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Plaque Assessment on Serial Coronary CTA

  • Guilherme Monteiro
  • Roberto C. Cury
  • Marcio S. BittencourtEmail author
Cardiac Computed Tomography (B Chow and G Small, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Cardiac Computed Tomography

Abstract

Purpose of Review

This review addresses the role of serial coronary computed tomography angiography (CTA) on the evaluation of atherosclerosis progression, risk stratification, and targeting individual pharmacotherapy.

Recent Findings

The presence, extent, and severity of coronary artery disease (CAD) detected by coronary CTA are associated with an adverse prognosis. Similarly, the presence of high-risk plaque features such as positive remodeling, low-attenuation plaque, spotty calcifications, and napkin-ring sign are associated with major adverse cardiac events. More recently, examinations using serial coronary CTA have also shown that these static CTA plaque features are associated with a more rapid progression of atherosclerosis on follow-up imaging and may identify a subset of patients at increased risk for plaque rupture. While the impact of serial CTA findings on management and hard outcomes remains a topic of ongoing investigation, available data supports the ability of statin therapy to reduce CTA-identified plaque burden and modify plaque composition.

Summary

Coronary CTA identifies various plaque features associated with an increased risk of plaque progression and adverse cardiac events. Available data support the use of CTA to individualize statin therapy and utilize serial CTA imaging to study the impact of pharmacotherapy on plaque burden and outcomes.

Keywords

Atherosclerosis Atherosclerotic plaque Plaque progression Coronary artery disease Coronary computed tomography angiography 

