Coronary Plaque Research Articles

Coronary atherosclerotic burden in master athletes: relationship with cardiovascular risk and volume of exercise

Abstract Background Although prior studies suggesting an association between coronary artery calcification (CAC) and lifelong exercise, the clinical relevance and mechanisms for this interaction remains unknown. Recent evidence suggests that a significant amount of exercise might not be linked to a more favourable composition of coronary plaques. We aimed to analyse the prevalence of high coronary atherosclerotic (CAS) burden assessed by coronary CT scan (CCTA) in master athletes, according to cardiovascular (CV) risk and volume of exercise. Methods A total of 105 master male athletes (48±5.6 years old), asymptomatic and without known CV disease, were prospectively studied. A high CAS burden was defined as the presence of at least one of the following characteristics in CCTA: CAC score >100; CAC score >75th percentile; obstructive plaques; plaques in the left main, three vessels or two vessels including the proximal anterior descending artery; segment Involvement Score (SIS) >5; CT-adapted Leaman score (CT-LeSc) ≥5T. his variable was evaluated according to the CV risk, stratified by SCORE2, and volume of exercise, determined by metabolic equivalent task score (MET/hour/week). Results Most athletes (n=88) were engaged in endurance sports, during 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] METs/hour/week. The mean SCORE2 was 2.8±1.5%, with 76.9% of athletes classified as having a low to moderate CV risk, and none having very high-risk. A high CAS burden was present in 25.7% of the athletes, without significant differences according to the SCORE2 risk categories [Low- Moderate Vs. High Risk: 25.5% Vs. 37.5%, respectively ; p=0.142] nor volume of exercise [below Vs. above median: 30.6% Vs. 21.4%, respectively; p=0.283)] (Figure 1 A). Combining these variables, athletes with high CV risk and a high volume of exercise showed significantly higher occurrence of a high CAS burden compared to those with low-moderate risk and high volume of exercise (50% Vs. 15.6%; p=0.017). Among athletes with low-moderate risk, high volume of exercise trended to be protective (15.6% Vs. 31.4%; p=0,092), while there was a similar rate of high CAS burden in athletes with low volume of exercise, independently of risk class (Figure 1B). Conclusions In our cohort of master athletes, one fourth demonstrated a high burden of CAS burden evaluated by CCTA. While a higher volume of exercise combined with high cardiovascular risk showed an association with worse coronary composition it trended to be protective in athletes with lower risk. Integrating clinical and exercise-related data is crucial for evaluating athletes amidst the complex associations between exercise, cardiovascular risk, and CAS burden, necessitating longitudinal studies for comprehensive understanding.Figure 1Figure 2

Exercise-induced inflammatory and thrombotic acute phase response in hypertensive patients

Abstract Background/Introduction Vigorous physical activity may acutely trigger the onset of an acute coronary syndrome especially in sedentary persons with established cardiovascular risk factors such as arterial hypertension. The rupture of an inflamed coronary plaque and the activation of the coagulation cascade are the main underlying mechanisms. Purpose The present study aimed to determine the effect of acute exercise on the inflammatory and thrombotic response in patients with arterial hypertension as compared to normotensive peers. Methods After excluding patients with any inflammatory or/and coronary artery disease, a total of 60 non-treated hypertensive patients and 65 normotensive individuals underwent a maximal treadmill exercise testing. Βlood samples were drawn at rest and immediately after peak exercise. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cell (WBC), interleukin-6 (IL-6), and total fibrinogen (TF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured. Results All biomarkers increased with exercise, except PAI-1, which decreased (P<0.05 for the change between resting and peak exercise for all biomarkers). The normotensive group had less marked (P<0.05) exercise-induced changes than the hypertensive group in hsCRP (7.7 vs. 8.6%), SAA (5.6 vs. 11.9%), WBC (45.0 vs. 51.7%), and PAI-1 (-17.3 vs. -20.1%) and a similar (P=NS) change in IL-6 (23.8 vs. 23.0%) and TF (8.5 vs. 8.5%) (see also Figure). Conclusion(s) In conclusion, the exercise-induced inflammatory and thrombotic acute phase response seems to be more pronounced in non-treated hypertensive patients than in normotensive controls. The effect of blood-pressure lowering treatment on the exercise-induced acute phase response remains to be elucidated.Figure

The relationship between atherogenic index of plasma and plaque vulnerabilities: an optical coherence tomography study

