4.5 Article

Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up

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

  1. Bundesministerium fur Bildung und Forschung (Spitzencluster Medical Valley) [01EX1012B]
  2. National Heart, Lung, and Blood Institute [1R01HL133616]
  3. Cardiac Imaging Research Initiative (AdelsonMedical Research Foundation)

向作者/读者索取更多资源

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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