Calcified versus noncalcified atherosclerosis: Implications for evaluating cardiovascular risk
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rresponding author Khurram Nasir, MD, MPH Blalock 524 C–Division of Cardiology, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:150–155 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
Although the quantification of coronary arterial calcification (CAC) correlates well with disease burden, calcified plaques only represent a portion of the total plaque burden. Contrast-enhanced multidetector CT angiography has emerged as a promising noninvasive tool to directly examine the coronary artery wall and accurately determine atherosclerotic plaque burden and composition. Published literature on plaque subtypes (noncalcified, mixed, and calcified) suggests that mixed plaque burden is more likely to be associated with high-risk groups, such as those with diabetes mellitus, inflammatory biomarkers, increasing stenotic coronary artery disease, myocardial perfusion defects, higher CAC scores and, more importantly, features of plaque instability such as thin-cap fibroatheroma. One small study suggested that mixed plaque burden can predict cardiovascular outcomes. Based on emerging data, determination of mixed plaque burden appears more promising, but the value of exclusively calcified and noncalcified plaque is less convincing.
prevention efforts [2]. Established and emerging imaging modalities that can readily identify subclinical atherosclerosis are being used more often for this purpose. Quantification of coronary arterial calcification (CAC) provides prognostic information beyond identification of traditional CV risk factors [3,4,5••]. Although the CAC score correlates well with disease burden, calcified plaques only represent a portion of the total atherosclerosis plaque burden [6]. Contrast-enhanced multidetector CT (CE-MDCT) angiography has emerged as a promising noninvasive tool to directly examine the coronary artery wall, determine the degree of plaque burden, and assess the degree of coronary artery stenosis [7,8]. Based on the tissuespecific x-ray attenuation characteristics, CE angiography also provides additional information about atherosclerotic plaque composition. As the reliability of detecting and grading coronary artery stenosis has been established, the challenge now is to define the ability of this diagnostic tool to distinguish coronary artery plaque prone to rupture and potentially responsible for acute coronary events. It is able to differentiate plaques that are calcified, noncalcified, and mixed (containing both components) [9,10]. There is a paucity of data regarding the association of plaque morphology, or plaque subtype, with varying CV risk profi les and outcomes. As a result, we strive to review the literature to elucidate the current understanding, explore the relationship of plaque subtypes with current and future CV risk, and discuss potential limitations of these novel coronary imaging markers.
Accuracy of Assessing Plaque Subtypes Introduction Coronary ath
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