Notes

Compliance with Ethical Standards

Conflict of Interest

Guilherme Monteiro, Roberto C. Cury, and Marcio S. Bittencourt declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20:1262–75.CrossRefGoogle Scholar
  2. 2.
    Sandfort V, Lima JA, Bluemke DA. Noninvasive imaging of atherosclerotic plaque progression: status of coronary computed tomography angiography. Circ Cardiovasc Imaging. 2015;8:e003316.CrossRefGoogle Scholar
  3. 3.
    • Bittencourt MS, Hulten E, Ghoshhajra B, O’Leary D, Christman MP, Montana P, et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging. 2014;7:282–91 This study illustrated the prognostic value of atherosclerotic burden in individuals with nonobstructive and obstructive CAD detected by coronary CTA. CrossRefGoogle Scholar
  4. 4.
    • Ahmadi A, Leipsic J, Blankstein R, Taylor C, Hecht H, Stone GW, et al. Do plaques rapidly progress prior to myocardial infarction?: the interplay between plaque vulnerability and progression. Circ Res. 2015;117:99–104 This study provides data supporting the idea that atherosclerotic plaques tend to progress to obstructive disease prior to acute coronary syndrome. CrossRefGoogle Scholar
  5. 5.
    Weintraub WS. Relation of angiographic and ultrasound assessment of plaque progression to clinical outcomes. Am J Cardiol. 1998;81:69f–72f.CrossRefGoogle Scholar
  6. 6.
    Achenbach S, Ulzheimer S, Baum U, Kachelriess M, Ropers D, Giesler T, et al. Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT. Circulation. 2000;102:2823–8.CrossRefGoogle Scholar
  7. 7.
    de Graaf FR, van Velzen JE, de Boer SM, van Werkhoven JM, Kroft LJ, de Roos A, et al. Non-invasive computed tomography coronary angiography as a gatekeeper for invasive coronary angiography. Int J Cardiovasc Imaging. 2013;29:221–8.CrossRefGoogle Scholar
  8. 8.
    Butler J, Shapiro M, Reiber J, Sheth T, Ferencik M, Kurtz EG, et al. Extent and distribution of coronary artery disease: a comparative study of invasive versus noninvasive angiography with computed angiography. Am Heart J. 2007;153:378–84.CrossRefGoogle Scholar
  9. 9.
    Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ, et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3:122–36.CrossRefGoogle Scholar
  10. 10.
    • Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, et al. CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr. 2016;10:269–81 This is the official recommendation for structured reporting of CAD in coronary CTA. CrossRefGoogle Scholar
  11. 11.
    Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34:48–55.CrossRefGoogle Scholar
  12. 12.
    • Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;57:1237–47 This meta-analysis provides detailed data on the prognostic value of the presence and severity of CAD detected on coronary CTA. CrossRefGoogle Scholar
  13. 13.
    Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–70.CrossRefGoogle Scholar
  14. 14.
    Mock MB, Ringqvist I, Fisher LD, Davis KB, Chaitman BR, Kouchoukos NT, et al. Survival of medically treated patients in the coronary artery surgery study (CASS) registry. Circulation. 1982;66:562–8.CrossRefGoogle Scholar
  15. 19.
    Shah NR, Cheezum MK, Motoyama S, Chatzizisis YS. Do we really need another individual coronary plaque characterization measurement? Atherosclerosis. 2017;261:160–2.CrossRefGoogle Scholar
  16. 15.
    Maddox TM, Stanislawski MA, Grunwald GK, Bradley SM, Ho PM, Tsai TT, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312:1754–63.CrossRefGoogle Scholar
  17. 16.
    Hadamitzky M, Taubert S, Deseive S, Byrne RA, Martinoff S, Schomig A, et al. Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. 2013;34:3277–85.CrossRefGoogle Scholar
  18. 17.
    Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58:849–60.CrossRefGoogle Scholar
  19. 18.
    Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47:C13–8.CrossRefGoogle Scholar
  20. 20.
    Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol. 2015;66:337–46.CrossRefGoogle Scholar
  21. 21.
    •• Maldonado N, Kelly-Arnold A, Cardoso L, Weinbaum S. The explosive growth of small voids in vulnerable cap rupture; cavitation and interfacial debonding. J Biomech. 2013;46:396–401 This is the first study to define low-attenuation plaque, positive remodeling, and spotty calcifications as markers of prognosis in coronary CTA. CrossRefGoogle Scholar
