Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis
Abstract
:1. Introduction
2. Noninvasive Coronary Atherosclerosis Assessment by CT
2.1. Cardiac CT: Technological Background
2.2. Coronary Artery Calcium Score (CACS): Noncontrast CT
2.3. Coronary Artery Evaluation by CCTA
2.4. Advanced Atherosclerosis Analysis by CCTA
3. Current Evidence on CCTA Use among Asymptomatic Patients
4. Future Perspectives for Potential Use of CCTA in Primary Prevention
5. Limitation to CCTA in Asymptomatic Patients
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviation
CCTA | Coronary computed tomography angiography |
CACS | Coronary artery calcium score |
MACE | Major adverse cardiovascular events |
SIS | Segment-involvement score |
SSS | Segment-stenosis score |
CT-LeSC | CT-adapted Leaman score |
IVUS | Intravascular ultrasound |
CAD | Coronary artery disease |
References
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Left-Dominance | Right-Dominance | Balanced-Dominance | |
---|---|---|---|
Coronary Segments | |||
Left main | 5 | 6 | 5.5 |
LAD proximal | 3.5 | 3.5 | 3.5 |
LAD mid | 2.5 | 2.5 | 2.5 |
LAD distal/1st diagonal | 1 | 1 | 1 |
2nd diagonal | 0.5 | 0.5 | 0.5 |
LCX proximal | 1.5 | 2.5 | 2 |
LCX distal | 0.5 | 1.5 | 1 |
1st and 2nd marginal | 1 | 1 | 1 |
RCA (all segments) | 1 | 0 | 0.5 |
PDA | 1 | Not applicable | 0.5 |
PDA from LCA | Not applicable | 1 | Not applicable |
PL from RCA | 0.5 | Not applicable | Not applicable |
PL from LCA | Not applicable | 0.5 | 0.5 |
Intermedium | 1 | 1 | 1 |
Stenosis Severity | |||
Obstructive CAD | 1 | 1 | 1 |
Nonobstructive CAD | 0.615 | 0.615 | 0.615 |
Plaque composition | |||
Noncalcified or mixed | 1.5 | 1.5 | 1.5 |
Calcified | 1 | 1 | 1 |
Patient-Based | Segment-Based | ||
---|---|---|---|
Conventional Reading | Advanced Analysis | Conventional Reading | Advanced Analysis |
|
|
|
|
High-Risk Feature | Definition | Example |
---|---|---|
Remodeling index (RI) | Ratio between lesion plaque area (red circle) and reference lumen area (blue circle). Positive remodeling is defined as RI > 1.1. | |
Low-attenuation plaque (LAP) | Presence of any voxel < 30 HU in a coronary plaque. | |
Plaque burden (PB) | Derived by the following formula: (lesion plaque area (red circle)—lesion lumen area (blue circle))/lesion plaque area (red circle). | |
Napkin-ring sign (NRS) | Presence of rim-like thin enhancement (no more than 130 HU) distributed along the outer contour of the vessel and surrounding a fibro-lipidic plaque. | |
Small spotty calcifications (SC) | Any discrete calcification ≤ 3 mm in length and occupying ≤ 90° arc when viewed on short axis. | |
Authors | Publication Year | PopulationNumber | CACS/CCTA | Endpoints | Follow-Up | Main Results | Ref |
---|---|---|---|---|---|---|---|
Kondos et al. | 2003 | 8855 | CACS | (1) Death (2) MI (3) Revascularization procedure | 37 ± 12 months | CACS provides incremental information vs. conventional CAD risk assessment. | [14] |
Taylor et al. | 2005 | 2000 | CACS | (1) ACS (2) Sudden cardiac death | 3 ± 1.4 years | CACS provides substantial, cost-effective, independent prognostic value incremental coronary risk factors. | [6] |
Budoff et al. | 2007 | 25,253 | CACS | All-cause mortality | 6 ± 3 years | CACS provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality. | [15] |
Detrano et al. | 2008 | 6722 | CACS | (1) MI (2) Death due to coronary heart disease | 3.8 years | CACS provides predictive information beyond that provided by standard risk factors. | [41] |
Muhlestein et al. | 2014 | 900 | CCTA | (1) ACS (2) All causes of death | 4 years | Among asymptomatic patients with type 1 or type 2 diabetes, use of CCTA to screen for CAD did not reduce cardiovascular events. | [38] |
Cho et al. | 2015 | 3217 | CACS and CCTA | (1) MI (2) All causes of death | 24 months | CCTA provides incremental prognostic utility for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS. | [39] |
Joong Kim et al. | 2013 | 2133 | CCTA | (1) ACS (2) Cardiac death (3) Coronary revascularization | 29.3 ± 14.9 months | CCTA might have the potential to identify high-risk groups in the selected subjects regarded as a minimal-risk group according toNational Cholesterol Education Program NCEP guidelines. | [40] |
Min et al. | 2014 | 27,125 | CCTA | (1) ACS (2) Cardiac death (3) Coronary revascularization | 2.4 ± 1.1 years | For asymptomatic diabetic individuals, CCTA measures of CAD severity confer incremental risk prediction. | [42] |
Kang et al. | 2016 | 591 | CCTA | (1) Cardiac deaths (2) Nonfatal MI (3) UA (4) Late coronary revascularizations | 6 years | Results suggested long-term prognostic value of coronary CCTA for asymptomatic type 2 diabetes mellitus. | [43] |
Halon et al. | 2019 | 630 | CCTA | ACS | 9.2 years | In asymptomatic patients with type 2 diabetes, CCTA plaque volume, percent low-density plaque content, and mild calcification predicted late plaque events. | [44] |
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Conte, E.; Mushtaq, S.; Marchetti, D.; Mallia, V.; Belmonte, M.; Melotti, E.; Pontone, G.; Pepi, M.; Andreini, D. Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis. J. Clin. Med. 2021, 10, 521. https://doi.org/10.3390/jcm10030521
Conte E, Mushtaq S, Marchetti D, Mallia V, Belmonte M, Melotti E, Pontone G, Pepi M, Andreini D. Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis. Journal of Clinical Medicine. 2021; 10(3):521. https://doi.org/10.3390/jcm10030521
Chicago/Turabian StyleConte, Edoardo, Saima Mushtaq, Davide Marchetti, Vincenzo Mallia, Marta Belmonte, Eleonora Melotti, Gianluca Pontone, Mauro Pepi, and Daniele Andreini. 2021. "Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis" Journal of Clinical Medicine 10, no. 3: 521. https://doi.org/10.3390/jcm10030521
APA StyleConte, E., Mushtaq, S., Marchetti, D., Mallia, V., Belmonte, M., Melotti, E., Pontone, G., Pepi, M., & Andreini, D. (2021). Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis. Journal of Clinical Medicine, 10(3), 521. https://doi.org/10.3390/jcm10030521