Noncalcified Atherosclerotic Plaque Research Articles

Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease.

Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.

Discrepancies between Coronary Artery Calcium Score and Coronary Artery Disease Severity in Computed Tomography Angiography Studies.

The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25-50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25-50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used.

Early Development of Atherosclerotic Plaques in the Coronary Arteries after Radiotherapy for Breast Cancer (BACCARAT Study).

Background-Radiotherapy (RT) for breast cancer (BC) can lead to an increased risk of coronary artery disease several years after RT. The aim of this study was to evaluate the development of overall, non-calcified and calcified atherosclerotic plaques over 2 years after BC for RT and associations with cardiac exposure. Methods-The study included 101 left- or right-sided BC patients treated with RT without chemotherapy. A coronary CT angiography was performed before and 2 years after RT. Plaque development thorough the entire coronary network was defined as an increased number of plaques. Cardiac exposure was quantified with mean doses to the heart, left ventricle, and coronary arteries. Logistic regression models were used to assess association with doses. Results-At inclusion, 37% of patients had plaques, increasing to 42% two years after RT. Overall plaque development was observed in seven patients: five with calcified plaque development and four with non-calcified plaque development. The risk of overall plaque development was significantly associated with doses to the Left Main and Circumflex coronary arteries (OR at 1 Gy = 2.32, p = 0.03 and OR at 1 Gy = 2.27, p = 0.03, respectively). Specific analyses for calcified and non-calcified plaque development showed similar results. Conclusion-Our study suggests an association between coronary arteries exposure and the risk of developing both calcified and non-calcified atherosclerotic plaques over 2 years after BC RT. Trial registration number: NCT02605512.

Prevalence and distribution of aortic plaque by sex and age group among community-dwelling adults

Rationale and objectivesAtherosclerosis of the aorta is associated with increased risk of cardiovascular mortality and vascular events. We aim to describe the prevalence and distribution of non-calcified atherosclerotic plaque in the descending aorta as quantified by noncontrast cardiovascular magnetic resonance (CMR) in a community-dwelling cohort of adults. Materials and methodsWe used CMR to quantify noncalcified aortic plaque in 1726 participants (aged 65 ± 9 years, 46.7% men) from the Cohort Study Offspring cohort. ECG-gated, fat-suppressed, T2-weighted, black blood turbo spin echo sequence was used to acquire 36 transverse slices covering the descending aorta from just below the arch to the aortoiliac bifurcation. Plaque was defined as discrete luminal protrusions ≥1 mm; these were manually traced, then summed to determine total descending aortic plaque (DAP) and segmental thoracic and abdominal aortic plaque (TAP, AAP). Participants were stratified by sex and age group (<55, 55–64, 65–74, ≥75y). A healthy referent group (without clinical cardiovascular disease, smoking, diabetes, impaired renal function; (N = 768, 43.8% men) was used to determine upper 90th percentile cutpoints for DAP and AAP which were then applied to the overall study cohort. ResultsPrevalence of DAP was similar between men (47.3%) and women (48.9%), p = 0.50, as was AAP prevalence (men: 44.5%, women: 46.7%, p = 0.16); TAP was less prevalent in both sexes (men: 8.9%, women: 7.1%, p = 0.15). Both prevalence and burden of DAP, AAP and TAP increased with advancing age. ConclusionNoncalcified plaque prevalence, visualized on CMR, in community-dwelling adults is similar between the sexes, and both prevalence and burden of aortic plaque increase with greater age.

