| Part1Progression of coronary atherosclerosis by computed tomography angiography in patients with suspected coronary artery diseasePurpose:To assess the progression of calcified, non-calcified and mixed plaque burden and obstructive coronary lesions in patients with suspected coronary artery disease (CAD) who underwent2coronary CTA scans. The risk factors associated with progression of coronary atherosclerosis were also evaluated.Methods:We retrospectively evaluated consecutive patients with suspected CAD who had undergone coronary CTA scans twice from July,2009to December,2011. Patients had prior coronary revascularization before baseline CTA and suffering an interim coronary revascularization at the time of scanning between baseline and follow-up were excluded. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a16-segment basis as suggested by the American Heart Association classification. The types of plaque included non-calcified plaque (NCP), calcified plaque (CP) and mixed plaque (MP). The severity of coronary artery stenosis was graded as normal (0%), nonobstructive (<50%) or obstructive (=50%) luminal narrowing. Comparing each type of plaque and coronary stenosis progression per-segment and assessing risk factors relative to the progression of plaque.Results:A total of146patients were enrolled in the study (male,70.55%). Mean age58.95+10.42years. Among the34patients (23.29%) without detectable plaque at baseline,11(7.53%) developed incident plaque over an average of1.5years of follow-up, for an estimated incidence rate of21.57%per year. Estimated incidence rate of NCP and CP were7.84%and11.11%per year, respectively. On vessel and segment based, a total of35vessels and105segments developed newly detectable plaque at follow-up (p=0.021, p<0.001). The increasing segments of MP had significant difference (p=0.001). Obstructive segments of LAD and RCA increased40.98%and79.17%compared with baseline level (all p<0.05). With the increasing of obstructive lesions, MP increased significantly (p=0.036). Hyperlipidemia was relative to plaque progression after adjusting gender, age and interscan period (OR2.249,95%CI:1.066,5.701, p=0.049). Conclusions:The progression of coronary atherosclerosis in patients with suspected CAD including the increasing of total plaque burden and obstructive lesions. The increasing of mixed plaque has statistic difference. Obstructive vessels increased with the aggravation of calcified burden. Part2Relationship between progression of coronary artery calcium and coronary artery stenosis on cardiac computed tomographyPurpose:To assess the relationship between progression of calcification and obstructive lesions during follow-up in participants with suspected coronary artery disease (CAD) who had baseline and follow-up coronary computed tomography angiography (CTA) scans.Methods:We retrospectively evaluated consecutive patients with suspected CAD who had undergone coronary CTA scans twice from July,2009to December,2011. Patients had prior coronary revascularization before baseline CTA and suffering an interim coronary revascularization at the time of scanning between baseline and follow-up were excluded. Progression of coronary artery calcium (CAC) was defined in2ways:(1) Detectable CAC at the follow-up examination in a participant free of CAC at baseline examination;(2) Annualized increasing in CAC score>15%. The severity of coronary artery stenosis was graded as normal (0%), nonobstructive (<50%) or obstructive (=50%) luminal narrowing. Patients were divided into CAC progression group and CAC non-progression group. Comparing progression of CACS per year and coronary stenosis of the two groups.Results:A total of146patients including78(male,73.08%) individuals with CAC progression and68(male,67.65%) individuals without were enrolled in the study. Average increasing of CACS per year of progression group and non-progression group was75.07and7.47. Among98patients with detectable CP at baseline, average increasing of CACS per year<50in74(75.51%) patients,>100in11(11.22%) patients,>400in only1patient. In progression group,6patients with CACS of0had no coronary stenosis at baseline, while during follow-up,3patients developed non-obstructive stenosis and1developed obstructive stenosis. In41patients with CACS of1to99at baseline,11individuals developed CACS of100to399and5developed coronary stenosis=50%during follow-up. In23patients with CACS of100to399,6patients had CACS>400,7patients developed coronary stenosis=50%during follow-up. In8patients with CACS=400,3patients had coronary stenosis <50%at baseline and developed coronary stenosis=50%during follow-up. Hypertension (OR6.364,95%CI:2.307,17.552, p<0.001), current smoking (OR3.939,95%CI:1.226,12.658, p=0.021) and CACS>0at baseline level (OR22.639,95%CI:6.874,74.555, p<0.001) were the relative risk factors to CAC progression.Conclusions:Coronary artery calcification developed progressively. With the development of CAC, obstructive lesions developed progressively. On patient level, vessel level and segment level, obstructive lesions were higher in progression group than non-progression group. Hypertension, current smoking and CACS>0at baseline level were the relative risk factors to CAC progression. Part3Evaluation of coronary