期刊
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
卷 18, 期 12, 页码 1331-1339出版社
OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jex183
关键词
cardiac death; coronary plaque; plaque burden; prognosis; coronary computed tomography angiography
资金
- Bundesministerium fur Bildung und Forschung (Spitzencluster Medical Valley) [01EX1012B]
- National Heart, Lung, and Blood Institute [1R01HL133616]
- Cardiac Imaging Research Initiative (AdelsonMedical Research Foundation)
Aims Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up. Methods and results Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 +/- 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 +/- 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation < 30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume x 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146mm(3) [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LDNCP > 10.6mm(3) (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179mm(3) (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85; 1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score. Conclusion Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.
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