Prognostic Value of Coronary Computed Tomography Angiography-derived Morphologic and Quantitative Plaque Markers Using Semiautomated Plaque Software.

PURPOSE: In this study, we analyzed the prognostic value of coronary computed tomography angiography-derived morphologic and quantitative plaque markers and plaque scores for major adverse cardiovascular events (MACEs). MATERIALS AND METHODS: We analyzed the data of patients with suspected coronary artery disease (CAD). Various plaque markers were obtained using a semiautomated software prototype or derived from the results of the software analysis. Several risk scores were calculated, and follow-up data concerning MACE were collected from all patients. RESULTS: A total of 131 patients (65±12 y, 73% male) were included in our study. MACE occurred in 11 patients within the follow-up period of 34±25 months.CAD-Reporting and Data System score (odds ratio [OR]=11.62), SYNTAX score (SS) (OR=1.11), Leiden-risk score (OR=1.37), segment involvement score (OR=1.76), total plaque volume (OR=1.20), and percentage aggregated plaque volume (OR=1.32) were significant predictors for MACE (all P≤0.05). Moreover, the difference of the corrected coronary opacification (ΔCCO) correlated significantly with the occurrence of MACE (P<0.0001). The CAD-Reporting and Data System score, SS, and Leiden-risk score showed substantial sensitivity for predicting MACE (90.9%). The SS and Leiden-risk score displayed high specificities of 80.8% and 77.5%, respectively. These plaque markers and risk scores all provided high negative predictive value (>90%). CONCLUSION: The coronary computed tomography angiography-derived plaque markers of segment involvement score, total plaque volume, percentage aggregated plaque volume, and ΔCCO, and the risk scores exhibited predictive value for the occurrence of MACE and can likely aid in identifying patients at risk for future cardiac events.

Association of Serum Lipid Profile With Coronary Computed Tomographic Angiography-derived Morphologic and Functional Quantitative Plaque Markers.

PURPOSE: Recent advances in image quality of coronary computed tomographic angiography (cCTA) have enabled improved characterization of coronary plaques. Thus, we investigated the association between quantitative morphological plaque markers obtained by cCTA and serum lipid levels in patients with suspected or known coronary artery disease. MATERIALS AND METHODS: We retrospectively analyzed data of 119 statin-naive patients (55±14 y, 66% men) who underwent clinically indicated cCTA between January 2013 and February 2017. Patients were subdivided into a plaque and a no-plaque group. Quantitative and morphologic plaque markers, such as segment involvement score, segment stenosis score, remodeling index, napkin-ring sign, total plaque volume, calcified plaque volume, and noncalcified plaque volume (NCPV) and plaque composition, were analyzed using a semiautomated plaque software prototype. Total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, low-density lipoprotein/high-density lipoprotein ratio, and triglycerides were determine in both groups. RESULTS: Higher age (61±11 y vs. 52±14 y, P<0.0001) and a higher likelihood of male gender (77% vs. 56%, P<0.0001) were observed in the plaque group. Differences in lipid levels were neither observed for differentiation between plaque presence or absence, nor after subcategorization for plaque composition. LDL serum levels >160 mg/dL correlated with higher NCPV compared with patients with LDL between 100 and 160 mg/dL (112 vs. 27 mm, P=0.037). Other markers were comparable between the different groups. CONCLUSION: Statin-naive patients with known or suspected coronary artery disease did not show differences in lipid levels related to plaque composition by cCTA. Patients with plaques tended to be men and were significantly older. High LDL levels correlated with high NCPV.

Clinical Impact of Rest Dual-energy Computed Tomography Myocardial Perfusion in Patients with Coronary Artery Disease.

BACKGROUND/AIM: To evaluate the hypothesis that patients with suspected coronary artery disease (CAD) assessed using rest dual-energy computed tomography-derived myocardial perfusion imaging (DECT-P), could have fewer invasive coronary angiographies (ICA), showing non-obstructive CAD. MATERIALS AND METHODS: Patients who had undergone coronary computed tomography angiography (cCTA), rest DECT-P and ICA were analyzed. RESULTS: We evaluated 51 patients (62.7% males, mean age 51.6±12.8 years). Rest DECT-P identified perfusion defects in three (10.7%) of the 28 patients with cCTA negative for luminal stenosis and in 10 (43.5%) of the 23 patients with cCTA positive for luminal stenosis. In total, 21 patients underwent both cCTA and ICA, of which seven (33.3%) showed obstructive CAD. Rest DECT-P revealed false-negative results in four cases (19.1%) and false-positive results in six cases (28.6%). CONCLUSION: Adding rest DECT-P to cCTA has no incremental diagnostic value over cCTA alone, to exclude haemodynamically significant CAD. Therefore, a rest-stress-DECT-P protocol or a CT-based FFR calculation might be a promising concept to improve diagnostic accuracy in a real clinical setting.