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Volume 15
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10.3390/life15081288
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Article

Assessment of the Association Between Coronary Artery Calcification, Plaque Vulnerability, and Perivascular Inflammation via Coronary CT Angiography

by
Botond Barna Mátyás
1,2,
Imre Benedek
1,2,3,
Nóra Rat
1,3,4,*,
Emanuel Blîndu
1,2,3,4,
Ioana Patricia Rodean
1,3,4,
Ioana Haja
1,
Delia Păcurar
1,
Theofana Mihăilă
1,2,3,4 and
Theodora Benedek
1,2,3,4
1
Clinic of Cardiology, Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania
2
Doctoral School of Medicine and Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
3
Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, 540124 Târgu Mures, Romania
4
Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
*
Author to whom correspondence should be addressed.
Life 2025, 15(8), 1288; https://doi.org/10.3390/life15081288
Submission received: 14 July 2025 / Revised: 4 August 2025 / Accepted: 12 August 2025 / Published: 13 August 2025
(This article belongs to the Special Issue Coronary Artery Disease: Pathophysiological Mechanisms, Imaging Modalities and Therapeutic Implications)
Versions Notes

Abstract

Background: Coronary artery calcium (CAC) scores are a widely used surrogate marker for atherosclerotic burden, but they do not fully reflect plaque vulnerability or coronary inflammation. This study aimed to evaluate the relationship between CACs, coronary plaque characteristics, and perivascular inflammatory activity using advanced CCTA and CaRi-Heart® analysis. Methods: A total of 250 patients with no prior cardiovascular disease were retrospectively evaluated and stratified by CACs into three groups: 0 (n = 28), 1–100 (n = 121), and >100 (n = 101). Coronary plaque morphology, high-risk plaque (HRP) features, CAD-RADS scores, and AI-derived fat attenuation index (FAI) centiles were assessed. Results: Significant differences across CAC categories were observed for several key parameters. The number of diseased coronary segments increased markedly (from 1.39 ± 1.10 vs. 2.97 ± 1.57 vs. 3.94 ± 2.10; p < 0.0001, one-way ANOVA). A similar upward trend was seen for segment involvement scores, HRP prevalence, and the proportions of mixed and calcified plaque components. Regression analysis demonstrated that CACs correlated significantly with segment burden (r2 = 0.2520), CAD-RADS (r2 = 0.1352), and the FAI score centile (r2 = 0.0568). Conclusions: This study highlights the limitations of CACs as a standalone risk stratification tool. Vulnerable and inflamed plaques may already be present in patients with low or zero CACs. Integrating CCTA with perivascular FAI mapping enables earlier detection of biologically active atherosclerosis and supports more precise clinical decision-making.
Keywords: coronary artery disease; coronary artery calcium score; coronary computed tomography angiography; CAD-RADS; high-risk plaque features; perivascular inflammation; fat attenuation index coronary artery disease; coronary artery calcium score; coronary computed tomography angiography; CAD-RADS; high-risk plaque features; perivascular inflammation; fat attenuation index

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MDPI and ACS Style

Mátyás, B.B.; Benedek, I.; Rat, N.; Blîndu, E.; Rodean, I.P.; Haja, I.; Păcurar, D.; Mihăilă, T.; Benedek, T. Assessment of the Association Between Coronary Artery Calcification, Plaque Vulnerability, and Perivascular Inflammation via Coronary CT Angiography. Life 2025, 15, 1288. https://doi.org/10.3390/life15081288

AMA Style

Mátyás BB, Benedek I, Rat N, Blîndu E, Rodean IP, Haja I, Păcurar D, Mihăilă T, Benedek T. Assessment of the Association Between Coronary Artery Calcification, Plaque Vulnerability, and Perivascular Inflammation via Coronary CT Angiography. Life. 2025; 15(8):1288. https://doi.org/10.3390/life15081288

Chicago/Turabian Style

Mátyás, Botond Barna, Imre Benedek, Nóra Rat, Emanuel Blîndu, Ioana Patricia Rodean, Ioana Haja, Delia Păcurar, Theofana Mihăilă, and Theodora Benedek. 2025. "Assessment of the Association Between Coronary Artery Calcification, Plaque Vulnerability, and Perivascular Inflammation via Coronary CT Angiography" Life 15, no. 8: 1288. https://doi.org/10.3390/life15081288

APA Style

Mátyás, B. B., Benedek, I., Rat, N., Blîndu, E., Rodean, I. P., Haja, I., Păcurar, D., Mihăilă, T., & Benedek, T. (2025). Assessment of the Association Between Coronary Artery Calcification, Plaque Vulnerability, and Perivascular Inflammation via Coronary CT Angiography. Life, 15(8), 1288. https://doi.org/10.3390/life15081288

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