The feasibility and limitation of coronary computed tomographic angiography imaging to identify coronary lipid-rich atheroma in vivo: Findings from near-infrared spectroscopy analysis

Satoshi Kitahara, Yu Kataoka, Hiroyuki Miura, Tatsuya Nishii, Kunihiro Nishimura, Kota Murai, Takamasa Iwai, Hayato Nakamura, Hayato Hosoda, Hideo Matama, Takahito Doi, Takahiro Nakashima, Satoshi Honda, Masashi Fujino, Kazuhiro Nakao, Shuichi Yoneda, Kensaku Nishihira, Tomoaki Kanaya, Fumiyuki Otsuka, Yasuhide AsaumiKenichi Tsujita, Teruo Noguchi, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Coronary computed tomography angiography (CCTA) non-invasively visualizes lipid-rich plaque. However, this ability is not fully validated in vivo. The current study aimed to elucidate the association of CCTA features with near-infrared spectroscopy-derived lipidic plaque measure in patients with coronary artery disease. Methods: 95 coronary lesions (culprit/non-culprit = 51/44) in 35 CAD subjects were evaluated by CCTA and NIRS imaging. CT density, positive remodeling, spotty calcification, napkin-ring sign and NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI4mm) were analyzed by two independent physicians. The association of CCTA-derived plaque features with maxLCBI4mm ≥ 400 was evaluated. Results: The median CT density and maxLCBI4mm were 57.7 Hounsfield units (HU) and 304, respectively. CT density (r = -0.75, p < 0.001) and remodeling index (RI) (r = 0.58, p < 0.001) were significantly associated with maxLCBI4mm, respectively. Although napkin-ring sign (p < 0.001) showed higher prevalence of maxLCBI4mm ≥ 400 than those without it, spotty calcification did not (p = 0.13). On multivariable analysis, CT density [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.93–0.97; p < 0.001] and positive remodeling [OR = 7.71, 95%CI = 1.37–43.41, p = 0.02] independently predicted maxLCBI4mm ≥ 400. Receiver operating characteristic curve analysis demonstrated CT density <32.9 HU (AUC = 0.92, sensitivity = 85.7%, specificity = 91.7%) and RI ≥ 1.08 (AUC = 0.83, sensitivity = 74.3%, specificity = 85.0%) as optimal cut-off values of maxLCBI4mm ≥ 400. Of note, only 52.6% at lesions with one of these plaque features exhibited maxLCBI4mm ≥ 400, whereas the frequency of maxLCBI4mm ≥ 400 was highest at those with both features (88.5%, p < 0.001 for trend). Conclusions: CT density <32.9 HU and RI ≥ 1.08 were associated with lipid-rich plaque on NIRS imaging. Our findings underscore the synergistic value of CT density and positive remodeling to detect lipid-rich plaque by CCTA.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalAtherosclerosis
Volume322
DOIs
Publication statusPublished - 2021 Apr
Externally publishedYes

Keywords

  • Computed tomography
  • Coronary
  • Lipid-rich plaque
  • Near-infrared spectroscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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