. (4) Conclusion: Repetitive arousals during sleep are associated with an increased coronary plaque burden in patients with OSA, which remained robust after adjusting for multiple established cardiovascular risk factors.

Artificial intelligence-enabled comprehensive coronary phenotyping in patients with suspected CAD

Abstract Introduction The capabilities of artificial intelligence (AI) are rapidly progressing and the research community is getting increasingly interested in its possibilities. AI algorithms are able to work continuously and at high speed, reducing human workload and saving time that physicians can spend on more complex data or rarer cases. However, many clinical AI applications are currently only used in a research setting and lack proper testing and validation. Objectives This study aimed to determine the accuracy and performance of a novel AI-based software tool for CCTA analysis compared to conventional expert evaluation. Methods We evaluated 100 CCTA exams from a cohort of symptomatic patients with mild-to-moderately abnormal non-invasive ischemia test. Stenosis severity assessed by AI-based analysis (automatic evaluation, AEv) was compared with a level III expert CCTA interpretation (manual evaluation, MEv). AI-based analysis reported exact % stenosis and obstructive CAD was considered if maximal stenosis was ≥50%. Plaque phenotype was also estimated using AI algorithms. Results The study cohort was as follows: 52% male, mean age 68±10 years. The prevalence of hypertension, dyslipidemia and diabetes was 77%, 81% and 23%, respectively, and 10-year cardiovascular risk was 19±10% as predicted by Framingham risk score. Typical angina was present in 33%, of which 67% had a Canadian Cardiovascular Society angina grade ≥2. Overall prevalence of obstructive CAD determined by MEv and AEv was 25% and 21%, respectively, with a significant association between both assessments (p&amp;lt;0.001). When compared to MEv as reference, AEv method performed with a sensitivity, specificity, positive and negative predictive values of 0.56, 0.91, 0.58 and 0.86, respectively. Area under the curve was 0.871 (p&amp;lt;0.001) demonstrating high accuracy. AEv atherosclerosis quantification revealed significant differences between patients with and without obstructive CAD according to MEv: median total plaque volume (569 vs 115 mm3, p&amp;lt;0.001), calcified plaque volume (297 vs 19 mm3, p&amp;lt;0.001), non-calcified plaque volume (235 vs 71 mm, p&amp;lt;0.001), low-density non-calcified plaque volume (2.8 vs 1.0 mm3, p=0.023) and percent atheroma volume (16.1 vs 3.8 mm3, p&amp;lt;0.001). Conclusion In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy using AEv as a gatekeeper is effective, providing a quantitative stenosis evaluation with similar diagnostic performance for obstructive CAD when compared to MEv. AI-enabled approach additionally allows a fully automated quantification of coronary plaque volumes and composition, which would further enhance risk stratification. Funding Acknowledgement Type of funding sources: None.

Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study

Abstract Background and aims The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines. Methods Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation &amp;lt;30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay. Results Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p&amp;lt;0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p&amp;lt;0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p&amp;lt;0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p&amp;lt;0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p&amp;lt;0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006) Conclusion Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions. Funding Acknowledgement Type of funding sources: None.

18F-sodium fluoride positron emission tomography and coronary plaque radiomics derived from computed tomography angiography for prediction of myocardial infarction

Abstract Background Assessments of coronary disease activity with 18F-sodium fluoride positron emission tomography (18F-NaF PET) and radiomics-based precision coronary plaque phenotyping derived from contrast-enhanced computed tomography (CT) have both been shown to enhance risk stratification in patients with coronary artery disease (CAD). To date, no study has investigated whether these two promising methods (which can be obtained during a single imaging session on a hybrid PET/CT scanner) are interchangeable or can provide superior predictive performance when used in combination. Purpose We sought to investigate whether the prognostic information provided by latent morphological radiomic coronary plaque features and assessments of disease activity by 18F-NaF PET are complementary in prediction of myocardial infarction. Methods Patients with known CAD underwent coronary 18F-NaF PET and CT angiography on a hybrid PET/CT scanner. Coronary 18F-NaF uptake was determined by the coronary microcalcification activity (CMA). We performed quantitative plaque analysis of coronary CT angiography datasets. Additionally, coronary plaque segmentations on CT angiography were used to extract 1103 radiomic features. Using weighted correlation network analysis we derived latent morphological features of coronary plaques which were aggregated to patient-level radiomic normograms to predict myocardial infarction using univariate and multivariate Cox proportional hazard models. Results The study cohort comprised of 260 patients with established CAD (age: 65±9 years; 84% men); 179 (69%) participants showed increased coronary 18F-NaF activity (CMA &amp;gt;0). Over 53 [40–59] months of follow-up 18 patients had a myocardial infarction. Using weighted correlation network analysis, from the 1103 radiomic features we derived 15 distinct eigen radiomic features representing latent morphological coronary plaque patterns. On univariate cox modelling 7 of these emerged as predictors of myocardial infarction (Figure). Following adjustments for calcified, noncalcified and low-density noncalcified plaque volumes and 18F-NaF CMA 4 radiomic features (related to texture and geometry) remained independent predictors of myocardial infarction (Figure). Conclusion(s) In patients with established CAD latent morphological features of coronary plaques are predictors of myocardial infarction above and beyond plaque volumes and 18F-NaF uptake. Comprehensive plaque analysis with radiomics may enhance risk stratification of CAD patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH, Wellcome Trust

