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Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

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Abstract

To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss’ Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.

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Funding

Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark and Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research (EDITORS: Eastern Denmark Initative to improve Revascularization Strategies, Grant 09-066994). This study did not receive any financial support from industry.

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Authors and Affiliations

  1. Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Martina C. de Knegt, Jesper J. Linde, Andreas Fuchs, Lars V. Køber & Klaus F. Kofoed

  2. Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Martina C. de Knegt, Jesper J. Linde & Jens D. Hove

  3. Department of Clinical Biochemistry, Herlev Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Børge G. Nordestgaard

  4. Department of Radiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Klaus F. Kofoed

Authors
  1. Martina C. de Knegt
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  2. Jesper J. Linde
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  7. Klaus F. Kofoed
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Correspondence to Martina C. de Knegt.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Martina de Knegt is sub-investigator on studies sponsored by Novartis, Bayer, CSL-Behring, GlaxoSmithKline, AstraZeneca, Pheizer, Sanofi, and Amgen but does not receive any financial support from these industries. Jesper Linde has previously received lecturing fees from Toshiba Medical Systems. Lars Køber has received personal fees for presentation at symposiums, outside the submitted work. Klaus Kofoed has received research grants from AP Møller og hustru Chastine McKinney Møllers Fond, The John and Birthe Meyer Foundation, Research Council of Rigshopitalet, The University of Copenhagen, The Danish Heart Foundation, The Lundbeck Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research; is principle investigator of the investigator initiated CATCH-2 trial, CSub320 trial and at the steering committee of the CORE320 trial –supported in part by Toshiba Medical Corporation; and is on the Speakers Bureau of Toshiba Medical Systems, Advisory board work for VITAL Images Inc. All other authors report no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

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de Knegt, M.C., Linde, J.J., Fuchs, A. et al. Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments. Int J Cardiovasc Imaging 32, 1555–1566 (2016). https://doi.org/10.1007/s10554-016-0932-y

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