Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study

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

doi:10.1016/j.jcct.2020.01.012

Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study

Alexander R. van Rosendael, Fay Y. Lin, Xiaoyue Ma, Inge J. van den Hoogen, Umberto Gianni, Omar Al Hussein, Subhi J. Al'Aref, Jessica M. Peña, Daniele Andreini, Mouaz H. Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Edoardo Conte, Hugo Marques, Pedro de Araújo Gonçalves, Ilan Gottlieb, Martin Hadamitzky, Jonathon A. LeipsicErica Maffei, Gianluca Pontone, Gilbert L. Raff, Sanghoon Shin, Yong Jin Kim, Byoung Kwon Lee, Eun Ju Chun, Ji Min Sung, Sang Eun Lee, Daniel S. Berman, Renu Virmani, Habib Samady, Peter H. Stone, Jagat Narula, Jeroen J. Bax, Leslee J. Shaw, James K. Min, Hyuk Jae Chang

Department of Internal Medicine

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

16 Citations (Scopus)

Abstract

Background and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm³, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAV_norm) in mm³ [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAV_norm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. Results: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11–13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAV_norm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAV_norm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAV_norm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. Conclusions: PAV was less affected by patient's body surface area then PV and TAV_norm and may be the preferred method to report coronary atherosclerotic burden.

Original language	English
Pages (from-to)	400-406
Number of pages	7
Journal	Journal of Cardiovascular Computed Tomography
Volume	14
Issue number	5
DOIs	https://doi.org/10.1016/j.jcct.2020.01.012
Publication status	Published - 2020 Sept 1

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 (New York, NY) and the Michael Wolk Foundation (New York, NY) .

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 (New York, NY) and the Michael Wolk Foundation (New York, NY).Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures.

Funding Information:
Dr. James K. Min receives funding from the Dalio Foundation , National Institutes of Health , and GE Healthcare . Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures.

Publisher Copyright:
© 2020

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcct.2020.01.012

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van Rosendael, A. R., Lin, F. Y., Ma, X., van den Hoogen, I. J., Gianni, U., Al Hussein, O., Al'Aref, S. J., Peña, J. M., Andreini, D., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Conte, E., Marques, H., de Araújo Gonçalves, P., Gottlieb, I., Hadamitzky, M., ... Chang, H. J. (2020). Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study. Journal of Cardiovascular Computed Tomography, 14(5), 400-406. https://doi.org/10.1016/j.jcct.2020.01.012

@article{2c0a7d76460b4b559c440975885ea2f5,

title = "Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study",

abstract = "Background and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. Results: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11–13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. Conclusions: PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.",

author = "{van Rosendael}, {Alexander R.} and Lin, {Fay Y.} and Xiaoyue Ma and {van den Hoogen}, {Inge J.} and Umberto Gianni and {Al Hussein}, Omar and Al'Aref, {Subhi J.} and Pe{\~n}a, {Jessica M.} and Daniele Andreini and Al-Mallah, {Mouaz H.} and Budoff, {Matthew J.} and Filippo Cademartiri and Kavitha Chinnaiyan and Choi, {Jung Hyun} and Edoardo Conte and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Ilan Gottlieb and Martin Hadamitzky and Leipsic, {Jonathon A.} and Erica Maffei and Gianluca Pontone and Raff, {Gilbert L.} and Sanghoon Shin and Kim, {Yong Jin} and Lee, {Byoung Kwon} and Chun, {Eun Ju} and Sung, {Ji Min} and Lee, {Sang Eun} and Berman, {Daniel S.} and Renu Virmani and Habib Samady and Stone, {Peter H.} and Jagat Narula and Bax, {Jeroen J.} and Shaw, {Leslee J.} 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 (New York, NY) and the Michael Wolk Foundation (New York, NY) . 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 (New York, NY) and the Michael Wolk Foundation (New York, NY).Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures. Funding Information: Dr. James K. Min receives funding from the Dalio Foundation , National Institutes of Health , and GE Healthcare . Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures. Publisher Copyright: {\textcopyright} 2020",

year = "2020",

month = sep,

day = "1",

doi = "10.1016/j.jcct.2020.01.012",

language = "English",

volume = "14",

pages = "400--406",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

number = "5",

}

van Rosendael, AR, Lin, FY, Ma, X, van den Hoogen, IJ, Gianni, U, Al Hussein, O, Al'Aref, SJ, Peña, JM, Andreini, D, Al-Mallah, MH, Budoff, MJ, Cademartiri, F, Chinnaiyan, K, Choi, JH, Conte, E, Marques, H, de Araújo Gonçalves, P, Gottlieb, I, Hadamitzky, M, Leipsic, JA, Maffei, E, Pontone, G, Raff, GL, Shin, S, Kim, YJ, Lee, BK, Chun, EJ, Sung, JM, Lee, SE, Berman, DS, Virmani, R, Samady, H, Stone, PH, Narula, J, Bax, JJ, Shaw, LJ, Min, JK & Chang, HJ 2020, 'Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study', Journal of Cardiovascular Computed Tomography, vol. 14, no. 5, pp. 400-406. https://doi.org/10.1016/j.jcct.2020.01.012

TY - JOUR

T1 - Percent atheroma volume

T2 - Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study

AU - van Rosendael, Alexander R.

AU - Lin, Fay Y.

AU - Ma, Xiaoyue

AU - van den Hoogen, Inge J.

AU - Gianni, Umberto

AU - Al Hussein, Omar

AU - Al'Aref, Subhi J.

AU - Peña, Jessica M.

AU - Andreini, Daniele

AU - Al-Mallah, Mouaz H.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha

AU - Choi, Jung Hyun

AU - Conte, Edoardo

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Gottlieb, Ilan

AU - Hadamitzky, Martin

AU - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Shin, Sanghoon

AU - Kim, Yong Jin

AU - Lee, Byoung Kwon

AU - Chun, Eun Ju

AU - Sung, Ji Min

AU - Lee, Sang Eun

AU - Berman, Daniel S.

AU - Virmani, Renu

AU - Samady, Habib

AU - Stone, Peter H.

AU - Narula, Jagat

AU - Bax, Jeroen J.

AU - Shaw, Leslee J.

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 (New York, NY) and the Michael Wolk Foundation (New York, NY) . 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 (New York, NY) and the Michael Wolk Foundation (New York, NY).Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures. Funding Information: Dr. James K. Min receives funding from the Dalio Foundation , National Institutes of Health , and GE Healthcare . Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic. Dr. Kavitha Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. The remaining authors have no relevant disclosures. Publisher Copyright: © 2020

PY - 2020/9/1

Y1 - 2020/9/1

N2 - Background and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. Results: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11–13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. Conclusions: PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.

AB - Background and aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. Results: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11–13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. Conclusions: PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.

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Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study

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Bibliographical note

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UN SDGs

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