[Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a descriptive study] (original) (raw)
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Journal of Epidemiology, 2012
Both American and European guidelines recommend coronary artery calcification (CAC) as a tool for screening asymptomatic individuals at intermediate risk. These recommendations are based on epidemiological studies mostly in the United States (U.S.). We review (1) the use of CAC in primary prevention of coronary heart disease (CHD) in the U.S., (2) epidemiological studies of CAC in asymptomatic adults outside of the U.S., and (3) international epidemiological studies of CAC. This review does not consider clinical studies of CAC among patients or symptomatic individuals. Studies in the U.S. have documented that CAC is a strong independent predictor of CHD for both sexes, middle-to old-age groups, various ethnic groups, and diabetics and nondiabetics and that CAC plays an important role in reclassifying individuals at intermediate into high risk. Studies in Europe support these conclusions. The Electron-Beam Tomography, Risk factor Assessment among Japanese and U.S. men in the post-World-War-II birth cohort (ERA JUMP) Study is the first international research comparing subclinical atherosclerosis including CAC in Japanese, Japanese Americans, Koreas, and Caucasians. The study has demonstrated that Japanese had lower levels of atherosclerosis compared to Caucasians whereas Japanese Americans compared to Caucasians had similar or higher levels. CAC is being established as a screening tool for asymptomatic individuals in Europe and the U.S. CAC is a powerful research tool, enabling us to describe the difference in atherosclerotic burden across populations. Such research could elucidate factors responsible for the population difference, which may lead to prevention of CHD.
THE PROFESSIONAL MEDICAL JOURNAL, 2016
ORIGINAL PROF-3713 ABSTRACT… Background: Due to increased risk of CAD and cardiovascular events, prediction of severity and/ or complexity of coronary artery disease (CAD) are valuable. Previously association between severity of CAD and total coronary artery calcium (CAC) score was not demonstrated but now there are lot of studies which have proven this association but still association between total CAC score and complexity of CAD is not well established. Objective: This study was conducted: (1) To investigate the association between coronary artery calcium (CAC) score and CAD assessed by CCTA. (2) To find which one of the two, CAD severity or complexity, is better associated with total CAC score in symptomatic patients having significant CAD. Study Design: Observational cross sectional study. Place and Duration: The study was conducted at Shifa International Hospital Faisalabad from March 2013 to June 2016. Materials and Methods: Total 195 consecutive patients of both gender age ≥20 years who was referred for CT angiography to our hospital and who fulfill the inclusion and exclusion criteria was included in the study. Before enrollment in the study all patients gave informed consent. Before CT angiography total CAC score was obtained by non-enhanced CT scans. Demographic characteristics of all patients were obtained. Regarding risk factors for CAD, history of hypertension, diabetes mellitus, family H/O ischemic heart disease and hyperlipidemia was noted. In all patients before CT angiography, Lab. investigations including complete blood count, fasting blood sugar, fasting lipid profile, blood urea and serum creatinine levels were obtained. Calcium scores were quantified by the scoring algorithm proposed by Agatston et al. All lesions were added to calculate the total CAC score by the Agatston method. Calcium scores were divided into the following categories: 0, 1-100, 101-400, and ≥400. The degree of stenosis was classified into four categories: (1) no stenosis, (2) minimal or mild stenosis (≤50%), (3) moderate stenosis (50%-70%), and (4) severe stenosis (>70%). CAD was defined when lumen diameter reduction was greater than 50% (moderate or severe stenosis). Results: Total 195 patients were studied. 136 (69.7%) were male and 59 (30.3%) were female. Mean age of study population was 52.8±10.38 years. 81(41.54%) patients had H/O chest pain, 11(5.64%) had H/O shortness of breath and 96(49.23%) presented with chest tightness. 104(53.33%) patients were hypertensive, 71(36.41%) were diabetic, 67(34.35%) had increased cholesterol level. In 57 (29.2%) there was no coronary artery disease, 58(29.7%) had mild CAD, 32 (16.4%) had moderate and 48 (24.6%) had severe coronary artery disease on CT angiography. Single vessel was involved in 38(19.5%) patients, 20(10.3%) had two vessel disease and triple vessel disease was present in 22(11.3%) patients. 104(53.3%) patients had zero calcium score. 44(22.6%) had CAC score between 1-100, 37 (19%) had CAC score between 101-400 and more than 400 CAC score was documented in 10 (5.1%) patients. Conclusions: This study in addition to patient based analysis also confirms the significant relationship between vessels based CAD and CAC score. The prevalence of multivessel CAD increased in patients with CACS >100 and there is 100% incidence of CAD in patients with CACS >1000. Zero calcium cannot exclude the presence of significant CAD. Our data supports that in symptomatic patients calcium scoring is an additional filter before coronary angiography.
BioMed Research International, 2013
This work aims to validate the clinical significance of coronary artery calcium score (CACS) in predicting coronary artery disease (CAD) and cardiac events in 100 symptomatic patients (aged 37-87 years, mean 62.5, 81 males) that were followed up for a mean of 5 years. Our results showed that patients with CAD and cardiac events had significantly higher CACS than those without CAD and cardiac events, respectively. The corresponding data were 1450.42 ± 3471.24 versus 130 ± 188.29 ( < 0.001) for CAD, and 1558.67 ± 513.29 versus 400.46 ± 104.47 ( = 0.031) for cardiac events. Of 72 patients with CAD, cardiac events were found in 56 (77.7%) patients. The prevalence of cardiac events in our cohort was 13.3% for calcium score 0, 50% for score 11-100, 56% for score 101-400, 68.7% for score 401-1,000, and 75.0% for score >1000. Increased CACS (>100) was also associated with an increased frequency of multi-vessel disease. Nonetheless, 3 (20%) out of 15 patients with zero CACS had single-vessel disease. Significant correlation ( < 0.001) was observed between CACS and CAD on a vessel-based analysis for coronary arteries. It is concluded that CACS is significantly correlated with CAD and cardiac events.
Non-invasive assessment of coronary calcification
European Journal of Epidemiology, 2004
Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to car-diovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for noninvasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research.
Selective use of coronary calcification measurements in an expanded intermediate risk group
Journal of Cardiovascular Computed Tomography, 2008
Risk assessment is an imperative initial step in the clinical management of cardiovascular risk factors. On the basis of the estimation of the 10-year absolute risk of manifesting coronary heart disease (myocardial infarction or coronary heart disease death), risk categories are conventionally divided into low, intermediate, and high. The most widely used quantitative risk assessment algorithm, the Framingham risk score for hard events, is based on traditional risk factors, but it does not fully account for all available cardiovascular risk factors. Current national guidelines defining coronary heart disease risk categories based on the Framingham risk score may inaccurately assign persons with a high burden of subclinical coronary atherosclerosis to a low-risk group (Ͻ10% risk), failing to predict the true risk of a cardiovascular event. Coronary artery calcification as a measure of subclinical atherosclerosis has already established itself as a useful adjunct for refining the broad intermediate risk category of adults, leading to more decisive management strategies. In a point-counterpoint format this article argues for the improved accuracy of coronary calcium scoring in predicting the risk of future cardiac events in persons with a low Framingham risk score (including women and different ethnic groups). To better incorporate recent scientific findings into cardiovascular assessment and to refine stratification in those with a low Framingham risk score, we therefore propose a timely algorithm supporting coronary calcium screening in a selected group of low-risk persons.
Vascular Health and Risk Management, 2010
The presence of mural calcification has, for decades, been recognized as a marker for atheromatous plaque in the coronary arteries and the aorta, but only in the past decade has the application of noncontrast computed tomography (CT) been shown to be a reproducible, safe, and convenient test, which now is available worldwide. However, awareness of coronary artery calcium scanning is insufficient and the practitioner must be aware of the available literature as well as understanding clinical recommendations for applications and interpretation. It is best applied in the medium/intermediate risk, asymptomatic adult regardless of ethnicity across broad age ranges for both men and women; additional prognostic information is also afforded from the calcium distribution in the coronary artery system. Additionally, information can also be derived from the same CT scan regarding heart and aorta size and assessment of the epicardial fat pad (an anatomic marker for the metabolic syndrome). Details of how this test can aid in cardiovascular risk assessment and management in adults are provided.
European journal of radiology, 2017
Population studies have shown coronary calcium score to improve risk stratification in subjects suspected for cardiovascular disease. The aim of this work was to assess the validity of multidetector computed tomography (MDCT) for measurement of calibrated mass scores (MS) in a phantom study, and to investigate inter-scanner variability for MS and Agaston score (AS) recorded in a population study on two different high-end MDCT scanners. A calcium phantom was scanned by a first (A) and second (B) generation 320-MDCT. MS was measured for each calcium deposit from repeated measurements in each scanner and compared to known physical phantom mass. Random samples of human subjects from the Copenhagen General Population Study were scanned with scanner A (N=254) and scanner B (N=253) where MS and AS distributions of these two groups were compared. The mean total MS of the phantom was 32.9±0.8mg and 33.1±0.9mg (p=0.43) assessed by scanner A and B respectively - the physical calcium mass was 3...
The role of coronary artery calcification score in clinical practice
BMC Cardiovascular Disorders, 2008
Background: Coronary artery calcification (CAC) measured by electron-beam computed tomography (EBCT) has been well studied in the prediction of coronary artery disease (CAD). We sought to evaluate the impact of the CAC score in the diagnostic process immediately after its introduction in a large tertiary referral centre.
Frontiers in Cardiovascular Medicine, 2021
Background: Coronary artery calcification (CAC) may provide insight to the patients' coronary artery disease (CAD) risks and influence early intervention. With increasing use of non-gated CT scans in clinical practice, the visual coronary artery scoring system (Weston Method) could quickly provide clinicians with important information of CAC for patient triage and management. Methods: We retrospectively studied the available CT imaging data and estimated CAC burden using the Weston method in 493 emergency room or other hospitalized patients. The Weston scores were calculated by the sum of the score for each vessel including the left main, left anterior descending, left circumflex artery and right coronary artery (range 0-12). The primary endpoint was a composite of the major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and coronary revascularization. Results: During a median follow-up of 85 months, a total of 25 (5.1%) MACE were recorded and 57 (11.2%) patients died from any causes. Detectable CAC was most common (96%) in the left anterior descending coronary arteries. Multivariable analysis showed that CAC total scores were independent predictors for MACE and all-cause mortality. Receiver operating characteristic analysis showed that CAC total score ≥5 was the optimal cutoff value for predicting MACEs. Conclusions: In the emergency room and hospitalized patients, the semi-quantitation of CAC burden using the Weston score system was related to the long-term cardiovascular outcomes including mortality. Clinicians and radiologists should maximize the value of non-contrast chest CT images by reporting CAC details.