Coronary Artery Microcalcification: Imaging and Clinical Implications
Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the nec...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-09-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/9/4/125 |
| _version_ | 1798039013757550592 |
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| author | Federico Vancheri Giovanni Longo Sergio Vancheri John S. H. Danial Michael Y. Henein |
| author_facet | Federico Vancheri Giovanni Longo Sergio Vancheri John S. H. Danial Michael Y. Henein |
| author_sort | Federico Vancheri |
| collection | DOAJ |
| description | Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification. |
| first_indexed | 2024-04-11T21:48:05Z |
| format | Article |
| id | doaj.art-d08eb4c23a47467aa247e446b028e923 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-04-11T21:48:05Z |
| publishDate | 2019-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-d08eb4c23a47467aa247e446b028e9232022-12-22T04:01:21ZengMDPI AGDiagnostics2075-44182019-09-019412510.3390/diagnostics9040125diagnostics9040125Coronary Artery Microcalcification: Imaging and Clinical ImplicationsFederico Vancheri0Giovanni Longo1Sergio Vancheri2John S. H. Danial3Michael Y. Henein4Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, ItalyCardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, ItalyRadiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Chemistry, University of Cambridge, Cambridge CB2 1EW, UKInstitute of Public Health and Clinical Medicine, Umea University, 901 87 Umea, SwedenStrategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.https://www.mdpi.com/2075-4418/9/4/125atherosclerosiscoronary microcalcificationatherosclerosis imagingconfocal microcalcification imaging |
| spellingShingle | Federico Vancheri Giovanni Longo Sergio Vancheri John S. H. Danial Michael Y. Henein Coronary Artery Microcalcification: Imaging and Clinical Implications Diagnostics atherosclerosis coronary microcalcification atherosclerosis imaging confocal microcalcification imaging |
| title | Coronary Artery Microcalcification: Imaging and Clinical Implications |
| title_full | Coronary Artery Microcalcification: Imaging and Clinical Implications |
| title_fullStr | Coronary Artery Microcalcification: Imaging and Clinical Implications |
| title_full_unstemmed | Coronary Artery Microcalcification: Imaging and Clinical Implications |
| title_short | Coronary Artery Microcalcification: Imaging and Clinical Implications |
| title_sort | coronary artery microcalcification imaging and clinical implications |
| topic | atherosclerosis coronary microcalcification atherosclerosis imaging confocal microcalcification imaging |
| url | https://www.mdpi.com/2075-4418/9/4/125 |
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