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Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector

Martina C de Knegt1,2, Jesper J Linde1, Andreas Fuchs1

  • 1Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.

European Heart Journal. Cardiovascular Imaging
|October 17, 2018
PubMed

Insights

Quantitative computed tomography (QCT) reveals that coronary atherosclerotic plaque volume and composition significantly differ based on clinical presentation. This highlights distinct morphological features associated with patient risk profiles and symptoms.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Coronary atherosclerosis assessment traditionally relies on non-invasive imaging.
  • Quantitative computed tomography (QCT) offers detailed morphological analysis of coronary plaque.
  • Understanding the link between clinical presentation and plaque characteristics is crucial for risk stratification.

Purpose of the Study:

  • To investigate whether distinct morphological features of coronary atherosclerosis are associated with different clinical patient presentations.
  • To correlate quantitative plaque characteristics with clinical risk profiles.

Main Methods:

  • 1652 participants with varying clinical risk profiles underwent multidetector computed tomography.
  • QCT was used in a subset (n=801) to analyze coronary plaque volume and composition (dense calcium, fibrous, fibro fatty, necrotic core).
  • Analysis included assessment of vulnerable plaques based on volume and tissue composition.

Main Results:

  • Coronary plaque volume significantly increased with worsening clinical risk profile (asymptomatic, chest pain without ACS, chest pain with ACS).
  • Plaque composition significantly differed across cohorts, with decreasing dense calcium and increasing fibro fatty and necrotic core proportions in higher-risk groups.
  • These compositional differences persisted after multivariable adjustment for multiple clinical and imaging variables.

Conclusions:

  • Coronary atherosclerotic plaque volume and composition are strongly associated with clinical presentation.
  • QCT-derived plaque morphology provides insights into the pathophysiology underlying different clinical scenarios of coronary artery disease.
Abstract

Keywords:
atherosclerosiscardiac computed tomography angiographyplaque compositionplaque quantificationplaque volumequantitative computed tomography

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