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Preventative Imaging with Coronary Computed Tomography Angiography

  • Cardiac PET, CT, and MRI (P Cremer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Coronary computed tomography angiography (CCTA) is the diagnostic modality of choice for patients with stable chest pain. In this review, we scrutinize the evidence on the use of CCTA for the screening of asymptomatic patients.

Recent Findings

Clinical evidence suggests that CCTA imaging enhances cardiovascular risk stratification and prompts the timely initiation of preventive treatment leading to reduced risk of major adverse coronary events. Visualization of coronary plaques by CCTA also helps patients to comply with preventive medications. The presence of non-obstructive plaques and total plaque burden are prognostic for cardiovascular events. High-risk plaque features and pericoronary fat attenuation index, enrich the prognostic output of CCTA on top of anatomical information by capturing information on plaque vulnerability and coronary inflammatory burden.

Summary

Timely detection of atherosclerotic disease or coronary inflammation by CCTA can assist in the deployment of targeted preventive strategies and novel therapeutics to prevent cardiovascular disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nicol ED, Norgaard BL, Blanke P, Ahmadi A, Weir-McCall J, Horvat PM, Han K, Bax JJ, Leipsic J. The future of cardiovascular computed tomography: Advanced analytics and clinical insights. JACC Cardiovasc Imaging. 2019;12(6):1058–72.

    Article  PubMed  Google Scholar 

  2. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77.

    Article  PubMed  Google Scholar 

  3. Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, Naruse H, Ishii J, Hishida H, Wong ND, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54(1):49–57.

    Article  PubMed  Google Scholar 

  4. Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, Margaritis M, Shirodaria C, Kampoli AM, Akoumianakis I, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 2017;9(398).

  5. Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: Current state-of-the-art. Eur J Prev Cardiol. 2022;29(4):608–24.

    Article  PubMed  Google Scholar 

  6. Hoffmann U, Ferencik M, Udelson JE, Picard MH, Truong QA, Patel MR, Huang M, Pencina M, Mark DB, Heitner JF, et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: Insights from the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017;135(24):2320–32.

    Article  PubMed  PubMed Central  Google Scholar 

  7. •• Investigators S-H, Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, Flather M, Forbes J, Hunter A, Lewis S, et al. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med. 2018;379(10):924–33. Findings from this study suggest that CCTA imaging in patients with stable chest pain is associated with lower fatal or non-fatal cardiac events compared to standard care.

    Article  Google Scholar 

  8. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.

    Article  CAS  PubMed  Google Scholar 

  9. Hong JC, Blankstein R, Shaw LJ, Padula WV, Arrieta A, Fialkow JA, Blumenthal RS, Blaha MJ, Krumholz HM, Nasir K. Implications of coronary artery calcium testing for treatment decisions among statin candidates according to the ACC/AHA cholesterol management guidelines: A cost-effectiveness analysis. JACC Cardiovasc Imaging. 2017;10(8):938–52.

    Article  PubMed  Google Scholar 

  10. Geisel MH, Bauer M, Hennig F, Hoffmann B, Lehmann N, Mohlenkamp S, Kroger K, Kara K, Muller T, Moebus S, et al. Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population. Eur Heart J. 2017;38(23):1815–22.

    Article  CAS  PubMed  Google Scholar 

  11. Yeboah J, Young R, McClelland RL, Delaney JC, Polonsky TS, Dawood FZ, Blaha MJ, Miedema MD, Sibley CT, Carr JJ, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67(2):139–47.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Blaha MJ, Whelton SP, Al Rifai M, Dardari Z, Shaw LJ, Al-Mallah MH, Matsushita K, Rozanski A, Rumberger JA, Berman DS, et al. Comparing risk scores in the prediction of coronary and cardiovascular deaths: Coronary artery calcium consortium. JACC Cardiovasc Imaging. 2021;14(2):411–21.

