DOES CALCIUM DENSITY PLAY A ROLE OVER AND ABOVE PLAQUE VOLUME IN DETERMINING ISCHEMIA?

1759 JACC April 5, 2016 Volume 67, Issue 13

Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) DOES CALCIUM DENSITY PLAY A ROLE OVER AND ABOVE PLAQUE VOLUME IN DETERMINING ISCHEMIA? Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Cardiac CT Angiography: Prognosis, Plaque and Perfusion Abstract Category: 28. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1230-242 Authors: Lohendran Baskaran, Fay Lin, Heidi Gransar, James Min, Weill Cornell Medical College, New York, NY, USA

Background: Coronary Artery Calcification is a strong predictor of cardiovascular (CV) events, but dense calcified plaque has been thought to play a stabilizing role in reducing CV events. We investigate the relationship between dense calcified plaque volume (DCV) and ischemia, to determine whether DCV plays an additive effect over and above lesion plaque volume (LPV). Methods: Patients with stable angina were recruited prospectively and underwent invasive FFR and CT angiography (CTA) plaque analysis. Ischemia was defined as FFR ≤0.8. Dense calcium was defined as >350 HU. The DCV, maximum Plaque Intensity (Max PI) and %DCV (DCV/LPV) were all measured and correlation was measured using logistic regression, adjusting for LPV and CV risk factors.

Results: 252 patients (399 lesions) were analyzed. There was a strong incremental association between DCV, Max PI and ischemia. However, after adjusting for LPV, these relationships no longer held true (Table 1). There was a strong association between LPV and ischemia, with every 100mm3 increment resulting in a 44% increase in ischemia likelihood(p<0.0005, 95% CI =1.28-1.63). There was also a strong association between DCV (Coefficient 17,CI 13-21, p=0), %DCV (Coefficient 19,CI 9-29, p=0), Max PI (Coefficient 1.3, CI 0.9-1.7, p=0) and LPV. Conclusions: Dense calcium plays only a secondary role to plaque volume in determining ischemia. The proportion of dense calcium in a lesion also does not determine lesion-specific ischemia independently of plaque volume. Association between dense calcium and ischemia Parameter

OR, Unadjusted

OR, Adjusted for LPV

DCV (increments, 10mm3)

1.073 (1.027 - 1.121), p = 0.002

1.014 (0.969 - 1.061), p = 0.56

%DCV(increments, 10%)

1.119 (0.996 - 1.256), p = 0.058

1.048 (0.919 - 1.194), p = 0.486

Max PI (increments, 10 HU)

1.008 (1.004 - 1.0127), p < 0.0005

1.004 (0.999 - 1.009), p = 0.124