Cardiac myocardial perfusion imaging using dual source computed tomography

Purpose of this study was the evaluation of the thoracic aortic wall thickness as a potential identifier of patients at increased risk for future cardiac events. Thoracic aortic wall thickness was measured with MDCT in 160 patients. The CT-scans were implemented as non-invasive coronary angiography studies. Relationships between aortic wall thickness, sex, age, major risk factors and atherosclerotic plaque burden of the coronary arteries were explored. Higher values of maximum aortic wall thickness of the descending aorta (women P = 0.02, men P = 0.01) were found in patients with coronary atherosclerosis, compared to patients with same gender but excluded atherosclerosis. Aortic wall thickness of the mid-portion of the descending aorta of 3.0 mm is associated with coronary artery disease (CAD) with a specificity of 96.6% (sensitivity 27.5%) and a positive predictive value (PPV) of 93.3%. For patients with two or more major risk factors and a maximum wall thickness of equal or more than 2.6 mm we found a PPV of 100%. We conclude that measurements of maximum wall thickness of the descending aorta are a potential tool for detecting patients with coronary atherosclerosis. The potential effect of combining measurements of aortic wall thickness at routine chest CT studies with a possible cardiovascular screening is substantial and merits further study.     

Association of atherosclerosis in the descending thoracic aorta with coronary artery disease on multi detector row computed tomography coronary angiography in patients with suspected coronary artery disease

The association between atherosclerosis in the descending thoracic aorta (DTA) visualized on computed tomography coronary angiography (CTA) and coronary artery disease (CAD) has not been extensively explored. Therefore, a comprehensive analysis of DTA atherosclerosis on CTA was performed and the association of DTA atherosclerosis with CAD was evaluated in patients with suspected CAD. A total of 344 patients (54 ± 12 years, 54 % men) with suspected CAD underwent CTA. CTA were classified based on CAD severity in no signs of atherosclerosis or minor wall-irregularities <30 %, non-significant CAD 30–50 %, or significant CAD ≥50 % stenosis. The DTA was divided in segments according the posterior intercostal arteries. Per segment the presence of atherosclerotic plaque (defined as ≥2 mm wall thickness) was determined and maximal wall thickness was measured. Plaque composition was scored as non-calcified or mixed and the percentage of DTA segments with atherosclerosis was calculated. Significant CAD was present in 152 (44 %) patients and 278 (81 %) had DTA atherosclerotic plaque. DTA maximal wall thickness and percentage of DTA segments with atherosclerosis were 2.7 ± 1 mm and 49 ± 36 %. The presence, severity and extent of DTA atherosclerosis significantly increased with increasing CAD severity. Multivariate logistic regression analysis corrected for age and other risk factors demonstrated independent associations of DTA plaque (OR 6.56, 95 % CI 1.78–24.19, p = 0.005) and maximal DTA wall thickness (OR 2.00, 95 % CI 1.28–3.12, p = 0.002) with significant CAD. The presence and severity of DTA atherosclerosis were independently related with significant CAD on CTA in patients with suspected CAD.     

心外膜脂肪组织体积与冠状动脉粥样斑块的关系

目的 探讨CT测量心外膜脂肪组织的体积、密度与冠状动脉粥样硬化斑块的关系。方法 疑似冠心病患者接受多螺旋CT造影检查,测量相应心外膜脂肪体积。根据造影检查结果分为有斑块患者及无斑块患者,并进一步将冠状动脉斑块分为钙化斑块、混合斑块、非钙化斑块。以心外膜脂肪体积>85 ml为暴露组,分析心外膜脂肪体积与冠状动脉粥样硬化斑块的相关性。结果 141例患者纳入研究,其中有冠状动脉斑块者63例,钙化斑块者15例,非钙化斑块20例,混合斑块28例;无冠状动脉斑块者78例。有冠状动脉斑块者的心外膜脂肪组织体积大于无冠状动脉斑块者(103.23±76.03 vs 74.07±42.47, P=0.027);暴露组发生冠状动脉粥样硬化斑块的危险性大于非暴露组,差异有统计学意义(P<0.05)。结论 心外膜脂肪体积与冠状动脉粥样硬化斑块形成存在较强的相关性。     

心外膜脂肪体积与冠状动脉粥样硬化及心肌桥的关系

目的探讨心外膜脂肪(EAT)体积与冠状动脉粥样硬化及心肌桥(MB)之间的关系。方法回顾性分析接受冠状动脉CTA检查的375例患者的影像学资料,其中粥样硬化斑块导致冠状动脉狭窄患者116例(斑块组),单纯MB患者78例(MB组),MB合并动脉粥样硬化斑块患者35例(MB合并斑块组),冠状动脉正常者146例(正常组)。测量并比较4组EAT体积。结果斑块组、MB组、MB合并斑块组、正常组平均EAT体积分别为(110.76±37.17)cm 3、(104.97±36.72)cm 3、(112.02±45.32)cm 3、(91.06±34.27)cm 3,斑块组、MB组、MB合并斑块组均高于正常组(P=0.001、0.031、0.043),斑块组、MB组、MB合并斑块组两两比较差异均无统计学差异(P均>0.05)。结论MB患者EAT体积增大,具有发展为动脉粥样硬化的潜在风险。     

Pericardial fat is more abundant in patients with coronary atherosclerosis and even in the non-obese patients: evaluation with cardiac CT angiography

Epicardial adipose tissue (EAT) may play an important role for developing an unfavorable cardiovascular risk profile. However, it has not been investigated if EAT is associated with coronary atherosclerosis in non-obese patients. We aimed to evaluate whether EAT is related to coronary atherosclerosis in non-obese patients. Among the consecutive patients who underwent coronary CT angiography (CCTA) with an intermediate pretest likelihood for having coronary artery disease, we excluded the patients whose body mass index (BMI) was over 30 kg/m² or whose CCTA image quality was not sufficient for the detection of coronary plaque. The remaining patients were divided into the normal and abnormal groups based on the presence of atherosclerotic plaques as seen on the CCTA images. The cardiovascular risk factors were matched between the two groups. Ultimately, 100 patients were included in the normal group and 100 patients were included in the abnormal group. The pericardial fat area was measured at the subaortic level of the heart on the axial CT images. The pericardial fat area was significantly larger in the abnormal group as compared to the normal group (18.1 ± 10.2 vs. 14.6 ± 8.7 cm², P = 0.019). Even though the overweight patients (25 ≤ BMI < 30) were excluded, the pericardial fat area was still significantly larger in the patients with coronary atherosclerotic plaque as compared to that of the patients without coronary atherosclerotic plaque (18.7 ± 11.5 vs. 13.2 ± 7.9 cm², P = 0.006). Pericardial fat was more abundant in the non-obese patients with coronary atherosclerosis as compared to that of the patients without coronary atherosclerosis, after controlling for the other cardiovascular risk factors.     

超声测量心外膜脂肪组织厚度与冠状动脉病变的相关性研究

目的 评价经超声测量的心外膜脂肪组织厚度(EAT)和冠状动脉病变的相关性.方法 147例接受冠状动脉造影患者,根据造影结果分为冠心病组101例,非冠心病组46例;超声测量EAT,对各组之间的EAT值进行比较,观察EAT与冠心病之间的关系.结果 冠心病组与非冠心病组EAT值分别为(7.41±1.63)mm和(4.41±1.60)mm,冠心病组的EAT值显著升高(P＜0.01).严重冠状动脉病变组EAT较轻度冠状动脉病变组EAT明显升高[(8.53±1.00)mm对(6.36±1.73)mm,P＜0.01].冠状动脉Gensini评分与EAT呈正相关(r=0.71,P＜0.001).以EAT值≥5.35 mm预测冠心病的敏感性为87.13%,特异件为80.43%,ROC曲线下面积为0.89(95%可信区间0.84-0.95,P=0.01).结论 超声测量心外膜脂肪组织厚度简易无创,可能是一个评价冠心病风险的辅助指标,和冠状动脉病变严重程度显著相关.     

心外膜脂肪组织及颈动脉内中膜厚度对冠心病的预测价值

目的 探讨高频超声测量心外膜脂肪组织及颈动脉内中膜厚度对冠心病的预测价值.方法 应用高频超声分别测量正常对照组(29例)、冠心病单支病变组(43例)、冠心病多支病变组(28例)的心外膜脂肪组织及颈动脉内中膜厚度,并进行比较.结果 正常对照组、冠心病单支病变组、冠心病多支病变组心外膜脂肪组织厚度分别为(4.8±1.3)mm、(7.6±1.8)mm、(10.1±2.6)mm,颈动脉内中膜厚度分别为(0.8±0.1)mm、(1.0±0.2)mm、(1.1±0.2)mm;三组间心外膜脂肪组织及颈动脉内中膜厚度差异有统计学意义(P＜0.01).心外膜脂肪组织厚度预测冠心病存在的ROC曲线下面积为0.947,以心外膜脂肪厚度＞6 mm为截断值预测冠心病的敏感性为90.1%,特异性为86.2%.颈动脉内中膜厚度预测冠心病存在的ROC曲线下面积为0.917,以颈动脉内中膜厚度0.85 mm为截断值预测冠心病的敏感性为87.3%,特异性为82.8%.二者曲线下面积比较,差异无统计学意义(P＞0.05).结论 心外膜脂肪组织及颈动脉内中膜厚度能准确预测冠心病,心外膜脂肪组织厚度可以作为冠心病的一个新的预测因子.