    Article  PubMed  Google Scholar 

  13. Bell KJL, White S, Hassan O, Zhu L, Scott AM, Clark J, Glasziou P. Evaluation of the incremental value of a coronary artery calcium score beyond traditional cardiovascular risk assessment: A systematic review and meta-analysis. JAMA Intern Med. 2022;182(6):634–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, Benetos A, Biffi A, Boavida JM, Capodanno D, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–337.

    Article  PubMed  Google Scholar 

  15. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88.

    Article  PubMed  Google Scholar 

  16. Mortensen MB, Falk E, Li D, Nasir K, Blaha MJ, Sandfort V, Rodriguez CJ, Ouyang P, Budoff M. Statin trials, cardiovascular events, and coronary artery calcification: Implications for a trial-based approach to statin therapy in MESA. JACC Cardiovasc Imaging. 2018;11(2 Pt 1):221–30.

    Article  PubMed  Google Scholar 

  17. Puri R, Nicholls SJ, Shao M, Kataoka Y, Uno K, Kapadia SR, Tuzcu EM, Nissen SE. Impact of statins on serial coronary calcification during atheroma progression and regression. J Am Coll Cardiol. 2015;65(13):1273–82.

    Article  CAS  PubMed  Google Scholar 

  18. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359(22):2324–36.

    Article  CAS  PubMed  Google Scholar 

  19. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724–32.

    Article  PubMed  Google Scholar 

  20. Chao SP, Law WY, Kuo CJ, Hung HF, Cheng JJ, Lo HM, Shyu KG. The diagnostic accuracy of 256-row computed tomographic angiography compared with invasive coronary angiography in patients with suspected coronary artery disease. Eur Heart J. 2010;31(15):1916–23.

    Article  PubMed  Google Scholar 

  21. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58(8):849–60.

    Article  PubMed  Google Scholar 

  22. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, Lippolis NJ, Berman DS, Callister TQ. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50(12):1161–70.

    Article  PubMed  Google Scholar 

  23. Finck T, Hardenberg J, Will A, Hendrich E, Haller B, Martinoff S, Hausleiter J, Hadamitzky M. 10-year follow-up after coronary computed tomography angiography in patients with suspected coronary artery disease. JACC Cardiovasc Imaging. 2019;12(7 Pt 2):1330–8.

    Article  PubMed  Google Scholar 

  24. Mortensen MB, Dzaye O, Steffensen FH, Botker HE, Jensen JM, Ronnow Sand NP, Kragholm KH, Sorensen HT, Leipsic J, Maeng M, et al. Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis. J Am Coll Cardiol. 2020;76(24):2803–13.

    Article  PubMed  Google Scholar 

  25. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364(3):226–35.

    Article  CAS  PubMed  Google Scholar 

  26. Al-Mallah MH, Qureshi W, Lin FY, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Chang HJ, Cademartiri F, Chinnaiyan K, et al. Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry. Eur Heart J Cardiovasc Imaging. 2014;15(3):267–74.

    Article  PubMed  Google Scholar 

  27. Ahmed AI, Han Y, Al Rifai M, Alnabelsi T, Nabi F, Chang SM, Chamsi-Pasha MA, Nasir K, Mahmarian JJ, Cainzos-Achirica M, et al. Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging. Atherosclerosis. 2021;334:9–16.

    Article  CAS  PubMed  Google Scholar 

  28. Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, et al. CAD-RADS 2.0–2022 coronary artery disease-reporting and data system: An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). JACC Cardiovasc Imaging. 2022;15(11):1974–2001.

    Article  PubMed  Google Scholar 

  29. Chow BJ, Small G, Yam Y, Chen L, McPherson R, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, et al. Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: Results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) registry. Arterioscler Thromb Vasc Biol. 2015;35(4):981–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. • Fuchs A, Kuhl JT, Sigvardsen PE, Afzal S, Knudsen AD, Moller MB, de Knegt MC, Sorgaard MH, Nordestgaard BG, Kober LV, et al. Subclinical coronary atherosclerosis and risk for myocardial infarction in a Danish cohort: A prospective observational cohort study. Ann Intern Med. 2023;176(4):433–42. This study indicates that 46% of asymptomatic persons have coronary atheromatosis detected by CCTA.