Abstract 10115: Unique Imaging Morphology and Rare Location of Papillary Fibroelastoma Resulting in a Cardioembolic Stroke

Clinical Presentation: Afro-Caribbean female, age 59, with a comorbidity of hypertension presented with acute painless right-sided vision loss. Brain MRI revealed numerous scattered T2/FLAIR hyperintense foci throughout the periventricular, deep, and subcortical white matter, which were favored to represent chronic microvascular ischemic changes. CTA of the head and neck demonstrated mild atherosclerotic calcification of the cavernous segment of the left internal carotid artery without significant stenosis, mild noncalcified atherosclerotic plaque at the right carotid bifurcation, and mild irregularity and narrowing of the mid basilar artery. Cardiac Imaging: Transthoracic Echocardiography (TTE) demonstrated severe concentric left ventricular hypertrophy, left ventricle ejection fraction 60-65%, and a mobile, intracavitary mass measuring 1.60cm x 1.59cm. Repeat TTE estimated the mass to be 1.8cm x 1.2cm in the region of the posteromedial papillary muscle. Transesophageal Echocardiography (TEE) redemonstrated a mobile left ventricular mass measuring 2.0cm x 1.8cm along the inferior wall of the interventricular septum. Left heart catheterization demonstrated nonobstructive coronary artery disease with a 30% stenosis of the proximal Right Coronary and Distal Circumflex. Patient underwent surgical removal of the cardiac mass, biopsy-proven to be a Papillary Fibroelastoma (PFE). Discussion: PFEs account for 7.9% of all primary benign cardiac tumors and are the most common valvular tumor. More than 80% of these tumors are attached on the aortic or mitral valve, unlike in this patient where it was attached to the left ventricular trabeculae without involvement of the mitral valve or sub-valvular apparatus. The classic appearance of PFEs on TTE is pedunculated and often compared to a sea anemone but appeared homogenous in nature with central vacuolization in this case. This made characterizing the mass as a thrombus or cardiac tumor challenging.

Age related compositional plaque burden by CT in patients with future ACS

BackgroundWe examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS. MethodsA total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from the main epicardial vessels and side branches on a 0.5 ​mm cross-sectional basis. Calcified plaque and non-calcified plaque were defined by above or below 350 Hounsfield units. Patients were categorized according to their age by deciles. Also, coronary artery calcium scores (CACS) were evaluated when available. ResultsPatients were on average 62.2 ​± ​11.5 years old. On the pre-ACS CCTA, patients showed diffuse, multi-site, predominantly non-obstructive atherosclerosis across all age categories, with plaque being detected in 93.5% of all ACS cases. The proportion calcified plaque from the total plaque burden increased significantly with older presentation (10% calcification in those <50 years, and 50% calcification in those >80 years old). Patients with ACS <50 years had remarkably lower atherosclerotic burden compared with older patients, but a high proportion of high risk markers such as low-attenuation plaque. CACS was >0 in 85% of the patients older than 50 years, and in 57% of patients younger than 50 years. ConclusionThe proportion of calcified plaque varied depending on patient age at the time of ACS. Only a small proportion of plaque was calcified when ACS occurred at <50 years old, while this increased gradually with older age. Purely non-calcified atherosclerotic plaque was not uncommon in patients <50 years.

Clinical feasibility of using effective atomic number maps derived from non-contrast spectral computed tomography to identify non-calcified atherosclerotic plaques: a preliminary study.

