Quantitative CCTA biomarkers for cardiovascular risk stratification: a narrative review

A single CCTA exam can now provide quantitative plaque analysis, FFR-CT, epicardial fat, pericoronary inflammation, and hepatic steatosis—improving cardiovascular risk stratification. Hepatic steatosis on noncontrast CT for calcium scoring is tied to a 64% increased odds of card…

• Quantitative plaque analysis of high-risk features (low-attenuation plaque, positive remodeling, napkin-ring sign) independently predicts major adverse events beyond stenosis severity.
• FFR-CT holds a Class 2a guideline recommendation for intermediate lesions and demonstrates superior vessel-level accuracy versus SPECT, comparable to PET.
• Combining plaque, epicardial fat, pericoronary inflammation, and hepatic steatosis into multimarker models offers incremental discriminatory value over individual biomarkers or clinical risk scores.

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