Evaluation of CTCA in assessing plaque pathology and physiology
Research type
Research Study
Full title
Evaluation of the efficacy of computed tomographic coronary angiography in assessing coronary artery morphology and physiology
IRAS ID
228131
Contact name
Christos Bourantas
Contact email
Sponsor organisation
University College London
Clinicaltrials.gov Identifier
Z6364106/2017/09/23, Data protection reference number
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Research Summary
Coronary artery disease - furring up of the arteries by atherosclerosis - is one of the major causes of death in the UK. Despite the existing therapies the event rate remains high especially in patients who already had a heart attack as some of these have aggressive atherosclerotic disease. If we could identify these vulnerable patients, then we will be able to treat them better with new effective treatments that however are expensive or are associated with a risk of side-effects. We believe that computed tomography (CT) is able to assess atherosclerotic disease, detect plaques that will cause heart attacks and thus identify patients at risk. We think this because it has been shown that invasive imaging taken by passing a wire into the coronary arteries can predict disease progression. Thus we have designed this study in order to compare the efficacy of CT and invasive imaging in detecting high-risk plaques.
In 70 patients with angina we will study the arteries of the heart with invasive imaging and CT and create maps of all plaques. These maps will be compared to identify what features match-up and examine the efficacy of CT in detecting high-risk vulnerable plaques.
If we can prove that CT can detect high-risk plaques then we will use this modality to assess the coronary arteries and identify patients that are at risk for suffering cardiovascular events and will benefit from new therapies targeting atherosclerosis.Summary of Results
The main objectives of the study were to examine the efficacy of computed tomography in assessing plaque pathology and physiology in the vessels of the heart using state of the art invasive imaging - imaging that is obtained by passing a catheter in these vessels - that allows detailed assessment of the plaques as reference standard. We found that computed tomography has significant limitations in measuring the vessel wall dimensions and detecting the plaques in the vessels of the heart. It underestimates lumen and vessel area and can identify only 2 out of the 3 plaques seen by intravascular imaging.
Moreover, computed tomography cannot accurately detect plaque composition which enables prediction of the plaques that will progress and cause heart attacks. The limitations of computed tomography in measuring the vessel dimensions also affected its performance in measuring vessel physiology and the distribution of the local haemodynamic forces. We found that computed tomography has a moderate accuracy in detecting segments that are exposed to unforvaroble local haemodynamic forces as it is capable to detect 2 out of the 3 segments with impaired flow patterns.REC name
South Central - Hampshire B Research Ethics Committee
REC reference
17/SC/0566
Date of REC Opinion
20 Nov 2017
REC opinion
Further Information Favourable Opinion