Impact of Calcified Plaque Volume on Technical and 1-Year Outcomes After Transcarotid Artery Revascularization

To quantify percent calcification within carotid artery plaques and assess its impact on percent residual stenosis and rate of restenosis in patients undergoing transcarotid artery revascularization (TCAR) for symptomatic and asymptomatic carotid artery stenosis at a high-volume center.

Serial Changes in Coronary Plaque Formation Using CT Angiography in Patients Undergoing PCSK9-Inhibitor Therapy With 1-year Follow-up.

Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters. We analyzed 74 coronary plaques in 23 patients (60±9y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66mg/dL ( P <0.0001). Significant changes were found for VV (196 to 215mm 3 , P =0.0340), MLA (3.1 to 2.6mm 2 , P =0.0413), and MLD (1.7 to 1.4mm, P =0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly ( P >0.05). Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.

523 Association Between Coronary Artery Calcium And Calcified Plaque Volume And Their Ability To Predict Obstructive Coronary Artery Disease: Clarify Registry

Introduction: Agatston coronary artery calcium (CAC) score is a strong predictor of cardiovascular mortality. However, the relationship between CAC and calcified plaque volume (CPV), which is measured on coronary computed tomography angiography (CCTA) is not well understood. Furthermore, it is unknown whether there is a difference between CAC and CPV in predicting the obstructive CAD.

426 Impact Of Visceral Abdominal Tissue On Coronary Artery Disease As Defined By Quantitative Computed Tomographic Angiography

Introduction: Obesity has long been associated with all-cause mortality and cardiovascular disease (CVD). Visceral abdominal tissue (VAT) has been proposed as an important CVD risk stratification metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VAT with the presence and severity of coronary artery plaque as defined by total plaque volume, calcified plaque volume, non-calcified plaque volume, and high risk low-density non-calcified plaque using quantitative coronary computed tomography atherosclerosis imaging (AI-QCT).

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

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Traditionally non-high-density lipoprotein (non-HDL) indicators have been utilized to stratify cardiovascular risk. Population studies have demonstrated an inverse relationship between HDL cholesterol levels and cardiovascular risk, however, the mechanism by which HDL exhibits its protective effect on the cardiovascular system remains unclear. <h3>Objective/Purpose</h3> To investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with coronary artery plaque burden as determined by coronary computed tomography angiography (CCTA). <h3>Methods</h3> This is a cross-sectional study evaluating the association of HDL-C and TC/HDL ratio with coronary artery plaque volumes. We identified 190 subjects who had undergone quantitative plaque analysis and had lipoprotein values available at our institution. Plaque was analyzed quantitatively utilizing semi-automated plaque analysis software (QAngio version 2.0.5). The plaque volumes are presented as total atheroma volume normalized (TAVnorm). The HDL-C level and TC/HDL ratio were analyzed as continuous variables and categorized at clinically relevant levels. Multivariate regression models adjusted for cardiovascular risk factors were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. <h3>Results</h3> The mean (SD) age of the 190 subjects was 58.9 (+/-9.8) years, and 63% were male. After adjustment for cardiovascular risk factors, HDL- C (>40mg/dL) is inversely associated with fibrous (p=0.003), fibrous fatty (p=0.009), low attenuation plaque (LAP) (p=0.014), total non- calcified plaque (TNCP)(p=0.003), and total plaque (TP)(p=0.005) volume but not associated with dense calcified plaque (p=0.229). TC/HDL ratio (>4.0) is directly associated with LAP (p=0.024) and not associated with fibrous, fibrofatty, TNCP, dense calcified plaque and TP volume. Notably, when examined as continuous variables, increasing HDL- C level is inversely associated with fibrous plaque, TNCP and TP volume and increasing TC/HDL ratio is directly associated with increasing fibrous plaque, and fibrous fatty plaque, LAP, TNCP and TP volume, independent of other risk factors. <h3>Conclusions</h3> There is a strong association between low HDL-C and increasing TC/HDL ratio with increasing coronary plaque volumes, independent of traditional risk factors of atherosclerosis. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C in coronary artery disease. Additionally, TC/HDL ratio offers value as a secondary treatment target beyond LDL-C, which is especially beneficial in individuals with prevalent lipid discordance, such as those with diabetes and metabolic syndrome.

