Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan; Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA.
Atherosclerosis. 2020 Oct;311:30-36. doi: 10.1016/j.atherosclerosis.2020.08.010. Epub 2020 Aug 29.
Although coronary artery calcium (CAC) density has been associated with plaque stability, pathological evidence is lacking. We investigated the relationship between coronary computed tomography (CCT)-derived CAC density and multiple calcified and high-risk plaque (HRP) characteristics using optical coherence tomography (OCT).
We analyzed 83 plaques from 33 stable angina patients who underwent both CCT and OCT. CAC density was measured at calcium plaques with ≥90 Hounsfield units (HU) and ≥130 HU using custom CT software. The correlation between median CAC density and OCT-derived calcium size (thickness and area) was assessed. To investigate whether median CAC densities measured at the 90 HU threshold were associated with plaque vulnerability, OCT-derived plaque characteristics and HRP characteristics were compared between the low (90-129 HU), intermediate (130-199 HU) and high (≥200 HU) CAC HU groups.
Median CAC densities at 130 HU were moderately associated with calcium thickness (R = 0.573, p < 0.001) and area (R = 0.560, p < 0.001). Similar results were observed at 90 HU (thickness, R = 0.615, p < 0.001; area, R = 0.612, p < 0.001). Among groups with low, intermediate and high HU levels, calcium thickness (0.42 ± 0.14 mm, 0.60 ± 0.17 mm and 0.77 ± 0.19 mm, respectively; p < 0.001) and area (0.55 ± 0.29 mm, 1.20 ± 0.58 mm and 1.78 ± 0.87 mm, respectively; p < 0.001) were significantly greater in the high HU group. HRP characteristics, however, did not differ among the three groups.
OCT-derived calcium size, but not HRP characteristics, were associated with CAC density, suggesting that CAC density is driven mainly by calcified plaque size but not local plaque vulnerability.
尽管冠状动脉钙（CAC）密度与斑块稳定性有关，但缺乏病理学证据。我们使用光学相干断层扫描（OCT）研究了冠状动脉计算机断层扫描（CCT）衍生的 CAC 密度与多种钙化和高危斑块（HRP）特征之间的关系。
我们分析了 33 例稳定性心绞痛患者的 83 个斑块，这些患者均接受了 CCT 和 OCT 检查。使用定制 CT 软件在≥90 HU 和≥130 HU 的钙斑处测量 CAC 密度。评估中位数 CAC 密度与 OCT 衍生的钙大小（厚度和面积）之间的相关性。为了研究中位数 CAC 密度在 90 HU 阈值处是否与斑块脆弱性相关，我们比较了低（90-129 HU）、中（130-199 HU）和高（≥200 HU）CAC HU 组之间 OCT 衍生的斑块特征和 HRP 特征。
中位数 CAC 密度在 130 HU 时与钙厚度（R=0.573，p<0.001）和面积（R=0.560，p<0.001）中度相关。在 90 HU 时也观察到类似的结果（厚度，R=0.615，p<0.001；面积，R=0.612，p<0.001）。在低、中、高 HU 水平组中，钙厚度（0.42±0.14 mm、0.60±0.17 mm 和 0.77±0.19 mm，分别；p<0.001）和面积（0.55±0.29 mm、1.20±0.58 mm 和 1.78±0.87 mm，分别；p<0.001）在高 HU 组中显著更大。然而，HRP 特征在三组之间没有差异。
OCT 衍生的钙大小，但不是 HRP 特征，与 CAC 密度相关，表明 CAC 密度主要由钙化斑块大小驱动，而不是局部斑块脆弱性。
