Presence Of Non-calcified Coronary Plaques Research Articles

Prevalence and associated risk factors of coronary artery disease in patients with a zero coronary calcium score

PurposeA zero coronary calcium score (CCS) is not able to provide a definite exclusion for coronary artery disease (CAD). The goal of this study was to determine the prevalence and associated cardiovascular risk factors of CAD in patients with zero CCS. MethodsSix hundred thirteen patients with zero CCS referred to coronary calcium score analysis (CCSA) and coronary computed tomography angiography (CCTA) with suspicion of CAD were included. The descriptive, univariate, and multivariate analyses were used to determine the prevalence and predictors of CAD presence. ResultsAmong 613 patients, 17 patients (2.7%) have NCCP, and obstructive CAD was found in 3 patients (0.48%). Multivariate analysis revealed that male gender and older age (≥50 years) were significantly associated with the presence of noncalcified coronary plaques (NCCP) (p < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the male gender and older age (≥50 years) model had 70.6% sensitivity and 84.2% specificity for predicting NCCP. ConclusionA non-negligible portion of patients with zero CCS had CAD. Male gender and older age (≥50 years) were independently associated with NCCP. Due to the high specificity value (84.2%) and negative predictive value (99.0%) of the male gender and older age (≥50 years) model, selective use of CCTA is recommended in <50 years old female patients to avoid unnecessary radiation exposure.

Abstract 10411: Significance of Inflammation and Neoangiogenesis of Epicardial Adipose Tissue on Coronary Atherosclerosis Based on Computed Tomography Analysis

Background: Previous studies indicate that epicardial adipose tissue (EAT) biologically contributes to coronary atherosclerosis progression. The inflammation and neoangiogenesis have been reported to be biological markers of ‘diseased’ adipose tissues. We evaluated the relation of EAT pathologies, represented by inflammation and neoangiogenesis, to computed tomography (CT)-based coronary atherosclerosis. Methods: We enrolled 45 patients undergoing cardiac CT examination before elective cardiac surgery (coronary artery bypass graft [CABG], n = 21; non-CABG, n = 24). Each patient was evaluated with visceral adipose tissue (VAT) area, EAT volume, coronary calcium score (CCS), and presence of non-calcified coronary plaque (NCP) on CT angiography. During each cardiac surgery, histological samples for immunohistochemistry were obtained from EATs adjacent to the left anterior descending and right coronary arteries. Each patient was assessed with the numbers of CD-68+ individual macrophages and CD-31+ neovessels in a total of 6 random high-power fields (x400) of EAT samples. Results: The EAT volume had no correlation with macrophage infiltration (r = 0.09, p = 0.53) or neoangiogenesis (r = 0.08, p = 0.59) in EAT. In the comparisons of EAT pathologies based on CCS levels or NCP presence, the moderate CCS (101-400) or NCP present group had more macrophage infiltration and neoangiogenesis in EAT (Fig 1). On multivariate analyses adjusting for age, sex, CABG vs. non-CABG, VAT area, and EAT volume, both the moderate CCS and NCP presence showed significant correlation with increased macrophage infiltration (β = 0.65; p &lt; 0.0001, and β = 0.49; p = 0.0089, respectively) and neoangiogenesis (β = 0.55; p = 0.0011, and β = 0.53; p = 0.012, respectively) in EAT (Fig 2). Conclusions: The EAT biological activities independently correlate with moderate, rather than severe, coronary calcium and NCP formation, suggesting the stage in the process of coronary atherosclerosis growing.

The relationship between inflammation and neoangiogenesis of epicardial adipose tissue and coronary atherosclerosis based on computed tomography analysis

ObjectivePrevious studies indicate that epicardial adipose tissue (EAT) biologically contributes to the progression of coronary atherosclerosis. We evaluated the relationship between EAT pathology, represented by inflammation and neoangiogenesis, and coronary atherosclerosis on computed tomography (CT) images. MethodsWe performed CT examination in 45 patients scheduled for cardiac surgery (coronary artery bypass graft [CABG], n = 21; non-CABG, n = 24) to assess visceral adipose tissue (VAT) area, EAT volume, coronary calcium score (CCS), and presence of non-calcified coronary plaque (NCP) on CT angiography. Each patient was assessed with the numbers of CD68+ individual macrophages and CD31+ neovessels in six random high-power fields (400×) of EAT samples subsequently obtained during cardiac surgery. ResultsIn three groups based on CCS (mild, 0–100; moderate, 101–400; severe, >400), the moderate group had the most extensive macrophage infiltration (p = 0.0025) and neoangiogenesis (p = 0.0036) in EAT. The patients with NCP had more extensive macrophage infiltration (p = 0.010) and neoangiogenesis (p = 0.0043) in EAT than those without. On multivariate analysis adjusted for age, sex, CABG versus. non-CABG, VAT area, and EAT volume, moderate CCS and the presence of NCP showed significant correlations with increased macrophage infiltration (β = 0.65; p < 0.0001, and β = 0.49; p = 0.0089, respectively) and neoangiogenesis (β = 0.55; p = 0.0011, and β = 0.53; p = 0.012, respectively) in EAT. ConclusionInflammation and neoangiogenesis in EAT independently correlate with moderate coronary calcification and presence of NCP, suggesting that these two factors may have a role in promoting coronary atherosclerosis.

HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS).

HIV-infected individuals bear increased cardiovascular risk even in the absence of traditional cardiovascular risk factors. In the general population, coronary artery calcium (CAC) scanning is of value for cardiovascular risk stratification, but whether a CAC score of zero implies a low noncalcified coronary plaque burden in HIV-infected persons is unknown. We assessed the prevalence of noncalcified coronary plaque and compared noncalcified coronary plaque burden between HIV-infected and HIV-uninfected participants who had CAC scores of zero in the Multicenter AIDS Cohort Study (MACS) using coronary computed tomography (CT) angiography. HIV infection was associated with the presence of noncalcified coronary plaque among these men with CAC scores of zero. In a model adjusted only for age, race, centre, and pre- or post-2001 cohort, the prevalence ratio for the presence of noncalcified plaque was 1.27 (95% confidence interval 1.04-1.56; P = 0.02). After additionally adjusting for cardiovascular risk factors, HIV infection remained associated with the presence of noncalcified coronary plaque (prevalence ratio 1.31; 95% confidence interval 1.07-1.6; P = 0.01). Among men with CAC scores of zero, HIV infection is associated with an increased prevalence of noncalcified coronary plaque independent of traditional cardiovascular risk factors. This finding suggests that CAC scanning may underestimate plaque burden in HIV-infected men.

Carotid doppler ultrasonography as a surrogate for coronary CT angiography to exclude subclinical coronary atherosclerosis in asymptomatic patients with a negative coronary calcium score

To evaluate the diagnostic accuracy of carotid Doppler ultrasonography (CDU) to predict the presence of subclinical coronary atherosclerosis in asymptomatic subjects with a zero coronary calcium score. Retrospective study of CDU and coronary CT angiography (CTA) findings in 118 asymptomatic subjects with a zero calcium score. CDU was considered abnormal when carotid intima-media thickness was >75 percentile or was ≥ 1 mm, or in presence of carotid plaque(s). We analyzed the diagnostic accuracy of CDU to predict the presence of non-calcified coronary plaque in comparison with coronary CTA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of abnormal CDU to identify the presence of non-calcified coronary plaque on coronary CTA were 82.4% [(14/17); 95% confidence interval (CI), 56.6%-96.2%], 53.5% [(54/101); 95% CI, 43.3%-63.5%], 23.0% [(14/61); 95% CI, 13.1%-35.6%], and 94.7% [(54/57); 95% CI, 85.4%-98.9%], respectively. Although CDU has a low PPV for identifying the presence of non-calcified plaque on coronary CTA, its NPV is high to exclude subclinical coronary atherosclerosis in asymptomatic subjects with a zero calcium score.

Association Between Visceral Adipose Tissue Area and Coronary Plaque Morphology Assessed by CT Angiography

We sought to investigate the association between visceral adipose tissue (VAT) with the presence, extent, and characteristics of noncalcified coronary plaques (NCPs) using 64-slice computed tomography angiography (CTA). Although visceral adiposity is associated with cardiovascular events, its association with NCP burden and vulnerability is not well known. The study population consisted of 427 patients (age 67 ± 11 years; 63% men) with proven or suspected coronary artery disease who underwent 64-slice CTA. We assessed the presence and number of NCPs for each patient. The extent of NCP was tested for the difference between high (≥ 2) and low (≤ 1) counts. We further evaluated the vulnerable characteristics of NCPs with positive remodeling (remodeling index >1.05), low CT density (≤ 38 HU), and the presence of adjacent spotty calcium. Plain abdominal scans were also performed to measure the VAT and subcutaneous adipose tissue area. A total of 260 (61%) patients had identifiable NCPs. Multivariate analyses revealed that increased VAT area (per 1 standard deviation, 58 cm(2)) was significantly associated with both the presence (odds ratio [OR]: 1.68; 95% confidence interval [CI]: 1.28 to 2.22) and extent (OR: 1.31; 95% CI: 1.03 to 1.68) of NCP. Other body composition measures, including subcutaneous adipose tissue area, body mass index, and waist circumference were not significantly associated with either presence or extent of NCP. Increased VAT area was also independently associated with the presence of NCP with positive remodeling (OR: 1.71; 95% CI: 1.18 to 2.53), low CT density (OR: 1.69; 95% CI: 1.17 to 2.47), and adjacent spotty calcium (OR: 1.52; 95% CI: 1.03 to 2.27). Increased VAT area was significantly associated with NCP burden and vulnerable characteristics identified by CTA. Our findings may explain the excessive cardiovascular risk in patients with visceral adiposity, and support the potential role of CTA to improve risk stratification in such patients.