Future Directions in Coronary CT Angiography: CT-Fractional Flow Reserve, Plaque Vulnerability, and Quantitative Plaque Assessment

Coronary computed tomography angiography (CCTA) is a well-validated and noninvasive imaging modality for the assessment of coronary artery disease (CAD) in patients with stable ischemic heart disease and acute coronary syndromes (ACSs). CCTA not only delineates the anatomy of the heart and coronary arteries in detail, but also allows for intra- and extraluminal imaging of coronary arteries. Emerging technologies have promoted new CCTA applications, resulting in a comprehensive assessment of coronary plaques and their clinical significance. The application of computational fluid dynamics to CCTA resulted in a robust tool for noninvasive assessment of coronary blood flow hemodynamics and determination of hemodynamically significant stenosis. Detailed evaluation of plaque morphology and identification of high-risk plaque features by CCTA have been confirmed as predictors of future outcomes, identifying patients at risk for ACSs. With quantitative coronary plaque assessment, the progression of the CAD or the response to therapy could be monitored by CCTA. The aim of this article is to review the future directions of emerging applications in CCTA, such as computed tomography (CT)-fractional flow reserve, imaging of vulnerable plaque features, and quantitative plaque imaging. We will also briefly discuss novel methods appearing in the coronary imaging scenario, such as machine learning, radiomics, and spectral CT.

Association between Coronary Atherosclerotic Plaque Composition and Cardiovascular Disease Risk / 生物医学与环境科学（英文）

OBJECTIVE@#The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease (CVD) risk in Chinese adults.@*METHODS@#We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography (CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score (FRS) and the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score.@*RESULTS@#Among the 549 participants, 267 (48.6%) had no coronary plaques, 201 (36.6%) had noncalcified coronary plaques, and 81 (14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio (OR) 2.41; 95% confidence interval (CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score (OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment.@*CONCLUSION@#Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.

Effects of Jiangzhi Xiaoban Tablets Facilitating Routine Western Medicine Therapy on Coronary Plaque and Inflammatory Factors of Coronary Heart Disease Angina / 中国中医药信息杂志

Objective To observe the clinical efficacy of Jiangzhi Xiaoban Tables facilitating routine Western medicine therapy on coronary plaque and inflammatory factors in patients with coronary heart disease angina (CHDA) of blood stasis obstruction syndrome. Methods Totally 156 patients were divided into TCM group and control group with randomized parallel controlled method, with 78 cases in each group. The control group orally took aspirin enteric-coated tablets and trimetazidine hydrochloride tablets and received symptomatic treatment. On the basis of control group,TCM group received Jiangzhi Xiaoban Tablets,4 tablets per time,three times per day,for 12 weeks. Angina pectoris, TCM curative effect, electrocardiogram, TCM symptom scores, TPS, SSS, CADS and inflammatory factors before and after treatment in both groups were evaluated. Results 12 and 10 cases in TCM group and control group were lost, respectively. The total effective rate of angina pectoris was 89.39% (59/66) in the TCM group and 72.06% (49/68) in the control group. The total effective rate of TCM efficacy was 90.09% (60/66) in the TCM group and 67.65% (46/68) in the control group. TCM group better than the control group (P<0.05). Compared with before treatment, the numbers of ST segment down shift, T wave lowering and T wave inverting decreased in both groups (P<0.05). After treatment, the numbers of ST segment down shift, T wave lowering and T wave inverting in the TCM group were less than the control group (P<0.05). Compared with before treatment, SAQ scores in both groups increased, while TCM syndrome score decreased significantly. SAQ scores in the TCM group after treatment were higher than the control group, while TCM score were lower than the control group (P<0.05). Compared with before treatment, the TPS, SSS and CADS of the patients with blocking coronary lesions decreased in both groups (P<0.05). After treatment, the ratio of TPS, SSS and CADS of the patients with blocking coronary lesions in TCM group was lower than the control group (P<0.05). Compared with before treatment, the levels of hs-CRP, IL-6, TNF-α, TGF-β1 and MCP-1 decreased in both groups after treatment (P<0.05). The levels of hs-CRP, IL-6, TNF-α and TGF-β1 in the TCM group were better than the control group (P<0.05). Conclusion Jiangzhi Xiaoban Tables facilitating routine Western medicine therapy can stabilize coronary plaque of CHDA of blood stasis obstruction syndrome, which may realize cardiomyocyte protection by inhibiting inflammatory factors.

Statin Therapy with Coronary Plaque Imaging

If there is coronary plaque, do we need statin therapy? Many studies have been conducted to answer this question. According to global guidelines, there is a high-risk patient population who could benefit from statin therapy. According to the guidelines, patients with a history of previous cardiovascular disease are subject to statin therapy. In addition, several other studies have shown that asymptomatic coronary plaque could cause future cardiovascular events. Therefore, statin therapy could be considered in patients with coronary artery plaque. These coronary plaques can be quantified through invasive intra-coronary imaging equipment. Especially, vulnerable arteriosclerosis is the main cause of cardiovascular events. Use of statins in the presence of coronary plaques may help reduce atheroma volume and stabilize vulnerability. In conclusion, coronary artery imaging is very useful for the initiation and evaluation of statin therapy.

Correlation of epicardial adipose tissue volume with coronary plaques in patients with a coronary artery calcium score of zero / 实用放射学杂志

Objective To evaluate the correlation of epicardial adipose tissue volume (EATV)with coronary plaques in patients with a coronary artery calcium score of zero.Methods 183 patients with a coronary artery calcium score of zero were selected.They were divided into plaque group and control group according to the findings of CT coronary angiography.Independent t test was used to analyze the difference of EATV between two groups.Results ①EATV was significant higher in plaque group than that in control group (P 0.05), while it was significant higher in plaque group than that in control group for male individuals (P <0.05).③EATV was significant higher in plaque group than that in control group for the individuals with age< 50 years (P <0.05 ),meanwhile it was significant higher in plaque group than that in control group in age≥50 years(P <0.05).Conclusion EATV is correlated with coronary plaques in male patients with a coronary artery calcium score of zero while there is no correlation with female patients.EATV is correlated with coronary plaques in different age patients with a coronary artery calcium score of zero.