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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Comparison of Coronary Artery Calcium and Quantitative Coronary Plaque in Predicting Obstructive Coronary Artery
Venkat Sanjay Manubolu1, Suraj Dahal1, Suvasini Lakshmanan1
1Lundquist Institute, Harbor UCLA, Torrance, CA, USA.
Insights
Coronary artery calcium (CAC) score and plaque volumes (CPV, TPV) from CCTA predict obstructive coronary artery disease (CAD). CPV and TPV show higher sensitivity than CAC for detecting significant stenosis, though CAC has comparable negative predictive value to CPV.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Agatston coronary artery calcium (CAC) score is a known mortality predictor.
- The relationship between CAC and quantitative calcified plaque volume (CPV) on CCTA is not fully understood.
- Limited evidence compares CAC, CPV, and total plaque volume (TPV) in predicting obstructive coronary artery disease (CAD).
Purpose of the Study:
- To investigate the relationship between CAC and quantitative plaque volumes (CPV, TPV) measured by CCTA.
- To compare the diagnostic performance of CAC, CPV, and TPV in detecting obstructive CAD.
Main Methods:
- 147 patients from the CLARIFY registry undergoing CCTA and CAC scoring.
- Automated software for CCTA plaque quantification (CPV, TPV) and stenosis assessment.
- Standard Agatston method for CAC measurement.
- Spearman correlation and ROC analysis to evaluate diagnostic abilities.
Main Results:
- Strong positive correlations found between CAC and CPV (r=0.76) and CAC and TPV (r=0.72).
- CPV (77%) and TPV showed higher sensitivity than CAC (68%) for predicting >50% stenosis.
- TPV demonstrated higher negative predictive value than CAC for obstructive CAD.
Conclusions:
- CPV and TPV are more sensitive than CAC for predicting obstructive CAD severity.
- CAC's negative predictive value is comparable to CPV but lower than TPV.
- This study clarifies CAC relationships with plaque volumes and highlights differences between CAC and CPV/TPV in obstructive CAD prediction.
Abstract:
Background: Agatston coronary artery calcium (CAC) score is a strong predictor of mortality. However, the relationship between CAC and quantitative calcified plaque volume (CPV), which is measured on coronary computed tomography angiography (CCTA), is not well understood. Furthermore, there is limited evidence evaluating the difference between CAC versus CPV and CAC versus total plaque volume (TPV) in predicting obstructive coronary artery disease (CAD). Methods: This study included 147 subjects from the CLARIFY registry, a multicentered study of patients undergoing assessment using CCTA and CAC score as part of acute and stable chest pain evaluation. Automated software service (Cleerly.Inc, Denver, CO, USA) was used to evaluate the degree of vessel stenosis and plaque quantification on CCTA. CAC was measured using the standard Agatston method. Spearman correlation and receiver operating characteristic curve analysis was performed to evaluate the diagnostic ability of CAC, CPV and TPV in detecting obstructive CAD. Results: Results demonstrated a very strong positive correlation between CAC and CPV (r=0.76, p=0.0001) and strong correlation between CAC and TPV (r=0.72, p<0.001) at per-patient level analysis. At per-patient level analysis, the sensitivity of CAC (68%) is lower than CPV (77%) in predicting >50% stenosis, but negative predictive value is comparable. However, the sensitivity of TPV is higher compared with CAC in predicting >50% stenosis, and the negative predictive value of TPV is also higher. Conclusion: CPV and TPV are more sensitive in predicting the severity of obstructive CAD compared with the CAC score. However, the negative predictive value of CAC is comparable to CPV, but is lower than TPV. This study elucidates the relationship between CAC and quantitative plaque types, and especially emphasizes the differences between CAC and CPV which are two distinct plaque measurement techniques that are utilized in predicting obstructive CAD.
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