HomeCirculation: Cardiovascular ImagingVol. 4, No. 5Letter by Korosoglou et al Regarding Article, “Association Between High-Sensitivity C-Reactive Protein and Coronary Plaque Subtypes Assessed by 64-Slice Coronary Computed Tomography Angiography in an Asymptomatic Population” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Korosoglou et al Regarding Article, “Association Between High-Sensitivity C-Reactive Protein and Coronary Plaque Subtypes Assessed by 64-Slice Coronary Computed Tomography Angiography in an Asymptomatic Population” Grigorios Korosoglou, Evangelos Giannitsis and Hugo A. Katus Grigorios KorosoglouGrigorios Korosoglou University of Heidelberg Department of Cardiology Heidelberg, Germany (Korosoglou, Giannitsis, Katus) Search for more papers by this author , Evangelos GiannitsisEvangelos Giannitsis University of Heidelberg Department of Cardiology Heidelberg, Germany (Korosoglou, Giannitsis, Katus) Search for more papers by this author and Hugo A. KatusHugo A. Katus University of Heidelberg Department of Cardiology Heidelberg, Germany (Korosoglou, Giannitsis, Katus) Search for more papers by this author Originally published1 Sep 2011https://doi.org/10.1161/CIRCIMAGING.111.967257Circulation: Cardiovascular Imaging. 2011;4:e26To the Editor:We read with interest the study of Rubin and colleagues,1 who investigated the association between high-sensitivity C-reactive protein (hs-CRP) with the composition and extent of atherosclerotic coronary plaque, based on coronary computed tomography angiography (CCTA). The study cohort consisted of 1004 asymptomatic subjects who underwent 64-slice CCTA as part of a health screening evaluation. Overall, 211 (21%) patients showed coronary artery disease (CAD), yielding mixed, calcified and noncalcified plaques (10%, 9%, and 8%, respectively), which resulted in lumen narrowing of ≥50% in 51 (5%) and in nonobstructive CAD in 160 (16%) cases. Hs-CRP values were arbitrarily separated to low-normal, intermediate, and high. Weak associations were observed between hs-CRP with the presence of any plaque and mixed plaque. No associations were found for either noncalcified or calcified plaque. After adjustment for clinical and laboratory data the association between the presence of plaque (all subtypes) and hs-CRP yielded borderline statistical significance (odds ratio, 1.35; 95% confidence interval, 0.91 to 2.0) for intermediate hs-CRP and of 1.63 (95% confidence interval, 1.09 to 2.44) for high hs-CRP).This report underlines the importance of biochemical markers for patient risk stratification and the potential of noninvasive cardiac imaging to shed light into the underlying pathophysiology of coronary atherosclerosis. However, several issues should be taken into account with this report before interpreting the acquired results. First of all, the patients studied were asymptomatic and self-referred, so that the study results cannot be extrapolated to a routine clinical out patient setting of patients with suspected CAD. Furthermore, the classification of atherosclerotic plaque was performed categorically, and no quantification analysis of the total noncalcified plaque burden was assessed, which is actually possible using contemporary software algorithms.2 Furthermore, the presence of both spotty calcification patterns and vascular remodeling, which have been indicated as markers of plaque vulnerability, were not considered. Particularly, the visual estimation of the calcified plaque area, which guided plaque categorization, may be completely misleading due to blooming effects surrounding coronary calcification, which may result in substantial overestimation of the calcified area. Furthermore, visually guided estimation of calcified plaque content will be strongly dependent on the projection selected for visual analysis. In addition, although native scans seem to have been performed according to the Methods section, results on quantitative calcium scoring and its association with hs-CRP are not reported.From a pathophysiologic point of view, hs-CRP represents a marker of systemic low-grade inflammation. Although this marker was previously reported as a potential predictor of cardiovascular disease, its value for the individual clinical risk profiling was limited in recent studies.3–4 Studying atherosclerotic plaque in patients who underwent clinically indicated CCTA for suspected CAD, we recently demonstrated a close association between plaque composition and high-sensitive troponin T elevation (hs-TnT),2 whereas an independent association with hs-CRP could not be established. In the same line Laufer et al5 recently reported on a strong association between hs-TnT with disease severity and CT plaque burden in a cohort of 646 patients with suspected CAD, whereas again, an association with hs-CRP was not observed. In contrast to hs-CRP, troponins are cardiospecific biomarkers, which are released into the circulation with cardiomyocyte injury. Their role in the diagnostic classification and risk stratification of patients with acute coronary syndromes is clearly established, and recent studies indicate that hs-TnT is also an independent predictor of cardiovascular mortality in patients with stable CAD.6 Together, with our findings and those of Laufer et al, this may implicate that chronic clinically silent plaque microrupture and embolization rather than systemic inflammation may be the right key to comprehend the underlying pathophysiology in stable CAD and possibly predict future plaque rupture and clinical manifestation of acute coronary syndromes.Grigorios Korosoglou, MDEvangelos Giannitsis, MDHugo A. Katus, MD University of Heidelberg Department of Cardiology Heidelberg, GermanyDisclosuresNone.
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