Reduction of calcified plaque volume in ex vivo pericardial tissue, with nanobubbles

The present research investigated the effect of nanobubbles in Ringer’s solution on calcified plaque within ex vivo coronary and peripheral artery tissue. The goal of the work was to determine whether nanobubbles generated using an alternating magnetic field (AMF) system can reproducibly reduce the size of plaque obstructions in ex vivo pericardial tissue specimens compared to that in an untreated control. Nanoparticle tracking analysis (NTA) measurements were used to first confirm that AMF can produce nanobubbles in Ringer’s solution as well as it does in water. Experiments were performed in which ex vivo human coronary artery and peripheral artery tissues containing plaque were exposed to Ringer’s solution with and without the presence of AMF generated nanobubbles. Measurements on intravascular optical coherence tomography (IVOCT) images consistently indicated that plaque volume is significantly reduced in the presence of nanobubbles. A theory of induced dissolution by nanobubble/nanoparticle cluster formation provides a causal explanation for the observed reductions in plaque size.

Association Between Changes in Perivascular Adipose Tissue Density and Plaque Progression

BackgroundThe association between the change in vessel inflammation, as quantified by perivascular adipose tissue (PVAT) density, and the progression of coronary atherosclerosis remains to be determined. ObjectivesThe purpose of this study was to explore the association between the change in PVAT density and the progression of total and compositional plaque volume (PV). MethodsPatients were selected from a prospective multinational registry. Patients who underwent serial coronary computed tomography angiography studies with ≥2-year intervals and were scanned with the same tube voltage at baseline and follow-up were included. Total and compositional PV and PVAT density at baseline and follow-up were quantitatively analyzed for every lesion. Multivariate linear regression models using cluster analyses were constructed. ResultsA total of 1,476 lesions were identified from 474 enrolled patients (mean age 61.2 ± 9.3 years; 65.0% men). The mean PVAT density was −74.1 ± 11.5 HU, and total PV was 48.1 ± 83.5 mm3 (19.2 ± 44.8 mm3 of calcified PV and 28.9 ± 51.0 mm3 of noncalcified PV). On multivariate analysis (adjusted for clinical risk factors, medication use, change in lipid levels, total PV at baseline, luminal HU attenuation, location of lesions, and tube voltage), the increase in PVAT density was positively associated with the progression of total PV (estimate = 0.275 [95% CI: 0.004-0.545]; P = 0.047), driven by the association with fibrous PV (estimate = 0.245 [95% CI: 0.070-0.420]; P = 0.006). Calcified PV progression was not associated with the increase in PVAT density (P > 0.050). ConclusionsIncrease in vessel inflammation represented by PVAT density is independently associated with the progression of the lipid component of coronary atherosclerotic plaques. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)

The Impact of Calcified Plaque Volume on Short-Term and Long-Term Outcomes After Transcarotid Artery Revascularization

To quantify calcification within carotid artery plaques and assess the effects on the percent residual stenosis, risk of restenosis, and rate of restenosis in patients undergoing transcarotid artery revascularization (TCAR) for symptomatic and asymptomatic carotid artery stenosis at a high-volume center.

Atherosclerotic Progression Is Related to Immune-Related Adverse Events.

Immune checkpoint inhibitors (ICIs) are widely used in various types of cancers and patients. Recently, it has been reported that ICIs aggravate atherosclerosis. This study aimed to identify characteristics that are related to the progression of atherosclerosis.This study was conducted in a single medical center and included 32 patients who were grouped based on the presence of an immune-related adverse event (IRAE). There were 16 IRAE patients and 16 non-IRAE patients. Atherosclerosis was measured as the volume of calcified plaque at the aortic arch on a computed tomography (CT) scan. We measured the volume on CT at 3 time points as follows: before treatment, at ICI initiation, and after 180 days or more.After the first ICI administration, the IRAE group showed significant exacerbation of atherosclerosis compared to the non-IRAE group (P = 0.002). A high volume of plaque was observed in IRAE patients after ICI treatment as compared to before ICI administration (P = 0.058).ICIs tend to hasten atherosclerosis progression in IRAE patients, indicating that high-risk cardiovascular patients should be concerned about cardiovascular events. Moreover, this study suggests the possibility of predicting IRAEs based on the volume of calcified plaques.