Comparative differences in the atherosclerotic disease burden between the epicardial coronary arteries: quantitative plaque analysis on coronary computed tomography angiography
European Heart Journal - Cardiovascular Imaging, vol. 22, pp. 322–330
Abstract
AIMS: Anatomic series commonly report the extent and severity of coronary artery disease (CAD), regardless of location. The aim of this study was to evaluate differences in atherosclerotic plaque burden and composition across the major epicardial coronary arteries. METHODS AND RESULTS: A total of 1271 patients (age 60 ± 9 years; 57% men) with suspected CAD prospectively underwent coronary computed tomography angiography (CCTA). Atherosclerotic plaque volume was quantified with categorization by composition (necrotic core, fibrofatty, fibrous, and calcified) based on Hounsfield Unit density. Per-vessel measures were compared using generalized estimating equation models. On CCTA, total plaque volume was lowest in the LCx (10.0 ± 29.4 mm3), followed by the RCA (32.8 ± 82.7 mm3; P < 0.001), and LAD (58.6 ± 83.3 mm3; P < 0.001), even when correcting for vessel length or volume. The prevalence of ≥2 high-risk plaque features, such as positive remodelling or spotty calcification, occurred less in the LCx (3.8%) when compared with the LAD (21.4%) or RCA (10.9%, P < 0.001). In the LCx, the most stenotic lesion was categorized as largely calcified more often than in the RCA and LAD (55.3% vs. 39.4% vs. 32.7%; P < 0.001). Median diameter stenosis was also lowest in the LCx (16.2%) and highest in the LAD (21.3%; P < 0.001) and located more distal along the LCx when compared with the RCA and LAD (P < 0.001). CONCLUSION: Atherosclerotic plaque, irrespective of vessel volume, varied across the epicardial coronary arteries; with a significantly lower burden and different compositions in the LCx when compared with the LAD and RCA. These volumetric and compositional findings support a diverse milieu for atherosclerotic plaque development and may contribute to a varied acute coronary risk between the major epicardial coronary arteries.
Authors 36
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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NewYork–Presbyterian Hospital · Leiden University Medical Center · Weill Cornell Medicine
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
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NewYork–Presbyterian Hospital · Leiden University Medical Center · Weill Cornell Medicine
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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Affiliation as printed
Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Affiliation as printed
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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Affiliation as printed
Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Affiliation as printed
Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
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Affiliation as printed
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
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Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Pusan University Hospital, Busan, South Korea
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Affiliation as printed
Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Affiliation as printed
Department of Radiology,UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
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Hospital da Luz · Universidade Nova de Lisboa
Affiliation as printed
Department of Cardiology, NOVA Medical School, Lisboa, Portugal
Department of Radiology,UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
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Affiliation as printed
Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
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Affiliation as printed
Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany
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University of British Columbia
Affiliation as printed
Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
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Affiliation as printed
Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
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Affiliation as printed
Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Ewha Womans University Seoul Hospital
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Ewha Woman’s University Seoul Hospital, Seoul, Korea
Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea
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Seoul National University · Seoul National University Hospital
Affiliation as printed
Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
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Yonsei University · Gangnam Severance Hospital
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Seoul National University Bundang Hospital
Affiliation as printed
Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
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Yonsei University · Severance Hospital · Yonsei University Health System
Affiliation as printed
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Yonsei University · Yonsei University Health System · Ewha Womans University Seoul Hospital
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Ewha Woman’s University Seoul Hospital, Seoul, Korea
Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea
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Affiliation as printed
Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
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Affiliation as printed
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Affiliation as printed
Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Affiliation as printed
Cleerly, Inc., New York, NY, USA
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Icahn School of Medicine at Mount Sinai
Affiliation as printed
Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
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NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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Yonsei University · Severance Hospital · Yonsei University Health System
Affiliation as printed
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Leslee J. Shaw corresponding
NewYork–Presbyterian Hospital · Weill Cornell Medicine
Affiliation as printed
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
Cited by 26 stored of 26
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