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Coronary Atherosclerotic Plaque Burden Assessment by Computed Tomography and Its Clinical Implications
Nishant Vatsa1, Christian Faaborg-Andersen2, Tiffany Dong3
1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.V.).
Insights
Coronary plaque burden, assessed by computed tomography (CT) methods like calcium scoring and CT angiography, is a better predictor of cardiovascular disease than ischemia. These advanced imaging techniques improve risk stratification and patient care.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary plaque burden is increasingly recognized as a superior predictor of adverse atherosclerotic cardiovascular disease (ASCVD) outcomes compared to myocardial ischemia.
- Traditional stress testing is being complemented by advanced computed tomography (CT) methods for earlier and more cost-effective coronary disease detection.
Purpose of the Study:
- To review recent clinical data on coronary artery calcium scoring and coronary CT angiography for plaque quantification.
- To compare noninvasive CT methods with invasive angiography for assessing coronary plaque burden.
- To evaluate the performance characteristics of coronary artery calcium scoring versus coronary CT angiography.
Main Methods:
- Noncontrast CT for coronary artery calcium scoring.
- Contrast-enhanced CT angiography for coronary CT angiography.
- Comparison with invasive coronary angiography for disease burden correlation.
Main Results:
- Coronary plaque quantification via noncontrast CT (calcium scoring) and contrast-enhanced CT angiography correlates with invasive angiography findings.
- These noninvasive imaging modalities demonstrate utility in risk stratification and prognostication of adverse cardiovascular events.
- Artificial intelligence is being integrated to enhance plaque quantification platforms.
Conclusions:
- Coronary plaque burden assessment using CT methods offers greater prognostic value than myocardial ischemia.
- Coronary artery calcium scoring and coronary CT angiography are valuable tools for risk stratification in patients with and without chest pain.
- Ongoing technological advancements, including AI, are further refining coronary plaque evaluation.
Abstract:
Recent studies have demonstrated that coronary plaque burden carries greater prognostic value in predicting adverse atherosclerotic cardiovascular disease outcomes than myocardial ischemia, thereby challenging the existing paradigm. Advances in plaque quantification through both noncontrast and contrast-enhanced computed tomography (CT) methods have led to earlier and more cost-effective detection of coronary disease compared with traditional stress testing. The 2 principal techniques of noninvasive coronary plaque quantification assessment are coronary artery calcium scoring by noncontrast CT and coronary CT angiography, both of which correlate with disease burden on invasive angiography. Plaque quantification from these imaging modalities has shown utility in risk stratification and prognostication of adverse cardiovascular events, leading to increased incorporation into clinical practice guidelines and preventive care pathways. Furthermore, due to their expanding clinical value, emerging technologies such as artificial intelligence are being integrated into plaque quantification platforms, placing more advanced measures of plaque burden at the forefront of coronary plaque evaluation. In this review, we summarize recent clinical data on coronary artery calcium scoring and coronary CT angiography plaque quantification in the evaluation of adverse atherosclerotic cardiovascular disease in patients with and without chest pain, highlight how these methods compare to invasive quantification approaches, and directly compare the performance characteristics of coronary artery calcium scoring and coronary CT angiography.
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