Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Characteristics Detected on Computed Tomography Angiography Predict Coronary Artery Plaque Progression in Non-Culprit Lesions

  • Tan, Yahang (Department of Cardiology, Chinese PLA General Hospital) ;
  • Zhou, Jia (Department of Cardiology, Chinese PLA General Hospital) ;
  • Zhou, Ying (Department of Cardiology, Chinese PLA General Hospital) ;
  • Yang, Xiaobo (Department of Cardiology, Chinese PLA General Hospital) ;
  • Yang, Junjie (Department of Cardiology, Chinese PLA General Hospital) ;
  • Chen, Yundai (Department of Cardiology, Chinese PLA General Hospital)
  • Received : 2016.06.25
  • Accepted : 2016.10.03
  • Published : 2017.06.01
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Abstract

Objective: This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). Materials and Methods: In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. Results: Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391-24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103-22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242-43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000-1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). Conclusion: Noninvasive assessment of NCLs by CCTA has potential prognostic value.

Keywords

References

  1. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011;364:226-235 https://doi.org/10.1056/NEJMoa1002358
  2. Glaser R, Selzer F, Faxon DP, Laskey WK, Cohen HA, Slater J, et al. Clinical progression of incidental, asymptomatic lesions discovered during culprit vessel coronary intervention. Circulation 2005;111:143-149 https://doi.org/10.1161/01.CIR.0000150335.01285.12
  3. Narula J, Kovacic JC. Putting TCFA in clinical perspective. J Am Coll Cardiol 2014;64:681-683 https://doi.org/10.1016/j.jacc.2014.06.1163
  4. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007;50:319-326 https://doi.org/10.1016/j.jacc.2007.03.044
  5. Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 2009;54:49-57 https://doi.org/10.1016/j.jacc.2009.02.068
  6. Inoue K, Motoyama S, Sarai M, Sato T, Harigaya H, Hara T, et al. Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention. JACC Cardiovasc Imaging 2010;3:691-698 https://doi.org/10.1016/j.jcmg.2010.04.011
  7. Motoyama S, Sarai M, Narula J, Ozaki Y. Coronary CT angiography and high-risk plaque morphology. Cardiovasc Interv Ther 2013;28:1-8 https://doi.org/10.1007/s12928-012-0140-1
  8. Hajsadeghi F, Nabavi V, Bhandari A, Choi A, Vincent H, Flores F, et al. Increased epicardial adipose tissue is associated with coronary artery disease and major adverse cardiovascular events. Atherosclerosis 2014;237:486-489 https://doi.org/10.1016/j.atherosclerosis.2014.09.037
  9. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients with Chronic Stable Angina). J Am Coll Cardiol 2003;41:159-168
  10. Lee AM, Beaudoin J, Engel LC, Sidhu MS, Abbara S, Brady TJ, et al. Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study. Int J Cardiovasc Imaging 2013;29:1361-1370 https://doi.org/10.1007/s10554-013-0208-8
  11. Han Y, Jing J, Tu S, Tian F, Xue H, Chen W, et al. ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis. Int J Cardiovasc Imaging 2014;30:253-261 https://doi.org/10.1007/s10554-013-0354-z
  12. Xia Y, Junjie Y, Ying Z, Bai H, Qi W, Qinhua J, et al. Accuracy of 128-slice dual-source CT using high-pitch spiral mode for the assessment of coronary stents: first in vivo experience. Eur J Radiol 2013;82:617-622 https://doi.org/10.1016/j.ejrad.2012.11.033
  13. Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014;64:684-692 https://doi.org/10.1016/j.jacc.2014.05.039
  14. Ito H, Motoyama S, Sarai M, Kawai H, Harigaya H, Kan S, et al. Characteristics of plaque progression detected by serial coronary computed tomography angiography. Heart Vessels 2014;29:743-749 https://doi.org/10.1007/s00380-013-0420-4
  15. Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, et al. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 2006;47:1655-1662 https://doi.org/10.1016/j.jacc.2006.01.041
  16. Gauss S, Achenbach S, Pflederer T, Schuhback A, Daniel WG, Marwan M. Assessment of coronary artery remodelling by dual-source CT: a head-to-head comparison with intravascular ultrasound. Heart 2011;97:991-997 https://doi.org/10.1136/hrt.2011.223024