Abstract Background Atherogenic index of plasma (AIP) has been recommended as a marker of plasma atherogenicity. The impact of AIP on plaque characteristics is not fully understood. Purpose The study investigates the relationship between AIP and coronary plaque features in patients with acute coronary syndrome (ACS). Methods From January 2015 to June 2017 pre-intervention optical coherence tomography (OCT) was performed in 522 ACS patients. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Patients were divided into four groups according to AIP quartiles. Results A total of 332 patients were included for the analysis. The incidence of thin-cap fibroatheroma (TCFA) (group I [lowest] 9.09% vs group II 16.5% vs group III 44.7% vs group IV [highest] 52.9%), macrophage accumulation (group I 18.2% vs group II 22.4% vs group III 31.8% vs group IV 47.1%), plaque rupture (group I 10.4% vs group II 14.1% vs group III 17.6% vs group IV 34.1%) and plaque erosion (group I 2.6% vs group II 2.4% vs group III 14.1% vs group IV 12.9%) were significantly different among AIP quartiles. Multivariate logistic regression revealed the risk of TCFA (odds ratio 11.938, 95% confidence interval 4.723-30.174, p<0.001) and plaque rupture (OR 4.976, 95% CI 1.993-12.424, p<0.001) increased in group IV compared to group I. Receiver operating characteristics curve showed the predictive value of AIP for TCFA and plaque rupture were 0.720 and 0.669 respectively. Conclusions AIP is an independent predictor for vulnerable plaques beyond traditional factors. It can be integrated in clinical practice for risk stratification of ACS patients.Multivariate logistic analysisROC curves

Immunohistochemical Localization of Fibroblast Activation Protein in Coronary Arteries with Different Forms of Atherosclerosis

Background: Fibroblast activation protein (FAP) is a cell surface glycoprotein expressed by myofibroblasts in areas of active tissue remodeling. It plays a potentially important role in cardiac remodeling, atherosclerotic plaque formation, and plaque rupture. Given the distinct pathophysiology and morphology of different forms of atherosclerosis, we analyzed FAP expression in human coronary vessels with no coronary artery disease, atherosclerotic plaques at different levels of progression, and other distinct forms of coronary disease in post bypass vein grafting and cardiac allograft vasculopathy after a heart transplant. Methods: Immunohistochemical staining with monoclonal F19 mouse anti-human FAP antibody was performed to identify FAP in human atherosclerotic plaques, coronary bypass atherosclerosis, and post-transplant arteriosclerosis. The presence and distribution of FAP in different types and stages of human atherosclerosis were compared. Results: There was no FAP staining in patients with no significant coronary disease. All different types of human atherosclerotic lesioning lesions showed the presence of FAP expression, with different staining patterns in advanced atherosclerotic plaque, vein graft atherosclerosis lesions, and arteriosclerosis after a heart transplant. Conclusions: These data suggest that FAP may be a potential diagnostic marker and target for interventions, not only in coronary atherosclerotic plaque, but also in other forms of coronary disease, which have distinct pathophysiologies and currently limited treatment options.

Impact of hypertension on coronary artery plaques and FFR-CT in type 2 diabetes mellitus patients: evaluation utilizing artificial intelligence processed coronary computed tomography angiography.

This study utilized artificial intelligence (AI) to quantify coronary computed tomography angiography (CCTA) images, aiming to compare plaque characteristics and CT-derived fractional flow reserve (FFR-CT) in type 2 diabetes mellitus (T2DM) patients with or without hypertension (HTN). A retrospective analysis was conducted on 1,151 patients with suspected coronary artery disease who underwent CCTA at a single center. Patients were grouped into T2DM (n = 133), HTN (n = 442), T2DM (HTN+) (n = 256), and control (n = 320). AI assessed various CCTA parameters, including plaque components, high-risk plaques (HRPs), FFR-CT, severity of coronary stenosis using Coronary Artery Disease Reporting and Data System 2.0 (CAD-RADS 2.0), segment involvement score (SIS), and segment stenosis score (SSS). Statistical analysis compared these parameters among groups. The T2DM (HTN+) group had the highest plaque volume and length, SIS, SSS, and CAD-RADS 2.0 classification. In the T2DM group, 54.0% of the plaque volume was noncalcified and 46.0% was calcified, while in the HTN group, these values were 24.0 and 76.0%, respectively. The T2DM (HTN+) group had more calcified plaques (35.7% noncalcified, 64.3% calcified) than the T2DM group. The average necrotic core volume was 4.25 mm3 in the T2DM group and 5.23 mm3 in the T2DM (HTN+) group, with no significant difference (p > 0.05). HRPs were more prevalent in both T2DM and T2DM (HTN+) compared to HTN and control groups (p < 0.05). The T2DM (HTN+) group had a higher likelihood (26.1%) of FFR-CT ≤0.75 compared to the T2DM group (13.8%). FFR-CT ≤0.75 correlated with CAD-RADS 2.0 (OR = 7.986, 95% CI = 5.466-11.667, cutoff = 3, p < 0.001) and noncalcified plaque volume (OR = 1.006, 95% CI = 1.003-1.009, cutoff = 29.65 mm3, p < 0.001). HRPs were associated with HbA1c levels (OR = 1.631, 95% CI = 1.387-1.918). AI analysis of CCTA identifies patterns in quantitative plaque characteristics and FFR-CT values. Comorbid HTN exacerbates partially calcified plaques, leading to more severe coronary artery stenosis in patients with T2DM. T2DM is associated with partially noncalcified plaques, whereas HTN is linked to partially calcified plaques.