To assess the clinical feasibility of using effective atomic number (Zeff) maps derived from non-contrast-enhanced computed tomography (NCECT) scans obtained by dual-layer spectral computed tomography (DLCT) to identify non-calcified atherosclerotic plaques. A total of 37 patients with 86 non-calcified atherosclerotic plaques confirmed by contrast-enhanced CT (CECT) were enrolled in this retrospective study. Both spectral-based-images (SBI) and conventional images (CI) were reconstructed from NCECT and CECT scans. The presence of plaques on NCECT Zeff maps and CIs were independently assessed by 2 radiologists. In CECT scans, plaques and regions of interest (ROIs) in vessel lumens were assessed with CT attenuation and Zeff values, and the proportion of plaques was determined as Area (plaque)/Area (vessel). The CT and Zeff values for plaques and blood were recorded from both CECT and NCECT scans. Contrast-to-noise ratios (CNRs) of the plaques were calculated and compared using CT attenuation and Zeff values. Finally, interobserver agreement was evaluated. A total of 47 of the 86 (54.7%) plaques were identified on Zeff map images derived from the NCECT scans while only 7 (8.1%) plaques were identified on the CI. There was no significant difference between the mean vessel ROI area measured on CIs and that measured on Zeff map images (502.19 vs. 498.14 mm2; P=0.28), while the mean plaque ROI area was larger (81.45 vs. 75.46 mm2). The observer consensus of vessel and plaque ROI area measurements using both methods was excellent, with interclass correlation coefficients (ICCs) of 0.99 and 0.94, respectively. For the 7 plaques detected both by NCECT CI and Zeff mapping, the CT attenuation and Zeff blood values were both larger than the plaque values [42.00 vs. 25.67 Hounsfield unit (HU); 7.33 vs. 7.19 HU; both P<0.05]; the plaque ROI area measurement on the NCE Zeff map was smaller than that on the CE CI (48.73 vs. 77.76 mm2), but was much larger than that on the NCE CI (18.39 mm2). For all 47 plaques detected by NCE Zeff mapping, the CT attenuation and Zeff values of blood and plaques on the NCECT images showed no significant differences (42.53 vs. 35.14 HU; P=0.18; 7.32 vs. 7.31, P=0.71); however, the CNR of Zeff was significantly higher than the CT attenuation value (1.69 vs. 1.12; P<0.05) derived from the NCECT scans. Inter-reviewer agreement was good (ICC =0.78). Zeff map images derived from NCECT SBI with DLCT provide a potentially feasible approach for identifying non-calcified atherosclerotic plaques, which might be clinically useful for the screening of asymptomatic at-risk patients.

Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer.

Aims: To evaluate spectral photon-counting CT’s (SPCCT) objective image quality characteristics in vitro, compared with standard-of-care energy-integrating-detector (EID) CT. Methods: We scanned a thorax phantom with a coronary artery module at 10 mGy on a prototype SPCCT and a clinical dual-layer EID-CT under various conditions of simulated patient size (small, medium, and large). We used filtered back-projection with a soft-tissue kernel. We assessed noise and contrast-dependent spatial resolution with noise power spectra (NPS) and target transfer functions (TTF), respectively. Detectability indices (d’) of simulated non-calcified and lipid-rich atherosclerotic plaques were computed using the non-pre-whitening with eye filter model observer. Results: SPCCT provided lower noise magnitude (9–38% lower NPS amplitude) and higher noise frequency peaks (sharper noise texture). Furthermore, SPCCT provided consistently higher spatial resolution (30–33% better TTF10). In the detectability analysis, SPCCT outperformed EID-CT in all investigated conditions, providing superior d’. SPCCT reached almost perfect detectability (AUC ≈ 95%) for simulated 0.5-mm-thick non-calcified plaques (for large-sized patients), whereas EID-CT had lower d’ (AUC ≈ 75%). For lipid-rich atherosclerotic plaques, SPCCT achieved 85% AUC vs. 77.5% with EID-CT. Conclusions: SPCCT outperformed EID-CT in detecting simulated coronary atherosclerosis and might enhance diagnostic accuracy by providing lower noise magnitude, markedly improved spatial resolution, and superior lipid core detectability.

Significant Coronary Stenosis And Coronary Calcium Score Of 0: Results From A Mexican Cohort At A Third Level Hospital.

Introduction: Coronary artery calcium (CAC) scoring is a helpful tool in the stratification of cardiovascular risk. Patients with a CAC score of 0 have a low risk of cardiovascular events and mortality in the long term. However, a CAC score of 0 does not rule out the presence of non-calcified atherosclerotic plaques. We sought to analyze the presence of significant coronary artery stenosis in a Mexican cohort with a CAC of 0.

Positron emission tomographic studies of the association between atherogenesis and aortitis among psoriatic patients.

