Total coronary artery plaque burden measured by cardiac computed tomography is associated with metabolic syndrome

Prevalence of high-risk coronary plaques in patients with and without metabolic syndrome and the relationship with prognosis

BACKGROUND

Metabolic syndrome (MS) is a disorder, characterized by clusters of cardiovascular risk factors such as central obesity, insulin resistance, dyslipidemia and hypertension. Patients with MS may have a higher plaque burden that increases their risk of major adverse cardiovascular events (MACEs). This study aimed to analyze the prevalence of high-risk coronary plaques in patients with and without MS by coronary computed tomography angiography (CCTA) and to investigate the relationship between MS, high-risk coronary plaques, and their prognosis.

METHODS

This was a retrospective cohort study of 1136 patients who underwent CCTA due to chest pain without obstructive heart disease (≥50% coronary stenosis) between January 2014 and December 2015 in our hospital. The relationships between high risk coronary plaques, MS, and other clinical factors were assessed. Multicollinearity analysis was performed to identify the collinearity between the variables. The proportional hazard assumption was checked and using Schoenfeld residual test. Cox proportional hazards model and Kaplan-Meier survival analysis assessed the relationship between MS, high-risk coronary plaques and MACEs.

RESULTS

High-risk plaques were more frequent in the MS group than non-MS group (P = 0.004). MS (HR = 2.128, 95%CI: 1.524-2.970, P < 0.001), presence of high-risk plaques (HR = 11.059, 95%CI: 7.749-57.232, P < 0.001) and high sensitivity C-reactive protein (hsCRP) (HR = 1.629, 95%CI: 1.128-2.352, P = 0.009) were related with an increased risk of MACEs in patients with risk factors for coronary heart disease. In patients with high-risk plaques, MS (HR = 2.265, 95%CI: 1.629-3.150, P < 0.001) and hsCRP (HR = 1.267, 95%CI: 1.191-1.348, P = 0.004) were related with an increased risk of MACEs. Kaplan-Meier analysis showed differences in MACEs between the MS and non-MS groups in the whole population and those with high-risk plaques (both P < 0.0001).

CONCLUSIONS

High-risk plaques were more common in patients with MS. MS and the presence of high-risk plaques were independent risk factors for MACEs.

Relationship between diverse patient body size- and image acquisition-related factors, and quantitative and qualitative image quality in coronary computed tomography angiography: a multicenter observational study

PURPOSE

We investigated the effects of patient- and image acquisition-related factors on the image quality in coronary CT angiography (CCTA).

MATERIALS AND METHODS

We enrolled 1197 patients (728 men; 65 ± 12 years). All underwent CCTA under the routine scan protocol in 23 participating hospitals. The subjective image quality (3-point Likert scale: excellent, good, and poor) and the attenuation of the left and right coronary artery (LCA, RCA) were recorded; the effects of patient and image acquisition-related factors on vascular attenuation were then compared.

RESULTS

The mean LCA attenuation was 515.2 ± 65.8 (excellent), 401.4 ± 63.4 (good), and 319.5 ± 47.6 HU (poor). The corresponding RCA attenuation was 496.6 ± 67.6, 390.5 ± 58.5, and 308.5 ± 50.7 HU, respectively. Univariate analysis revealed significant associations between sufficient coronary attenuation (> 400 HU) and the age, gender, body surface area (BSA), number of detectors, contrast synchronization, scan mode, and the fractional contrast dose. Multivariate analysis revealed that the bolus tracking method, prospective electrocardiogram gating, and fractional contrast dose were significantly associated with sufficient coronary enhancement.

CONCLUSION

BSA and fractional contrast dose are the most important patient- and image acquisition-related factors for sufficient coronary attenuation in CCTA.