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Utilizing (serial) coronary computed tomography angiography (CCTA) to predict plaque progression and major adverse cardiac events (MACE): results, merits and challenges

  • Cardiac
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Abstract

Objectives

To present an overview of studies using serial coronary computed tomography angiography (CCTA) as a tool for finding both quantitative (changes) and qualitative plaque characteristics as well as epicardial adipose tissue (EAT) volume changes as predictors of plaque progression and/or major adverse cardiac events (MACE) and outline the challenges and advantages of using a serial non-invasive imaging approach for assessing cardiovascular prognosis.

Methods

A literature search was performed in PubMed, Embase, Web of Science, Cochrane Library and Emcare. All observational cohort studies were assessed for quality using the Newcastle–Ottawa Scale (NOS). The NOS score was then converted into Agency for Healthcare Research and Quality (AHRQ) standards: good, fair and poor.

Results

A total of 36 articles were analyzed for this review, 3 of which were meta-analyses and one was a technical paper. Quantitative baseline plaque features seem to be more predictive of MACE and/or plaque progression as compared to qualitative plaque features.

Conclusions

A critical review of the literature focusing on studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. Significant questions regarding the clinical implications of these specific quantitative and qualitative plaque features as well as the challenges of using serial CCTA have yet to be resolved in studies using this imaging technique.

Key Points

• Use of (serial) CCTA can identify plaque characteristics and plaque changes as well as changes in EAT volume that are predictive of plaque progression and/or major adverse events (MACE) at follow-up.

• Studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features.

• Ultimately, serial CCTA is a promising technique for the evaluation of cardiovascular prognosis, yet technical details remain to be refined.

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Abbreviations

%DS:

Percentage diameter stenosis

ACS:

Acute coronary syndrome

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CI:

Confidence interval

CX:

Circumflex artery

EAT:

Epicardial adipose tissue

EFV:

Epicardial fat volume

HR:

Hazard ratio

HRP:

High-risk plaque features

HU:

Hounsfield units

ICA:

Invasive coronary angiography

IQR:

Interquartile range

IVOCT:

Intravascular optical coherence tomography

IVUS:

Intravascular ultrasound

LAD:

Left anterior descending artery

LAP:

Low-attenuation plaque

LAPV:

Low-attenuation plaque volume

LM:

Left main

MACE:

Major adverse cardiac events

OR:

Odds ratio

PAV:

Percentage atheroma volume

PR:

Positive remodelling

TPV:

Total plaque volume

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Acknowledgements

The Department of Cardiology of Leiden University Medical Centre received research grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare and Edwards Lifesciences. Arthur Scholte received a speaker’s fee from Canon Medical Systems. This research did not receive any specific grants from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    F. Y. van Driest, C. M. Bijns, A. J. H. A. Scholte & J. W. Jukema

  2. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    R. J. van der Geest, A. Broersen & J. Dijkstra

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  1. F. Y. van Driest
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Correspondence to J. W. Jukema.

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The authors of this manuscript declare relationships with the following companies: Arthur Scholte received a speaker’s fee from Canon Medical Systems. The remaining authors have nothing to disclose.

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van Driest, F.Y., Bijns, C.M., van der Geest, R.J. et al. Utilizing (serial) coronary computed tomography angiography (CCTA) to predict plaque progression and major adverse cardiac events (MACE): results, merits and challenges. Eur Radiol 32, 3408–3422 (2022). https://doi.org/10.1007/s00330-021-08393-9

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