There is increased interest in the use of positron emission tomography (PET) in psoriatic patients. We used PET induced with tracer fluorine-18 (18F) fluorodeoxyglucose (FDG) to study the association between the process of early-atherogenesis (eAg) and aortitis by quantifying enhanced aortic vascular inflammation along with calculation of total coronary plaque load (TCPL) and non-calcified atherosclerotic plaque load (NcAPL). In order to study the utility of aortitis in capturing eAg, we also assessed luminal stenosis atherosclerosis (LSA) and high-risk coronary plaques (HrCP). The study was conducted at our hospital between 1 April 2014 and 31 December 2017, and the analysis was done in July 2018. We recruited 180 consecutive psoriatic patients and subjected them to 18F-FDG PET. However, in order to characterise eAg, 160 out of 180 patients were also subjected to coronary angiographic computed tomographic studies (CACTS). Among 180 psoriatic patients (76 women, 42%) (mean [SD] age, 51.1 [13.2] years), greater prevalence values of LSA (odd ratio [OR], 3.71; 95% confidence interval [CI], 1.84-7.89; p = 0.001) and HrCP (OR, 3.11; 95% CI: 1.54-6.51; p = 0.003) along with enhanced TCPL (standardised β = 0.44; p < 0.001) were observed in patients with enhanced aortitis. However, the association between aortitis and HrCP was controlled by low-attenuation plaque (LAP), while the same between aortitis and TCPL was controlled by NcAPL (β = 0.45; p < 0.001). Association between aortitis and broad coronary angiographic indices was achieved and hence predicted the possibility of a surrogate role of aortitis in eAg.

CT-pathologic correlation of non-calcified atherosclerotic arterial plaques: a study using carotid endarterectomy specimens

Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents. 50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared. CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis. In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability. Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.

Predictive value of coronary artery calcium score in cardiovascular disease.

We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03-0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101-300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1-100 (HR=0.03, 95% CI 0.01-0.06, Z=1.66, P=0.096), and further increased with CACS of 101-300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.

P3432Coronary artery calcium score is of limited sensitivity in detecting subclinical atherosclerosis in young individuals with family history of coronary artery disease

Abstract Introduction Family history of premature coronary artery disease (CAD) is known to predispose individuals to adverse CAD events, often at a younger age. Current risk stratification strategy is suboptimal, as up to 50% of individuals were considered “low-risk” prior to their first presentation of myocardial infarction. Coronary artery calcium score (CACS) is a marker of atherosclerosis and provides incremental value in risk stratification. However, the utility of CACS may be limited in younger patients as they often have non-calcified atherosclerotic plaques. In this study, we evaluate the sensitivity of CACS in detecting subclinical atherosclerosis in different age groups. Method From 310 referrals to a specialized unit in the management of early atherosclerosis, 222 individuals with a family history of premature CAD (defined as CAD events in first-degree family members, male&lt;55 and female&lt;65) and aged between 35 and 55 were enrolled for assessment of their CAD risks. Individuals with possible, probably or definite familial hypercholesterolemia were excluded. In addition to clinical and risk factor evaluation, cardiac CT and CACS were performed in select individuals, at the discretion of the treating physician. Results Of the 141 (59% male, mean age 45.9±6.0 year) individuals that completed clinical evaluation, 65 (73% male, mean age 47.4±6.9 years) have subclinical atherosclerosis (defined by the presence of atherosclerotic plaques in any of the coronary artery segments in cardiac CT). Of them, 52 have CACS&gt;0, giving an overall sensitivity of 80%. The breakdown by age group is shown in table 1. The sensitivity of CACS in detecting subclinical atherosclerosis is quite modest in younger individuals (60% in individuals &lt;45 year-old) but improves with patient age (&gt;85% in &gt;45 years). Table 1. Sensitivity of CACS in different age groups Age group True Positive Fast Negative Sensitivity N (CAC+ CTCA+) (CAC+ CTCA−) (%) &lt;40 6 4 60 10 41–45 7 4 55 11 46–50 19 3 86 22 51–55 20 1 95 21 Conclusion In younger individuals (&lt;45 years) with family history of premature CAD, CACS is of limited sensitivity in detecting subclinical atherosclerosis, and should not be used to rule out CAD. Further studies are warranted.

In-situ analysis of mast cells and dendritic cells in coronary atherosclerosis in chronic kidney disease (CKD).

