Vessel-specific plaque features on coronary computed tomography angiography among patients of varying atherosclerotic cardiovascular disease risk

European Heart Journal - Cardiovascular Imaging, vol. 23, pp. 1171–1179

Abstract

AIMS: The relationship between AtheroSclerotic CardioVascular Disease (ASCVD) risk and vessel-specific plaque evaluation using coronary computed tomography angiography (CCTA), focusing on plaque extent and composition, has not been examined. To evaluate differences in quantified plaque characteristics (using CCTA) between the three major coronary arteries [left anterior descending (LAD), right coronary (RCA), and left circumflex (LCx)] among subgroups of patients with varying ASCVD risk. METHODS AND RESULTS: Patients were included from a prospective, international registry of consecutive patients who underwent CCTA for evaluation of coronary artery disease. ASCVD risk groups were <7.5% (low), 7.5-20% (intermediate), and ≥20% (high). Among the ASCVD risk groups, the three coronary arteries were compared regarding quantified plaque volume and composition. Whole-heart plaque quantification was performed in 1340 patients (age 60 ± 9 years, 58% men). Across low, intermediate, and high ASCVD risk patients, the volume of plaque increased proportionally but was least in the LCx (7.4, 9.0, and 25.3 mm3, respectively) as compared with the RCA (19.3, 32.6, and 67.0 mm3, respectively, all P ≤ 0.006) and LAD (39.9, 60.8, and 93.3 mm3, respectively, all P < 0.001). In each ASCVD risk group, the composition of plaque in the LCx exhibited the least necrotic core and fibrofatty plaque (P < 0.05 vs. LAD and RCA). CONCLUSION: Among patients with varying risk of ASCVD, plaque in the LCx is decidedly less and is comprised of less non-calcified plaque supporting prior evidence of the lower rates of acute coronary events in this vessel.

Authors 31

1. A. Maxim Bax

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

2. Yeonyee Elizabeth Yoon

   NewYork–Presbyterian Hospital · Seoul National University · Seoul National University Hospital · Seoul National University Bundang Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital , Seoul , South Korea

   Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

   Department of Radiology, Seoul National University Bundang Hospital , Sungnam , South Korea

3. Umberto Gianni

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

4. Alexander R. van Rosendael Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Leiden , The Netherlands

5. Yao Lu

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Healthcare Policy and Research, New York-Presbyterian Hospital, The Weill Cornell Medical College , New York, NY , USA

6. Xiaoyue Ma

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Healthcare Policy and Research, New York-Presbyterian Hospital, The Weill Cornell Medical College , New York, NY , USA

7. Benjamin Goebel

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

8. Sara W. Tantawy

   NewYork–Presbyterian Hospital · Weill Cornell Medicine

   Affiliation as printed

   Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

9. Daniele Andreini

   Centro Cardiologico Monzino

   Affiliation as printed

   Department of Medicine, Centro Cardiologico Monzino, IRCCS Milan , Milan , Italy

10. Matthew Jay Budoff

    The Lundquist Institute

    Affiliation as printed

    Department of Medicine, Los Angeles Biomedical Research Institute , Torrance, CA , USA

11. Filippo Cademartiri
    Affiliation as printed

    Department of Medicine, Cardiovascular Imaging Center, SDN IRCCS , Naples , Italy

12. Kavitha M. Chinnaiyan

    Beaumont Hospital, Royal Oak

    Affiliation as printed

    Department of Cardiology, William Beaumont Hospital , Royal Oak, MI , USA

13. Jung Hyun Choi
    Affiliation as printed

    Division of Cardiology, Department of Internal Medicine, Pusan University Hospital , Busan , South Korea

14. Edoardo Conte

    Centro Cardiologico Monzino

    Affiliation as printed

    Department of Medicine, Centro Cardiologico Monzino, IRCCS Milan , Milan , Italy

15. Pedro de Araújo Gonçalves

    Hospital da Luz

    Affiliation as printed

    Department of Cardiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz , Lisboa , Portugal

16. Ilan Gottlieb

    Fundação Saúde

    Affiliation as printed

    Department of Radiology, Casa de Saude São Jose , Rio de Janeiro , Brazil

17. Martin Hadamitzky

    Deutsches Herzzentrum München

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, German Heart Center Munich , Munich , Germany

18. Jonathon A Leipsic

    University of British Columbia

    Affiliation as printed

    Department of Medicine and Radiology, University of British Columbia , Vancouver, BC , Canada

19. Erica Maffei
    Affiliation as printed

    Department of Radiology, Area Vasta 1/ASUR Marche , Urbino , Italy

20. Gianluca Pontone

    Centro Cardiologico Monzino

    Affiliation as printed

    Department of Medicine, Centro Cardiologico Monzino, IRCCS Milan , Milan , Italy

21. Sanghoon Shin

    Ewha Womans University · Ewha Womans University Seoul Hospital

    Affiliation as printed

    Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital , Seoul , Korea

22. Yong Jin Kim

    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

23. Byoung Kwon Lee

    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

24. Eun Ju Chun

    Seoul National University Bundang Hospital

    Affiliation as printed

    Department of Radiology, Seoul National University Bundang Hospital , Sungnam , South Korea

25. Ji Min Sung

    Yonsei University · Severance Hospital · Yonsei University Health System

    Affiliation as printed

    Department of Cardiology, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System , Seoul , South Korea

    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System , Seoul , South Korea

26. Sang Eun Lee

    Ewha Womans University · Yonsei University · Yonsei University Health System · Ewha Womans University Seoul Hospital

    Affiliation as printed

    Department of Cardiology, 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 Womans University Seoul Hospital , Seoul , Korea

27. Daniel S. Berman

    Cedars-Sinai Medical Center

    Affiliation as printed

    Department of Imaging and Medicine, Cedars Sinai Medical Center , Los Angeles, CA , USA

28. Jagat Narula

    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, Marie-Josée and Henry R. Kravis Center for Cardiovascular Health , New York, NY , USA

29. Fay Yu-Huei Lin

    NewYork–Presbyterian Hospital · Weill Cornell Medicine

    Affiliation as printed

    Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA

30. Hyuk‐Jae Chang

    Yonsei University · Severance Hospital · Yonsei University Health System

    Affiliation as printed

    Department of Cardiology, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System , Seoul , South Korea

    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System , Seoul , South Korea

31. Leslee J. Shaw corresponding

    NewYork–Presbyterian Hospital · Weill Cornell Medicine

    Affiliation as printed

    Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medicine , 413 East 69th Street, Suite 108, New York, NY 10021 , USA