Thread by @CoronaryDoc

⚡️ #YesCCT Coronary Plaque Assessment #Tweetorial ⚡️

By @CoronaryDoc + @AChoiHeart

✅ Why Plaque Assessment?
✅ High Risk Plaque Features
✅ Plaque Characterization/Quantification
✅ Supporting Clinical Data

#CardioTwitter #ACCImaging #SCCT2019 @heart_scct @journalCCT
1/14

2/14
As #SCD or #MI is 1st symptom of #atherosclerosis in 2/3 of pts, early ID of #CAD is of paramount importance

#YesCCT allows for
✅ ID of plaque
✅ Quant. of plaque
✅ Characterization of plaque
✅ Arterial remodeling

Lin, @LubbDup & @lesleejshaw: bit.ly/2x1b5Yz

3/14
Serial angiographic studies have demonstrated an accelerated & rapid plaque progression before most cases of ACS

Rapid plaque growth ➡️ plaque rupture ➡️ thrombus formation ➡️ MI

@LubbDup & @JonathonLeipsic et al: bit.ly/2WIt5Bj

4/12
Evaluation of established adverse plaque characteristics (shown in slide) plus hemodynamic factors (e.g. #FFR & #WSS) provide complementary insights to high-risk plaque assessment

@CoronaryDoc & @habib_samady et al: bit.ly/2KmlCGp
bit.ly/2WS9Sgx

5/12
Here’s a summary of high risk or rupture-prone plaques from histological studies with corresponding #YesCCT findings

Rosendael et al @JACCJournals: bit.ly/2x04Iox
Otsuka et al @NatRevCardiol: go.nature.com/2WPhpgq

6/14
#YesCCT is able to differentiate between calcified, partially-calcified (mixed), and non-calcified plaques

Calcified plaques have been shown to be an independent predictor of cardiac events
#ACCImaging

@PalMaurovich et al @NatRevCardiol:
go.nature.com/2WPhL6K

7/14
#YesCCT refines plaque composition by differentiating between high attenuation (necrotic core and fibrofatty tissues or lipid-rich plaque) & low attenuation areas (fibrous tissue) that are predictive of cardiac events

bit.ly/2ZsVAou
go.nature.com/2WPhL6K

8/14
Taken together, recent investigation has centered around fully quantifying high risk plaques on a fully #YesCCT imaging dataset

Slide’s info:
PR: positive remodeling
LAP: low attenuation plaque
SC: spotty calcification

Rosendael et al @JACCJournals: bit.ly/2x04Iox

9/14
In #SCOTHeart study, presence of adverse #YesCCT plaque (+ remodeling or low attenuation plaque), obstructive disease & #CAC (surrogate measure of overall plaque burden) were associated with ⬆️ risk of #CHD death or nonfatal MI

@imagingmedsci et al:
bit.ly/2WPjI34

10/14
In ICONIC study, quantitative assessment of #YesCCT plaque composition showed ACS culprit lesion precursors with ↑fibrofatty & necrotic core. Low-attenuation plaque, + remodeling, spotty Ca++ & plaque burden also identified lesions & pts with ACS

bit.ly/2x1F0Qz

11/14
In #ROMICAT II Trial, high-risk plaque in acute CP (positive remodeling, low attenuation plaque, napkin-ring sign, spotty ca++) was associated with ACS independently & incrementally to presence of significant stenosis & clinical risk assessment

bit.ly/2WP0GtF

12/14
While there remain limitations at present, quantitative plaque burden offers important insights

New automated plaque quantification tools may enable further prospective evaluation of these plaque characteristics in clinical setting

13/14
🔑 Takeaways:

#YesCCT:
✅ IDs & quantifies plaque
​✅ Global assessment plaque burden
​✅ Detects high-risk plaques: high burden, low attenuation, napkin-ring, +remodeling, +spotty Ca++

These features allow personalized risk ID & Rx initiation before a cardiac event!

14/14
For a deeper dive:

1️⃣ Read @journalCCT review on role of non-invasive atherosclerosis imaging by Lin & @lesleejshaw
bit.ly/2x1b5Yz

2️⃣ Attend #SCCT2019 or follow Twitter coverage of Advanced Plaque Quantification by #YesCCT on 7/12 @ 3:45
scct.org/page/SCCT2019