Feasibility of morphological assessment of coronary artery calcification with electrocardiography-gated non-contrast com
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ORIGINAL PAPER
Feasibility of morphological assessment of coronary artery calcification with electrocardiography‑gated non‑contrast computed tomography: a comparative study with optical coherence tomography Yu Takahashi1 · Takayoshi Toba1 · Hiromasa Otake1 · Yusuke Fukuyama1 · Shinsuke Nakano1 · Yoichiro Matsuoka1 · Kosuke Tanimura1 · Yu Izawa1 · Hiroyuki Kawamori1 · Atsushi K. Kono2 · Sei Fujiwara1 · Ken‑ichi Hirata1 Received: 13 August 2020 / Accepted: 28 October 2020 © Springer Nature B.V. 2020
Abstract To investigate the feasibility of pre-procedural morphological assessment of coronary artery calcification in severely calcified lesions with electrocardiography (ECG)-gated non-contrast computed tomography (CT). Severely calcified coronary arteries in patients who underwent ECG-gated non-contrast CT prior to optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) were studied retrospectively. CT and OCT data were co-registered by marking landmark structures such as side branches and reviewed side by side with cross-sectional images. The maximum calcium angle (MCA) and presence of nodular calcification (NC) were evaluated. A total of 496 cross-sections in 16 lesions were included in this analysis. The Pearson correlation coefficient between CT- and OCT-derived MCA was 0.92 (p 270 degrees were 90.3%, 79.7%, 92.1%, and 97.4%, respectively. Sensitivity, specificity, and positive and negative predictive values of CT in identifying NC were 73.3%, 97.5%, 47.8%, and 99.2%, respectively. ECG-gated non-contrast coronary CT might be helpful to obtain detailed information of severe coronary artery calcification before PCI. Keywords Coronary artery calcification · Non-contrast computed tomography · Optical coherence tomography · Nodular calcification Abbreviations CT Computed tomography ECG Electrocardiography HU Hounsfield unit ICC Intraclass correlation coefficients LAD Left anterior descending artery MCA Maximum calcium angle NC Nodular calcification NPV Negative predictive value OCT Optical coherence tomography * Takayoshi Toba [email protected] 1
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe 6500017, Japan
Department of Radiology, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe 6500017, Japan
2
PCI Percutaneous coronary intervention PPV Positive predictive value RA Rotational atherectomy
Introduction Over the past decade, the rates of coronary revascularization have continued to decline with the advent of drug-eluting stents [1, 2]. However, percutaneous coronary intervention (PCI) for severely calcified lesions remains challenging with increased rates of in-stent restenosis and stent thrombosis, mainly due to insufficient stent expansion [3, 4]. To obtain adequate stent expansion, and subsequently avoid target lesion failure, appropriate lesion modification with balloon and/or rotational atherectomy (RA) is important. Accordi
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