CT Coronary Angiography in Early Detection of Atherosclerosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (1 March 2022) | Viewed by 16686

Special Issue Editors


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Guest Editor
1. Chairman, Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy
2. Associate Professor of Radiology, Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
3. Cardiovascular Research Director, SDN IRCCS, Naples, Italy
4. Past-President, Italian College of Cardiac Radiology (SIRM; Italian Society of Radiology), Milan, Italy
Interests: cardiac CT; cardiac MR; cardiovascular CT; cardiovascular MR; atherosclerosis; coronary artery disease; imaging; diagnosis; prognosis; epidemiology

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Guest Editor
Senior Staff, Cardiovascular Radiologist, Department of Radiology, Area Vasta 1, ASUR Marche, Urbino, Italy
Interests: cardiac CT; cardiac MR; cardiovascular CT; cardiovascular MR; atherosclerosis; coronary artery disease; imaging; diagnosis; prognosis; epidemiology

Special Issue Information

Dear Colleagues,

The field of advanced cardiovascular imaging has been developing very fast for the last two decades.

Significant advances have been made in the field of cardiac computed tomography (CCT), and today we are entering the era in which any clinical question concerning coronary arteries in stable patients can and should be first addressed using CCT. European Guidelines have already positioned CCT in Class I of indication and most probably, very soon, American Guidelines will do the same.

One field of research that developed because of the introduction of CCT is definitely the field of exploration of coronary atherosclerosis on large scales and even in asymptomatic individuals. This a totally new field which starts from risk stratification in primary prevention and develops into personalized medical therapy based on qualitative and quantitative evaluation of coronary plaque burden.

This Special Issue will evaluate and collect scientific material on the topic both from a basic research standpoint and from a clinical research standpoint. Original research articles and early feasibility studies will be evaluated. Intermodality imaging assessment of coronary artery disease will be of interest as well. Reviews and systematic reviews will also be accepted. The main interest is focusing on what the paradigm shift is that is inherent with the extensive clinical introduction and usage of cardiac CT.

Prof. Dr. Filippo Cademartiri
Dr. Erica Maffei
Guest Editor
s

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Keywords

  • Atherosclerosis
  • Coronary artery disease
  • Cardiac CT
  • Cardiovascular imaging
  • Prevention
  • Medical therapy
  • Radiomics
  • Diagnosis
  • Prognosis

Published Papers (6 papers)

