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Radiology

New method shown effective in detecting dangerous coronary plaque

Asignificant number of patients who suffer a heart attack never have any warning signs.

For many of these individuals, the source of the problem is noncalcified plaque, a buildup of soft deposits embedded deep within the walls of the heart's arteries, undetectable by angiography or cardiac stress tests - and prone to rupture without warning.

Now a new noninvasive method has shown success in detecting and measuring noncalcified plaque. In a pilot clinical study led by investigators at Beth Israel Deaconess Medical Center (BIDMC), the technique - voxel analysis used in conjunction with MDCTA (multi-detector computed tomography angiography) - was shown to be equally as effective as catheter coronary angiography in identifying patients at risk for heart disease.

Reported in the June 2008 issue of the American Journal of Roentgenology (AJR), the new findings may help doctors monitor the effects of medical treatment to reduce patients' risk of atherosclerosis and heart disease.

"The importance of quantifying plaque is critical because total plaque burden is considered the most important predictor of coronary events," explains the study's senior author Melvin Clouse, MD, PhD, Emeritus Chairman of the Department of Radiology and Director of Radiology Research at BIDMC and Deaconess Professor of Radiology at Harvard Medical School.

"Furthermore, the rupture of soft noncalcified plaque has been implicated as the cause of heart attack."

Exercise stress testing and coronary angiography, the standard methods for diagnosing atherosclerosis and heart attack risk, both work by visualizing the lumen, the channel through which blood flows.

However, because the lumen also increases in size as plaque progresses, coronary artery disease may go undetected until late in the disease process. And, adds Clouse, "Because soft plaque buildup may not significantly narrow the lumen, conventional angiography and stress tests fail to provide a complete picture of plaque accumulation."

The investigators set out to evaluate a new method of plaque assessment using multidetector computed tomography angiography (MDCTA). Unlike coronary angiography, in which a catheter is threaded through the femoral artery and up into the heart, MDCTA is not invasive.

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