Abstract：

Objective To explore the predictive value for coronary heart disease by epicardial adipose tissue(EAT) thickness and carotid intima-media thickness(IMT) measured with high-frequency ultrasound.Methods According to the results of coronary angiography, the cases were divided into the normal control group (29 patients),coronary artery disease group with single-vessel lesion (43 patients),coronary artery disease group with multi-vessels lesion (28 patients), respectively. EAT and IMT were measured by high-frequency ultrasound. Results The EAT in the three groups were (4.8 ± 1.3) mm, (7.6 ± 1.8) mm,(10.1±2.6) mm respectively, and the IMT were (0.8±0.1)mm,(1.0±0.2)mm,(1.1 ± 0.2)mmrespectively. In either coronary artery disease group with single-vessel lesion or multi-vessels lesion, the EAT and IMT were significantly higher than those in the normal control group ( P＜ 0.01 ). And the difference between groups of single-vessel lesion and multi-vessels lesion was also statistically significant (P＜ 0.01). The areas under receive operating characteristic(ROC) curve to predict coronary heart disease by EAT and IMT was 0.947 and 0.917, respectively, there was no significant difference between the two areas. For patient with coronary artery stenosis＞50%, the sensitivity and specificity of EAT＞6 mm were 90.1% and 86.2% ,respectively,the sensitivity and specificity of IMT＞0.85 mm were 87.3% and 82.8%,respectively. Conclusions EAT and IMT measured by high-frequency ultrasound can precisely predictcoronary heart disease. EAT can be a new predictor to diagnose coronary heart disease.     

高频超声测量心外膜脂肪组织厚度与冠心病危险因素的相关性分析

目的 采用高频超声技术探讨冠心病患者心外膜脂肪(EAT)厚度与冠心病危险因素的相关性.方法 84例患者根据冠脉造影结果分为冠脉正常组(28例)、冠心病单支病变组(28例)、冠心病多支病变组(28例),用高频超声分别测量EAT厚度和颈动脉IMT,将EAT厚度与颈动脉IMT等冠心病危险因素进行相关性分析.结果 冠心病单支病...     

低剂量心脏平扫与冠脉CT血管造影在测量心外膜脂肪体积方面具有等效性

  目的   分析低剂量心脏平扫检查与冠状动脉CT血管造影（CTA）检查在定量心外膜脂肪体积（EATV）的一致程度。   方法   对临床提示有冠心病征象的208名患者进行低剂量心脏平扫检查及冠状动脉CTA检查，分别在两种检查的图像上测量心外膜脂肪体积，两种检查测量所得心外膜脂肪体积EATV _心脏平扫和EATV_CTA间的相关性采用Pearson相关系数进行评估，采用BlandAltman分析法评价两者的一致性。将患者分为无斑块组及斑块组，比较两组患者EATV _心脏平扫和EATV_CTA差异；通过操作者工作特征曲线评估EATV _心脏平扫和EATV_CTA预测冠状动脉硬化的价值及差异。   结果   低剂量EATV _心脏平扫为103.12±44.01 cm3，EATV_CTA为106.72±44.14 cm3，两者具有显著的相关性（r = 0.955，P< 0.001）；EATV _心脏平扫和EATV_CTA的一致性均数为-3.5，4.8%（10/208）的点落位于95%CI界限以外（95%CI:24.0930~29.2116，P< 0.001）；EATV _心脏平扫和EATV_CTA预测冠状动脉硬化发生的曲线下面积分别为0.601及0.605，差异无统计学意义（P= 0.935）。   结论   低剂量心脏平扫检查与冠状动脉CTA两组检查方法在测量EAT方面具有等效性，对冠状动脉硬化的预测方面两者具有相当的价值。      

经食管超声对冠心病患者胸主动脉粥样硬化的研究

目的　探讨胸主动脉粥样硬化与冠状动脉粥样硬化的关系。方法　用多平面经食管超声技术, 检测了４１例正常人和４９例冠心病患者胸主动脉。对胸主动脉内径、内膜－中层厚度（ＩＭＴ）、僵硬度（β）和粥样斑块进行了评价。结果　与对照组比较, 冠心病组胸主动脉内径扩大, ＩＭＴ增厚, β值增大（Ｐ＜ ０．０５～０．００１）; 胸主动脉粥样斑块对冠心病诊断的敏感性为６３．２７％ , 特异性为９７．５６％ 。阳性预测值为９６．８８％ , 阴性预测值为６８．９７％ 。结论　冠心病人胸主动脉的解剖和功能发生了明显的变化; 胸主动脉粥样斑块是预测冠心病的较为敏感而特异的指标。     

Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease

The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE’s), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94?±?3.6 months. Mean EAT thickness was 4.6?±?1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC?>?0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR?=?3.91; 95% CI 1.01–15.08; p?=?0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE’s than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.     

Coronary plaque imaging and characterization by CT

Multi-slice spiral CT (MDCT) is a noninvasive modality for visualization and evaluation of atherosclerosis in vivo in different arterial beds. Rapid technical advances led to a significant improvement of the diagnostic accuracy of coronary MDCT angiography. The most popular clinical application of MDCT with the best scientific evidence is the noninvasive detection and quantification of coronary calcifications. In particular, the concept of coronary age by evaluating an individual’s biological age (rather than chronological age) is attractive and currently under scientific evaluation. Additionally, when evaluating contrast-enhanced coronary arteries, different stages of atherosclerosis can be visualized. It could be shown by comparative studies with intracoronary ultrasound that echogenicity corresponds well with the density measured within atherosclerotic plaques expressed in Hounsfield units using MDCT. Continuously improving and still under development, the potential of MDCT to evaluate plaque composition and plaque volumes noninvasively in vivo is promising.     

Aortic pathophysiology by cardiovascular magnetic resonance in patients with clinical suspicion of coronary artery disease.

PURPOSE: To correlate cardiovascular magnetic resonance (CMR)-based measurement of aortic pulse wave velocity (PWV) with serum markers for atherosclerosis and plaque burden in the thoracic aorta. METHOD: Individuals with risk factors for coronary atherosclerosis underwent CMR pulse wave velocity examination of the descending thoracic aorta and computed tomography for coronary calcium scoring. Inversion recovery images allowed quantification of aortic plaque. Serum lipids and c-reactive protein levels were measured. RESULTS: Mean PWV did not correlate with presence of aortic plaque (p = 0.55). Subgroup analysis showed no significant correlation with PWV and total plaque. PWV and pulse pressure correlated (PP) (R2 0.38, p = 0.0003), but PWV and other predictor variables did not. Total plaque area correlated with aortic diameter (p = 0.0066). CONCLUSIONS: In patients with suspected coronary artery disease, aortic pulse wave velocity reflects increased aortic stiffness demonstrated by elevated pulse pressure, but does not directly correlate with aortic plaque or serum markers for arterial disease.     

胸主动脉粥样斑块的经食管超声研究

本文应用多平面经食管超声技术检测了２４０例受试者的胸主动脉，旨在探讨胸主动脉粥样斑块的超声特征、好发部位及临床意义。结果显示，检出斑块７３例，其中单纯型占５８．９０％，复合型占４２．４６％。复合型斑块的发生率在心脑血管病变组明显高于高血压组（５２．９０％ＶＳ１９．０５％，Ｐ＜０．０１）。胸主动脉粥样斑块的好发部位为同时发生于主动脉弓和降主动脉（５８．９１％），其次为降主动脉（２１．９５）和主动脉弓部（１９．２５％），Ｐ均＜０．００１。结果表明，复合型斑块与心脑血管病变密切相关，经食管超声技术是检测活体胸主动脉粥样硬化病变的重要方法     

双源CT心外膜脂肪体积定量对冠状动脉斑块稳定性的影响

目的探讨冠心病患者心外膜脂肪体积对冠状动脉斑块稳定性的影响。方法纳入同期行双源CT冠状动脉成像与经皮冠状动脉造影的冠心病患者145例,测量患者的身高、体重、血压、血生化指标,通过64排双源CT测定心外膜脂肪体积与斑块性质、重构指数、点状钙化,并进行心外膜脂肪体积与易损斑块的相关分析。结果年龄、性别、吸烟、糖尿病、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)在斑块性质、血管重构、点状钙化中的差异均无统计学意义(P>0.05)。LDL-C在斑块性质与点状钙化中也无统计学差异(P>0.05),正性重构组LDL-C水平高于非正性重构组(P=0.040)。非钙化斑块组、正性重构组、点状钙化组的高血压患病率、BMI与心外膜脂肪体积均高于钙化斑块组、非正性重构组、无点状钙化组(P<0.05),其中心外膜脂肪体积差异最大(P<0.001)。Logistic回归分析表明心外膜脂肪体积是影响易损斑块的独立危险因素(OR=2.015,P=0.001)。ROC曲线分析表明心外膜脂肪体积诊断易损斑块的阈值为103.7 cm3,诊断的敏感性与特异性分别为93.0%和61.8%(P<0.001)。结论双源CT测量心外膜脂肪体积与冠状动脉粥样硬化斑块的斑块性质、血管重构、点状钙化具有良好的相关性,可作为影响易损斑块的独立危险因素,并早期判断冠心病患者的预后。     

Increased epicardial adipose tissue thickness is correlated with ascending aortic diameter

Epicardial adipose tissue (EAT), localized beneath the visceral pericardium, is a metabolically active endocrine and paracrine organ with possible interactions within the heart. Recent studies identified possible roles of uric acid (UA)-induced oxidative stress and increased inflammatory status in the pathogenesis of ascending aortic dilatation. The aim of this study was to investigate whether EAT is an independent factor for ascending aortic dilatation. The patients were evaluated by a complete transthoracic echocardiographic examination including measurements of EAT and aortic dimensions. Serum levels of UA and C-reactive protein and EAT thicknesses were compared in 38 patients with dilated ascending aorta (DAA) (the diameter ≥ 37 mm) vs. 107 subjects with normal aortic diameter (AD) of < 37 mm. EAT thickness was significantly higher in DAA group compared to normal AD group (8.3 ± 2.7 vs. 5.4 ± 2.2 mm, p < 0.001) as well as age (53 ± 10 vs. 48 ± 9 years, p = 0.004), the presence of hypertension (54% vs. 30%, p = 0.009) and UA levels (6.0 ± 1.4 vs. 5.2 ± 1.1 mg/dL, p < 0.001). There was a strong correlation between EAT thickness and ascending aortic diameter (r = 0.521, p < 0.001). In multiple logistic regression analysis, EAT thickness (OR: 1.429, p = 0.006), body mass index (OR: 1.169, p = 0.014) and UA levels (OR: 1.727, p = 0.023) were independently correlated to ascending aortic dilatation. We therefore propose that increased EAT thickness is an independent predictor of ascending aortic dilation.     

64层螺旋CT冠状动脉血管成像评估心肌桥

目的运用64层螺旋CT冠状动脉成像描述壁冠状动脉在舒张期受压情况，探讨心肌桥与冠状动脉粥样硬化形成关系。方法分析611例行冠状动脉CTA扫描病人，对心肌桥长度、厚度，壁冠状动脉在舒张期受压及其伴随的动脉粥样硬化情况进行评估。分析壁冠状动脉舒张期受压与动脉粥样硬化形成的相关性。并按心肌桥存在与否进行分组配对，比较有心肌桥组动脉粥样硬化发生率与无心肌桥组动脉粥样硬化发生率。结果611例病人中173例发现心肌桥（28．3％）。左前降发生率最高（122／173）。舒张中期壁冠状动脉重度受压者心肌桥厚度与无或轻度受压心肌桥厚度存在显著差异性（P=0．016）。壁冠状动脉受压情况与动脉粥样硬化斑块所致狭窄程度存在正相关关系（r=0．842，P=0．002）。邻近心肌桥段冠状动脉粥样硬化发生率与单纯冠状动脉粥样硬化发生率存在显著性差异（P=0．017）。结论心肌桥厚度与壁冠状动脉舒张期受压程度及邻近冠状动脉斑块形成相关；心肌桥可能是评估冠心病的危险因素之一。     

经食管超声心动图检测主动脉粥样硬化斑块与冠状动脉病变严重程度的相关性研究

目的 通过经食管超声心动图检测主动脉的不同部位不同斑块性质与冠状动脉血管病变严重程度进行对比研究,寻找冠状动脉病变严重程度的预测因素.方法 对118例同时进行了经食管超声心动图及冠状动脉造影检查的患者进行对比研究.冠状动脉造影显示血管内径狭窄≥70%定义为冠状动脉病变.粥样硬化斑块厚度大于4 mm,有漂浮物形成或斑块溃疡定义为复杂斑块;其他大于2 mm并小于4 mm的斑块定义为简单斑块.根据冠状动脉病变支数将研究对象分为4组:A组(0支病变)99例,B组(1支病变)31例,C组(2支病变)8例,D组(3支病变)30例,比较各组间粥样硬化斑块的发生部位及程度特征.结果 与A组0支病变的99例相比,有血管狭窄的89例患者(包括B,C,D组)的主动脉内粥样斑块的发生率、严重度均明显增高(P＜0.05).多元回归分析显示高血压(优势比3.0,95%可信区间1.3～7.0,P=0.013)、糖尿病(优势比2.4,95%可信区间1.1～4.9,P=0.022)及主动脉斑块(优势比3.8,95%可信区间1.8～8.2,P=0.001)与冠状动脉病变发生明显相关.简单及复杂斑块均与冠状动脉病变严重度明显相关(P＜0.001).多元回归分析显示主动脉降部复杂斑块是冠状动脉病变的最强预测因子(优势比5.4.95%可信区间1.8～16.4,P=0.003).结论 主动脉内简单及复杂粥样斑块均与冠状动脉病变严重度明显相关.降主动脉复杂斑块是冠状动脉病变的最强预测因子.     

Coronary artery ectasia diagnosed using multidetector computed tomography: morphology and relation to coronary artery calcification

Coronary artery ectasia (CAE) is usually considered a variant of coronary artery atherosclerosis; however, a definite link has not yet been confirmed. As not all patients with CAE are symptomatic, the real incidence is unknown. The aim of this study was to evaluate the prevalence of CAE and its clinical and angiographic characteristics as well as its relation to coronary artery calcification and any associated vascular abnormality by using multidetector computed tomography (MDCT). We prospectively enrolled 2,600 patients (mean age 55 ± 10 years) who were scheduled for computed tomography coronary angiography (CTCA). CTCA was performed using 64-MDCT with dedicated software for calcium measurement. CAE was defined as an arterial segment with a diameter of >1.5 times the diameter of the adjacent normal segment. The presence of ≥70 % diameter stenosis of any major epicardial vessel was considered an obstructive lesion. CAE was encountered in 192 (7.4 %) patients and showed gender predominance in men (88 %). Patients with CAE were more hypertensive but less diabetic. Left anterior descending artery was the most commonly affected vessel. Only 16 % of CAE patients had no atherosclerotic lesion. Coronary artery calcium score (CACS) and prevalence of ascending aorta aneurysm were shown to be significantly higher in CAE patients compared to patients having no ectasia. A significant negative correlation was noted between CACS and Markis classification. CTCA is a feasible technique to identify and evaluate morphology of CAE. The link between CACS and CAE may favor the consideration that ectasia is an advanced form of atherosclerosis.     

Aortic plaque imaging and monitoring atherosclerotic plaque interventions

The atherosclerotic process that results in coronary artery disease (CAD) is recognized to be a generalized process that may involve the entire vasculature. The association between CAD and atherosclerotic plaques in the thoracic aorta has often been reported using transesophageal echocardiography. An autopsy study showed plaques in the abdominal aorta, but not in the thoracic aorta, to be severe in patients with cardiac events. However, studies evaluating an association between abdominal aortic plaques and CAD are scarce. Recently, magnetic resonance imaging (MRI) has become a useful tool for the noninvasive evaluation of atherosclerotic plaques in both the thoracic and abdominal aortas. Plaques in the thoracic and abdominal aortas were found to be characteristically associated with hypercholesterolemia and smoking, respectively, suggesting different susceptibilities to risk factors. Because patients have various risk factors, it seems to be preferable to evaluate atherosclerosis in multiple vascular beds than in just 1 bed. Magnetic resonance imaging can evaluate atherosclerosis in multiple vascular beds in the same examination session. Complex aortic plaques, especially in the abdominal aorta, were found to be associated with myocardial infarction and complex coronary lesions, suggesting a link between aortic and coronary plaque instability. Aortic MRI may thus be useful for identifying vulnerable patients. Moreover, MRI is a powerful tool to serially evaluate plaque progression and regression. Intensive lipid-lowering therapy can regress aortic plaques, but the susceptibility to lipid lowering and the process of plaque regression may differ between the thoracic and abdominal aortic plaques.