CCTA Showing Significant CAD Associated With High Biomarker Score in a 46-Year-Old Male With Multiple Cardiometabolic Risk Factors
This image is a coronary computed tomography angiography (CCTA) and plaque activity characterization of a 46-year-old white male with a normal stress test, a positive family history, and metabolic syndrome (low high-density lipoprotein [HDL], borderline low-density lipoprotein [LDL] and total cholesterol). The image can be used to study plaque morphology, function, and risk of rupture. Plaque activity was measuring nine serum proteins (CTACK, eotaxin, MCP-3, IL-16, HGF, sFas, Fas ligand, hemoglobin A1c, and HDL). The patient was shown to have significantly elevated risk of a heart attack (acute coronary syndrome) at 8.07% (absolute risk) within 5 years. This score corresponds to a 5.34-fold higher relative risk for acute coronary syndrome than expected for the patient's age and sex. Vulnerable plaque characteristics can be assessed both quantitatively and qualitatively, and their impact on coronary flow limitation can be determined by CCTA. These features have been shown to strongly correlate with invasive coronary angiography and are predictive of future acute coronary events. Panel A) Vulnerable proximal left anterior descending (LAD) artery plaque identified using CCTA. Longitudinal view displaying the luminal narrowing at the vulnerable plaque site in LAD (right). Cross-sectional views of the proximal LAD plaque (left). The cross section with the highest percent area stenosis is denoted by red arrow with corresponding values listed in red. Green: lumen, red: necrotic core, blue: fibrotic core, yellow: calcium core. Panel B) Two-dimensional illustration of the contrast column (LAD lumen) impinged by proximal LAD plaque to give a convergent-divergent double cone, appropriate for application of the Navier-Stokes computational fluid dynamics equations. Panel C) Limitation of coronary flow across the vulnerable proximal LAD plaque as determined by a decrease in CCTA-based fractional flow reserve (FFRCT). Panel D) Patient developed ST-elevation myocardial infarction 12 days after identification of vulnerable proximal LAD plaque by CCTA. Emergent cardiac catheterization showed total occlusion of the LAD at the vulnerable proximal LAD plaque site. Panel E) Successful revascularization with angioplasty and stenting of LAD.
Authors: Hassan Tariq, MD, MSc; Angel Martin, MD; Meody Strattan, MD; Cesar Alberto Morales-Pabon, MD; Charles Taylor, PhD; Eric E. Harrison, MD; Douglas S. Harrington, MD.
Date: February 02, 2016
Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Lipid Metabolism, Nonstatins, Heart Failure and Cardiac Biomarkers, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Angioplasty, Blood Proteins, Cardiac Catheterization, Cholesterol, Constriction, Pathologic, Coronary Angiography, Coronary Vessels, Cross-Sectional Studies, Exercise Test, Fas Ligand Protein, Hemoglobins, Hydrodynamics, Interleukin-16, Lipoproteins, HDL, Lipoproteins, LDL, Metabolic Syndrome X, Myocardial Infarction, Risk Factors, Tomography