Coronary Artery Calcification: Current Concepts and Clinical Implications.
Carlotta OnnisRenu VirmaniKenji KawaiValentina NardiAmir LermanFilippo CademartiriRoberta ScicoloneAlberto BoiTerenzio CongiuGavino FaaPeter LibbyLuca SabaPublished in: Circulation (2024)
Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.
Keyphrases
- coronary artery
- coronary artery disease
- cardiovascular events
- computed tomography
- pulmonary artery
- cardiovascular risk factors
- chronic kidney disease
- cardiovascular disease
- high resolution
- percutaneous coronary intervention
- positron emission tomography
- magnetic resonance imaging
- coronary artery bypass grafting
- metabolic syndrome
- healthcare
- heart failure
- current status
- randomized controlled trial
- contrast enhanced
- artificial intelligence
- pulmonary arterial hypertension
- magnetic resonance
- left ventricular
- genome wide
- mass spectrometry
- image quality
- fluorescence imaging
- deep learning
- living cells