I've posted before on some complicated concepts around atherosclerosis progression and calcification. This one is certainly not populist pap for everyone, but crucial for those who wish to understand the deeper mechanisms. Today's paper is from Dr. Scott Murray, a research cardiologist currently operating out of Royal Liverpool University Hospital (the paper is down bottom of the post, after some of my preamble).
First here is a blog post of Scott's which gives an introduction to the value of calcification: http://www.invasivecardiology.com/blog/Vascular-Calcification-Friend-or-Foe
Here is another post which highlights the problem of assuming we know the mechanisms underlying acute coronary events: http://www.invasivecardiology.com/blog/unveiling-evanescent-chameleon-%E2%80%94-true-risk-coronary-plaque-can-only-be-determined-prospectively
However, the primary paper for atherosclerosis and plaque property insight is linked at the end. It greatly improved my understanding of what is really happening in "vulnerable plaque". And how calcification metrics play into it. Scott and the team used vascular ultrasound to scrutinize the plaque properties in detail. They then created new mathematical constructs to quantify "vulnerability level" of the plaque. To say that it resonates with me is an understatement. Also, it explains why the "density versus volume" part of the CAC score (from a simple CT scan) can be so important to analyse.
To grossly simplify, a person who has high density for a given plaque volume in the CAC, would likely on average get a desirable score in Scott's modeled variables of vulnerability. They would likely have a higher plaque calcification equipoise (PCE) and a lower calcified interface area (CIA) in general. Thus Scott's work may bridge the local mechanistic physics of vulnerable plaque, to the prognostic power of the CAC score - especially when the latter is examined for the interplay of both density and volume.
Confused? That's ok - read the below paper again, and link the insights to what I've discussed before here: http://www.thefatemperor.com/blog/2017/3/3/dr-mike-eades-important-note-on-calcification-volume-vs-density-cac .
Really confused? Don't worry - just ping Scott, Mike Eades, Jeff Gerber or Gearoid O'Laoi - and they'll explain it all to you ! But first internalise Scott's fascinating paper at the link below !!