CT attenuation features of individual calcified coronary plaque: differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups

Yi-Luan Huang, Huey-Shyan Lin, Carol C Wu, Fu-Zong Wu, Chinson Yeh, Kuan-Ran Chiou, Guang-Yuan Mar, Ming-Ting Wu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups.

METHODS: In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2.

RESULTS: Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001).

CONCLUSIONS: Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.

Original languageEnglish
Pages (from-to)e0131254
JournalPLoS One
Volume10
Issue number6
DOIs
Publication statusPublished - 2015
Externally publishedYes

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Stable Angina
Acute Coronary Syndrome
coronary vessels
Coronary Vessels
Calcium
calcium
Computerized tomography
computed tomography
Area Under Curve
risk factors
Cohort Studies

Keywords

  • Acute Coronary Syndrome/diagnostic imaging
  • Aged
  • Angina, Stable/diagnostic imaging
  • Artifacts
  • Calcinosis
  • Cohort Studies
  • Coronary Artery Disease/diagnostic imaging
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic/diagnostic imaging
  • ROC Curve
  • Radiographic Image Interpretation, Computer-Assisted
  • Reproducibility of Results
  • Risk Factors
  • Tomography, X-Ray Computed

Cite this

CT attenuation features of individual calcified coronary plaque : differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups. / Huang, Yi-Luan; Lin, Huey-Shyan; Wu, Carol C; Wu, Fu-Zong; Yeh, Chinson; Chiou, Kuan-Ran; Mar, Guang-Yuan; Wu, Ming-Ting.

In: PLoS One, Vol. 10, No. 6, 2015, p. e0131254.

Research output: Contribution to journalArticle

Huang, Yi-Luan ; Lin, Huey-Shyan ; Wu, Carol C ; Wu, Fu-Zong ; Yeh, Chinson ; Chiou, Kuan-Ran ; Mar, Guang-Yuan ; Wu, Ming-Ting. / CT attenuation features of individual calcified coronary plaque : differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups. In: PLoS One. 2015 ; Vol. 10, No. 6. pp. e0131254.
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title = "CT attenuation features of individual calcified coronary plaque: differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups",
abstract = "BACKGROUND: Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups.METHODS: In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2.RESULTS: Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001).CONCLUSIONS: Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.",
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author = "Yi-Luan Huang and Huey-Shyan Lin and Wu, {Carol C} and Fu-Zong Wu and Chinson Yeh and Kuan-Ran Chiou and Guang-Yuan Mar and Ming-Ting Wu",
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TY - JOUR

T1 - CT attenuation features of individual calcified coronary plaque

T2 - differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups

AU - Huang, Yi-Luan

AU - Lin, Huey-Shyan

AU - Wu, Carol C

AU - Wu, Fu-Zong

AU - Yeh, Chinson

AU - Chiou, Kuan-Ran

AU - Mar, Guang-Yuan

AU - Wu, Ming-Ting

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups.METHODS: In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2.RESULTS: Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001).CONCLUSIONS: Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.

AB - BACKGROUND: Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups.METHODS: In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2.RESULTS: Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001).CONCLUSIONS: Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.

KW - Acute Coronary Syndrome/diagnostic imaging

KW - Aged

KW - Angina, Stable/diagnostic imaging

KW - Artifacts

KW - Calcinosis

KW - Cohort Studies

KW - Coronary Artery Disease/diagnostic imaging

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Plaque, Atherosclerotic/diagnostic imaging

KW - ROC Curve

KW - Radiographic Image Interpretation, Computer-Assisted

KW - Reproducibility of Results

KW - Risk Factors

KW - Tomography, X-Ray Computed

U2 - 10.1371/journal.pone.0131254

DO - 10.1371/journal.pone.0131254

M3 - Article

C2 - 26106881

VL - 10

SP - e0131254

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 6

ER -