Coronary CT angiography and high-risk plaque morphology
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REVIEW ARTICLE
Coronary CT angiography and high-risk plaque morphology Sadako Motoyama • Masayoshi Sarai Jagat Narula • Yukio Ozaki
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Received: 6 September 2012 / Accepted: 1 October 2012 / Published online: 30 October 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Computed tomography angiography (CTA) is commonly employed for exclusion of coronary artery disease and demonstration of the extent of coronary vascular involvement. It has been recently proposed that coronary artery plaques could be visualized noninvasively. This review article focused on the high risk plaque detected by CTA. Plaque characteristics of acute coronary syndrome (ACS) was compared to sable angina pectoris (SAP). The presence of positive remodeling (ACS 87 %, SAP 12 %, p \ 0.0001), low attenuation plaque (LAP) (ACS 79 %, SAP 9 %, p \ 0.0001), and spotty calcification (ACS 63 %, SAP 21 %, p = 0.0005) were significantly more frequent in the culprit ACS lesions. Furthermore, in asymptomatic patients, presence of positively remodeling and LAP portends a greater risk for development of acute coronary events (hazard ratio = 22.8, CI = 6.9–75.2, p \ 0.001). Possibility of drug intervention to high risk plaque was also reported. Serial CTA assessment allows for evaluation of interval change in morphological plaque characteristics and can be employed for assessment of efficacy of therapeutic intervention. Use of statin results in substantial reduction in LAP volume (follow-up: 4.9 ± 7.8 versus baseline: 1.3 ± 2.3 mm3, p = 0.02) forwards stabilization of plaques. Although not recommended currently as a population-based strategy, CT angiographic
S. Motoyama (&) M. Sarai Y. Ozaki Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan e-mail: [email protected] J. Narula Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
examination may help identify very high risk asymptomatic subjects. Keywords Coronary computed tomography angiography Acute coronary syndrome High risk plaque
Introduction Since the initial reports describing the usefulness of computed tomography angiography (CTA) with 4-row multislice CT for the examination of the coronary arteries, the number of detector rows has been increased repeatedly over the last 20 years. When a CT system with 64 or more detector rows is used, the entire heart can be visualized noninvasively during a single breath-hold. As such, it has become possible to better define not only the extent coronary artery luminal stenoses, but also plaque characteristics [1, 2]. Rupture of an atherosclerotic plaque is responsible for at least two-thirds of the acute coronary events [3, 4]. Various imaging modalities have identified the morphological characteristics of disrupted plaques and proposed that these characteristics may allow recognition of intact coronary lesions likely to result in acute coronary syndromes (ACS) [5–7]. Multiple catheter-based techniqu
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