Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study

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. The PARADIGM study...

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Bibliographic Details
Published in:Journal of cardiovascular computed tomography 2020-09, Vol.14 (5), p.400-406
Main Authors: van Rosendael, Alexander R., Lin, Fay Y., Ma, Xiaoyue, van den Hoogen, Inge J., Gianni, Umberto, Al Hussein, Omar, Al'Aref, Subhi J., Peña, Jessica M., Andreini, Daniele, Al-Mallah, Mouaz H., Budoff, Matthew J., Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Conte, Edoardo, Marques, Hugo, de Araújo Gonçalves, Pedro, Gottlieb, Ilan, Hadamitzky, Martin, Leipsic, Jonathon A., Maffei, Erica, Pontone, Gianluca, Raff, Gilbert L., Shin, Sanghoon, Kim, Yong-Jin, Lee, Byoung Kwon, Chun, Eun Ju, Sung, Ji Min, Lee, Sang-Eun, Berman, Daniel S., Virmani, Renu, Samady, Habib, Stone, Peter H., Narula, Jagat, Bax, Jeroen J., Shaw, Leslee J., Min, James K., Chang, Hyuk-Jae
Format: Article
Language:English
Subjects:
Atherosclerosis
Coronary CTA
Imaging
Percent atheroma volume
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Summary: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. 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. 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 
ISSN:1934-5925
1876-861X
DOI:10.1016/j.jcct.2020.01.012