Coronary CT angiography and high-risk plaque morphology

被引：42
作者：
Motoyama S. [1 ]
Sarai M. [1 ]
Narula J. [2 ]
Ozaki Y. [1 ]
机构：
[1] Department of Cardiology, Fujita Health University, Toyoake, Aichi, 470-1192, 1-98 Dengakugakubo, Kutsukake
[2] Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, NY, NY
来源：
Cardiovascular Intervention and Therapeutics | 2013年 / 28卷 / 1期
关键词：
Acute coronary syndrome; Coronary computed tomography angiography; High risk plaque;
D O I：
10.1007/s12928-012-0140-1
中图分类号：
学科分类号：
摘要：
Computed tomography angiography (CTA) is commonly employed for exclusion of coronary artery disease and demonstration of the extent of coronary vascular involvement. It has been recently proposed that coronary artery plaques could be visualized noninvasively. This review article focused on the high risk plaque detected by CTA. Plaque characteristics of acute coronary syndrome (ACS) was compared to sable angina pectoris (SAP). The presence of positive remodeling (ACS 87 %, SAP 12 %, p < 0. 0001), low attenuation plaque (LAP) (ACS 79 %, SAP 9 %, p < 0. 0001), and spotty calcification (ACS 63 %, SAP 21 %, p = 0. 0005) were significantly more frequent in the culprit ACS lesions. Furthermore, in asymptomatic patients, presence of positively remodeling and LAP portends a greater risk for development of acute coronary events (hazard ratio = 22. 8, CI = 6. 9-75. 2, p < 0. 001). Possibility of drug intervention to high risk plaque was also reported. Serial CTA assessment allows for evaluation of interval change in morphological plaque characteristics and can be employed for assessment of efficacy of therapeutic intervention. Use of statin results in substantial reduction in LAP volume (follow-up: 4. 9 ± 7. 8 versus baseline: 1. 3 ± 2. 3 mm3, p = 0. 02) forwards stabilization of plaques. Although not recommended currently as a population-based strategy, CT angiographic examination may help identify very high risk asymptomatic subjects. © 2013 Japanese Association of Cardiovascular Intervention and Therapeutics.
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页码：1 / 8
页数：7
相关论文
共 49 条
  • [1] Bluemke D.A., Achenbach S., Budoff M., Et al., Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young, Circulation, 118, pp. 586-606, (2008)
  • [2] Raff G.L., Abidov A., Achenbach S., Et al., SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography, J Cardiovasc Comput Tomogr, 3, pp. 122-136, (2009)
  • [3] Davies M.J., The composition of coronary-artery plaques, N Engl J Med, 336, pp. 1312-1314, (1997)
  • [4] Burke A.P., Farb A., Malcom G.T., Liang Y.H., Smialek J., Virmani R., Coronary risk factors and plaque morphology in men with coronary disease who died suddenly, N Engl J Med, 336, pp. 1276-1282, (1997)
  • [5] Narula J., Finn A.V., Demaria A.N., Picking plaques that pop, J Am Coll Cardiol, 45, pp. 1970-1973, (2005)
  • [6] Narula J., Willerson J.T., Prologue: detection of vulnerable plaque, J Am Coll Cardiol, 47, (2006)
  • [7] Muller J.E., Tawakol A., Kathiresan S., Narula J., New opportunities for identification and reduction of coronary risk: treatment of vulnerable patients, arteries, and plaques, J Am Coll Cardiol, 47, (2006)
  • [8] Hassani S.-E., Mintz G.S., Fong H.S., Et al., Negative remodeling and calcified plaque in octogenarians with acute myocardial infarction: an intravascular ultrasound analysis, J Am Coll Cardiol, 47, pp. 2413-2419, (2006)
  • [9] Maehara A., Mintz G.S., Bui A.B., Et al., Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound, J Am Coll Cardiol, 40, pp. 904-910, (2002)
  • [10] Ehara S., Kobayashi Y., Yoshiyama M., Et al., Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study, Circulation, 110, pp. 3424-3429, (2004)
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