The feasibility and limitation of coronary computed tomographic angiography imaging to identify coronary lipid-rich atheroma in vivo: Findings from near-infrared spectroscopy analysis. (April 2021)

• Record Type: Journal Article
• Authors: Kitahara, Satoshi; Kataoka, Yu; Miura, Hiroyuki; Nishii, Tatsuya; Nishimura, Kunihiro; Murai, Kota; Iwai, Takamasa; Nakamura, Hayato; Hosoda, Hayato; Matama, Hideo; Doi, Takahito; Nakashima, Takahiro; Honda, Satoshi; Fujino, Masashi; Nakao, Kazuhiro; Yoneda, Shuichi; Nishihira, Kensaku; Kanaya, Tomoaki; Otsuka, Fumiyuki; Asaumi, Yasuhide; Tsujita, Kenichi; Noguchi, Teruo; Yasuda, Satoshi
• Is Part Of: Atherosclerosis. Volume 322(2021)
• Page Start: 1
• Page End: 7
• Publication Date: 2021-04
• Subjects: Coronary -- Computed tomography -- Near-infrared spectroscopy -- Lipid-rich plaque; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.02.019
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background: Coronary computed tomography angiography (CCTA) non-invasively visualizes lipid-rich plaque. However, this ability is not fully validated in vivo . The current study aimed to elucidate the association of CCTA features with near-infrared spectroscopy-derived lipidic plaque measure in patients with coronary artery disease. Methods: 95 coronary lesions (culprit/non-culprit = 51/44) in 35 CAD subjects were evaluated by CCTA and NIRS imaging. CT density, positive remodeling, spotty calcification, napkin-ring sign and NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI4mm ) were analyzed by two independent physicians. The association of CCTA-derived plaque features with maxLCBI4mm ≥ 400 was evaluated. Results: The median CT density and maxLCBI4mm were 57.7 Hounsfield units (HU) and 304, respectively. CT density (r = -0.75, p < 0.001) and remodeling index (RI) (r = 0.58, p < 0.001) were significantly associated with maxLCBI4mm, respectively. Although napkin-ring sign ( p < 0.001) showed higher prevalence of maxLCBI4mm ≥ 400 than those without it, spotty calcification did not ( p = 0.13). On multivariable analysis, CT density [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.93–0.97; p < 0.001] and positive remodeling [OR = 7.71, 95%CI = 1.37–43.41, p = 0.02] independently predicted maxLCBI4mm ≥ 400. Receiver operating characteristic curve analysis demonstrated CT density <32.9 HU (AUC = 0.92, sensitivity = 85.7%, specificity = 91.7%) and RI ≥ 1.08 (AUC = 0.83, sensitivity = 74.3%, specificity = 85.0%) as optimal cut-off values of maxLCBI4mm ≥ 400. Of note, only 52.6% at lesions with one of these plaque features exhibited maxLCBI4mm ≥ 400, whereas the frequency of maxLCBI4mm ≥ 400 was highest at those with both features (88.5%, p < 0.001 for trend). Conclusions: CT density <32.9 HU and RI ≥ 1.08 were associated with lipid-rich plaque on NIRS imaging. Our findings underscore the synergistic value of CT density and positive remodeling to detect lipid-rich plaque by CCTA. Graphical abstract: Image 1 Highlights: Positive remodeling and low CT density independently associated with near-infrared spectroscopy-derived lipidic measure. CT density and positive remodeling were independent predictors of lipid-rich plaque. CT density <32.9 HU and remodeling index ≥1.08 were optimal cut-off values of lipid-rich plaque. CT density and positive remodeling have synergistic value to detect lipid-rich plaque by coronary CT angiography.