Next Article in Journal
Association Between VEGF Expression and Diffusion Weighted Imaging in Several Tumors—A Systematic Review and Meta-Analysis
Next Article in Special Issue
Four Different Carotid Atherosclerotic Behaviors Based on Luminal Stenosis and Plaque Characteristics in Symptomatic Patients: An in Vivo Study
Previous Article in Journal
Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies
Previous Article in Special Issue
Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives
Open AccessReview

Coronary Artery Microcalcification: Imaging and Clinical Implications

Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy
Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
Institute of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden
Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
Molecular and Clinical Sciences Research Institute, St George’s University, London UB8 3PH, UK
Author to whom correspondence should be addressed.
Diagnostics 2019, 9(4), 125;
Received: 6 September 2019 / Revised: 18 September 2019 / Accepted: 19 September 2019 / Published: 23 September 2019
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification. View Full-Text
Keywords: atherosclerosis; coronary microcalcification; atherosclerosis imaging; confocal microcalcification imaging atherosclerosis; coronary microcalcification; atherosclerosis imaging; confocal microcalcification imaging
Show Figures

Figure 1

MDPI and ACS Style

Vancheri, F.; Longo, G.; Vancheri, S.; Danial, J.S.H.; Henein, M.Y. Coronary Artery Microcalcification: Imaging and Clinical Implications. Diagnostics 2019, 9, 125.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

Back to TopTop