    Article  PubMed  Google Scholar 

  31. Bittencourt MS, Hulten E, Ghoshhajra B, O’Leary D, Christman MP, Montana P, Truong QA, Steigner M, Murthy VL, Rybicki FJ, et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging. 2014;7(2):282–91.

    Article  PubMed  Google Scholar 

  32. Chow BJW, Yam Y, Small G, Wells GA, Crean AM, Ruddy TD, Hossain A. Prognostic durability of coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging. 2021;22(3):331–8.

    Article  PubMed  Google Scholar 

  33. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, Inoue K, Okumura M, Ishii J, Anno H, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50(4):319–26.

    Article  PubMed  Google Scholar 

  34. Motoyama S, Kondo T, Anno H, Sugiura A, Ito Y, Mori K, Ishii J, Sato T, Inoue K, Sarai M, et al. Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging. Circ J. 2007;71(3):363–6.

    Article  PubMed  Google Scholar 

  35. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the unstable plaque. Prog Cardiovasc Dis. 2002;44(5):349–56.

    Article  PubMed  Google Scholar 

  36. Williams MC, Kwiecinski J, Doris M, McElhinney P, D’Souza MS, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, et al. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: Results from the multicenter SCOT-HEART trial (Scottish Computed Tomography of the HEART). Circulation. 2020;141(18):1452–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316(22):1371–5.

    Article  CAS  PubMed  Google Scholar 

  38. Nakazato R, Otake H, Konishi A, Iwasaki M, Koo BK, Fukuya H, Shinke T, Hirata K, Leipsic J, Berman DS, et al. Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: A comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2015;16(4):373–9.

    Article  PubMed  Google Scholar 

  39. Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary computed tomography angiography assessment of high-risk plaques in predicting acute coronary syndrome. Front Cardiovasc Med. 2021;8:743538.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Finck T, Stojanovic A, Will A, Hendrich E, Martinoff S, Hausleiter J, Hadamitzky M. Long-term prognostic value of morphological plaque features on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging. 2020;21(3):237–48.

    PubMed  Google Scholar 

  41. Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshikawa J, Shimada K, Yoshiyama M. Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging. 2013;6(4):448–57.

    Article  PubMed  Google Scholar 

  42. Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, Tanimoto T, Takemoto K, Takarada S, Kubo T, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging. 2009;2(12):1412–9.

    Article  PubMed  Google Scholar 

  43. Yang DH, Kang SJ, Koo HJ, Chang M, Kang JW, Lim TH, Baek S, Han S, Lee PH, Roh JH, et al. Coronary CT angiography characteristics of OCT-defined thin-cap fibroatheroma: A section-to-section comparison study. Eur Radiol. 2018;28(2):833–43.

    Article  PubMed  Google Scholar 

  44. Maurovich-Horvat P, Schlett CL, Alkadhi H, Nakano M, Otsuka F, Stolzmann P, Scheffel H, Ferencik M, Kriegel MF, Seifarth H, et al. The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging. 2012;5(12):1243–52.

    Article  PubMed  Google Scholar 

  45. Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, Seneviratne S, Brown AJ. Computed tomographic coronary angiography-derived plaque characteristics predict major adverse cardiovascular events: A systematic review and meta-analysis. Circ Cardiovasc Imaging. 2018;11(1):e006973.

    Article  PubMed  Google Scholar 

  46. Williams MC, Moss AJ, Dweck M, Adamson PD, Alam S, Hunter A, Shah ASV, Pawade T, Weir-McCall JR, Roditi G, et al. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART study. J Am Coll Cardiol. 2019;73(3):291–301.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ferencik M, Mayrhofer T, Bittner DO, Emami H, Puchner SB, Lu MT, Meyersohn NM, Ivanov AV, Adami EC, Patel MR, et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: A secondary analysis of the PROMISE randomized clinical trial. JAMA Cardiol. 2018;3(2):144–52.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, et al. CAD-RADS 2.0–2022 coronary artery disease-reporting and data system: An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2022;16(6):536–57.