  17. Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging 2009;2:1412-1419 https://doi.org/10.1016/j.jcmg.2009.09.012
  18. Ueda H, Harimoto K, Tomoyama S, Tamaru H, Miyawaki M, Mitsusada N, et al. Relation of cardiovascular risk factors and angina status to obstructive coronary artery disease according to categorical coronary artery calcium score. Heart Vessels 2012;27:128-134 https://doi.org/10.1007/s00380-011-0128-2
  19. Bayturan O, Kapadia S, Nicholls SJ, Tuzcu EM, Shao M, Uno K, et al. Clinical predictors of plaque progression despite very low levels of low-density lipoprotein cholesterol. J Am Coll Cardiol 2010;55:2736-2742 https://doi.org/10.1016/j.jacc.2010.01.050
  20. Rioufol G, Finet G, Ginon I, Andre-Fouet X, Rossi R, Vialle E, et al. Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 2002;106:804-808 https://doi.org/10.1161/01.CIR.0000025609.13806.31
  21. Asakura M, Ueda Y, Yamaguchi O, Adachi T, Hirayama A, Hori M, et al. Extensive development of vulnerable plaques as a pancoronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol 2001;37:1284-1288 https://doi.org/10.1016/S0735-1097(01)01135-4
  22. Guazzi MD, Bussotti M, Grancini L, De Cesare N, Guazzi M, Pera IL, et al. Evidence of multifocal activity of coronary disease in patients with acute myocardial infarction. Circulation 1997;96:1145-1151 https://doi.org/10.1161/01.CIR.96.4.1145
  23. Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshiyama M, et al. Prognosis of vulnerable plaque on computed tomographic coronary angiography with normal myocardial perfusion image. Eur Heart J Cardiovasc Imaging 2014;15:332-340 https://doi.org/10.1093/ehjci/jet232
  24. Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 2015;66:337-346 https://doi.org/10.1016/j.jacc.2015.05.069
  25. Criqui MH, Denenberg JO, Ix JH, McClelland RL, Wassel CL, Rifkin DE, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA 2014;311:271-278 https://doi.org/10.1001/jama.2013.282535
  26. Bourantas CV, Garcia-Garcia HM, Farooq V, Maehara A, Xu K, Genereux P, et al. Clinical and angiographic characteristics of patients likely to have vulnerable plaques: analysis from the PROSPECT study. JACC Cardiovasc Imaging 2013;6:1263-1272 https://doi.org/10.1016/j.jcmg.2013.04.015
  27. Yun KH, Mintz GS, Farhat N, Marso SP, Taglieri N, Verheye S, et al. Relation between angiographic lesion severity, vulnerable plaque morphology and future adverse cardiac events (from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study). Am J Cardiol 2012;110:471-477 https://doi.org/10.1016/j.amjcard.2012.04.018
  28. Voros S, Rinehart S, Qian Z, Vazquez G, Anderson H, Murrieta L, et al. Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study. JACC Cardiovasc Interv 2011;4:198-208 https://doi.org/10.1016/j.jcin.2010.10.008
  29. Marwan M, Taher MA, El Meniawy K, Awadallah H, Pflederer T, Schuhback A, et al. In vivo CT detection of lipid-rich coronary artery atherosclerotic plaques using quantitative histogram analysis: a head to head comparison with IVUS. Atherosclerosis 2011;215:110-115 https://doi.org/10.1016/j.atherosclerosis.2010.12.006
  30. Raggi P. Epicardial adipose tissue and progression of coronary artery calcium: cause and effect or simple association? JACC Cardiovasc Imaging 2014;7:917-919 https://doi.org/10.1016/j.jcmg.2014.07.004
  31. Gauss S, Klinghammer L, Steinhoff A, Raaz-Schrauder D, Marwan M, Achenbach S, et al. Association of systemic inflammation with epicardial fat and coronary artery calcification. Inflamm Res 2015;64:313-319 https://doi.org/10.1007/s00011-015-0809-x
  32. Mahabadi AA, Lehmann N, Kalsch H, Robens T, Bauer M, Dykun I, et al. Association of epicardial adipose tissue with progression of coronary artery calcification is more pronounced in the early phase of atherosclerosis: results from the Heinz Nixdorf recall study. JACC Cardiovasc Imaging 2014;7:909-916 https://doi.org/10.1016/j.jcmg.2014.07.002
  33. Park JS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, et al. Echocardiographically measured epicardial fat predicts restenosis after coronary stenting. Scand Cardiovasc J 2013;47:297-302 https://doi.org/10.3109/14017431.2013.824604

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