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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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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 &gt;0.9). The majority (80%) of the high-risk plaques (LAP&amp;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 &amp; 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.</abstract><type>Journal Article</type><journal>Clinical Imaging</journal><volume>101</volume><journalNumber/><paginationStart>69</paginationStart><paginationEnd>76</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0899-7071</issnPrint><issnElectronic>1873-4499</issnElectronic><keywords>Coronary computed tomography, High-risk plaques, Atherosclerosis, Cardiac events</keywords><publishedDay>30</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-09-30</publishedDate><doi>10.1016/j.clinimag.2023.06.009</doi><url>http://dx.doi.org/10.1016/j.clinimag.2023.06.009</url><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><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). 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Rudd is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, HEFCE, the EPSRC and the Wellcome Trust.</funders><projectreference/><lastEdited>2023-10-04T13:49:19.2186066</lastEdited><Created>2023-09-12T17:20:49.3521407</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Ahmed</firstname><surname>Salem</surname><order>1</order></author><author><firstname>Joel</firstname><surname>Davis</surname><order>2</order></author><author><firstname>Deepa</firstname><surname>Gopalan</surname><order>3</order></author><author><firstname>James H.F.</firstname><surname>Rudd</surname><order>4</order></author><author><firstname>Sarah C.</firstname><surname>Clarke</surname><order>5</order></author><author><firstname>Peter M.</firstname><surname>Schofield</surname><order>6</order></author><author><firstname>Martin R.</firstname><surname>Bennett</surname><order>7</order></author><author><firstname>Adam J.</firstname><surname>Brown</surname><order>8</order></author><author><firstname>Daniel</firstname><surname>Obaid</surname><orcid>0000-0002-3891-1403</orcid><order>9</order></author></authors><documents><document><filename>64515__28526__755a157822e14f9fb7b101ed8bbba2b6.pdf</filename><originalFilename>64515.VOR.pdf</originalFilename><uploaded>2023-09-13T11:38:36.8732773</uploaded><type>Output</type><contentLength>1999943</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2023 The Authors. 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spelling v2 64515 2023-09-12 Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain fe8d190b0388826e229257c2d3d89d22 Ahmed Salem Ahmed Salem true false 1cb4b49224d4f3f2b546ed0f39e13ea8 0000-0002-3891-1403 Daniel Obaid Daniel Obaid true false 2023-09-12 FGMHL 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. Journal Article Clinical Imaging 101 69 76 Elsevier BV 0899-7071 1873-4499 Coronary computed tomography, High-risk plaques, Atherosclerosis, Cardiac events 30 9 2023 2023-09-30 10.1016/j.clinimag.2023.06.009 http://dx.doi.org/10.1016/j.clinimag.2023.06.009 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University SU Library paid the OA fee (TA Institutional Deal) 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. 2023-10-04T13:49:19.2186066 2023-09-12T17:20:49.3521407 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ahmed Salem 1 Joel Davis 2 Deepa Gopalan 3 James H.F. Rudd 4 Sarah C. Clarke 5 Peter M. Schofield 6 Martin R. Bennett 7 Adam J. Brown 8 Daniel Obaid 0000-0002-3891-1403 9 64515__28526__755a157822e14f9fb7b101ed8bbba2b6.pdf 64515.VOR.pdf 2023-09-13T11:38:36.8732773 Output 1999943 application/pdf Version of Record true © 2023 The Authors. Published by Elsevier Inc. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng http://creativecommons.org/licenses/by/4.0/
title Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
spellingShingle 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
Daniel Obaid
title_short Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
title_full Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
title_fullStr Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
title_full_unstemmed Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
title_sort Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain
author_id_str_mv fe8d190b0388826e229257c2d3d89d22
1cb4b49224d4f3f2b546ed0f39e13ea8
author_id_fullname_str_mv fe8d190b0388826e229257c2d3d89d22_***_Ahmed Salem
1cb4b49224d4f3f2b546ed0f39e13ea8_***_Daniel Obaid
author Ahmed Salem
Daniel Obaid
author2 Ahmed Salem
Joel Davis
Deepa Gopalan
James H.F. Rudd
Sarah C. Clarke
Peter M. Schofield
Martin R. Bennett
Adam J. Brown
Daniel Obaid
format Journal article
container_title Clinical Imaging
container_volume 101
container_start_page 69
publishDate 2023
institution Swansea University
issn 0899-7071
1873-4499
doi_str_mv 10.1016/j.clinimag.2023.06.009
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://dx.doi.org/10.1016/j.clinimag.2023.06.009
document_store_str 1
active_str 0
description 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.
published_date 2023-09-30T13:49:20Z
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