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Feasibility of morphological assessment of coronary artery calcification with electrocardiography-gated non-contrast computed tomography: a comparative study with optical coherence tomography

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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 < 0.001). Bland-Altman plots of OCT-derived MCA in relation to CT-derived MCA showed a mean bias of 4.8 degrees with 95% limits of agreement of − 69.7 to 79.4 degrees. Sensitivity, specificity, and positive and negative predictive values of CT in identifying MCA > 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.

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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

PCI:

Percutaneous coronary intervention

PPV:

Positive predictive value

RA:

Rotational atherectomy

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Acknowledgements

The authors thank our colleagues at Kobe University Graduate School of Medicine for their co-operation in CT and OCT image acquisition and reconstruction, and manuscript editing.

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None.

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Authors and Affiliations

  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

    Yu Takahashi, Takayoshi Toba, Hiromasa Otake, Yusuke Fukuyama, Shinsuke Nakano, Yoichiro Matsuoka, Kosuke Tanimura, Yu Izawa, Hiroyuki Kawamori, Sei Fujiwara & Ken-ichi Hirata

  2. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan

    Atsushi K. Kono

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  1. Yu Takahashi
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Corresponding author

Correspondence to Takayoshi Toba.

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Conflict of interest

Hiromasa Otake has received honoraria from Terumo, but had no role in study design, conduct, or manuscript preparation. The other authors have no conflicts of interest to declare.

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This study was conducted in agreement with the Declaration of Helsinki and was approved by the institutional ethics committee.

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Takahashi, Y., Toba, T., Otake, H. et al. Feasibility of morphological assessment of coronary artery calcification with electrocardiography-gated non-contrast computed tomography: a comparative study with optical coherence tomography. Int J Cardiovasc Imaging 37, 1445–1453 (2021). https://doi.org/10.1007/s10554-020-02093-z

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  • DOI: https://doi.org/10.1007/s10554-020-02093-z

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