Related Experiment Video
Updated: Aug 24, 2025
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
The Quantification of Total Coronary Atheroma Burden - A Major Step Forward
Jean-Marc Foult1, Shruthi Pranesh2, Matthew J Budoff3
1Department of Medicine, American Hospital of Paris, Paris, France.
Insights
Total coronary atheroma burden, measured by cardiac computed tomography (CT), is a superior predictor of cardiovascular events compared to high-risk plaque or stenosis. This review highlights atheroma burden as the best indicator for future cardiovascular disease prognosis.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Radiology
- Preventive Cardiology
Background:
- Coronary artery disease extent impacts prognosis.
- Cardiac computed tomography (CT) quantifies plaque burden using coronary artery calcium scanning and CT angiography (CTA).
- CTA can identify high-risk plaques, associated with acute coronary syndromes, but with limitations.
Purpose of the Study:
- To review literature comparing plaque assessment methods by CT.
- To determine the most effective CT-derived measure for predicting cardiovascular events.
- To establish total coronary atheroma burden as the optimal prognostic indicator.
Main Methods:
- Literature search of MEDLINE, EMBASE, and Cochrane Library.
- Inclusion of studies assessing plaque burden and clinical outcomes via CT.
- Utilized keywords and MeSH terms related to cardiac imaging, plaque, prognosis, and cardiovascular events.
Main Results:
- Total coronary atheroma burden demonstrates superior predictive power for coronary events compared to high-risk plaque or stenosis.
- High-risk plaque assessment shows poor reproducibility and limited positive predictive value.
- Atheroma burden is identified as a more robust predictor of future cardiovascular disease.
Conclusions:
- Total coronary atheroma burden measured by cardiac CT is the most significant predictor of future cardiovascular events.
- This metric surpasses traditional stenosis assessment and high-risk plaque identification for prognostic accuracy.
- Cardiac CT for atheroma burden assessment offers valuable insights for cardiovascular risk stratification.
Abstract:
The extent of coronary artery disease has been shown to be an important indicator of prognosis. Cardiac computed tomography (CT) has the ability to measure plaque, with both coronary artery calcium scanning and CT angiography (CTA), to give a measure of total atheroma burden. Beyond assessing stenosis and atherosclerosis, CTA can assess high-risk plaque. These plaques are thought to be consistent with plaques that are vulnerable and more likely to rupture and cause acute coronary syndromes. However, the high-risk plaque concept suffers from poor reproducibility and poor positive predictive power. Total coronary atheroma burden has been shown to be a better predictor of coronary events than high-risk plaques or stenosis. This paper reviews the literature in this regard and demonstrates total coronary atheroma burden to be the best predictor of future cardiovascular disease. We searched MEDLINE, EMBASE and the Cochrane library database for studies assessing plaque burden and outcomes by CT. We used text words and related Medical Subject Headings (MeSH) for cardiac, calcification, plaque burden, CT, prognosis, mortality, event, death, survival and myocardial infarction.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease II: Pathophysiology