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Research paper| Volume 14, ISSUE 3, P266-271, May 2020

A novel density-volume calcium score by non-contrast CT predicts coronary plaque burden on coronary CT angiography: Results from the MACS (Multicenter AIDS cohort study)

Published:September 24, 2019DOI:https://doi.org/10.1016/j.jcct.2019.09.016

      Abstract

      Background

      The purpose of this study is to determine if a new score calculated with coronary artery calcium (CAC) density and volume is associated with total coronary artery plaque burden and composition on coronary CT angiography (CCTA) compared to the Agatston score (AS).

      Methods

      We identified 347 men enrolled in the Multicenter AIDS cohort study who underwent contrast and non-contrast CCTs, and had CAC>0. CAC densities (mean Hounsfield Units [HU]) per plaque) and volumes on non-contrast CCT were measured. A Density-Volume Calcium score was calculated by multiplying the plaque volume by a factor based on the mean HU of the plaque (4, 3, 2 and 1 for 130–199, 200–299, 300–399, and ≥400HU). Total Density-Volume Calcium score was determined by the sum of these individual scores. The semi-quantitative partially calcified and total plaque scores (PCPS and TPS) on CCTA were calculated. The associations between Density-Volume Calcium score, PCPS and TPS were examined.

      Results

      Overall, 2879 CAC plaques were assessed. Multivariable linear regression models demonstrated a stronger association between the log Density-Volume Calcium score and both the PCPS (β 0.99, 95%CI 0.80–1.19) and TPS (β 2.15, 95%CI 1.88–2.42) compared to the log of AS (PCPS: β 0.77, 95%CI 0.61–0.94; TPS: β 1.70, 95%CI 1.48–1.94). Similar results were observed for numbers of PC or TP segments.

      Conclusion

      The new CAC score weighted towards lower density demonstrated improved correlation with semi-quantitative PC and TP burden on CCTA compared to the traditional AS, which suggests it has utility as an alternative measure of atherosclerotic burden.

      Keywords

      Abbreviations:

      CAC (Coronary artery calcium), CCTA (Coronary computed tomographic angiography), CAD (Coronary artery disease), HIV (Human immunodeficiency virus)
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      References

