Related Experiment Video
Updated: Nov 29, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Comparative differences in the atherosclerotic disease burden between the epicardial coronary arteries: quantitative
A Maxim Bax1, Alexander R van Rosendael1,2, Xiaoyue Ma3
1Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
Insights
Coronary artery disease plaque burden and composition differ significantly across major coronary arteries. The left circumflex artery (LCx) shows lower plaque volume and distinct features compared to the left anterior descending (LAD) and right coronary artery (RCA).
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Pathology
Background:
- Coronary artery disease (CAD) assessment typically focuses on extent and severity.
- Understanding plaque burden and composition variations is crucial for risk stratification.
Purpose of the Study:
- To compare atherosclerotic plaque volume and composition across the left circumflex (LCx), right coronary artery (RCA), and left anterior descending (LAD) arteries.
- To investigate differences in high-risk plaque features and stenosis severity among these major epicardial vessels.
Main Methods:
- Prospective coronary computed tomography angiography (CCTA) in 1271 patients with suspected CAD.
- Quantification of atherosclerotic plaque volume and composition (necrotic core, fibrofatty, fibrous, calcified).
- Comparison of per-vessel measures using generalized estimating equation models.
Main Results:
- Total plaque volume was significantly lower in the LCx compared to the LAD and RCA.
- The LCx had a lower prevalence of high-risk plaque features and less diameter stenosis.
- Lesions in the LCx were more frequently categorized as largely calcified and located distally.
Conclusions:
- Significant variations in atherosclerotic plaque burden and composition exist among epicardial coronary arteries.
- The LCx artery exhibits a lower plaque burden and different plaque characteristics compared to the LAD and RCA.
- These findings suggest a heterogeneous environment for plaque development, potentially influencing acute coronary risk across different arteries.
Aims:
Anatomic series commonly report the extent and severity of coronary artery disease (CAD), regardless of location. The aim of this study was to evaluate differences in atherosclerotic plaque burden and composition across the major epicardial coronary arteries.
Methods And Results:
A total of 1271 patients (age 60 ± 9 years; 57% men) with suspected CAD prospectively underwent coronary computed tomography angiography (CCTA). Atherosclerotic plaque volume was quantified with categorization by composition (necrotic core, fibrofatty, fibrous, and calcified) based on Hounsfield Unit density. Per-vessel measures were compared using generalized estimating equation models. On CCTA, total plaque volume was lowest in the LCx (10.0 ± 29.4 mm3), followed by the RCA (32.8 ± 82.7 mm3; P < 0.001), and LAD (58.6 ± 83.3 mm3; P < 0.001), even when correcting for vessel length or volume. The prevalence of ≥2 high-risk plaque features, such as positive remodelling or spotty calcification, occurred less in the LCx (3.8%) when compared with the LAD (21.4%) or RCA (10.9%, P < 0.001). In the LCx, the most stenotic lesion was categorized as largely calcified more often than in the RCA and LAD (55.3% vs. 39.4% vs. 32.7%; P < 0.001). Median diameter stenosis was also lowest in the LCx (16.2%) and highest in the LAD (21.3%; P < 0.001) and located more distal along the LCx when compared with the RCA and LAD (P < 0.001).
Conclusion:
Atherosclerotic plaque, irrespective of vessel volume, varied across the epicardial coronary arteries; with a significantly lower burden and different compositions in the LCx when compared with the LAD and RCA. These volumetric and compositional findings support a diverse milieu for atherosclerotic plaque development and may contribute to a varied acute coronary risk between the major epicardial coronary arteries.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations