Savo Maria Teresa, De Amicis Morena, Cozac Dan Alexandru, Cordoni Gabriele, Corradin Simone, Cozza Elena, Amato Filippo, Lassandro Eleonora, Da Pozzo Stefano, Tansella Donatella, Di Paolantonio Diana, Baroni Maria Maddalena, Di Stefano Antonio, De Conti Giorgio, Motta Raffaella, Pergola Valeria
Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy.
Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy.
J Clin Med. 2024 Sep 2;13(17):5205. doi: 10.3390/jcm13175205.
Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.
冠状动脉疾病（CAD）是全球主要的死亡原因，约占所有死亡人数的30%。其主要特征是冠状动脉内动脉粥样硬化斑块的积累，导致心肌血流减少。早期检测动脉粥样硬化斑块对于预防重大不良心脏事件至关重要。值得注意的是，最近的研究表明，15%的心肌梗死发生在非阻塞性CAD患者中，这凸显了全面斑块评估的重要性，而不仅仅是识别阻塞性病变。心脏计算机断层扫描血管造影（CCTA）已成为一种经济高效的技术，用于排除阻塞性CAD，特别是在疾病临床可能性较低至中等的患者中。CCTA技术的最新进展，如分辨率提高和扫描时间缩短，已经缓解了许多技术挑战，允许对钙化和非钙化动脉粥样硬化斑块进行精确量化和表征。本综述重点关注动脉粥样硬化斑块的两个关键生理方面：钙化负担，通过冠状动脉钙化评分（CACs）评估；以及血管周围脂肪衰减指数（pFAI），一种新兴的血管炎症标志物。通过非增强CT扫描获得的CACs量化钙化斑块负担，并广泛用于分层心血管风险，特别是在无症状患者中。尽管CACs具有预后价值，但它不能提供有关非钙化斑块或炎症状态的信息。相比之下，源自CCTA的pFAI作为冠状动脉炎症的间接标志物，在预测不良心脏事件方面显示出潜力。结合CACs和pFAI评估可以提供一种全面的风险分层方法，将既定的钙化负担与新的炎症标志物相结合，以加强CAD的预防和管理策略。
