Using noncontrast cardiac CT and coronary artery calcification measurements for cardiovascular risk assessment and management in asymptomatic adults (original) (raw)
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Revista española de cardiología, 2007
Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts. We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score <1), intermediate risk (i.e., score 1-100), or high risk (i.e., score >100). The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: kappa=.33 (P<.05) and kappa=.28 (P<.05), respectively, but agreement was poor with the REGICOR chart: kappa=.02 (P=.32). The SCORE and ...
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.
Jacc-cardiovascular Imaging, 2017
OBJECTIVES This study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth. BACKGROUND CAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved. METHODS At baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D 3 , parathyroid hormone, osteoprotegerin), lipid metabolism (triglyceride, high-and low-density lipoprotein, total cholesterol), inflammation (C-reactive protein, soluble urokinase-type plasminogen activator receptor), kidney function (creatinine, cystatin C, urate), and myocardial necrosis (cardiac troponin I) were analyzed. A second CT scan was scheduled after 5 years. General linear models were performed to examine the association between biomarkers and DCAC score, and additionally, sensitivity analyses were performed in terms of binary and ordinal logistic regressions. RESULTS A total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n ¼ 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with DCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n ¼ 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n ¼ 444; IRR: 3.60; 95% CI: 1.42 to 9.11). CONCLUSIONS In this prospective study, a large part of participants had incident CAC or progression of prevalent CAC at 5 years of follow-up. Low-density lipoprotein and total cholesterol were associated with CAC incidence and phosphate with CAC progression, whereas 12 other biomarkers had little value.
Can Non-calcified Coronary Artery Plaques Be Detected on Non-contrast CT Calcium Scoring Studies?
Academic Radiology, 2011
Rationale and Objectives: Coronary computed tomographic (CT) angiography has been shown to detect noncalcified coronary artery plaque. Depending on tissue composition, noncalcified plaque differs in CT attenuation from blood and epicardial fat. The aim of this study was to determine whether noncalcified plaque can be visually detected on non-contrast-enhanced CT calcium scoring studies.
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.
Use of Coronary Computed Tomography for Calcium Screening of Atherosclerosis
Heart International, 2020
oronary artery calcium (CAC) scoring serves as a highly specific marker of coronary atherosclerosis. Based on the results of multiple large-scale, longitudinal population-based studies, CAC scoring has emerged as a reliable predictor of atherosclerotic cardiovascular disease (ASCVD) presence and risk assessment in asymptomatic patients across all age, sex and racial groups. Therefore, the measurement of CAC is useful in guiding clinical decision-making for primary prevention (e.g. use of statin and aspirin). This tool has already been incorporated into the clinical guidelines and is steadily being integrated into standard clinical practice. The adoption of CAC scoring will be important for curbing the progressive burden that ASCVD is exerting on our healthcare system. It has already been projected that CAC testing will decrease healthcare spending and will hopefully be shown to improve ASCVD outcomes. The purpose of this review is to summarise the evidence regarding calcium screening for atherosclerosis, particularly in asymptomatic individuals, including the pathophysiology, the prognostic power of CAC in the context of population-based studies, the progressive inclusion of CAC into clinical guidelines and the existing concerns of cost and radiation.
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.