Serial Optical Coherence Tomography Assessment of Coronary Atherosclerosis and Long-Term Clinical Outcomes.

The impact of high-risk coronary artery plaques identified using optical coherence tomography on late luminal narrowing and clinical events remains poorly understood. This multicenter prospective study included 176 patients who underwent percutaneous coronary intervention and serial optical coherence tomography at baseline and 1-year follow-up to investigate nontarget regions with angiographically intermediate stenosis. At 1 year after percutaneous coronary intervention, the coronary artery lumen area decreased significantly from 6.06 (95% CI, 5.60-6.53) mm2 to 5.88 (95% CI, 5.41-6.35) mm2 (difference, -0.18; 95% CI, -0.22 to -0.14 mm2; P<0.001), particularly in thin-cap fibroatheromas, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. The prevalence of fibroatheroma decreased from 38% to 36% (P<0.001), whereas calcified plaque increased from 31% to 34% (P<0.001), accompanied by a significant increase in calcium thickness and angle. Diabetes and current smoking habits were independently associated with increasing calcium prevalence. Patients with thin-cap fibroatheroma had a significantly higher 3-year risk of ischemia-driven nontarget vessel revascularization (hazard ratio, 2.42 [95% CI, 1.03-5.71]; P=0.04), primarily due to revascularization in the imaged region. No significant association was observed between coronary artery calcium prevalence and clinical outcomes within 3 years. The coronary artery lumen area significantly decreased over a 1-year interval, particularly in thin-cap fibroatheromas, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. Although thin-cap fibroatheroma prevalence was associated with higher risk of ischemia-driven nontarget vessel revascularization, no significant association was noted between coronary artery calcium prevalence and clinical outcomes within 3 years. The interaction between calcium progression and long-term clinical events necessitates further investigation. URL: https://www.umin.ac.jp/ctr/; Unique Identifier: UMIN000031937.

Serum Level of Cadherin-P (CDH3) Is a Novel Predictor of Cardiovascular Events Related to Atherosclerosis in a 3-Year Follow-Up Study.

Background: Placental cadherin (CDH3) is an adhesion molecule expressed in many malignant tumors. The role of serum CDH3 in atherosclerosis is unclear. Methods: This 3-year follow-up study measured atherosclerosis and serum CDH3 in 218 angiography inpatients. Coronary stenosis was assessed as the Gensini score. The brachiocephalic and femoral plaques were quantified by ultrasound. Microarray serum profiling was conducted in selected samples. CDH3 in the serum was measured using an indirect ELISA. The odds ratio (OR), ROC analysis, and logistic regressions were used to evaluate the associations between CDH3 content, atherosclerotic lesions, and various serum biomarkers. Results: Serum CDH3 was associated with the severity of atherosclerosis and diastolic blood pressure. The levels of CDH3 were able to discriminate patients with total subclinical and hemodynamically significant atherosclerotic lesions in all circulation pools (coronary, brachiocephalic, and femoral). Elevated serum CDH3 appeared to be a risk factor for cardiovascular outcomes after 3-year follow up with OR = 1.81 (95% CI: 1.07-3.72; p = 0.022). Endothelin-1 and NOx were associated with the content of CDH3 in the serum, suggesting the involvement of certain signal transduction pathways that may participate in plaque formation. Conclusions: CDH3 was associated with cardiovascular outcomes adjusted for coronary plaque presence, indicating a role of CDH3 in plaque biology.

