Alexander R van Rosendael1, Fay Y Lin2, Xiaoyue Ma3, Inge J van den Hoogen1, Umberto Gianni4, Omar Al Hussein2, Subhi J Al'Aref2, Jessica M Peña2, Daniele Andreini5, Mouaz H Al-Mallah6, Matthew J Budoff7, Filippo Cademartiri8, Kavitha Chinnaiyan9, Jung Hyun Choi10, Edoardo Conte5, Hugo Marques11, Pedro de Araújo Gonçalves11, Ilan Gottlieb12, Martin Hadamitzky13, Jonathon A Leipsic14, Erica Maffei15, Gianluca Pontone5, Gilbert L Raff9, Sanghoon Shin16, Yong-Jin Kim17, Byoung Kwon Lee18, Eun Ju Chun19, Ji Min Sung20, Sang-Eun Lee20, Daniel S Berman21, Renu Virmani22, Habib Samady23, Peter H Stone24, Jagat Narula25, Jeroen J Bax26, Leslee J Shaw2, James K Min27, Hyuk-Jae Chang28. 1. Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. 3. Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 4. Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy. 5. Centro Cardiologico Monzino, IRCCS Milan, Italy. 6. Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA. 7. Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. 8. Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy. 9. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. 10. Pusan University Hospital, Busan, South Korea. 11. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. 12. Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. 13. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. 14. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. 15. Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. 16. Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea. 17. Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. 18. Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 19. Seoul National University Bundang Hospital, Sungnam, South Korea. 20. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea. 21. Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. 22. Department of Pathology, CVPath Institute, Gaithersburg, MD, USA. 23. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. 24. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 25. Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA. 26. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 27. Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu. 28. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
Abstract
BACKGROUND AND AIMS: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. METHODS: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. RESULTS: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. CONCLUSIONS: PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.
BACKGROUND AND AIMS: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. METHODS: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. RESULTS: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. CONCLUSIONS:PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.
Authors: Keva Garg; Toral R Patel; Arjun Kanwal; Todd C Villines; Niti R Aggarwal; Khurram Nasir; Roger S Blumenthal; Michael J Blaha; Pamela S Douglas; Leslee J Shaw; Garima Sharma Journal: J Cardiovasc Comput Tomogr Date: 2021-10-08
Authors: Todd C Villines; Subhi J Al'Aref; Daniele Andreini; Marcus Y Chen; Andrew D Choi; Carlo N De Cecco; Damini Dey; James P Earls; Maros Ferencik; Heidi Gransar; Harvey Hecht; Jonathon A Leipsic; Michael T Lu; Mohamed Marwan; Pál Maurovich-Horvat; Edward Nicol; Gianluca Pontone; Jonathan Weir-McCall; Seamus P Whelton; Michelle C Williams; Armin Arbab-Zadeh; Gudrun M Feuchtner Journal: J Cardiovasc Comput Tomogr Date: 2021-02-22