atherosclerosis progression by computed tomography angiography in patients with low, intermediate, and high cardiovascular riskPurpose:To evaluate the progression of coronary atherosclerosis including plaque burden and obstructive lesions in patients with high, intermediate, or low estimated pretest probability of having significant coronary artery disease (CAD).Methods:We retrospectively evaluated consecutive patients with suspected CAD who had undergone coronary CTA scans twice from July,2009to December,2011. Patients had prior coronary revascularization before baseline CTA and suffering an interim coronary revascularization at the time of scanning between baseline and follow-up were excluded. Patients were categorized into a low (1%to30%), intermediate (31%to70%), or high (71%to99%) estimated pretest probability group of having significant CAD according to Duke Clinical Score. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a16-segment basis as suggested by the American Heart Association classification. The types of plaque included non-calcified plaque (NCP), calcified plaque (CP) and mixed plaque (MP). The severity of coronary artery stenosis was graded as normal (0%), nonobstructive (<50%) or obstructive (=50%) luminal narrowing. Comparing each type of plaque and coronary stenosis progression per-segment and CACS progression of the three groups.Results:A total of146patients including47(32.19%) individuals with low risk,61(41.78%) individuals with intermediate risk and38(26.03%) individuals with high risk were enrolled in the study.86.84%were male patient in high risk group, mean age was73.17±4.59years, which was significantly higher than low risk and intermediate risk group. The increasing of each type of plaque in low risk group had no statistical difference. Total plaque burden significantly increased31.6%(p=0.005) and33.0%(p=0.013) in intermediate and high risk group, while only MP increased65.8%(p=0.014) in intermediate risk group had statistical difference. The increasing of CACS per year of high risk group was significantly higher than low risk (p<0.001) and intermediate risk group (p=0.028). While increasing of CACS per year of intermediate risk group was significantly higher than low risk group (p=0.012). On patient level and vessel level, only progression of obstructive lesions in intermediate risk group had statistical difference.Conclusions:Coronary atherosclerosis developed progressively in low, intermediate and high risk patients. Patients of high risk group had higher coronary atherosclerosis level and the progression of CAC was the fastest. MP and obstructive lesions in intermediate risk group had statistical difference compared with low and high risk groups. Part4Coronary atherosclerosis by computed tomography angiography in patients with metabolic syndromePurpose:To compare coronary plaque burden, composition, distribution and the degree of coronary artery stenosis in metabolic syndrome (MetS) and non-MetS patients with known or suspected CAD who have undergone invasive coronary angiography (ICA).Methods:From January,2008to June,2011, a total of1092consecutive adult patients who had undergone both CTA and ICA within three months were enrolled. Among them,220patients including124percutaneous coronary interventions (PCI) and96coronary artery bypass grafting (CABG) were excluded. Patients were divided into MetS and non-MetS groups. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a16-segment basis as suggested by the American Heart Association classification. The types of plaque included non-calcified plaque (NCP), calcified plaque (CP) and mixed plaque (MP). The severity of coronary artery stenosis was graded as nonobstructive (<50%) or obstructive (=50%or=75%) luminal narrowing. Comparing each type of plaque and coronary stenosis per-segment of the two groups, as ICA the reference standard. Then assessing risk factors relative to the obstructive stenosis.Results:The study population consisted of872patients (age60.18±10.02,72.7%of male patients) including377(43.2%) who had MetS and495who had not. The average CACS of MetS was higher than non-MetS (314.01+507.41vs241.3+442.97, p=0.001). Percentage of patients with no coronary artery calcium in MetS were significantly lower than non-MetS (19.6%vs.30.7%, p<0.001), while percentage of patients with severe coronary artery calcium (CACS>1000) in MetS were significantly higher than non-MetS (8.2%vs.4.6%, p=0.034). There were statistically significant differences in the proportions of total plaque and NCP of LM between the two groups. The proportion of MetS patients with1-vessel,2-vessel and3-vessel disease were all higher than non-MetS (all p<0.001). On patient and vessel level, the sensitivity, specificity to detect50%or70%stenosis were92.15%,83.18%, and83.06%,78.57%, respectively. HDL-C had negative correlation and Apo-a had positive correlation to obstructive lesion.Conclusions:Proportion of severe CAC was higher in MetS than non-MetS. CP in the middle and distal coronary artery and obstructive vessels were significantly higher in MetS than non-MetS. CTA prossesses high diagnostic sensitivity for detection of obstructive coronary stenosis at both thresholds of50%and70%stenosis.
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