Advances in CT coronary angiography-derived plaque analysis for comprehensive assessment of ischemic heart disease

Cozac, Dan-Alexandru; Lassandro, Eleonora; Savo, Maria Teresa; Cordoni, Gabriele; Tansella, Donatella; Motta, Raffaella; Pergola, Valeria

doi:10.2478/rjc-2024-0029

Figures & Tables

Methods of coronary plaque characterization in the left anterior descending artery using the software Aquarius TeraRecon (North Carolina, United States of America). The histogram of different plaque components is depicted on the left panel.

Pericoronary fat attenuation index (pFAI) analyses using the software Aquarius TeraRecon (North Carolina, United States of America) show gradients in the CT attenuation of peri coronary fat.

The proposed flowchart of the cardiac coronary computed tomography (CCTA) evaluation in patients with stable chest pain.

The advantages and limitations of the current cardiac computed tomography methods for assessing coronary artery plaque burden_

CT method	Description	Advantages	Limitations
SSS	Scores each segment based on stenosis severity	Quick estimation of plaque burden	Lacks detailed plaque composition
SIS	Scores the presence of plaque in each segment	Simple, rapid assessment	Does not quantify stenosis severity
Leaman Score	Considers plaque location, type, and stenosis degree	Detailed assessment	Time-consuming
Quantitative	Automated plaque volume and composition analysis	Accurate, detailed quantification	Requires advanced software

Characteristics and clinical relevance of high-risk coronary plaque features detected by cardiac computed tomography angiography_[31]

Plaque Feature	Description	Clinical Relevance
Positive Remodeling	Vessel enlargement at the plaque site	Indicator of plaque vulnerability
Spotty Calcifications	1-3 mm calcifications in the context of a soft plaque	Indicator of plaque vulnerability
Low Attenuation Plaque	Low density (<30 HU)	Associated with increased risk of rupture
Napkin-Ring Sign	Hypoattenuating core with a hyperattenuating rim	A strong predictor of adverse events

Summary of the key conclusions of major trials evaluating the role of CCTA in cardiovascular risk assessment_

Title	Journal, year	Key conclusions
Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain (ROMICAT-II) ^[34]	N Engl J Med. 2012	CCTA in patients with acute chest pain in the emergency department offers faster diagnostic results, reduces hospital stays, and provides similar safety and clinical outcomes compared to standard evaluation methods
1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study ^[46]	J Am Coll Cardiol. 2016	FFRCT-guided care strategy in patients with suspected coronary artery disease reduced unnecessary invasive coronary angiography without affecting safety or clinical outcomes. FFRCT improved diagnostic accuracy and efficiency while offering potential cost savings and maintaining patient quality of life
Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)^[5]	Circulation. 2017	CCTA offers superior prognostic information compared to functional testing in patients with stable chest pain CCTA’s ability to detect both obstructive and non-obstructive coronary artery disease provided a more accurate prediction of future cardiovascular events
Coronary CT Angiography and 5-Year Risk of Myocardial Infarction (SCOT-HEART trial)^[4]	N Engl J Med. 2018	Improved diagnostic accuracy of CCTA Reduction in fatal and non-fatal myocardial infarction over a 5-year follow-up Better cardiovascular risk stratification
Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data^[54]	Lancet. 2018	The perivascular fat attenuation index (FAI), a non-invasive marker of coronary inflammation derived from routine CT imaging, significantly improves the prediction of residual cardiovascular risk beyond traditional risk factors and coronary calcium scores
CT or Invasive Coronary Angiography in Stable Chest Pain (DISCHARGE trial)^[16]	N Engl J Med. 2022	CCTA is favored as a non-invasive, safe, and cost-effective approach for ruling out significant coronary artery disease and improving risk stratification

Advances in CT coronary angiography-derived plaque analysis for comprehensive assessment of ischemic heart disease

Figures & Tables

Figure 1

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Figure 3

The advantages and limitations of the current cardiac computed tomography methods for assessing coronary artery plaque burden_

Characteristics and clinical relevance of high-risk coronary plaque features detected by cardiac computed tomography angiography_[31]

Summary of the key conclusions of major trials evaluating the role of CCTA in cardiovascular risk assessment_

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