Total Plaque Volume Test

Total plaque volume, as measured by coronary computed tomography angiogram (CCTA), reflects the complete amount of atherosclerosis in your heart’s arteries, both hardened (calcified) plaque and softer, cholesterol-rich plaque. Atherosclerosis is the gradual buildup of fatty deposits, inflammatory cells, and scar tissue within the artery wall. Over time, this buildup narrows arteries, restricts blood flow, and increases the risk of a heart attack or sudden cardiac death.

Unlike a coronary calcium score, which only detects hardened plaque, CCTA can visualize and measure both types. This matters because soft plaque is more unstable and more likely to rupture, causing a clot to form suddenly. Many people with low or even zero calcium scores still carry significant amounts of soft plaque, which CCTA can uncover.

Research shows that total plaque volume is one of the strongest predictors of future cardiovascular events, often outperforming traditional risk factors like cholesterol levels or the percentage of narrowing seen on imaging. In the large ISCHEMIA trial, total plaque volume was the most accurate CCTA-derived marker for forecasting heart attacks and cardiovascular deaths. Deep learning-based analysis has confirmed that patients with higher total plaque volumes face a significantly increased risk, even when other tests look reassuring.

Modern software allows automated or semi-automated plaque measurement, making results highly reproducible when the scan quality is good. These measurements are more consistent and more predictive of adverse outcomes than a purely visual estimate by a radiologist. Compared with a calcium score, CCTA-based total plaque offers a more complete risk profile, especially useful in people who may appear low-risk by conventional scoring but still have dangerous amounts of soft plaque.