Mast cells (MC) and dendritic cells (DC) have immune modulatory function and can influence T-cell activity. Both cell types have been found in atherosclerotic plaques and are thought to play an important role for plaque stability. Compared to matched segments of the non-renal population, patients with chronic kidney disease (CKD) show a more pronounced and more aggressive course of atherosclerosis with higher plaque calcification and significantly higher complications rates. It was the aim of this study to analyze the number and localization of MCs and DCs, macrophages, T- and B-cells as well as the expression of markers of inflammation such as CRP and NFκB in calcified and non-calcified atherosclerotic plaques of patients with CKD and control patients. Fifty coronary atherosclerotic plaques from patients with endstage CKD (CKD, n=25) and control (n=25) patients were categorized according to the Stary classification and investigated using immunohistochemistry (markers for MC, DC, T, B, macrophage and NFκB). Expression was analyzed separately for the complete plaque area as well as for the different plaque subregions and correlations were analyzed. We found only very few DCs and MCs per lesion area with slightly increased numbers in calcified plaques. MCs per plaque area were significantly more frequent in CKD than in control patients and this was independent of plaque calcification. MCs were most frequently found in the shoulder and basis of the plaque. DCs per plaque area were significantly less in calcified plaques of CKD compared to control patients. In control, but not in CKD patients, DCs were significantly more frequent in calcified than in non-calcified plaques. Within the plaques DCs were similarly distributed between all 4 subregions. Coronary atherosclerotic plaques of CKD patients showed a significantly higher number of MCs whereas DCs were less frequent compared to control patients particularly if plaques were calcified. These findings might indicate a potential proinflammatory role of MCs, but not of DCs in atherosclerotic lesions of CKD patients, adding another characteristic of advanced atherosclerosis in these patients.

Combination of biomarkers of vascular calcification and sTWEAK to predict cardiovascular events in chronic kidney disease

Background and aimsVascular calcification (VC) and atherosclerosis are associated with an increased cardiovascular morbimortality in chronic kidney disease (CKD). Osteoprotegerin (OPG) and osteopontin (OPN) are involved in both VC and CKD. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) has been related to cardiovascular disease. We hypothesized that OPG, OPN and sTWEAK levels may be associated with a higher prevalence of cardiovascular outcomes in patients with CKD. MethodsThe presence of calcified or non-calcified atherosclerotic plaques was assessed in 1043 stage 3 to 5D CKD patients from The NEFRONA Study. Biochemical measurements and OPG, OPN and sTWEAK serum levels were analyzed. Patients were followed for cardiovascular outcomes (41 ± 16 months). ResultsAt recruitment, 26% of CKD patients had VC. The adjusted odds ratios for having VC were 2.22 (1.32–3.75); p=.003 for OPG, and 0.45 (0.24–0.84); p=.01 for sTWEAK concentrations. After follow-up, 95 CV events occurred. In a Cox model, patients with OPG or OPN above and sTWEAK below their optimal cut-off points had an adjusted higher risk of cardiovascular events [HR: 2.10 (1.49–3.90); p=.02; 1.65 (1.02–2.65); p=.04; 2.05 (1.28–3.29), p=.003; respectively]. When CKD patients were grouped according to the number of biomarkers above (OPG and OPN) or below (sTWEAK) their cut-off points, the combination of these biomarkers showed the highest risk for cardiovascular events [HR: 9.46 (3.80–23.5) p < .001]. A composite score of these three biomarkers increased the C-statistic and net reclassification index beyond conventional risk factors and VC. ConclusionsThe combination of OPG, OPN and sTWEAK increased the predictability of cardiovascular outcomes.

Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography.

The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed. The "Virtual" Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection. Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery. We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.

GW28-e0660 Elevated Hs-CRP Level is Independently Associated with the Presence of Non-calcified or Mixed Coronary Atherosclerotic Plaques in Chinese Population Undergoing Coronary Computed Tomography Angiography

GW28-e0660 Elevated Hs-CRP Level is Independently Associated with the Presence of Non-calcified or Mixed Coronary Atherosclerotic Plaques in Chinese Population Undergoing Coronary Computed Tomography Angiography

Sex-related differences in serum matrix metalloproteinase-9 screening non-calcified and mixed coronary atherosclerotic plaques in outpatients with chest pain.

