CT-derived composite coronary wall thickness as a marker of early vessel wall remodeling in patients with CAD-RADS 0–2

Background Early coronary atherosclerosis may involve vessel wall remodeling before significant luminal stenosis develops. Coronary computed tomography angiography (CCTA) may enable assessment of vessel wall geometry using composite measurements derived from luminal and outer vessel boundaries. Purpose To evaluate composite coronary wall thickness (TWT) using a CCTA-based virtual intravascular ultrasound (IVUS) approach in patients with CAD-RADS 0–2 and to assess its associations with cardiovascular risk factors, coronary calcium burden, positive remodeling, and CAD-RADS category. Material and Methods This retrospective single-center study included 234 patients (129 men, 105 women; mean age = 57 ± 11 years) who underwent clinically indicated CCTA between January 2023 and September 2025 and were classified as CAD-RADS 0–2. TWT was measured using a virtual IVUS-based reconstruction in proximal and mid segments of the left main, left anterior descending, left circumflex, and right coronary arteries. Associations between TWT and clinical or imaging variables were evaluated using multivariable regression and segment-level mixed-effects models. Results TWT was significantly higher in proximal than mid coronary segments ( P < 0.001). Hypertension, LDL cholesterol, and positive remodeling were independently associated with increased TWT ( P < 0.05), whereas diabetes mellitus was not. TWT independently predicted higher CAD-RADS category (odds ratio = 2.41; P = 0.003) and showed good discriminative performance (area under the curve = 0.81). Moderate correlations were observed between TWT and coronary calcium burden (r = 0.40–0.60; P < 0.001). Conclusion CCTA-derived TWT is associated with CAD-RADS category, cardiovascular risk factors, and coronary calcium burden, reflecting early vessel wall remodeling preceding overt luminal disease.