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Research

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13 pages, 1803 KiB  
Article
Periodontal Disease Is Associated with Increased Vulnerability of Coronary Atheromatous Plaques in Patients Undergoing Coronary Computed Tomography Angiography—Results from the Atherodent Study
by Ioana-Patricia Rodean, Luminița Lazăr, Vasile-Bogdan Halațiu, Carmen Biriș, Imre Benedek and Theodora Benedek
J. Clin. Med. 2021, 10(6), 1290; https://doi.org/10.3390/jcm10061290 - 21 Mar 2021
Cited by 9 | Viewed by 2300
Abstract
The present study aimed to investigate the link between the severity of periodontal disease (PD), coronary calcifications and unstable plaque features in patients who underwent coronary computed tomography for unstable angina (UA). Fifty-two patients with UA, included in the ATHERODENT trial (NCT03395041), underwent [...] Read more.
The present study aimed to investigate the link between the severity of periodontal disease (PD), coronary calcifications and unstable plaque features in patients who underwent coronary computed tomography for unstable angina (UA). Fifty-two patients with UA, included in the ATHERODENT trial (NCT03395041), underwent computed tomographic coronary angiography (CCTA) and dental examination. Based on the median value of the periodontal index (PI), patients were assigned to the low periodontal index (LPI) group (PI < 22) and a high periodontal index (HPI) group (PI > 22). Patients with HPI had higher plaque volume (p = 0.013) and noncalcified plaque volume (p = 0.0003) at CCTA. In addition, the presence of vulnerability features in the atheromatous plaques was significantly correlated with PI (p = 0.001). Among periodontal indices, loss of gingival attachment (p = 0.009) and papillary bleeding index (p = 0.002) were strongly associated with high-risk plaques. PI significantly correlated with coronary calcium score (r = 0.45, p = 0.0008), but not with traditional markers of subclinical atherosclerosis. Overall, this subgroup analysis of the ATHERODENT study indicates that patients with advanced PD and UA present a higher amount of calcium in the coronary tree and have a more vulnerable phenotype of their culprit plaques. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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10 pages, 19372 KiB  
Article
Subcutaneous, Paracardiac, and Epicardial Fat CT Density Before/After Contrast Injection: Any Correlation with CAD?
by Caterina Beatrice Monti, Davide Capra, Alexis Malavazos, Giorgia Florini, Carlo Parietti, Simone Schiaffino, Francesco Sardanelli and Francesco Secchi
J. Clin. Med. 2021, 10(4), 735; https://doi.org/10.3390/jcm10040735 - 12 Feb 2021
Cited by 3 | Viewed by 2080
Abstract
Adipose tissue, in particular epicardial adipose tissue, has been identified as a potential biomarker of cardiovascular pathologies such as coronary artery disease (CAD) in the light of its metabolic activity and close anatomic and pathophysiologic relationship to the heart. Our purpose was to [...] Read more.
Adipose tissue, in particular epicardial adipose tissue, has been identified as a potential biomarker of cardiovascular pathologies such as coronary artery disease (CAD) in the light of its metabolic activity and close anatomic and pathophysiologic relationship to the heart. Our purpose was to evaluate epicardial adipose tissue density at both unenhanced and contrast-enhanced computed tomography (CT), along with CT densities of paracardiac and subcutaneous adipose tissue, as well as the relations of such densities with CAD. We retrospectively reviewed patients who underwent cardiac CT at our institution for CAD assessment. We segmented regions of interest on epicardial, paracardiac, and subcutaneous adipose tissue on unenhanced and contrast-enhanced scans. A total of 480 patients were included, 164 of them presenting with CAD. Median epicardial adipose tissue density measured on contrast-enhanced scans (−81.5 HU; interquartile range −84.9 to −78.0) was higher than that measured on unenhanced scans (−73.4 HU; −76.9 to −69.4) (p < 0.001), whereas paracardiac and subcutaneous adipose tissue densities were not (p ≥ 0.055). Patients with or without CAD, did not show significant differences in density of epicardial, paracardiac, and subcutaneous adipose tissue either on unenhanced or contrast-enhanced scans (p ≥ 0.092). CAD patients may experience different phenomena (inflammation, fibrosis, increase in adipose depots) leading to rises or drops in epicardial adipose tissue density, resulting in variations that are difficult to detect. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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Review