Automated Classification of Coronary Plaque on Intravascular Ultrasound by Deep Classifier Cascades.

Intravascular ultrasound (IVUS) is the gold standard modality for in vivo visualization of coronary arteries and atherosclerotic plaques. Classification of coronary plaques helps to characterize heterogeneous components and evaluate the risk of plaque rupture. Manual classification is time-consuming and labor-intensive. Several machine learning-based classification approaches have been proposed and evaluated in recent years. In the current study, we develop a novel pipeline composed of serial classifiers for distinguishing IVUS images into five categories: normal, calcified plaque, attenuated plaque, fibrous plaque, and echolucent plaque. The cascades comprise densely connected classification models and machine learning classifiers at different stages. Over 100,000 IVUS frames of five different lesion types were collected and labeled from 471 patients for model training and evaluation. The overall accuracy of the proposed classifier is 0.877, indicating that the proposed framework has the capacity to identify the nature and category of coronary plaques in IVUS images. Further, it may provide real-time assistance on plaque identification and facilitate clinical decision-making in routine practice.

The role of artificial intelligence in coronary CT angiography.

Coronary CT angiography (CCTA) offers an efficient and reliable tool for the non-invasive assessment of suspected coronary artery disease through the analysis of coronary artery plaque and stenosis. However, the detailed manual analysis of CCTA is aburdensome task requiring highly skilled experts. Recent advances in artificial intelligence (AI) have made significant progress toward amore comprehensive automated analysis of CCTA images, offering potential improvements in terms of speed, performance and scalability. This work offers an overview of the recent developments of AI in CCTA. We cover methodological advances for coronary artery tree and whole heart analysis, and provide an overview of AI techniques that have shown to be valuable for the analysis of cardiac anatomy and pathology in CCTA. Finally, we provide ageneral discussion regarding current challenges and limitations, and discuss prospects for future research.

Pericoronary Fat Attenuation: Diagnosis and Clinical Implications.

The purpose of this review is to evaluate the current state of knowledge regarding the technical challenges associated with the Post-Acquisition Fat Attenuation Index (PFAI). By examining the limitations and gaps in the current methodologies, this review aims to provide a comprehensive understanding of how various factors impact the accuracy and reliability of PFAI measurements. PFAI correlates with plaque instability, as inflammation in coronary plaque alters surrounding adipose tissue composition, increasing its water content and reducing lipid content, which is detectable via cardiac CT as increased attenuation. Recent studies have demonstrated PFA's prognostic value, with elevated levels linked to higher risks of cardiac events and plaque instability. A 2022 meta-analysis confirmed its association with major adverse cardiac events. Machine learning algorithms incorporating PFA and additional imaging features have further enhanced risk prediction beyond traditional metrics. Pericoronary fat attenuation is a promising marker for assessing coronary inflammation and could be useful in predicting plaque development, rupture, and monitoring treatment response, though further prospective studies and technical standardization are needed to fully establish its clinical benefits.

Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA)

BackgroundDiscrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia. MethodsObservational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ​≥ ​50 ​% at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80. ResultsThe study population consisted of 192 patients, of whom 224 vessels (61 ​% LAD, 19 ​% LCX, 20 ​% RCA) had lesions with DS ​≥ ​50 ​% interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 ​% vs 43.2 ​% and 44.2 ​%, respectively, p ​= ​0.018). A significant correlation between DS and FFR was observed only in LAD (p ​= ​0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 ​%) for LAD, non-calcified plaque volume (threshold >130 ​mm3) for LCX, and lumen volume (threshold <844 ​mm3) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76–0.80). ConclusionsIntegrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients’ referral to the catheterization laboratory.

Interscan reproducibility of computed tomography derived coronary plaque volume measurements

BackgroundCoronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility. MethodsCCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level. ResultsMedian plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93–0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74–0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p ​= ​0.003), or lowest image reconstructive iteration level (p ​< ​0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p ​≤ ​0.001). ConclusionOverall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location.

Association of liver multi-parameter quantitative metrics determined by dual-layer spectral detector computed tomography (SDCT) with coronary plaque scores.

