Christian Tesche1, Fabian Plank2, Carlo N De Cecco3, Taylor M Duguay3, Moritz H Albrecht4, Akos Varga-Szemes3, Richard R Bayer5, Junjie Yang6, Isaac L Jacks3, Bettina M Gramer7, Ullrich Ebersberger1, Ellen Hoffmann8, Salvatore A Chiaramida9, Gudrun Feuchtner2, U Joseph Schoepf10. 1. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany. 2. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 3. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 4. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany. 5. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 6. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China. 7. Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany. 8. Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany. 9. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. 10. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: schoepf@musc.edu.
Abstract
OBJECTIVE: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE). MATERIALS AND METHODS: Pooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed. RESULTS: Patients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3 vs. 76.3 mm3), NCPV (67.3 mm3 vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013). CONCLUSION: Coronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power.
OBJECTIVE: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE). MATERIALS AND METHODS: Pooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed. RESULTS:Patients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3 vs. 76.3 mm3), NCPV (67.3 mm3 vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013). CONCLUSION: Coronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power.
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