Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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The Potential Role of Cardiac CT in Patients with Acute Coronary Syndrome

급성 관상동맥 증후군을 가진 환자에서 심장 CT의 역할

  • Sang Hyun Lee (Department of Cardiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Ki Seok Choo (Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital)
  • 이상현 (부산대학교 의과대학 양산부산대학교병원 심장내과) ;
  • 추기석 (부산대학교 의과대학 양산부산대학교병원 영상의학과)
  • Received : 2021.11.01
  • Accepted : 2021.12.27
  • Published : 2022.01.01
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Abstract

Acute coronary syndrome involves three types of coronary artery disease associated with sudden rupture of coronary artery plaque, and has a clinical presentation ranging from ST-segment elevation myocardial infarction (STEMI) to non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. Cardiac CT can help quantify and characterize atherosclerotic plaques. According to a previous study, low-attenuation plaque, napkin ring sign, positive remodeling, spotty calcification, and increased perivascular fat attenuation are associated with plaque ruptures on cardiac CT. Therefore, coronary artery stenosis, as well as acute coronary artery syndrome, can be diagnosed using cardiac CT.

급성 관상동맥 증후군은 관상동맥 경화반의 갑작스러운 파열과 관련된 3가지 유형의 관상동맥 질환을 의미하며 임상적으로는 ST 분절 상승 심근경색에서 비 ST 분절 상승 심근경색 또는 불안정성 협심증 등으로 표현된다. 심장 CT의 기술 발전을 통해 심장 CT는 관상동맥 내 죽상동맥경화반의 정량화 및 특성을 평가할 수 있게 되었으며, 현재까지 낮은 감쇠의 경화반, 냅킨 반지 표시, 양성 리모델링, 점상 석회화 및 증가된 혈관 주변 지방 감쇠가 심장 CT에서 경화반 파열을 의미하는 것으로 알려져 있다. 따라서 심장 CT는 관상동맥의 혈관협착정도를 진단하는 것을 넘어 급성 관상동맥 증후군을 진단하는데도 많은 기여를 하고 있다.

Keywords

Acknowledgement

This study was supported by a 2020 research grant from Pusan National University Yangsan Hospital.

References

  1. Zegre-Hemsey JK, Asafu-Adjei J, Fernandez A, Brice J. Characteristics of prehospital electrocardiogram use in north carolina using a novel linkage of emergency medical services and emergency department data. Prehosp Emerg Care 2019;23:772-779
  2. Alomari M, Bratton H, Musmar A, Al Momani LA, Young M. Ticagrelor-induced diarrhea in a patient with acute coronary syndrome requiring percutaneous coronary artery intervention. Cureus 2019;11:e3874
  3. Kerneis M, Nafee T, Yee MK, Kazmi HA, Datta S, Zeitouni M, et al. Most promising therapies in interventional cardiology. Curr Cardiol Rep 2019;21:26
  4. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267-315
  5. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-177
  6. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231-2264
  7. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 1992;326:242-250
  8. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 1992;326:310-318
  9. Sabia P, Afrookteh A, Touchstone DA, Keller MW, Esquivel L, Kaul S. Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. Circulation 1991;84:I85-I92
  10. Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289-1367
  11. Hur SH. Lesion characteristics in patients with acute coronary syndrome: a comparison with lesion in patients with stable angina by intravascular ultrasound. Korean Circulation J 2004;34:548-557
  12. Choe YH. Noninvasive detection of coronary atherosclerotic plaques and assessment of stenosis degree at multidetector CT coronary angiography. J Korean Med Assoc 2007;50:109-119
  13. Andre F, Buss SJ, Friedrich MG. The role of MRI and CT for diagnosis and work-up in suspected ACS. Diagnosis (Berl) 2016;3:143-154
  14. Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (rule out myocardial infarction using computer assisted tomography) trial. J Am Coll Cardiol 2009;53:1642-1650
  15. Hoffmann U, Truong QA, Fleg JL, Goehler A, Gazelle S, Wiviott S, et al. Design of the rule out myocardial ischemia/infarction using computer assisted tomography: a multicenter randomized comparative effectiveness trial of cardiac computed tomography versus alternative triage strategies in patients with acute chest pain in the emergency department. Am Heart J 2012;163:330-338
  16. Linde JJ, Kelbaek H, Hansen TF, Sigvardsen PE, Torp-Pedersen C, Bech J, et al. Coronary CT angiography in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2020;75:453-463
  17. Kolossvary M, Szilveszter B, Merkely B, Maurovich-Horvat P. Plaque imaging with CT-a comprehensive review on coronary CT angiography based risk assessment. Cardiovasc Diagn Ther 2017;7:489-506
  18. Bittencourt MS, Hulten E, Ghoshhajra B, O'Leary D, Christman MP, Montana P, et al. Prognostic value of non-obstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging 2014;7:282-291
  19. Hadamitzky M, Achenbach S, Al-Mallah M, Berman D, Budoff M, Cademartiri F, et al. Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: an InteRnational Multicenter Registry). J Am Coll Cardiol 2013;62:468-476
  20. Son MJ, Yoo SM, Lee D, Lee HY, Song IS, Chun EJ, et al. Current role of computed tomography in the evaluation of acute coronary syndrome. Diagnostics (Basel) 2021;11:266
  21. Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 2004;43:842-847
  22. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007;50:319-326
  23. Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014;64:684-692
  24. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, et al. Coronary artery disease - reporting and data system (CAD-RADS): an expert consensus document of SCCT, ACR and NASCI: endorsed by the ACC. JACC Cardiovasc Imaging 2016;9:1099-1113
  25. Pohle K, Achenbach S, Macneill B, Ropers D, Ferencik M, Moselewski F, et al. Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis 2007;190:174-180
  26. Voros S, Rinehart S, Qian Z, Vazquez G, Anderson H, Murrieta L, et al. Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study. JACC Cardiovasc Interv 2011;4:198-208
  27. Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, et al. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 2006;47:672-677
  28. Sun J, Zhang Z, Lu B, Yu W, Yang Y, Zhou Y, et al. Identification and quantification of coronary atherosclerotic plaques: a comparison of 64-MDCT and intravascular ultrasound. AJR Am J Roentgenol 2008;190:748-754
  29. Yang X, Gai L, Dong W, Liu H, Sun Z, Tian F, et al. Characterization of culprit lesions in acute coronary syndromes compared with stable angina pectoris by dual-source computed tomography. Int J Cardiovasc Imaging 2013;29:945-953
  30. Marwan M, Taher MA, El Meniawy K, Awadallah H, Pflederer T, Schuhback A, et al. In vivo CT detection of lipid-rich coronary artery atherosclerotic plaques using quantitative histogram analysis: a head to head comparison with IVUS. Atherosclerosis 2011;215:110-115
  31. Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging 2009;2:1412-1419
  32. Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high-risk coronary plaques? JACC Cardiovasc Imaging 2010;3:440-444
  33. Nishio M, Ueda Y, Matsuo K, Asai M, Nemoto T, Hirata A, et al. Detection of disrupted plaques by coronary CT: comparison with angioscopy. Heart 2011;97:1397-1402
  34. Gauss S, Achenbach S, Pflederer T, Schuhback A, Daniel WG, Marwan M. Assessment of coronary artery re-modelling by dual-source CT: a head-to-head comparison with intravascular ultrasound. Heart 2011;97:991-997
  35. Yoo SM, Lee HY, Jin KN, Chun EJ, Ann FA, White CS. Current concepts of vulnerable plaque on coronary CT angiography. Cardiovasc Imaging Asia 2017;1:4-12
  36. Maldonado N, Kelly-Arnold A, Vengrenyuk Y, Laudier D, Fallon JT, Virmani R, et al. A mechanistic analysis of the role of microcalcifications in atherosclerotic plaque stability: potential implications for plaque rupture. Am J Physiol Heart Circ Physiol 2012;303:H619-H628
  37. Ito T, Terashima M, Kaneda H, Nasu K, Matsuo H, Ehara M, et al. Comparison of in vivo assessment of vulnerable plaque by 64-slice multislice computed tomography versus optical coherence tomography. Am J Cardiol 2011;107:1270-1277
  38. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017;377:1119-1131
  39. Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 2017;12;9:eaal2658
  40. Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018;392:929-939
  41. Kluner LV, Oikonomou EK, Antoniades C. Assessing cardiovascular risk by using the fat attenuation index in coronary CT angiography. Radiol Cardiothorac Imaging 2021;3:e200563
  42. Seneviratne SK, Truong QA, Bamberg F, Rogers IS, Shapiro MD, Schlett CL, et al. Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial. Circ Cardiovasc Imaging 2010;3:375-383
  43. Figueras J, Cortadellas J, Soler-Soler J. Left ventricular free wall rupture: clinical presentation and management. Heart 2000;83:499-504