Is there a relationship between extracardiac pulmonary findings and coronary artery stenosis severity and plaque types?

BACKGROUND Extracardiac lung parenchymal findings (ECLF) are frequently identified during coronary computed tomography angiography (CCTA), although their relationship to coronary artery stenosis severity and plaque features is uncertain. OBJECTIVES To evaluate the relationship between the frequency and distribution of ECLF, observed in patients with normal coronary arteries and those with stenosed coronary arteries, the degree of coronary artery stenosis, and plaque types. METHODS The examination of 335 patients who underwent CCTA for stable angina analyzed at the existence and types of ECLF, as well as the features of stenosis and plaque types in the coronary arteries. Stenosis severity was defined as mild, moderate, or severe, and plaque type as calcified, soft, or mixed. ECLF such as emphysema, atelectasis, nodule, bronchiectasis, consolidation were systematically investigated. RESULTS Patients with calcified and mixed-type plaques were significantly older than those without plaques (p < 0.001). The prevalence of ECLF was significantly higher in patients with soft and mixed plaques compared to those with calcified plaques (p = 0.031). A significant association was observed between coronary artery stenosis severity and presence of ECFL (p = 0.0288), with emphysema being significantly more common in patients with severe stenosis (p < 0.001). Pulmonary nodules were more frequently detected in cases with soft plaques, whereas atelectasis and emphysema were more commonly associated with calcified plaques. CONCLUSION The frequency of ECLF increased with the severity of coronary stenosis. These findings highlight the importance of systematic assessment of extracardiac structures during CCTA.