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Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up.
Eur Heart J Cardiovasc Imaging. 2017 Dec 01; 18(12):1331-1339.EH

Abstract

Aims

Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up.

Methods and results

Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score.

Conclusion

Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.

Authors+Show Affiliations

Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Oklahoma Heart Institute, 1265 S. Utica Avenue Suite 300, Tulsa, OK 74104, USA.Mount Sinai St Lukes Hospital Cardiology, Division of Cardiology, 1111 Amsterdam Ave FL 3, New York, NY 10025, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany.Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28950315

Citation

Hell, Michaela M., et al. "Quantitative Global Plaque Characteristics From Coronary Computed Tomography Angiography for the Prediction of Future Cardiac Mortality During Long-term Follow-up." European Heart Journal Cardiovascular Imaging, vol. 18, no. 12, 2017, pp. 1331-1339.
Hell MM, Motwani M, Otaki Y, et al. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging. 2017;18(12):1331-1339.
Hell, M. M., Motwani, M., Otaki, Y., Cadet, S., Gransar, H., Miranda-Peats, R., Valk, J., Slomka, P. J., Cheng, V. Y., Rozanski, A., Tamarappoo, B. K., Hayes, S., Achenbach, S., Berman, D. S., & Dey, D. (2017). Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. European Heart Journal Cardiovascular Imaging, 18(12), 1331-1339. https://doi.org/10.1093/ehjci/jex183
Hell MM, et al. Quantitative Global Plaque Characteristics From Coronary Computed Tomography Angiography for the Prediction of Future Cardiac Mortality During Long-term Follow-up. Eur Heart J Cardiovasc Imaging. 2017 Dec 1;18(12):1331-1339. PubMed PMID: 28950315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. AU - Hell,Michaela M, AU - Motwani,Manish, AU - Otaki,Yuka, AU - Cadet,Sebastien, AU - Gransar,Heidi, AU - Miranda-Peats,Romalisa, AU - Valk,Jacob, AU - Slomka,Piotr J, AU - Cheng,Victor Y, AU - Rozanski,Alan, AU - Tamarappoo,Balaji K, AU - Hayes,Sean, AU - Achenbach,Stephan, AU - Berman,Daniel S, AU - Dey,Damini, PY - 2016/12/20/received PY - 2017/06/22/accepted PY - 2017/9/28/pubmed PY - 2018/7/28/medline PY - 2017/9/27/entrez KW - cardiac death KW - coronary computed tomography angiography KW - coronary plaque KW - plaque burden KW - prognosis SP - 1331 EP - 1339 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 18 IS - 12 N2 - Aims: Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up. Methods and results: Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score. Conclusion: Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/28950315/Quantitative_global_plaque_characteristics_from_coronary_computed_tomography_angiography_for_the_prediction_of_future_cardiac_mortality_during_long_term_follow_up_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jex183 DB - PRIME DP - Unbound Medicine ER -