    Article  PubMed  Google Scholar 

  49. •• Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, et al. Biomarkers of vascular inflammation for cardiovascular risk prognostication: A meta-analysis. JACC Cardiovasc Imaging. 2022;15(3):460–71. This study consists the largest meta-analysis of the prognostic value of vascular inflammation biomarkers, suggesting that CCTA-derived biomarkers enhance CVD risk prognostication.

    Article  PubMed  Google Scholar 

  50. Park HB, Arsanjani R, Sung JM, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Conte E, Andreini D, et al. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: Results from the PARADIGM study. Eur Heart J Cardiovasc Imaging. 2023.

  51. Antoniades C, Tousoulis D, Vavlukis M, Fleming I, Duncker DJ, Eringa E, Manfrini O, Antonopoulos AS, Oikonomou E, Padro T, et al. Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers. Eur Heart J. 2023.

  52. Kwiecinski J, Dey D, Cadet S, Lee SE, Otaki Y, Huynh PT, Doris MK, Eisenberg E, Yun M, Jansen MA, et al. Peri-coronary adipose tissue density is associated with (18)F-sodium fluoride coronary uptake in stable patients with high-risk plaques. JACC Cardiovasc Imaging. 2019;12(10):2000–10.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, Thomas S, Herdman L, Kotanidis CP, Thomas KE, 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(10151):929–39.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sagris M, Antonopoulos AS, Simantiris S, Oikonomou E, Siasos G, Tsioufis K, Tousoulis D. Pericoronary fat attenuation index-a new imaging biomarker and its diagnostic and prognostic utility: A systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2022;23(12):e526–36.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kato S, Utsunomiya D, Horita N, Hoshino M, Kakuta T. Prognostic significance of the perivascular fat attenuation index derived by coronary computed tomography: A meta-analysis. Hellenic J Cardiol. 2022;67:73–5.

    Article  PubMed  Google Scholar 

  56. Goeller M, Tamarappoo BK, Kwan AC, Cadet S, Commandeur F, Razipour A, Slomka PJ, Gransar H, Chen X, Otaki Y, et al. Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging. 2019;20(6):636–43.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Dai X, Yu L, Lu Z, Shen C, Tao X, Zhang J. Serial change of perivascular fat attenuation index after statin treatment: Insights from a coronary CT angiography follow-up study. Int J Cardiol. 2020;319:144–9.

    Article  PubMed  Google Scholar 

  58. Elnabawi YA, Oikonomou EK, Dey AK, Mancio J, Rodante JA, Aksentijevich M, Choi H, Keel A, Erb-Alvarez J, Teague HL, et al. Association of biologic therapy with coronary inflammation in patients with psoriasis as assessed by perivascular fat attenuation index. JAMA Cardiol. 2019;4(9):885–91.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Oikonomou EK, Antonopoulos AS, Schottlander D, Marwan M, Mathers C, Tomlins P, Siddique M, Kluner LV, Shirodaria C, Mavrogiannis MC, et al. Standardized measurement of coronary inflammation using cardiovascular computed tomography: Integration in clinical care as a prognostic medical device. Cardiovasc Res. 2021;117(13):2677–90.

    CAS  PubMed  Google Scholar 

  60. Weir-McCall JR, Williams MC, Shah ASV, Roditi G, Rudd JHF, Newby DE, Nicol ED. National trends in coronary artery disease imaging: Associations with health care outcomes and costs. JACC Cardiovasc Imaging. 2023;16(5):659–71.