  22. 22.
    Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49–57.CrossRefGoogle Scholar
  23. 23.
    van Velzen JE, de Graaf FR, de Graaf MA, Schuijf JD, Kroft LJ, de Roos A, et al. Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol. 2011;18:893–903.CrossRefGoogle Scholar
  24. 24.
    Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary-arteries. New Engl J Med. 1987;316:1371–5.CrossRefGoogle Scholar
  25. 25.
    •• Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–26 This study has defined the napkin-ring sign as a marker of increased risk in coronary CTA. CrossRefGoogle Scholar
  26. 26.
    Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high-risk coronary plaques? J Am Coll Cardiol Img. 2010;3:440–4.CrossRefGoogle Scholar
  27. 27.
    •• Nadjiri J, Hausleiter J, Jahnichen C, Will A, Hendrich E, Martinoff S, et al. Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. J Cardiovasc Comput Tomogr. 2016;10:97–104 This is the largest study to date evaluating the impact of atherosclerosis progression on coronary CTA and its impacts on prognosis. CrossRefGoogle Scholar
  28. 28.
    Feuchtner G, Kerber J, Burghard P, Dichtl W, Friedrich G, Bonaros N, et al. The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. Eur Heart J Cardiovasc Imaging. 2017;18:772–9.CrossRefGoogle Scholar
  29. 29.
    Budoff MJ, Raggi P. Coronary artery disease progression assessed by electron-beam computed tomography. Am J Cardiol. 2001;88:46–50.CrossRefGoogle Scholar
  30. 30.
    Bertrand OF, Poirier P, Rodes-Cabau J, Rinfret S, Title L, Dzavik V, et al. A multicentre, randomized, double-blind placebo-controlled trial evaluating rosiglitazone for the prevention of atherosclerosis progression after coronary artery bypass graft surgery in patients with type 2 diabetes. Design and rationale of the VeIn-Coronary aTherOsclerosis and Rosiglitazone after bypass surgerY (VICTORY) trial. Can J Cardiol. 2009;25:509–15.CrossRefGoogle Scholar
  31. 31.
    Fayad ZA, Mani V, Woodward M, Kallend D, Bansilal S, Pozza J, et al. Rationale and design of dal-PLAQUE: a study assessing efficacy and safety of dalcetrapib on progression or regression of atherosclerosis using magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Am Heart J. 2011;162:214–221.e2.CrossRefGoogle Scholar
  32. 32.
    Budoff M, Brent Muhlestein J, Le VT, May HT, Roy S, Nelson JR. Effect of Vascepa (icosapent ethyl) on progression of coronary atherosclerosis in patients with elevated triglycerides (200-499 mg/dL) on statin therapy: rationale and design of the EVAPORATE study. Clin Cardiol. 2018;41:13–9.CrossRefGoogle Scholar
  33. 33.
    Osawa K, Nakanishi R, Win TT, Li D, Rahmani S, Nezarat N, et al. Rationale and design of a randomized trial of apixaban vs warfarin to evaluate atherosclerotic calcification and vulnerable plaque progression. Clin Cardiol. 2017;40:807–13.CrossRefGoogle Scholar
  34. 34.
    Nakanishi R, Post WS, Osawa K, Jayawardena E, Kim M, Sheidaee N, et al. Multicenter AIDS cohort study quantitative coronary plaque progression study: rationale and design. Coron Artery Dis. 2018;29:23–9.PubMedPubMedCentralGoogle Scholar
  35. 43.
    Lehman SJ, Schlett CL, Bamberg F, Lee H, Donnelly P, Shturman L, et al. Assessment of coronary plaque progression in coronary computed tomography angiography using a semiquantitative score. J Am Coll Cardiol Img. 2009;2:1262–70.CrossRefGoogle Scholar
  36. 44.
    Imai A, Komatsu S, Ohara T, Kamata T, Yoshida J, Miyaji K, et al. Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque. Atherosclerosis. 2012;222:524–9.CrossRefGoogle Scholar
  37. 45.
    Ayad SW, ElSharkawy EM, ElTahan SM, Sobhy MA, Laymouna RH. The role of 64/128-slice multidetector computed tomography to assess the progression of coronary atherosclerosis. Clin Med Insights Cardiol. 2015;9:47–52.CrossRefGoogle Scholar
  38. 35.
    Psaltis PJ, Talman AH, Munnur K, Cameron JD, Ko BS, Meredith IT, et al. Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography. Int J Cardiovasc Imaging. 2016;32:317–28.CrossRefGoogle Scholar
  39. 46.
