Author + information
- Received May 22, 2017
- Revision received July 5, 2017
- Accepted July 21, 2017
- Published online October 17, 2018.
- Indre Ceponiene, MD, MSca,b,
- Rine Nakanishi, MD, PhDa,∗ (, )
- Kazuhiro Osawa, MD, PhDa,
- Mitsuru Kanisawa, MDa,
- Negin Nezarat, MDa,
- Sina Rahmani, MDa,
- Kendall Kissela,
- Michael Kim, BSa,
- Eranthi Jayawardena, BSa,
- Alexander Broersen, PhDc,
- Pieter Kitslaar, MScc,d and
- Matthew J. Budoff, MDa
- aLos Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
- bDepartments of Cardiology and Radiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- cDivision of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- dMedis Medical Imaging Systems, Leiden, the Netherlands
- ↵∗Address for correspondence:
Dr. Rine Nakanishi, Los Angeles Biomedical Research Institute at Harbor UCLA, 1124 West Carson Street, Torrance, California 90502.
Objectives The aim of this study was to determine whether coronary artery calcium (CAC) progression was associated with coronary plaque progression on coronary computed tomographic angiography.
Background CAC progression and coronary plaque characteristics are associated with incident coronary heart disease. However, natural history of coronary atherosclerosis has not been well described to date, and the understanding of the association between CAC progression and coronary plaque subtypes such as noncalcified plaque progression remains unclear.
Methods Consecutive patients who were referred to our clinic for evaluation and had serial coronary computed tomography angiography scans performed were included in the study. Coronary artery plaque (total, fibrous, fibrous-fatty, low-attenuation, densely calcified) volumes were calculated using semiautomated plaque analysis software.
Results A total of 211 patients (61.3 ± 12.7 years of age, 75.4% men) were included in the analysis. The mean interval between baseline and follow-up scans was 3.3 ± 1.7 years. CAC progression was associated with a significant linear increase in all types of coronary plaque and no plaque progression was observed in subjects without CAC progression. In multivariate analysis, annualized and normalized total plaque (β = 0.38; p < 0.001), noncalcified plaque (β = 0.35; p = 0.001), fibrous plaque (β = 0.56; p < 0.001), and calcified plaque (β = 0.63; p = 0.001) volume progression, but not fibrous-fatty (β = 0.03; p = 0.28) or low-attenuation plaque (β = 0.11; p = 0.1) progression, were independently associated with CAC progression. Plaque progression did not differ between the sexes. A significantly increased total and calcified plaque progression was observed in statin users.
Conclusions In a clinical practice setting, progression of CAC was significantly associated with an increase in both calcified and noncalcified plaque volume, except fibrous-fatty and low-attenuation plaque. Serial CAC measurements may be helpful in determining the need for intensification of preventive treatment.
This research was supported by R01 HL071739 (to Dr. Budoff). Dr. Kitslaar is an employee of Medis Medical Imaging Systems and has a research appointment at the Leiden University Medical Center. Dr. Budoff has served as a consultant for General Electric. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 22, 2017.
- Revision received July 5, 2017.
- Accepted July 21, 2017.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.