Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
Atherosclerosis. 2020 Oct;311:150-157. doi: 10.1016/j.atherosclerosis.2020.06.021. Epub 2020 Jul 6.
Coronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS.
One-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography.
Of 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation.
Both the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.
冠状动脉计算机断层扫描（CT）可计算冠状动脉钙评分（CACS）。然而，其他 CT 特征可能与斑块易损性和未来冠状动脉事件风险的关系更密切。本研究旨在探讨斑块钙化模式和衰减与斑块不稳定性特征、冠状动脉疾病（CAD）程度和 CACS 的相关性。
本研究共纳入 100 例伴有钙化斑块的冠状动脉狭窄患者。采用非增强和增强 CT 血管造影评估 CACS、CAD 程度、钙化模式和衰减、斑块不稳定性特征、心外膜脂肪组织（EAT）厚度和衰减。
373 个钙化斑块中，有 131 个斑块导致最高程度的冠状动脉狭窄（每位患者 1.31±0.53）。根据最高级病变的特征，将患者分为大（35%）、斑片状（52%）或混合（13%）钙化模式和斑块钙化衰减三分位（使用多个病变的平均值）。大钙化模式或更高的斑块钙化衰减患者的狭窄程度和 CACS 分级（以及 EAT 衰减）更高，但斑块不稳定性评分较低；而斑片状钙化模式或更低的斑块钙化衰减患者的狭窄程度和 CACS 分级（以及 EAT 衰减）较低，但斑块不稳定性评分较高。在不稳定性特征中，低衰减和餐巾环征，而不是正性重构，与斑片状模式和较低的钙化衰减相关。
除 CACS 外，对于非临界冠状动脉狭窄的重度钙化高危患者，还应考虑钙化的模式和衰减，以进行风险分层。