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14 pages, 1875 KiB  
Review
Cardiovascular Calcification as a Marker of Increased Cardiovascular Risk and a Surrogate for Subclinical Atherosclerosis: Role of Echocardiography
by Andrea Faggiano, Gloria Santangelo, Stefano Carugo, Gregg Pressman, Eugenio Picano and Pompilio Faggiano
J. Clin. Med. 2021, 10(8), 1668; https://doi.org/10.3390/jcm10081668 - 13 Apr 2021
Cited by 10 | Viewed by 3275
Abstract
The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a [...] Read more.
The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a promising tool to refine the individual cardiovascular risk identified by these models, to prognostic stratify asymptomatic individuals and to implement preventive strategies. Several imaging modalities have been proposed for the identification of subclinical organ damage, the main ones being coronary artery calcification scanning by cardiac computed tomography and the two-dimensional ultrasound evaluation of carotid arteries. In this context, echocardiography offers an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, findings that are associated with the clinical manifestation of atherosclerotic disease and are predictive of future cardiovascular events. The aim of this paper is to summarize the available evidence on clinical implications of cardiac calcification, review studies that propose semiquantitative ultrasound assessments of cardiac calcifications and evaluate the potential of ultrasound calcium scores for risk stratification and prevention of clinical events. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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14 pages, 1725 KiB  
Review
Coronary CT Angiography Guided Medical Therapy in Subclinical Atherosclerosis
by Alyssa L. S. Chow, Saad D. Alhassani, Andrew M. Crean and Gary R. Small
J. Clin. Med. 2021, 10(4), 625; https://doi.org/10.3390/jcm10040625 - 07 Feb 2021
Cited by 12 | Viewed by 2983
Abstract
The goals of primary prevention in coronary atherosclerosis are to avoid sudden cardiac death, myocardial infarction or the need for revascularization procedures. Successful prevention will rely on accurate identification, effective therapy and monitoring of those at risk. Identification and potential monitoring can be [...] Read more.
The goals of primary prevention in coronary atherosclerosis are to avoid sudden cardiac death, myocardial infarction or the need for revascularization procedures. Successful prevention will rely on accurate identification, effective therapy and monitoring of those at risk. Identification and potential monitoring can be achieved using cardiac computed tomography (CT). Cardiac CT can determine coronary artery calcification (CAC), a useful surrogate of coronary atherosclerosis burden. Cardiac CT can also assess coronary CT angiography (CCTA). CCTA can identify arterial lumen narrowing and highlight mural atherosclerosis hitherto hidden from other anatomical approaches. Herein we consider the role of CCTA and CAC-scoring in subclinical atherosclerosis. We explore the use of these modalities in screening and discuss data that has used CCTA for guiding primary prevention. We examine therapeutic trials using CCTA to determine the effects of plaque-modifying therapies. Finally, we address the role of CCTA and CAC to guide therapy as defined in current primary prevention documents. CCTA has emerged as an essential tool in the detection and management of clinical coronary artery disease. To date, its role in subclinical atherosclerosis is less well defined, yet with modern CT scanners and continued pharmacotherapy development, CCTA is likely to achieve a more prominent place in the primary prevention of coronary atherosclerosis. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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14 pages, 18992 KiB  
Review
Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis
by Edoardo Conte, Saima Mushtaq, Davide Marchetti, Vincenzo Mallia, Marta Belmonte, Eleonora Melotti, Gianluca Pontone, Mauro Pepi and Daniele Andreini
J. Clin. Med. 2021, 10(3), 521; https://doi.org/10.3390/jcm10030521 - 01 Feb 2021
Cited by 2 | Viewed by 2489
Abstract
In the present article, an overview of advanced analysis of coronary atherosclerosis by coronary computed tomography angiography (CCTA) is provided, focusing on the potential application of this technique in a primary prevention setting. Coronary artery calcium score (CACS) has a well-demonstrated prognostic value [...] Read more.
In the present article, an overview of advanced analysis of coronary atherosclerosis by coronary computed tomography angiography (CCTA) is provided, focusing on the potential application of this technique in a primary prevention setting. Coronary artery calcium score (CACS) has a well-demonstrated prognostic value even in a primary prevention setting; however, fibro-fatty, high-risk coronary plaque may be missed by this tool. On the contrary, even if not recommended for primary prevention in the general population, CCTA may enable early high-risk atherosclerosis detection, and specific subgroups of patients may benefit from its application. However, further studies are needed to determine the possible use of CCTA in a primary prevention setting. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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Other

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26 pages, 964 KiB  
Systematic Review
Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review
by Liberatore Tramontano, Bruna Punzo, Alberto Clemente, Sara Seitun, Luca Saba, Eduardo Bossone, Erica Maffei, Carlo Cavaliere and Filippo Cademartiri
J. Clin. Med. 2022, 11(19), 5842; https://doi.org/10.3390/jcm11195842 - 01 Oct 2022
Cited by 7 | Viewed by 2434
Abstract
Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate [...] Read more.
Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate management of risk factors and obtaining personalized preventive therapy. This systematic review aims to assess the prognostic value of CAC score in asymptomatic individuals. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the prognostic value of CAC score in asymptomatic individuals. The quality of the included studies was assessed by the QUIPS tool. A total of 45 articles were selected. Many of these (25 studies) evaluated the prognostic value of CAC score in asymptomatic subjects. In comparison, others (20 studies) evaluated the association of CAC score with other clinical parameters and imaging modalities or the comparison with computed tomography coronary angiography (CTCA). Our findings showed that the CAC score provides valuable prognostic information for predicting CAD risk in asymptomatic individuals. Full article
(This article belongs to the Special Issue CT Coronary Angiography in Early Detection of Atherosclerosis)
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