Aortic arch plaque morphology in patients with coronary artery disease undergoing coronary computed tomography angiography with wide-volume scan

Abstract

Background: Wide-volume scanning with 320-row multidetector computed tomography coronary angiography (CTCA-WVS) enables the assessment of the aortic arch plaque (AAP) morphology and coronary arteries without requiring additional contrast volume. This study aimed to investigate the prevalence of AAPs and their association with coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in patients who underwent CTCA-WVS.

Methods: This study included 204 patients without known CAD (mean age, 65 years; 53% men) who underwent CTCA-WVS. We evaluated the presence of aortic plaques in the ascending aorta, aortic arch, and thoracic descending aorta using CTCA-WVS. Large aortic plaques were defined as plaques of at least 4 mm in thickness. A complex aortic plaque was defined as a plaque with ulceration or protrusion. MACEs were defined as composite events of cardiovascular (CV) death, nonfatal myocardial infarction, and ischemic stroke.

Results: AAPs and large/complex AAPs were identified in 51% ( n = 105) and 18% ( n = 36) of the study patients, respectively. The prevalence of AAPs with large/complex morphology increased with CAD severity (2.1% in no CAD, 12% in nonobstructive CAD, and 39% in obstructive CAD). The univariate Cox hazard model demonstrated that the predictors associated with MACEs were diabetes, obstructive CAD, and large/complex AAPs. Independent factors associated with large/complex AAPs were male sex [odds ratio (OR), 2.90; P = 0.025], stroke history (OR, 3.48; P = 0.026), obstructive CAD (OR, 3.35; P = 0.011), and thoracic aortic calcification (OR, 1.77; P = 0.005).

Conclusion: CTCA-WVS provides a comprehensive assessment of coronary atherosclerosis and thoracic aortic plaques in patients with CAD, which may improve the stratification of patients at risk for CV events.

Fig. 1

Computed tomography coronary angiography with wide-volume scanning for the aortic arch and coronary plaque imaging. (a) Oblique image of the thoracic aorta and heart. A combined image of the first and second volume scans (wide-volume scan) is automatically generated using 320-row multidetector computed tomography. (b) Aortic plaque in the ascending aorta. (c) Aortic arch plaque with protrusion. (d) Aortic plaque with calcification. (e) Volume rendering image of the coronary arteries.

Fig. 2

Computed tomography coronary angiography with wide-volume scanning images to visualize the thoracic aorta together with the coronary arteries in an obstructive CAD patient without stroke history. (a) Maximum intensity projection image of coronary arteries with multivessel obstructive CAD. Curved planner reconstruction images of LAD (b), LCX (c), and RCA (d). (e) Straight CPR image of contrast-enhanced CT angiography for the thoracic aorta. The ascending aorta (f) and ulcered AAPs ≥ 4 mm (g and h). (i) The descending aortic plaque with ulceration. (j) Fly through view of the aortic arch from proximal to distal aortic arch. Irregular luminal surface indicates complex AAPs partially corresponding to (g and h). AAPs, aortic arch plaques; CAD, coronary artery disease; CPR, curved planar reformation; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; and RCA, right coronary artery.

Fig. 3

Prevalence of aortic plaques with or without large/complex morphology according to CAD severity. The prevalence of aortic plaques and large/complex aortic plaques in the ascending aorta (a), aortic arch (b), and descending aorta (c). Prevalence of aortic plaques with or without large/complex morphology increased along with the presence and severity of CAD in all the segments (all P < 0.001). CAD, coronary artery disease; CACS, coronary artery calcium score.

Fig. 4

Kaplan–Meier curve analysis according to the presence or absence of predictors. (a) Patients were stratified according to the presence of obstructive coronary artery disease. (b) Patients were stratified by the presence of aortic arch plaques with or without large/complex morphology.