Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector computed tomography
Author:
de Knegt Martina C12, Linde Jesper J1, Fuchs Andreas1, Pham Michael H C1, Jensen Andreas K3, Nordestgaard Børge G4, Kelbæk Henning5, Køber Lars V1, Heitmann Merete6, Fornitz Gitte2, Hove Jens D2, Kofoed Klaus F17, Kofoed Klaus F, Nordestgaard Børge, Køber Lars V, Kühl J Tobias, Fuchs Andreas, Sigvardsen Per, Sørgaard Mathias, de Knegt Martina C, Norsk Jakob, Frestad Daria, Mejdahl Mads, Elming Marie, Sørensen Samuel Kiil, Hindsøe Louise, Thomsen Anna Foged, Udholm Patricia Martens, Pihl Christian, Nilsson Julia, Byrne Christina, Knudsen Andreas Dehlbæk, Haugen Morten, Windfeld-Mathiasen Josefine, Wiegandt Yaffah Tamar Laura, Pham Michael H C, Ballegaard Christian, Arnaa Kirsten, Møller Christina, Thrysøe Kirsten, Linde Jesper J, Kofoed Klaus F, Hove Jens D, Jensen Gorm B, Sørgaard Mathias, Kelbæk Henning, Kühl J Tobias, Nielsen Walter, Køber Lars V, Trysøe Kirsten, Møller Christina, Bock-Pedersen Tina, Hansen Bettina, Udholm Patricia Martens, de Knegt Martina C, Kofoed Klaus F, Køber Lars V, Kløvgaard Lene, Linde Jesper J, Kühl J Tobias, Holmvang Lene, Engstrøm Thomas, Helquist Steffen, Jørgensen Erik, Petersen Frans, Saunamaki Kari, Clemmensen Peter, de Knegt Martina C, Sadjadieh Golnaz, Laursen Peter Nørkjær, Hansen Peter Riis, Gislason Gunnar, Abildgaard Ulrik, Jensen Jan Skov, Galatius Søren, Fritz-Hansen Thomas, Bech Jan, Wachtell Christian, Madsen Jan Kyst, Smedegaard Lærke, Özcan Cengiz, Svendsen Ida Hastrup, Nielsen Olav Wendelboe, Kristiansen Ole, Bjerre Andreas Fabricius, Hove Jens D, Nielsen Walter, Dixen Ulrik, Madsen Johnny Koertz, Fornitz Gitte Gleerup, Raymond Ilan, Abdulla Jawdat, Lyngbæk; Stig, Steffensen Rolf, Jurlander Birgit, Kragelund Charlotte, Dominguez Helena, Schou Morten, Kelbæk Henning, Elming Hanne, Therkelsen Susette,
Affiliation:
1. Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark 2. Department of Cardiology, Amager-Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, Hvidovre, Copenhagen, Denmark 3. Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark 4. Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, Copenhagen, Denmark 5. Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark 6. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen, Denmark 7. Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
Abstract
Abstract
Aims
Quantitative computed tomography (QCT) allows assessment of morphological features of coronary atherosclerosis. We aimed to test the hypothesis that clinical patient presentation is associated with distinct morphological features of coronary atherosclerosis.
Methods and results
A total of 1652 participants, representing a spectrum of clinical risk profiles [787 asymptomatic individuals from the general population, 468 patients with acute chest pain without acute coronary syndrome (ACS), and 397 patients with acute chest pain and ACS], underwent multidetector computed tomography. Of these, 274 asymptomatic individuals, 254 patients with acute chest pain without ACS, and 327 patients with acute chest pain and ACS underwent QCT to assess coronary plaque volumes and proportions of dense calcium (DC), fibrous, fibro fatty (FF), and necrotic core (NC) tissue. Furthermore, the presence of vulnerable plaques, defined by plaque volume and tissue composition, was examined. Coronary plaque volume increased significantly with worsening clinical risk profile [geometric mean (95% confidence interval): 148 (129–166) mm3, 257 (224–295) mm3, and 407 (363–457) mm3, respectively, P < 0.001]. Plaque composition differed significantly across cohorts, P < 0.0001. The proportion of DC decreased, whereas FF and NC increased with worsening clinical risk profile (mean proportions DC: 33%, 23%, 23%; FF: 50%, 61%, 57%; and NC: 17%, 17%, 20%, respectively). Significant differences in plaque composition persisted after multivariable adjustment for age, gender, body surface area, hypertension, statin use at baseline, diabetes, smoking, family history of ischaemic heart disease, total plaque volume, and tube voltage, P < 0.01.
Conclusion
Coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation.
Funder
AP Møller og hustru Chastine McKinney Møllers Fond John and Birthe Meyer Foundation Research Council of Rigshospitalet University of Copenhagen Danish Agency for Science, Technology and Innovation Danish Council for Strategic Research
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,General Medicine
Cited by
22 articles.
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