        • Sangiorgi G.
        • Rumberger J.A.
        • Severson A.
        • et al.
        Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology.
        J Am Coll Cardiol. 1998; 31: 126-133
        • Budoff M.J.
        • Shaw L.J.
        • Liu S.T.
        • et al.
        Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients.
        J Am Coll Cardiol. 2007; 49: 1860-1870
        • Budoff M.J.
        • Nasir K.
        • McClelland R.L.
        • et al.
        Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis).
        J Am Coll Cardiol. 2009; 53: 345-352
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • et al.
        Coronary calcium as a predictor of coronary events in four racial or ethnic groups.
        N Engl J Med. 2008; 358: 1336-1345
        • Yeboah J.
        • McClelland R.L.
        • Polonsky T.S.
        • et al.
        Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals.
        J Am Med Assoc : J Am Med Assoc. 2012; 308: 788-795
        • Nakanishi R.
        • Li D.
        • Blaha M.J.
        • et al.
        All-cause mortality by age and gender based on coronary artery calcium scores.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 1305-1314
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Kaslow R.A.
        • Ostrow D.G.
        • Detels R.
        • Phair J.P.
        • Polk B.F.
        • Rinaldo Jr., C.R.
        The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants.
        Am J Epidemiol. 1987; 126: 310-318
        • Post W.S.
        • Budoff M.
        • Kingsley L.
        • et al.
        Associations between HIV infection and subclinical coronary atherosclerosis.
        Ann Intern Med. 2014; 160: 458-467
        • Hacioglu Y.
        • Gupta M.
        • Choi T.Y.
        • et al.
        Use of cardiac CT angiography imaging in an epidemiology study - the Methodology of the Multicenter AIDS Cohort Study cardiovascular disease substudy.
        Anadolu Kardiyol Derg. 2013; 13: 207-214
        • Leipsic J.
        • Abbara S.
        • Achenbach S.
        • et al.
        SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.
        J Cardiovasc Comput Tomogr. 2014; 8: 342-358
        • Pagali S.R.
        • Madaj P.
        • Gupta M.
        • et al.
        Interobserver variations of plaque severity score and segment stenosis score in coronary arteries using 64 slice multidetector computed tomography: a substudy of the ACCURACY trial.
        J Cardiovasc Comput Tomogr. 2010; 4: 312-318
        • Criqui M.H.
        • Denenberg J.O.
        • Ix J.H.
        • et al.
        Calcium density of coronary artery plaque and risk of incident cardiovascular events.
        J Am Med Assoc : J Am Med Assoc. 2014; 311: 271-278
        • Virmani R.
        • Burke A.P.
        • Farb A.
        • Kolodgie F.D.
        Pathology of the vulnerable plaque.
        J Am Coll Cardiol. 2006; 47: C13-C18
        • Meirelles G.S.
        • Gonen M.
        • Strauss H.W.
        18F-FDG uptake and calcifications in the thoracic aorta on positron emission tomography/computed tomography examinations: frequency and stability on serial scans.
        J Thorac Imaging. 2011; 26: 54-62
        • Rudd J.H.
        • Myers K.S.
        • Bansilal S.
        • et al.
        Atherosclerosis inflammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations.
        J Nucl Med. 2008; 49: 871-878
        • Simons D.B.
        • Schwartz R.S.
        • Edwards W.D.
        • Sheedy P.F.
        • Breen J.F.
        • Rumberger J.A.
        Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study.
        J Am Coll Cardiol. 1992; 20: 1118-1126
        • Nasir K.
        • Rivera J.J.
        • Yoon Y.E.
        • et al.
        Variation in atherosclerotic plaque composition according to increasing coronary artery calcium scores on computed tomography angiography.
        Int J Cardiovasc Imaging. 2010; 26: 923-932
        • Tota-Maharaj R.
        • Al-Mallah M.H.
        • Nasir K.
        • Qureshi W.T.
        • Blumenthal R.S.
        • Blaha M.J.
        Improving the relationship between coronary artery calcium score and coronary plaque burden: addition of regional measures of coronary artery calcium distribution.
        Atherosclerosis. 2015; 238: 126-131
        • Blaha M.J.
        • Budoff M.J.
        • Tota-Maharaj R.
        • et al.
        Improving the CAC score by addition of regional measures of calcium distribution: multi-ethnic study of atherosclerosis.
        JACC Cardiovasc Imaging. 2016;
        • Otsuka F.
        • Sakakura K.
        • Yahagi K.
        • Joner M.
        • Virmani R.
        Has our understanding of calcification in human coronary atherosclerosis progressed?.
        Arterioscler Thromb Vasc Biol. 2014; 34: 724-736
        • Mauriello A.
        • Servadei F.
        • Zoccai G.B.
        • et al.
        Coronary calcification identifies the vulnerable patient rather than the vulnerable Plaque.
        Atherosclerosis. 2013; 229: 124-129
        • Arad Y.
        • Spadaro L.A.
        • Roth M.
        • Newstein D.
        • Guerci A.D.
        Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial.
        J Am Coll Cardiol. 2005; 46: 166-172
        • Houslay E.S.
        • Cowell S.J.
        • Prescott R.J.
        • et al.
        Progressive coronary calcification despite intensive lipid-lowering treatment: a randomised controlled trial.
        Heart. 2006; 92: 1207-1212
        • Dey D.
        • Schepis T.
        • Marwan M.
        • Slomka P.J.
        • Berman D.S.
        • Achenbach S.
        Automated three-dimensional quantification of noncalcified coronary plaque from coronary CT angiography: comparison with intravascular US.
        Radiology. 2010; 257: 516-522
        • Papadopoulou S.L.
        • Garcia-Garcia H.M.
        • Rossi A.
        • et al.
        Reproducibility of computed tomography angiography data analysis using semiautomated plaque quantification software: implications for the design of longitudinal studies.
        Int J Cardiovasc Imaging. 2013; 29: 1095-1104
        • Metkus T.S.
        • Brown T.
        • Budoff M.
        • et al.
        HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS).
        HIV Med. 2015; 16: 635-639