Hepatic steatosis is closely related to the occurrence and development of coronary plaques. Spectral detector computed tomography (SDCT) can provide more precise multiparameter quantitative parameters for hepatic steatosis. Hence, the purpose of this cross-sectional study was to explore the effect of quantitative liver metrics measured using SDCT on the extent and severity of coronary plaques. In patients who underwent upper abdomen unenhanced SDCT and coronary computed tomography angiography, plaque extent and severity were assessed using segmental involvement score (SIS) and segmental stenosis score (SSS). Liver fat quantification was evaluated by polychromatic and virtual mono-energetic images at 40 and 70 kev, spectral attenuation curve slope, and effective atomic number (CT40 keV, CT70 kev, λHU, and Zeff, respectively). A logistic regression model evaluated the factors influencing high SIS and SSS. Enrolled patients (n=644) were divided into groups: low SIS (<5) (n=451), high SIS (≥5) (n=193), low SSS (<5) (n=461), and high SSS (≥5) (n=183). Zeff was more closely correlated with SIS (standard partial regression coefficient =-0.422, P<0.001) and SSS (standard partial regression coefficient =-0.346, P<0.001). Zeff was divided into four groups using interquartile intervals. Compared with the patients in the lowest quartile, those in the second [odds ratio (OR) =2.116, 95% confidence interval (CI): 1.134-3.949, P=0.018], third (OR =2.832, 95% CI: 1.461-5.491, P=0.002), and fourth (OR =3.584, 95% CI: 1.857-6.918, P<0.001) quartiles showed higher risk for high SIS. And correspondingly, the second (OR =1.933, 95% CI: 1.040-3.592, P=0.037), third (OR =2.900, 95% CI: 1.499-5.609, P=0.002), and fourth (OR =3.368, 95% CI: 1.743-6.510, P<0.001) quartiles showed higher risk for high SSS, especially in those who were <60 years old, male and had visceral adipose tissue/subcutaneous adipose tissue <1.18. The SDCT-Zeff was an independent factor associated with high SIS and SSS. The quantification of liver fat may be useful for evaluating the risk and prognosis of coronary atherosclerosis.

Coronary Plaque Radiomic Phenotypes Predict Fatal or Nonfatal Myocardial Infarction: Analysis of the SCOT-HEART Trial

BackgroundCoronary computed tomography (CT) angiography–derived attenuation-based plaque burden assessments can identify patients at risk of myocardial infarction. ObjectivesThis study sought to assess whether more detailed plaque morphology assessment using patient-based radiomic characterization could further enhance the identification of patients at risk of myocardial infarction during long-term follow-up. MethodsPost hoc analysis of coronary CT angiography was performed within the SCOT-HEART (Scottish Computed Tomography of the HEART) clinical trial. Coronary plaque segmentations were used to calculate plaque burdens and eigen radiomic features that described plaque morphology. Univariable and multivariable Cox proportional hazard models were used to evaluate the association between clinical and image-based features and fatal or nonfatal myocardial infarction, whereas Harrell’s C-statistic and cumulative/dynamic area under the curve (AUC) values with cross-validation were used to evaluate prognostic performance. ResultsScans from 1,750 patients (aged 58 ± 9 years; 56% male) were analyzed. Over a median of 8.6 years of follow-up, 82 patients had a fatal or nonfatal myocardial infarction. Among the eigen radiomic features, 15 were associated with myocardial infarction in univariable analysis, and 8 features retained their association following adjustment for cardiovascular risk score and plaque burden metrics. Adding plaque burden metrics to a clinical model incorporating cardiovascular risk score, Agatston score and presence of obstructive coronary artery disease had similar prediction performance (C-statistic 0.70 vs 0.70), whereas further addition of eigen radiomic features improved model performance (C-statistic 0.74). In temporal analysis, the model including eigen radiomic features had higher cumulative/dynamic AUC values following the fifth year of follow-up. ConclusionsRadiomics-based precision phenotyping of coronary plaque morphology provided improvements to long-term prediction of myocardial infarction by CT angiography over and above clinical factors and plaque burden. (Scottish Computed Tomography of the HEART [SCOT-HEART]; NCT01149590)

Intraindividual Comparison of Ultrahigh-Spatial-Resolution Photon-Counting Detector CT and Energy-Integrating Detector CT for Coronary Stenosis Measurement.