The objective of this study is to evaluate the clinical feasibility of serum matrix metalloproteinase-9 (MMP-9) for screening plaque composition as assessed by coronary computed tomography angiography (CCTA) in outpatients with chest pain,and the effects of sex on this feasibility. Eight hundred and sixty-two consecutive outpatients with chest pain were divided into three groups according to the results of CCTA: non-plaque (NP, n=474), calcified plaques (CPs, n=179), non-calcified and mixed plaques (NCPs and MPs, n=209). We found that serum MMP-9 levels were significantly higher in patients with NCPs and MPs compared to those with either NP or CPs, especially in women (649.7±279.8 vs. 485.7±231.6ng/mL or 515.7±274.5ng/mL, P<0.001). MMP-9 showed better identification of NCPs and MPs than other related factors and was an independent predictor for NCPs and MPs both in women and men. The receiver operating characteristic analysis indicated a substantial superiority in women with area under the curve of 0.75 (95% CI 0.69-0.82, P<0.01), compared with men of 0.59 (95% CI 0.53-0.65, z=3.71, P<0.01). The diagnostic tests revealed a moderate risk of the presence of NCPs and MPs with MMP-9 ≥531.6ng/mL in female patients.

The Value of Coronary Artery Calcium Scoring in Early Diagnosis of Radiation-Induced Coronary Artery Disease in Breast Cancer Patients Following Radiation

: Background: Breast cancer (BC) mortality rate has significantly decreased during the past decades by introducing adjuvant chemotherapy and/or radiotherapy (RT) in addition to surgery. However, as an emerging phenomenon, the corresponding therapeutic side effects caused non-malignant morbidity and mortality. Coronary artery disease (CAD) is the leading non-malignant cause of death in BC patients. It is established that chest RT has a role in atherosclerotic plaque formation in the coronary arteries. Newer techniques of RT like three-dimensional conformal radiotherapy (3D-CRT) use technical methods in which less radiation doses are given to the non-cancerous tissues. Non-invasive technique of coronary artery calcium score (CACS) can detect atherosclerotic plaques long before the plaques become symptomatic, helping to treat them in early stages, so improve BC patients’ outcome. The aim of this study is to assess and compare CACS in BC patients with a history of 3D-RT and non-BC women in the same age range with no history of RT. Methods: CACS of fifty BC patients (age range: 34 - 70 years) with different time intervals from RT (range: 3-9 years) and CACS of fifty age-matched control group of non-BC women with no history of chest RT, using 64-slice ECG-gated CT scan were calculated and presented as the quantitative value of Agatston score (AS). The risk factors contributing to CAD (hypertension, hyperlipidemia, diabetes mellitus, smoking), and the Framingham’s 10-year risk score, as well as the age-matched CACS percentiles, were evaluated. Results: No correlation between AS and history of RT, RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001). Conclusions: No difference between CACS was noted between BC patients with a history of 3D-CRT and the non-BC women without a history of RT. Although cardiac radiation dose reduction in 3D-CRT technique can justify the findings, as multiple studies have shown increase of CAD in BC patients with history of old RT techniques, but some studies show no difference in CACS between new and old RT techniques, other reason would be non-calcified atherosclerotic plaques after RT or myocardial microvascular disease due to reduced cardiac doses after 3D-CRT rather than calcified atherosclerotic plaques seen naturally by aging.

GW27-e0281 Association of Neutrophil to Lymphocyte Ratio and the Presence of Non-calcified or Mixed Coronary Atherosclerotic Plaques in Chinese Population Undergoing Coronary Computed Tomography Angiography

Several studies had demonstrated that there is an association between neutrophil to lymphocyte ratio (NLR) and the severity, non-calcified plaque burden and coronary artery calcium score of coronary atherosclerosis. Patients with non-calcified or mix plaques had a higher risk of adverse outcomes.