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Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up.
J Cardiovasc Comput Tomogr. 2016 Mar-Apr; 10(2):97-104.JC

Abstract

OBJECTIVE

We sought to assess the incremental prognostic value of quantitative plaque characterization beyond established CT risk scores.

BACKGROUND

Several plaque characteristics detectable by coronary computed tomographic angiography (coronary CTA) are thought to be indicative of vulnerable plaques and subsequent cardiac events, particularly low attenuation plaque volume (LAPV), positive remodeling and the napkin-ring sign which is high density vascular adhesion with a small center of low density. It is unknown how quantitative plaque assessment can contribute to the long-term prediction of cardiovascular events in relation to established CT risk scores such as the calcium score or Segment Stenosis Score (SSS).

METHODS

In 1168 consecutive patients with suspected coronary artery disease (CAD), calcium score measurement and coronary plaque characterization was performed comprising the presence of calcified, non-calcified, and partially calcified plaques on a per-segment basis. In all non-calcified or partially calcified plaques, semi-automated plaque analysis was performed to quantify low attenuation plaque volume (density <30 HU), total non-calcified plaque volume (<150 HU, TNCPV) and remodeling index. The presence of the napkin-ring sign was assessed visually. The study endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction and coronary revascularization more than 90 days after coronary CTA.

RESULTS

During a clinical follow up of 5.7 years, MACE was observed in 46 patients (3.9%). All plaque characteristics were associated with MACE. The strongest association was observed for LAPV (HR 1.12, p < 0.0001). LAPV showed incremental prognostic value in a stepwise multivariable model including the Morise Score for clinical risk, calcium score and SSS (p = 0.036).

CONCLUSION

LAPV, TPV, PR and presence of the napkin-ring sign are predictors of MACE independently of clinical risk presentation. LAPV carries slight additional prognostic information beyond the calcium score and conventional coronary CTA analysis. It may therefore improve risk prediction after CT imaging.

Authors+Show Affiliations

Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. Electronic address: mhy@dhm.mhn.de.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26837235

Citation

Nadjiri, Jonathan, et al. "Incremental Prognostic Value of Quantitative Plaque Assessment in Coronary CT Angiography During 5 Years of Follow Up." Journal of Cardiovascular Computed Tomography, vol. 10, no. 2, 2016, pp. 97-104.
Nadjiri J, Hausleiter J, Jähnichen C, et al. Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. J Cardiovasc Comput Tomogr. 2016;10(2):97-104.
Nadjiri, J., Hausleiter, J., Jähnichen, C., Will, A., Hendrich, E., Martinoff, S., & Hadamitzky, M. (2016). Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. Journal of Cardiovascular Computed Tomography, 10(2), 97-104. https://doi.org/10.1016/j.jcct.2016.01.007
Nadjiri J, et al. Incremental Prognostic Value of Quantitative Plaque Assessment in Coronary CT Angiography During 5 Years of Follow Up. J Cardiovasc Comput Tomogr. 2016 Mar-Apr;10(2):97-104. PubMed PMID: 26837235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. AU - Nadjiri,Jonathan, AU - Hausleiter,Jörg, AU - Jähnichen,Christin, AU - Will,Albrecht, AU - Hendrich,Eva, AU - Martinoff,Stefan, AU - Hadamitzky,Martin, Y1 - 2016/01/13/ PY - 2015/03/02/received PY - 2015/12/16/revised PY - 2016/01/11/accepted PY - 2016/2/4/entrez PY - 2016/2/4/pubmed PY - 2016/12/15/medline KW - Coronary artery disease KW - Coronary computed tomographic angiography KW - Napkin-ring sign KW - Plaque characterization KW - Prognosis SP - 97 EP - 104 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 10 IS - 2 N2 - OBJECTIVE: We sought to assess the incremental prognostic value of quantitative plaque characterization beyond established CT risk scores. BACKGROUND: Several plaque characteristics detectable by coronary computed tomographic angiography (coronary CTA) are thought to be indicative of vulnerable plaques and subsequent cardiac events, particularly low attenuation plaque volume (LAPV), positive remodeling and the napkin-ring sign which is high density vascular adhesion with a small center of low density. It is unknown how quantitative plaque assessment can contribute to the long-term prediction of cardiovascular events in relation to established CT risk scores such as the calcium score or Segment Stenosis Score (SSS). METHODS: In 1168 consecutive patients with suspected coronary artery disease (CAD), calcium score measurement and coronary plaque characterization was performed comprising the presence of calcified, non-calcified, and partially calcified plaques on a per-segment basis. In all non-calcified or partially calcified plaques, semi-automated plaque analysis was performed to quantify low attenuation plaque volume (density <30 HU), total non-calcified plaque volume (<150 HU, TNCPV) and remodeling index. The presence of the napkin-ring sign was assessed visually. The study endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction and coronary revascularization more than 90 days after coronary CTA. RESULTS: During a clinical follow up of 5.7 years, MACE was observed in 46 patients (3.9%). All plaque characteristics were associated with MACE. The strongest association was observed for LAPV (HR 1.12, p < 0.0001). LAPV showed incremental prognostic value in a stepwise multivariable model including the Morise Score for clinical risk, calcium score and SSS (p = 0.036). CONCLUSION: LAPV, TPV, PR and presence of the napkin-ring sign are predictors of MACE independently of clinical risk presentation. LAPV carries slight additional prognostic information beyond the calcium score and conventional coronary CTA analysis. It may therefore improve risk prediction after CT imaging. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/26837235/Incremental_prognostic_value_of_quantitative_plaque_assessment_in_coronary_CT_angiography_during_5_years_of_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(16)30005-3 DB - PRIME DP - Unbound Medicine ER -