    Article  PubMed  Google Scholar 

  61. Maron DJ, Hochman JS, Reynolds HR, Bangalore S, O’Brien SM, Boden WE, Chaitman BR, Senior R, Lopez-Sendon J, Alexander KP, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020;382(15):1395–407.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Cho I, Chang HJ, Sung JM, Pencina MJ, Lin FY, Dunning AM, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, et al. Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: An international multicenter registry). Circulation. 2012;126(3):304–13.

    Article  PubMed  Google Scholar 

  63. Cho I, Al’Aref SJ, Berger A, Ó Hartaigh B, Gransar H, Valenti V, Lin FY, Achenbach S, Berman DS, Budoff MJ, et al. Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: A 6-year follow-up from the prospective multicentre international CONFIRM study. Eur Heart J. 2018;39(11):934–41.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, et al. SCCT 2021 Expert consensus document on coronary computed tomographic angiography: A report of the society of cardiovascular computed tomography. J Cardiovasc Comput Tomogr. 2021;15(3):192–217.

    Article  PubMed  Google Scholar 

  65. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140(11):e596–646.

    PubMed  PubMed Central  Google Scholar 

  66. Schmermund A, Marwan M, Hausleiter J, Barth S, Bruder O, Kerber S, Korosoglou G, Leber A, Moshage W, Schroder S, et al. Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009–2014. Clin Res Cardiol. 2017;106(11):905–12.

    Article  CAS  PubMed  Google Scholar 

  67. Stocker TJ, Deseive S, Leipsic J, Hadamitzky M, Chen MY, Rubinshtein R, Heckner M, Bax JJ, Fang XM, Grove EL, et al. Reduction in radiation exposure in cardiovascular computed tomography imaging: Results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI). Eur Heart J. 2018;39(41):3715–23.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Si-Mohamed SA, Boccalini S, Lacombe H, Diaw A, Varasteh M, Rodesch PA, Dessouky R, Villien M, Tatard-Leitman V, Bochaton T, et al. Coronary CT angiography with photon-counting CT: First-in-human results. Radiology. 2022;303(2):303–13.

    Article  PubMed  Google Scholar 

  69. Lloyd-Jones DM, Huffman MD, Karmali KN, Sanghavi DM, Wright JS, Pelser C, Gulati M, Masoudi FA, Goff DC Jr. Estimating longitudinal risks and benefits from cardiovascular preventive therapies among medicare patients: The million hearts longitudinal ASCVD risk assessment tool: A special report from the American Heart Association and American College of Cardiology. Circulation. 2017;135(13):e793–813.

    Article  PubMed  Google Scholar 

  70. Antonopoulos AS, Simantiris S, Benetos G, Vlachopoulos C, Tsioufis K, Tousoulis D. Screening of asymptomatic patients with elevated lipoprotein(a) levels by coronary computed tomography angiography. Eur J Prev Cardiol. 2022;29(15):2049–51.

    Article  PubMed  Google Scholar 

  71. Karpouzas GA, Malpeso J, Choi TY, Li D, Munoz S, Budoff MJ. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann Rheum Dis. 2014;73(10):1797–804.

    Article  PubMed  Google Scholar 

  72. Fragkou PC, Moschopoulos CD, Dimopoulou D, Triantafyllidi H, Birmpa D, Benas D, Tsiodras S, Kavatha D, Antoniadou A, Papadopoulos A. Cardiovascular disease and risk assessment in people living with HIV: Current practices and novel perspectives. Hellenic J Cardiol. 2023;71:42–54.

    Article  PubMed  Google Scholar 

  73. Maurer MH, Zimmermann E, Schlattmann P, Germershausen C, Hamm B, Dewey M. Indications, imaging technique, and reading of cardiac computed tomography: Survey of clinical practice. Eur Radiol. 2012;22(1):59–72.

    Article  CAS  PubMed  Google Scholar 

  74. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, Fonseca F, Nicolau J, Koenig W, Anker SD, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119–31.

