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Natural History of Coronary Atherosclerosis by Multislice Computed Tomography

Objective

This study sought to analyze the natural history of coronary atherosclerosis by multislice computed tomography (CT) and assess the serial changes in coronary plaque burden, lumen dimensions, and arterial remodeling.
Non-Invasive Imaging


Background

CT can comprehensively assess coronary atherosclerosis by combining lumen and plaque size parameters.

Methods

Thirty-two patients with acute coronary syndromes underwent 64-slice computed tomography angiography after percutaneous coronary intervention at baseline and after a median of 39 months. All patients received contemporary medical treatment. All available coronary segments in every subject were analyzed. The progression of atherosclerosis per segment and per patient was assessed by means of change in percent atheroma volume (PAV), change in normalized total atheroma volume (TAVnorm), and percent change in TAV (% change in TAV). Serial coronary remodeling was also assessed. Measures of lumen stenosis included percent diameter stenosis (%DS), minimum lumen diameter (MLD), percent area stenosis (%AS), and minimum lumen area (MLA). For each patient, the mean of all matched segments was calculated at the 2 time points. Clinical events at follow-up were documented.

Results

The PAV did not change significantly (-0.15±3.64%, p=0.72). The mean change in TAVnorm was 47.36±143.24 mm3 (p=0.071), and the % change in TAV was 6.7% (p=0.029). The MLD and MLA increased by 0.15 mm (-0.09 to 0.24, p=0.039) and 0.52 mm2 (-0.38 to 1.04, p=0.034) respectively, which was accompanied by vessel enlargement, with 53% of the patients showing expansive positive remodeling. Patients with clinical events had a larger TAVnorm at baseline (969.72 mm3 vs. 810.77 mm3, p=0.010).

Conclusion:

CT can assess the progression of coronary atherosclerosis and may be used for noninvasive monitoring of pharmacological interventions in coronary artery disease. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).

Notes to editor


Presented by: Dr Francesca Pugliese
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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