Manubolu Venkat Sanjay, Dahal Suraj, Lakshmanan Suvasini, Crabtree Tami, Kinninger April, Shafter Ahmed M, Bitar Jairo Aldana, Verghese Dhiran, Alalawi Luay, Dailing Chris, Earls James P, Budoff Matthew J
Lundquist Institute, Harbor UCLA, Torrance, CA, USA.
Cleerly, Inc, Denver, CO, USA.
Heart Int. 2024 Mar 28;18(1):44-50. doi: 10.17925/HI.2024.18.1.7. eCollection 2024.
Agatston coronary artery calcium (CAC) score is a strong predictor of mortality. However, the relationship between CAC and quantitative calcified plaque volume (CPV), which is measured on coronary computed tomography angiography (CCTA), is not well understood. Furthermore, there is limited evidence evaluating the difference between CAC versus CPV and CAC versus total plaque volume (TPV) in predicting obstructive coronary artery disease (CAD). This study included 147 subjects from the CLARIFY registry, a multicentered study of patients undergoing assessment using CCTA and CAC score as part of acute and stable chest pain evaluation. Automated software service (Cleerly.Inc, Denver, CO, USA) was used to evaluate the degree of vessel stenosis and plaque quantification on CCTA. CAC was measured using the standard Agatston method. Spearman correlation and receiver operating characteristic curve analysis was performed to evaluate the diagnostic ability of CAC, CPV and TPV in detecting obstructive CAD. Results demonstrated a very strong positive correlation between CAC and CPV (r=0.76, p=0.0001) and strong correlation between CAC and TPV (r=0.72, p<0.001) at per-patient level analysis. At per-patient level analysis, the sensitivity of CAC (68%) is lower than CPV (77%) in predicting >50% stenosis, but negative predictive value is comparable. However, the sensitivity of TPV is higher compared with CAC in predicting >50% stenosis, and the negative predictive value of TPV is also higher. CPV and TPV are more sensitive in predicting the severity of obstructive CAD compared with the CAC score. However, the negative predictive value of CAC is comparable to CPV, but is lower than TPV. This study elucidates the relationship between CAC and quantitative plaque types, and especially emphasizes the differences between CAC and CPV which are two distinct plaque measurement techniques that are utilized in predicting obstructive CAD.
阿加斯顿冠状动脉钙化（CAC）评分是死亡率的有力预测指标。然而，CAC与通过冠状动脉计算机断层扫描血管造影（CCTA）测量的定量钙化斑块体积（CPV）之间的关系尚未完全明确。此外，评估CAC与CPV以及CAC与总斑块体积（TPV）在预测阻塞性冠状动脉疾病（CAD）方面差异的证据有限。本研究纳入了CLARIFY注册研究中的147名受试者，该研究是一项多中心研究，对使用CCTA和CAC评分进行评估的患者进行急性和稳定胸痛评估。使用自动化软件服务（美国科罗拉多州丹佛市的Cleerly.Inc公司）评估CCTA上的血管狭窄程度和斑块定量。使用标准阿加斯顿方法测量CAC。进行Spearman相关性分析和受试者操作特征曲线分析，以评估CAC、CPV和TPV在检测阻塞性CAD方面的诊断能力。结果显示，在患者层面分析中，CAC与CPV之间存在非常强的正相关（r = 0.76，p = 0.0001），CAC与TPV之间存在强相关（r = 0.72，p < 0.001）。在患者层面分析中，在预测>50%狭窄方面，CAC的敏感性（68%）低于CPV（77%），但阴性预测值相当。然而，在预测>50%狭窄方面，TPV的敏感性高于CAC，且TPV的阴性预测值也更高。与CAC评分相比，CPV和TPV在预测阻塞性CAD的严重程度方面更敏感。然而，CAC的阴性预测值与CPV相当，但低于TPV。本研究阐明了CAC与定量斑块类型之间的关系，尤其强调了CAC与CPV之间的差异，这两种是用于预测阻塞性CAD的不同斑块测量技术。
