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Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the
Alexander R van Rosendael1, Fay Y Lin2, Xiaoyue Ma3
1Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Insights
Percent atheroma volume (PAV) is less affected by body surface area (BSA) than total plaque volume (PV) or normalized total atheroma volume (TAVnorm). PAV may be the preferred method for reporting coronary atherosclerotic burden from CCTA.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Biomedical Engineering
Background:
- Coronary computed tomography angiography (CCTA) is used to assess whole-heart atherosclerotic plaque.
- Various methodologies exist for reporting plaque burden.
- Standardization is needed to account for patient variability.
Purpose of the Study:
- To compare three common plaque burden definitions: total plaque volume (PV), percent atheroma volume (PAV), and normalized total atheroma volume (TAVnorm).
- To determine which definition is least affected by body surface area (BSA) and sex.
- To identify the optimal method for reporting coronary atherosclerotic burden.
Main Methods:
- Analysis of baseline CCTA data from the PARADIGM study (n=1479).
- Quantification of coronary lumen, vessel, and plaque on a per-patient basis.
- Comparison of PV, PAV, and TAVnorm between patients in the top BSA quartile and others, and between sexes.
Main Results:
- Patients with larger BSA had significantly higher PV and TAVnorm, but similar PAV.
- Coronary vessel volume mediated the relationship between BSA and absolute plaque volumes (PV, TAVnorm).
- PAV showed no significant correlation with vessel volume, unlike PV and TAVnorm.
Conclusions:
- Percent atheroma volume (PAV) is less influenced by body surface area compared to total plaque volume (PV) and normalized total atheroma volume (TAVnorm).
- PAV may be the preferred method for reporting coronary atherosclerotic burden due to its reduced dependence on patient size.
- Further standardization in reporting plaque burden is recommended.
Background And Aims:
Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.
Methods:
The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed.
Results:
The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex.
Conclusions:
PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.
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