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Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia.
J Cardiovasc Comput Tomogr. 2019 Nov - Dec; 13(6):305-314.JC

Abstract

BACKGROUND

The association of plaque morphology with ischemia in non-obstructive lesions has not been fully eludicated: Calcium density and high-risk plaque features have not been explored.

OBJECTIVES

to assess whether high-risk plaque or calcified, and global mixed including non-calcified plaque burden (G-score) by coronary CTA predict ischemia in non-obstructive lesions using non-invasive fractional flow reserve (FFRCT).

METHODS

In 106 patients with low-to-intermediate pre-test probability referred to coronary 128-slice dual source CTA, lesion-based and distal FFRCT were computated. The 4 high-risk-plaque criteria: Low-attenuation-plaque, Napkin Ring Sign, positive remodelling and spotty calcification were recorded. Plaque density (HU) and stenosis (MLA,MLD,%area,%diameter stenosis) were quantified. Plaque composition was classified as type 1-4:1 = calcified, 2 = mixed (calcified > non-calcified), 3 = mixed (non-calcified > calcified), 4 = non-calcified, and expressed by the G-score: Z = Sum of type 1-4 per segment. The total plaque segment involvement score (SIS) and the Coronary Calcium Score (Agatston) were calculated.

RESULTS

89 non-obstructive lesions were included. Both lesion-based and distal FFRCT were lower in high-risk-plaque as compared to calcified (0.85 vs 0.93, p < 0.001 and 0.79 vs 0.86, p = 0.002). The prevalence of lesion-based ischemia (FFRCT<0.8) was higher in high-risk-plaque as compared to calcified (25% vs. 2.5%, p = 0.007). Similarly, the rate of distal ischemia (40% vs 17.5%) was higher, respectively. Lower plaque density (HU) indicating higher lipid plaque component (p = 0.024) predicted lesion based FFRCT in low attenuation plaque. For all lesions (n = 89) including calcified (p = 0.003), the correlation enhanced. Positive remodelling and an increasing non-calcified plaque burden (G-score) in relation to calcified were associated with lower FFRCT distal (p = 0.042), but not the SIS and calcium score.

CONCLUSION

High-risk-plaque but not calcified, an increasing lipid-necrotic-core component and non-calcified mixed plaque burden (G-score) predict ischemia in non-obstructive lesions (INOCA), while an increasing calcium compactness acts contrary.

Authors+Show Affiliations

Dept. Radiology, Innsbruck Medical University, Austria. Electronic address: Gudrun.Feuchtner@i-med.ac.at.Dept. Internal Medicine III, Cardiology, Innsbruck Medical University, Austria.Dept. Radiology, Innsbruck Medical University, Austria.Dept. Radiology, Innsbruck Medical University, Austria.Dept. Radiology, Innsbruck Medical University, Austria.Dept. Internal Medicine III, Cardiology, Innsbruck Medical University, Austria.Dept. Radiology, Innsbruck Medical University, Austria.Dept. Internal Medicine III, Cardiology, Innsbruck Medical University, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30661963

Citation

Feuchtner, Gudrun M., et al. "Non Obstructive High-risk Plaque but Not Calcified By Coronary CTA, and the G-score Predict Ischemia." Journal of Cardiovascular Computed Tomography, vol. 13, no. 6, 2019, pp. 305-314.
Feuchtner GM, Barbieri F, Langer C, et al. Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia. J Cardiovasc Comput Tomogr. 2019;13(6):305-314.
Feuchtner, G. M., Barbieri, F., Langer, C., Beyer, C., Widmann, G., Friedrich, G. J., Cartes-Zumelzu, F., & Plank, F. (2019). Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia. Journal of Cardiovascular Computed Tomography, 13(6), 305-314. https://doi.org/10.1016/j.jcct.2019.01.010
Feuchtner GM, et al. Non Obstructive High-risk Plaque but Not Calcified By Coronary CTA, and the G-score Predict Ischemia. J Cardiovasc Comput Tomogr. 2019 Nov - Dec;13(6):305-314. PubMed PMID: 30661963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia. AU - Feuchtner,Gudrun M, AU - Barbieri,Fabian, AU - Langer,Christian, AU - Beyer,Christoph, AU - Widmann,Gerlig, AU - Friedrich,Guy J, AU - Cartes-Zumelzu,Fabiola, AU - Plank,Fabian, Y1 - 2019/01/04/ PY - 2018/09/24/received PY - 2018/11/11/revised PY - 2019/01/03/accepted PY - 2019/1/22/pubmed PY - 2020/2/11/medline PY - 2019/1/22/entrez SP - 305 EP - 314 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 13 IS - 6 N2 - BACKGROUND: The association of plaque morphology with ischemia in non-obstructive lesions has not been fully eludicated: Calcium density and high-risk plaque features have not been explored. OBJECTIVES: to assess whether high-risk plaque or calcified, and global mixed including non-calcified plaque burden (G-score) by coronary CTA predict ischemia in non-obstructive lesions using non-invasive fractional flow reserve (FFRCT). METHODS: In 106 patients with low-to-intermediate pre-test probability referred to coronary 128-slice dual source CTA, lesion-based and distal FFRCT were computated. The 4 high-risk-plaque criteria: Low-attenuation-plaque, Napkin Ring Sign, positive remodelling and spotty calcification were recorded. Plaque density (HU) and stenosis (MLA,MLD,%area,%diameter stenosis) were quantified. Plaque composition was classified as type 1-4:1 = calcified, 2 = mixed (calcified > non-calcified), 3 = mixed (non-calcified > calcified), 4 = non-calcified, and expressed by the G-score: Z = Sum of type 1-4 per segment. The total plaque segment involvement score (SIS) and the Coronary Calcium Score (Agatston) were calculated. RESULTS: 89 non-obstructive lesions were included. Both lesion-based and distal FFRCT were lower in high-risk-plaque as compared to calcified (0.85 vs 0.93, p < 0.001 and 0.79 vs 0.86, p = 0.002). The prevalence of lesion-based ischemia (FFRCT<0.8) was higher in high-risk-plaque as compared to calcified (25% vs. 2.5%, p = 0.007). Similarly, the rate of distal ischemia (40% vs 17.5%) was higher, respectively. Lower plaque density (HU) indicating higher lipid plaque component (p = 0.024) predicted lesion based FFRCT in low attenuation plaque. For all lesions (n = 89) including calcified (p = 0.003), the correlation enhanced. Positive remodelling and an increasing non-calcified plaque burden (G-score) in relation to calcified were associated with lower FFRCT distal (p = 0.042), but not the SIS and calcium score. CONCLUSION: High-risk-plaque but not calcified, an increasing lipid-necrotic-core component and non-calcified mixed plaque burden (G-score) predict ischemia in non-obstructive lesions (INOCA), while an increasing calcium compactness acts contrary. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/30661963/Non_obstructive_high_risk_plaque_but_not_calcified_by_coronary_CTA_and_the_G_score_predict_ischemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(18)30397-6 DB - PRIME DP - Unbound Medicine ER -