    Sakellarios A, Bourantas CV, Papadopoulou SL, Tsirka Z, de Vries T, Kitslaar PH, et al. Prediction of atherosclerotic disease progression using LDL transport modelling: a serial computed tomographic coronary angiographic study. Eur Heart J Cardiovasc Imaging. 2017;18:11–8.CrossRefGoogle Scholar
  40. 47.
    Nakanishi R, Ceponiene I, Osawa K, Luo Y, Kanisawa M, Megowan N, et al. Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: a propensity-score matching study. Atherosclerosis. 2016;255:73–9.CrossRefGoogle Scholar
  41. 48.
    Tan Y, Zhou J, Zhou Y, Yang X, Wang J, Chen Y. Epicardial adipose tissue is associated with high-risk plaque feature progression in non-culprit lesions. Int J Cardiovasc Imaging. 2017;33:2029–37.CrossRefGoogle Scholar
  42. 49.
    Suzuki T, Nozawa T, Fujii N, Sobajima M, Ohori T, Shida T, et al. Combination therapy of candesartan with statin inhibits progression of atherosclerosis more than statin alone in patients with coronary artery disease. Coron Artery Dis. 2011;22:352–8.CrossRefGoogle Scholar
  43. 36.
    Zeb I, Li D, Nasir K, Malpeso J, Batool A, Flores F, et al. Effect of statin treatment on coronary plaque progression - a serial coronary CT angiography study. Atherosclerosis. 2013;231:198–204.CrossRefGoogle Scholar
  44. 50.
    Li Z, Hou Z, Yin W, Liu K, Gao Y, Xu H, et al. Effects of statin therapy on progression of mild noncalcified coronary plaque assessed by serial coronary computed tomography angiography: a multicenter prospective study. Am Heart J. 2016;180:29–38.CrossRefGoogle Scholar
  45. 37.
    Shin S, Park HB, Chang HJ, Arsanjani R, Min JK, Kim YJ, et al. Impact of intensive LDL cholesterol lowering on coronary artery atherosclerosis progression: a serial CT angiography study. J Am Coll Cardiol Img. 2017;10:437–46.CrossRefGoogle Scholar
  46. 51.
    Matsumoto S, Ibrahim R, Gregoire JC, L'Allier PL, Pressacco J, Tardif JC, et al. Effect of treatment with 5-lipoxygenase inhibitor VIA-2291 (atreleuton) on coronary plaque progression: a serial CT angiography study. Clin Cardiol. 2017;40:210–5.CrossRefGoogle Scholar
  47. 38.
    Lo J, Lu MT, Ihenachor EJ, Wei J, Looby SE, Fitch KV, et al. Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial. Lancet HIV. 2015;2:e52–63.CrossRefGoogle Scholar
  48. 40.
    Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, et al. Effects of statins on coronary atherosclerotic plaques: the PARADIGM study. J Am Coll Cardiol Img. 2018;11:1475–84.CrossRefGoogle Scholar
  49. 39.
    Lee SE, Chang HJ, Rizvi A, Hadamitzky M, Kim YJ, Conte E, et al. Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: a comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study. Am Heart J. 2016;182:72–9.CrossRefGoogle Scholar
  50. 52.
    Tan Y, Zhou J, Zhou Y, Yang X, Yang J, Chen Y. Characteristics detected on computed tomography angiography predict coronary artery plaque progression in non-culprit lesions. Korean J Radiol. 2017;18:487–97.CrossRefGoogle Scholar
  51. 53.
    Gu H, Gao Y, Wang H, Hou Z, Han L, Wang X, et al. Sex differences in coronary atherosclerosis progression and major adverse cardiac events in patients with suspected coronary artery disease. J Cardiovasc Comput Tomogr. 2017;11:367–72.CrossRefGoogle Scholar
  52. 54.
    Gu H, Gao Y, Hou Z, Schoepf UJ, Snyder AN, Duguay TM, et al. Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina. Eur Radiol. 2018;28:1066–76.CrossRefGoogle Scholar
  53. 41.
    Lee SE, Sung JM, Rizvi A, Lin FY, Kumar A, Hadamitzky M, et al. Quantification of coronary atherosclerosis in the assessment of coronary artery disease. Circ Cardiovasc Imaging. 2018;11:e007562.CrossRefGoogle Scholar
  54. 42.
    Ito H, Motoyama S, Sarai M, Kawai H, Harigaya H, Kan S, et al. Characteristics of plaque progression detected by serial coronary computed tomography angiography. Heart Vessel. 2014;29:743–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Guilherme Monteiro
    • 1
  • Roberto C. Cury
    • 2
  • Marcio S. Bittencourt
    • 2
    • 3
    • 4
    Email author
  1. 1.Imagem Cardíaca da Clínica Imagem - FlorianópolisSão PauloBrazil
  2. 2.Delboni - DASASão PauloBrazil
  3. 3.Hospital Israelita Albert EinsteinSão PauloBrazil
  4. 4.Center for Clinical and Epidemiological ResearchUniversity Hospital, University of Sao PaulSao PauloBrazil

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