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Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain

Ahmed Salem, Joel Davis, Deepa Gopalan, James H.F. Rudd, Sarah C. Clarke, Peter M. Schofield, Martin R. Bennett, Adam J. Brown, Daniel Obaid Orcid Logo

Clinical Imaging, Volume: 101, Pages: 69 - 76

Swansea University Authors: Ahmed Salem, Daniel Obaid Orcid Logo

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DOI (Published version): 10.1016/j.clinimag.2023.06.009

Abstract

Background: Coronary computed tomography angiography (CCTA) can identify high-risk coronary plaque types. However, the inter-observer variability for high-risk plaque features, including low attenuation plaque (LAP), positive remodelling (PR), and the Napkin-Ring sign (NRS), may reduce their utility...

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Published in: Clinical Imaging
ISSN: 0899-7071 1873-4499
Published: Elsevier BV 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa64515
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Abstract: Background: Coronary computed tomography angiography (CCTA) can identify high-risk coronary plaque types. However, the inter-observer variability for high-risk plaque features, including low attenuation plaque (LAP), positive remodelling (PR), and the Napkin-Ring sign (NRS), may reduce their utility, especially amongst less experienced readers. Methodology: In a prospective study, we compared the prevalence, location and inter-observer variability of both conventional CT-defined high-risk plaques with a novel index based on quantifying the ratio of necrotic core to fibrous plaque using individualised X-ray attenuation cut-offs (the CT-defined thin-cap fibroatheroma - CT-TCFA) in 100 patients followed-up for 7 years. Results: In total, 346 plaques were identified in all patients. Seventy-two (21%) of all plaques were classified by conventional CT parameters as high-risk (either NRS or PR and LAP combined), and 43 (12%) of plaques were considered high-risk using the novel CT-TCFA definition of (Necrotic Core/fibrous plaque ratio of >0.9). The majority (80%) of the high-risk plaques (LAP&PR, NRS and CT-TCFA) were located in the proximal and mid-LAD and RCA. The kappa co-efficient of inter-observer variability (k) for NRS was 0.4 and for PR and LAP combined 0.4. While the kappa co-efficient of inter-observer variability (k) for the new CT-TCFA definition was 0.7. During follow-up, patients with either conventional high-risk plaques or CT-TCFAs were significantly more likely to have MACE (Major adverse cardiovascular events) compared to patients without coronary plaques (p value 0.03 & 0.03, respectively). Conclusion: The novel CT-TCFA is associated with MACE and has improved inter-observer variability compared with current CT-defined high-risk plaques.
Keywords: Coronary computed tomography, High-risk plaques, Atherosclerosis, Cardiac events
College: Faculty of Medicine, Health and Life Sciences
Funders: This work was funded by BHF grants RG71070 and RG84554, the BHF Centre for Research Excellence (London, UK), and the National Institute of Health Research Cambridge Biomedical Research Centre (London, UK). James. H.F. Rudd is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, HEFCE, the EPSRC and the Wellcome Trust.
Start Page: 69
End Page: 76

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