    Article  CAS  PubMed  Google Scholar 

  75. Ridker PM, Devalaraja M, Baeres FMM, Engelmann MDM, Hovingh GK, Ivkovic M, Lo L, Kling D, Pergola P, Raj D, et al. IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): A double-blind, randomised, placebo-controlled, phase 2 trial. Lancet. 2021;397(10289):2060–9.

    Article  CAS  PubMed  Google Scholar 

  76. Antoniades C, Patel P, Antonopoulos AS. Using artificial intelligence to study atherosclerosis, predict risk and guide treatments in clinical practice. Eur Heart J. 2023;44(6):437–9.

    Article  PubMed  Google Scholar 

  77. Antonopoulos AS, Tsioufis K. Cardiometabolic risk assessment by imaging: current status and future perspectives. Eur J Prev Cardiol. 2022;28(18):2056–8.

    Article  PubMed  Google Scholar 

  78. West HW, Siddique M, Williams MC, Volpe L, Desai R, Lyasheva M, Thomas S, Dangas K, Kotanidis CP, Tomlins P, et al. Deep-learning for epicardial adipose tissue assessment with computed tomography: Implications for cardiovascular risk prediction. JACC Cardiovasc Imaging. 2023;16(6):800–16.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Oikonomou EK, Williams MC, Kotanidis CP, Desai MY, Marwan M, Antonopoulos AS, Thomas KE, Thomas S, Akoumianakis I, Fan LM, et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. Eur Heart J. 2019;40(43):3529–43.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Kotanidis CP, Xie C, Alexander D, Rodrigues JCL, Burnham K, Mentzer A, O’Connor D, Knight J, Siddique M, Lockstone H, et al. Constructing custom-made radiotranscriptomic signatures of vascular inflammation from routine CT angiograms: A prospective outcomes validation study in COVID-19. Lancet Digit Health. 2022;4(10):e705–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Lin A, Kolossvary M, Cadet S, McElhinney P, Goeller M, Han D, Yuvaraj J, Nerlekar N, Slomka PJ, Marwan M, et al. Radiomics-based precision phenotyping identifies unstable coronary plaques from computed tomography angiography. JACC Cardiovasc Imaging. 2022;15(5):859–71.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Si N, Shi K, Li N, Dong X, Zhu C, Guo Y, Hu J, Cui J, Yang F, Zhang T. Identification of patients with acute myocardial infarction based on coronary CT angiography: The value of pericoronary adipose tissue radiomics. Eur Radiol. 2022;32(10):6868–77.

    Article  CAS  PubMed  Google Scholar 

  83. Shang J, Ma S, Guo Y, Yang L, Zhang Q, Xie F, Ma Y, Ma Q, Dang Y, Zhou K, et al. Prediction of acute coronary syndrome within 3 years using radiomics signature of pericoronary adipose tissue based on coronary computed tomography angiography. Eur Radiol. 2022;32(2):1256–66.

    Article  PubMed  Google Scholar 

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Funding

Dr. Antonopoulos is supported by the Hellenic Foundation for Research and Innovation (HFRI, Grant Number 00468) and from the European Union’s Horizon 2020 Research and Innovation Programme (Grant agreement number 965286—MAESTRIA).

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Authors and Affiliations

  1. Biomedical Research Foundation of the Academy of Athens (BRFAA), 4 Soranou Efesiou Street, Athens, Greece

    Alexios S. Antonopoulos

  2. 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Alexios S. Antonopoulos & Spyridon Simantiris

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  1. Alexios S. Antonopoulos
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  2. Spyridon Simantiris
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Correspondence to Alexios S. Antonopoulos.

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Conflict of Interest

Dr. Antonopoulos is the inventor of patents US10,695,023B2 and GR20180100510 licensed through exclusive license to Caristo Diagnostics Ltd., an Oxford University spinout company. Dr. Simantiris has nothing to disclose.

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Antonopoulos, A.S., Simantiris, S. Preventative Imaging with Coronary Computed Tomography Angiography. Curr Cardiol Rep 25, 1623–1632 (2023). https://doi.org/10.1007/s11886-023-01982-8

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