A recent simulation study proposed that stenosis measurements on coronary computed tomography (CT) angiography are influenced by the improved spatial resolution of photon-counting detector (PCD)-CT. The aim of the current study was to evaluate the impact of ultrahigh-spatial-resolution (UHR) on coronary stenosis measurements and Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification rates in patients undergoing coronary CT angiography on both PCD-CT and energy-integrating detector (EID)-CT and to compare measurements against quantitative coronary angiography. Patients with coronary calcification on EID-CT (collimation, 192×0.6 mm) were prospectively enrolled for a research coronary CT angiography with UHR PCD-CT (collimation, 120×0.2 mm) within 30 days (between April 1, 2023 and January 31, 2024). PCD-CT was acquired with the same or lower CT dose index and equivalent contrast media volume as EID-CT. Percentage diameter stenosis (PDS) for calcified, partially calcified, and noncalcified lesions were compared between scanners. Patient-level reclassification rates for CAD-RADS were evaluated. The accuracy of PDS measurements was validated against quantitative coronary angiography in patients who underwent invasive coronary angiography. In total, PDS of 278 plaques were quantified in 49 patients (calcified, 202; partially calcified, 51; noncalcified, 25). PCD-CT-based PDS values were lower than EID-CT measurements for calcified (45.1±20.7 versus 54.6±19.2%; P<0.001) and partially calcified plaques (44.3±19.6 versus 54.9±20.0%; P<0.001), without significant differences for noncalcified lesions (39.1±15.2 versus 39.0±16.0%; P=0.98). The reduction in stenosis degrees led to a 49.0% (24/49) reclassification rate to a lower CAD-RADS with PCD-CT. In a subset of 12 patients with 56 lesions, UHR-based PDS values showed higher agreement with quantitative coronary angiography (mean difference, 7.3%; limits of agreement, -10.7%/25.2%) than EID-CT measurements (mean difference, 17.4%; limits of agreement, -6.9%/41.7%). Compared with conventional EID-CT, UHR PCD-CT results in lower PDS values and more accurate stenosis measurements in coronary plaques with calcified components and leads to a substantial Coronary Artery Disease Reporting and Data System reclassification rate in 49.0% of patients.

TCT-966 Integrated Assessment of Coronary Physiology and Plaque Vulnerability Based on Coronary Angiography in Heart Transplanted Patients

TCT-966 Integrated Assessment of Coronary Physiology and Plaque Vulnerability Based on Coronary Angiography in Heart Transplanted Patients

TCT-722 Coronary Artery Plaque Distribution in Functional Focal and Diffuse Disease

TCT-722 Coronary Artery Plaque Distribution in Functional Focal and Diffuse Disease

Impactful Cardiac CT and MRI Articles from 2023.

Cardiac imaging is important in diagnosing, treating, and predicting prognosis in patients with cardiovascular disease. Imaging protocols and analysis are consistently evolving, and the implementation of artificial intelligence-based applications is of increasing interest. This review presents recent advancements in noninvasive cardiac imaging, specifically focusing on cardiac CT and MRI, from notable publications across multidisciplinary journals in 2023 of interest to both radiologists and referring clinicians in the field. The discussion encompasses the latest trials of CT fractional flow reserve and the performance of the newest generation of photon-counting detector CT, particularly in coronary stenosis quantification. Additionally, it addresses coronary plaque quantification using artificial intelligence applications and their implications from large patient cohorts, alongside prognostic outcomes, and the value of coronary artery calcification scores. Various aspects of CT trials, such as anatomic planning before revascularization, high-risk plaque features, outcomes, and pericoronary fat index, are evaluated. New insights from cardiac MRI trials for cardiomyopathies, including cardiac amyloidosis, dilated cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, and valvular disease, are also outlined. The review concludes by highlighting impactful societal statements and guidelines. Keywords: CT Angiography, MR Imaging, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Coronary Arteries, Heart, Left Ventricle © RSNA, 2024.

TCT-1010 Enhanced Clinical Benefit of Preventive PCI of Vulnerable Coronary Plaques in Patients With Concomitant Non-Target Vessel PCI: A Prespecified Subgroup Analysis of the PREVENT Trial

TCT-1010 Enhanced Clinical Benefit of Preventive PCI of Vulnerable Coronary Plaques in Patients With Concomitant Non-Target Vessel PCI: A Prespecified Subgroup Analysis of the PREVENT Trial

Effects of CPAP on Atherosclerotic Coronary Plaques in Patients with Sleep-Disordered Breathing: The ENTERPRISE Trial

Effects of CPAP on Atherosclerotic Coronary Plaques in Patients with Sleep-Disordered Breathing: The ENTERPRISE Trial