Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA

Sang Eun Lee; Ji Min Sung; Daniele Andreini; Mouaz H. Al-Mallah; Matthew J. Budoff; Filippo Cademartiri; Kavitha Chinnaiyan; Jung Hyun Choi; Eun Ju Chun; Edoardo Conte; Ilan Gottlieb; Martin Hadamitzky; Yong Jin Kim; Byoung Kwon Lee; Jonathon A. Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L. Raff; Sanghoon Shin; Peter H. Stone; Habib Samady; Renu Virmani; Jagat Narula; Daniel S. Berman; Leslee J. Shaw; Jeroen J. Bax; Fay Y. Lin; James K. Min; Hyuk Jae Chang

doi:10.1016/j.jcmg.2019.09.011

Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA

Sang Eun Lee, Ji Min Sung, Daniele Andreini, Mouaz H. Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Eun Ju Chun, Edoardo Conte, Ilan Gottlieb, Martin Hadamitzky, Yong Jin Kim, Byoung Kwon Lee, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Gilbert L. RaffSanghoon Shin, Peter H. Stone, Habib Samady, Renu Virmani, Jagat Narula, Daniel S. Berman, Leslee J. Shaw, Jeroen J. Bax, Fay Y. Lin, James K. Min, Hyuk Jae Chang

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

41 Citations (Scopus)

Abstract

Objectives: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). Background: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. Methods: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). Conclusions: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions.

Original language	English
Pages (from-to)	1409-1417
Number of pages	9
Journal	JACC: Cardiovascular Imaging
Volume	13
Issue number	6
DOIs	https://doi.org/10.1016/j.jcmg.2019.09.011
Publication status	Published - 2020 Jun

Bibliographical note

Funding Information:
This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper.

Funding Information:
This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper.

Publisher Copyright:
© 2020 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jcmg.2019.09.011

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Lee, S. E., Sung, J. M., Andreini, D., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Chun, E. J., Conte, E., Gottlieb, I., Hadamitzky, M., Kim, Y. J., Lee, B. K., Leipsic, J. A., Maffei, E., Marques, H., de Araújo Gonçalves, P., Pontone, G., ... Chang, H. J. (2020). Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA. JACC: Cardiovascular Imaging, 13(6), 1409-1417. https://doi.org/10.1016/j.jcmg.2019.09.011

@article{63eeadf9edc24d28b899fe2c919ce8b8,

title = "Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA",

abstract = "Objectives: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). Background: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. Methods: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). Conclusions: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions.",

author = "Lee, {Sang Eun} and Sung, {Ji Min} and Daniele Andreini and Al-Mallah, {Mouaz H.} and Budoff, {Matthew J.} and Filippo Cademartiri and Kavitha Chinnaiyan and Choi, {Jung Hyun} and Chun, {Eun Ju} and Edoardo Conte and Ilan Gottlieb and Martin Hadamitzky and Kim, {Yong Jin} and Lee, {Byoung Kwon} and Leipsic, {Jonathon A.} and Erica Maffei and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Gianluca Pontone and Raff, {Gilbert L.} and Sanghoon Shin and Stone, {Peter H.} and Habib Samady and Renu Virmani and Jagat Narula and Berman, {Daniel S.} and Shaw, {Leslee J.} and Bax, {Jeroen J.} and Lin, {Fay Y.} and Min, {James K.} and Chang, {Hyuk Jae}",

note = "Funding Information: This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper. Funding Information: This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = jun,

doi = "10.1016/j.jcmg.2019.09.011",

language = "English",

volume = "13",

pages = "1409--1417",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "6",

}

Lee, SE, Sung, JM, Andreini, D, Al-Mallah, MH, Budoff, MJ, Cademartiri, F, Chinnaiyan, K, Choi, JH, Chun, EJ, Conte, E, Gottlieb, I, Hadamitzky, M, Kim, YJ, Lee, BK, Leipsic, JA, Maffei, E, Marques, H, de Araújo Gonçalves, P, Pontone, G, Raff, GL, Shin, S, Stone, PH, Samady, H, Virmani, R, Narula, J, Berman, DS, Shaw, LJ, Bax, JJ, Lin, FY, Min, JK & Chang, HJ 2020, 'Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA', JACC: Cardiovascular Imaging, vol. 13, no. 6, pp. 1409-1417. https://doi.org/10.1016/j.jcmg.2019.09.011

TY - JOUR

T1 - Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA

AU - Lee, Sang Eun

AU - Sung, Ji Min

AU - Andreini, Daniele

AU - Al-Mallah, Mouaz H.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha

AU - Choi, Jung Hyun

AU - Chun, Eun Ju

AU - Conte, Edoardo

AU - Gottlieb, Ilan

AU - Hadamitzky, Martin

AU - Kim, Yong Jin

AU - Lee, Byoung Kwon

AU - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Shin, Sanghoon

AU - Stone, Peter H.

AU - Samady, Habib

AU - Virmani, Renu

AU - Narula, Jagat

AU - Berman, Daniel S.

AU - Shaw, Leslee J.

AU - Bax, Jeroen J.

AU - Lin, Fay Y.

AU - Min, James K.

AU - Chang, Hyuk Jae

N1 - Funding Information: This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper. Funding Information: This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper. Publisher Copyright: © 2020 American College of Cardiology Foundation

PY - 2020/6

Y1 - 2020/6

N2 - Objectives: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). Background: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. Methods: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). Conclusions: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions.

AB - Objectives: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). Background: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. Methods: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). Conclusions: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions.

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Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA

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