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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary distensibility index measured by computed tomography is associated with the severity of coronary artery
Naser Ahmadi1, David Shavelle, Vahid Nabavi
1Los Angeles Biomedical Research Institute at Harbor University of California Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA. nahmadi@labiomed.org
Insights
Coronary artery disease severity is inversely related to the coronary distensibility index (CDI) measured by computed tomographic angiography (CTA). CTA-derived CDI effectively predicts coronary artery disease (CAD) progression.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Biomedical Engineering
Background:
- Atherosclerosis impacts coronary artery wall distensibility.
- Assessing coronary artery disease (CAD) severity is crucial for patient management.
Purpose of the Study:
- To evaluate the relationship between the coronary distensibility index (CDI) and CAD severity.
- To determine if computed tomographic angiography (CTA) can accurately measure CDI and correlate it with CAD extent.
Main Methods:
- One hundred thirteen subjects underwent coronary artery calcium (CAC) scanning and CTA.
- Coronary distensibility index (CDI) was calculated using lumen cross-sectional area changes during the cardiac cycle derived from CTA.
- Coronary artery disease (CAD) severity was categorized based on stenosis percentage from CTA and compared with quantitative coronary angiography (QCA).
Main Results:
- A strong correlation (r² = 0.96) was found between CTA-derived CDI and QCA.
- CDI significantly decreased with increasing CAD severity, from normal to severe disease (P = 0.004).
- CDI addition to CAC improved the prediction of obstructive CAD (stenosis ≥50%) with an increased ROC area from 0.71 to 0.84 (P < 0.05).
Conclusions:
- Computed tomographic angiography (CTA)-measured coronary distensibility index (CDI) is inversely related to coronary artery disease (CAD) severity.
- CTA-derived CDI provides valuable information for assessing CAD, independent of traditional risk factors and CAC.
- CDI shows potential as a non-invasive imaging biomarker for CAD assessment.
Background:
Atherosclerotic changes within the coronary artery wall can affect vessel distensibility.
Objective:
This study evaluated the relationship between the coronary distensibility index (CDI) and the severity of coronary artery disease (CAD) measured by computed tomographic angiography (CTA).
Methods:
One hundred thirteen subjects, age 63 +/- 10 years, 32% women, who underwent coronary artery calcium (CAC) scanning and CTA, were studied. Early diastolic and mid diastolic (MD) cross-section area (CSA) of the left anterior descending (LAD) artery were measured 5 mm distal to the left main bifurcation. CDI was defined as Deltalumen CSA/[lumen CSA in MD x estimated central pulse pressure (eCPP)] x 10(3) {eCPP = 0.77 x peripheral pulse pressure}. LAD diameter measured by CTA and quantitative coronary angiography (QCA) was compared in 19 subjects without CAD. CAD was defined as normal (no stenosis and CAC 0), mild (stenosis
Results:
Excellent correlation was observed between CTA and QCA measured by CDI (r(2) = 0.96, P = 0.0001). CDI decreased from normal coronaries (6.75 +/- 1.43) to arteries with mild (5.78 +/- 1.45), moderate (3.96 +/- 1.06), and severe (3.31 +/- 1.06) disease (P = 0.004). The risk factor adjusted odds ratio of lowest versus 2 upper tertiles of CDI was 1.28 for mild, 8.47 for moderate, and 10.59 for severe CAD compared with the normal cohort. The area under the ROC curve to predict obstructive CAD (stenosis >or= 50%) increased significantly from 0.71 to 0.84 by addition of CDI to CAC (P < 0.05).
Conclusion:
CTA-measured CDI is inversely related to the severity of CAD independent of age, sex, cardiovascular risk factors, and CAC.
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