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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population
Toshiki Kuno1, Javier Arce1, Michael Fattouh1
1Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States.
Insights
Low-attenuation non-calcified plaque (LAP) burden predicts cardiovascular outcomes, especially in Hispanic patients. Elevated LAP, linked to risk factors like hypertension, is a significant prognostic marker.
Area of Science:
- Cardiology
- Radiology
- Biomarkers
Background:
- Coronary CT angiography (CCTA) identifies high-risk plaque features like low-attenuation non-calcified plaque (LAP) and pericoronary adipose tissue (PCAT) inflammation.
- These imaging biomarkers are associated with cardiovascular outcomes.
Purpose of the Study:
- To investigate the relationship between cardiometabolic risk factors, including lipoprotein(a) and epicardial adipose tissue (EAT), and CCTA-derived LAP and vascular inflammation.
- To assess the prognostic significance of these imaging biomarkers.
Main Methods:
- Retrospective analysis of 364 patients undergoing CCTA for stable chest pain.
- Semiautomated software used to measure plaque, PCAT, and EAT from CT.
- Defined elevated LAP (≥4%) and PCAT attenuation (≥70.5 HU).
- Primary endpoint: composite of myocardial infarction, revascularization, or cardiovascular death.
Main Results:
- Prevalence of elevated LAP was 31% and elevated PCAT attenuation was 18%.
- Lipoprotein(a) correlated with LAP burden in Hispanic patients.
- Elevated LAP was associated with older age, diabetes, hypertension, hyperlipidemia, smoking, higher CAC, and increased EAT volume.
- Elevated LAP, but not elevated PCAT, was significantly associated with adverse cardiovascular outcomes (P<0.001).
Conclusions:
- Elevated LAP burden is a significant predictor of cardiovascular events.
- Cardiometabolic risk factors like hypertension and hyperlipidemia increase the odds of elevated LAP.
- Lipoprotein(a) shows a correlation with LAP burden in specific ethnic groups (Hispanic patients).
Introduction:
Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation.
Methods:
The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death.
Results:
A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797).
Conclusion:
The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.
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