Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector computed tomography
Authors: de Knegt Martina C , Linde Jesper J , Fuchs Andreas , Pham Michael H C , Jensen Andreas K , Nordestgaard Børge G , Kelbæk Henning , Køber Lars V , Heitmann Merete , Fornitz Gitte , Hove Jens D , Kofoed Klaus F ,   CGPS, the CATCH, and the VERDICT Investigators, Kofoed Klaus F , Nordestgaard Børge , Køber Lars V , Kühl J Tobias , Fuchs Andreas , Sigvardsen Per , Sørgaard Mathias , de Knegt Martina C , Norsk Jakob , Frestad Daria , Mejdahl Mads , Elming Marie , Sørensen Samuel Kiil , Hindsøe Louise , Thomsen Anna Foged , Udholm Patricia Martens , Pihl Christian , Nilsson Julia , Byrne Christina , Knudsen Andreas Dehlbæk , Haugen Morten , Windfeld-Mathiasen Josefine , Wiegandt Yaffah Tamar Laura , Pham Michael H C , Ballegaard Christian , Arnaa Kirsten , Møller Christina , Thrysøe Kirsten , Linde Jesper J , Kofoed Klaus F , Hove Jens D , Jensen Gorm B , Sørgaard Mathias , Kelbæk Henning , Kühl J Tobias , Nielsen Walter , Køber Lars V , Trysøe Kirsten , Møller Christina , Bock-Pedersen Tina , Hansen Bettina , Udholm Patricia Martens , de Knegt Martina C , Kofoed Klaus F , Køber Lars V , Kløvgaard Lene , Linde Jesper J , Kühl J Tobias , Holmvang Lene , Engstrøm Thomas , Helquist Steffen , Jørgensen Erik , Petersen Frans , Saunamaki Kari , Clemmensen Peter , de Knegt Martina C , Sadjadieh Golnaz , Laursen Peter Nørkjær , Hansen Peter Riis , Gislason Gunnar , Abildgaard Ulrik , Jensen Jan Skov , Galatius Søren , Fritz-Hansen Thomas , Bech Jan , Wachtell Christian , Madsen Jan Kyst , Smedegaard Lærke , Özcan Cengiz , Svendsen Ida Hastrup , Nielsen Olav Wendelboe , Kristiansen Ole , Bjerre Andreas Fabricius , Hove Jens D , Nielsen Walter , Dixen Ulrik , Madsen Johnny Koertz , Fornitz Gitte Gleerup , Raymond Ilan , Abdulla Jawdat , Lyngbæk; Stig , Steffensen Rolf , Jurlander Birgit , Kragelund Charlotte , Dominguez Helena , Schou Morten , Kelbæk Henning , Elming Hanne , Therkelsen Susette 
Published: September 2018

Abstract

Aims
Quantitative computed tomography (QCT) allows assessment of morphological features of coronary atherosclerosis. We aimed to test the hypothesis that clinical patient presentation is associated with distinct morphological features of coronary atherosclerosis.

Methods and results
A total of 1652 participants, representing a spectrum of clinical risk profiles [787 asymptomatic individuals from the general population, 468 patients with acute chest pain without acute coronary syndrome (ACS), and 397 patients with acute chest pain and ACS], underwent multidetector computed tomography. Of these, 274 asymptomatic individuals, 254 patients with acute chest pain without ACS, and 327 patients with acute chest pain and ACS underwent QCT to assess coronary plaque volumes and proportions of dense calcium (DC), fibrous, fibro fatty (FF), and necrotic core (NC) tissue. Furthermore, the presence of vulnerable plaques, defined by plaque volume and tissue composition, was examined. Coronary plaque volume increased significantly with worsening clinical risk profile [geometric mean (95% confidence interval): 148 (129–166) mm3, 257 (224–295) mm3, and 407 (363–457) mm3, respectively, P < 0.001]. Plaque composition differed significantly across cohorts, P < 0.0001. The proportion of DC decreased, whereas FF and NC increased with worsening clinical risk profile (mean proportions DC: 33%, 23%, 23%; FF: 50%, 61%, 57%; and NC: 17%, 17%, 20%, respectively). Significant differences in plaque composition persisted after multivariable adjustment for age, gender, body surface area, hypertension, statin use at baseline, diabetes, smoking, family history of ischaemic heart disease, total plaque volume, and tube voltage, P < 0.01.

Conclusion
Coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation.