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Association of Serum Lipid Profile With Coronary Computed Tomographic Angiography–derived Morphologic and Functional Quantitative Plaque Markers

Baumann, Stefan, MD*,†; Kryeziu, Philipp, BSc*,†; Tesche, Christian, MD‡,§; Shuler, Darby C., MS; Becher, Tobias, MD*,†; Rutsch, Marlon, BSc*,†; Behnes, Michael, MD*,†; Stach, Ksenija, MD*,†; Jacobs, Brian E., BSc; Renker, Matthias, MD; Henzler, Thomas, MD; Haubenreisser, Holger, MD; Schoenberg, Stefan O., MD; Weiss, Christel, PhD#; Borggrefe, Martin, MD*,†; Schwemmer, Chris, MSc**; Schoepf, U. Joseph, MD; Akin, Ibrahim, MD*,†; Lossnitzer, Dirk, MD*,†

doi: 10.1097/RTI.0000000000000356
Imaging in Cardiac Risk Prediction

Purpose: Recent advances in image quality of coronary computed tomographic angiography (cCTA) have enabled improved characterization of coronary plaques. Thus, we investigated the association between quantitative morphological plaque markers obtained by cCTA and serum lipid levels in patients with suspected or known coronary artery disease.

Materials and Methods: We retrospectively analyzed data of 119 statin-naive patients (55±14 y, 66% men) who underwent clinically indicated cCTA between January 2013 and February 2017. Patients were subdivided into a plaque and a no-plaque group. Quantitative and morphologic plaque markers, such as segment involvement score, segment stenosis score, remodeling index, napkin-ring sign, total plaque volume, calcified plaque volume, and noncalcified plaque volume (NCPV) and plaque composition, were analyzed using a semiautomated plaque software prototype. Total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, low-density lipoprotein/high-density lipoprotein ratio, and triglycerides were determine in both groups.

Results: Higher age (61±11 y vs. 52±14 y, P<0.0001) and a higher likelihood of male gender (77% vs. 56%, P<0.0001) were observed in the plaque group. Differences in lipid levels were neither observed for differentiation between plaque presence or absence, nor after subcategorization for plaque composition. LDL serum levels >160 mg/dL correlated with higher NCPV compared with patients with LDL between 100 and 160 mg/dL (112 vs. 27 mm3, P=0.037). Other markers were comparable between the different groups.

Conclusion: Statin-naive patients with known or suspected coronary artery disease did not show differences in lipid levels related to plaque composition by cCTA. Patients with plaques tended to be men and were significantly older. High LDL levels correlated with high NCPV.

*First Department of Medicine-Cardiology, University Medical Centre Mannheim

DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim

Institute of Clinical Radiology and Nuclear Medicine, Faculty of Medicine Mannheim, University Medical Center Mannheim, Heidelberg University

#Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim

§Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich

Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim

**Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany

Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC

The presented software is based on research and is currently not commercially available.

Supported by the DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung-German Centre for Cardiovascular Research). U. Joseph Schoepf receives research support from Astellas, Bayer, Bracco, GE, and Siemens and is a consultant for Bayer, Guerbet, and Siemens. Chris Schwemmer is an employee of Siemens Healthcare. The remaining authors declare no conflicts of interest.

Correspondence to: Stefan Baumann, MD, First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany (e-mail:

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