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Lim P, Bleich D. Revisiting cardiovascular risk reduction in type 2 diabetes and dyslipidemia. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200141. [PMID: 36060284 PMCID: PMC9434405 DOI: 10.1016/j.ijcrp.2022.200141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
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Koopman MY, Willemsen RTA, van der Harst P, van Bruggen R, Gratama JWC, Braam R, van Ooijen PMA, Doggen CJM, Dinant GJ, Kietselaer B, Vliegenthart R. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. ROFO-FORTSCHR RONTG 2022; 194:257-265. [PMID: 35081649 PMCID: PMC8837467 DOI: 10.1055/a-1662-5711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background
Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints.
Method
PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n = 38 137 patients) focused on diagnostic value and 23 articles (n = 44 683 patients) on prognostic value of CCS. Of these, 10 articles (n = 21 208 patients) focused on both the diagnostic and prognostic value of CCS.
Results
Between 22 and 10 037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43 % and 51 % patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD (OCAD, defined as a luminal stenosis of ≥ 50 % in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4 % (n = 703/16 074) with a range of 0–26 % in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0 % to 2.1 % during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98 % and 100 % in CCS 0 patients. At increasing CCS, the OCAD probability and MACE risk increased. OCAD was present in 58.3 % (n = 617/1058) of CCS > 400 patients with percentages ranging from 20 % to 94 % and MACE occurred in 16.7 % (n = 175/1048) of these patients with percentages ranging from 6.9 % to 50 %.
Conclusion
Accumulating evidence shows that OCAD is unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCAD and risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting.
Key Points:
Citation Format
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Affiliation(s)
| | | | - Pim van der Harst
- Cardiology, University Medical Centre Utrecht Department of Cardiology, Utrecht, Netherlands.,Division Heart and Lungs, University Medical Centre Groningen, Netherlands
| | - Rykel van Bruggen
- Primary Health Care, Multicenter General Practitioners Organisation "HuisartsenOrganisatie Oost-Gelderland", Apeldoorn, Netherlands
| | | | | | - Peter M A van Ooijen
- Data Science Center in Health, University Medical Centre Groningen, Netherlands.,Radiation Oncology, University Medical Centre Groningen, Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, Netherlands
| | | | - Bas Kietselaer
- Cardiology, Zuyderland Medical Centre Sittard-Geleen, Netherlands
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Bourque JM, Beller GA. Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies. JACC Cardiovasc Imaging 2016; 8:1309-21. [PMID: 26563861 DOI: 10.1016/j.jcmg.2015.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 02/07/2023]
Abstract
Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. In addition to exercise-induced ischemic ST-segment depression, such markers as ST-segment elevation in lead aVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 metabolic equivalents on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher-risk populations (e.g., poor functional capacity, diabetes, or chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, University of Virginia Health System, Charlottesville, Virginia.
| | - George A Beller
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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Alexanderson-Rosas E, Berríos-Bárcenas E, Meave A, de la Fuente-Mancera JC, Oropeza-Aguilar M, Barrero-Mier A, Monroy-González ADG, Cruz-Mendoza R, Guinto-Nishimura GY. Novel contributions of multimodality imaging in hypertension: A narrative review. World J Hypertens 2015; 5:28-40. [DOI: 10.5494/wjh.v5.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.
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Computed Tomograph Cardiovascular Imaging. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Descalzo M, Vidal-Pérez R, Leta R, Alomar X, Pons-Lladó G, Carreras F. Usefulness of coronary artery calcium for detecting significant coronary artery disease in asymptomatic individuals. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Usefulness of coronary artery calcium for detecting significant coronary artery disease in asymptomatic individuals. Rev Clin Esp 2014; 214:235-41. [PMID: 24555968 DOI: 10.1016/j.rce.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/21/2013] [Accepted: 01/10/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To confirm the value of the coronary artery calcium (CAC) score as an indicator of significant coronary artery disease (CAD) in the asymptomatic Spanish population, using noninvasive coronary angiography by multidetector computed tomography (MDCT). METHODS This was a retrospective study of 232 asymptomatic individuals, referred for a cardiovascular health checkup that included CAC and MDCT. RESULTS Participants' mean age was 54.6 years (SD ± 12.8); 73.3% of them were men. The mean CAC value was 117.8 (SD ± 277). The individuals with arterial hypertension, diabetes mellitus, smoking and 3 or more risk factors had significantly greater CAC scores. Some 16.4% of the participants were in the ≥75 percentile population for CAC. The MDCT identified 148 individuals (63.8%) with CAD; the coronary lesions were not significant in 116 individuals (50%) and were significant (>50% stenosis) in 32 (13.8%). The participants with diabetes, smoking and ≥3 risk vascular factors had a greater prevalence of significant stenosis. The individuals with >50% stenosis had higher CAC values (352.5 vs. 1; P<.0001), and those in the ≥75 percentile had a high percentage of significant lesions (57.9% vs. 5.2%; P<.0001). The predictors of significant CAD were a CAC score >300 (OR=10.9; 95% CI 3.35-35.8; P=.0001), belonging to the ≥75 percentile (OR=5.65; 95% CI 1.78-17.93; P=.03) and having 3 or more vascular risk factors (OR=4.19; 95% CI 1.44-12.14; P=.008). CONCLUSION CAC quantification is an effective method for determining the extent and magnitude of CAD and delimiting the predictive capacity of traditional risk factors.
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Kemmer N, Case J, Chandna S, Neff G. The Role of Coronary Calcium Score in the Risk Assessment of Liver Transplant Candidates. Transplant Proc 2014; 46:230-3. [DOI: 10.1016/j.transproceed.2013.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 11/26/2022]
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The Value of Dual-source 64-Slice CT Coronary Angiography in the Assessment of Patients Presenting to an Acute Chest Pain Service. Heart Lung Circ 2010; 19:213-8. [DOI: 10.1016/j.hlc.2010.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 12/23/2009] [Accepted: 01/04/2010] [Indexed: 11/21/2022]
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Knaapen P, de Haan S, Hoekstra O, Halbmeijer R, Appelman Y, Groothuis J, Comans E, Meijerink M, Lammertsma A, Lubberink M, Götte M, van Rossum A. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. Neth Heart J 2010; 18:90-8. [PMID: 20200615 PMCID: PMC2828569 DOI: 10.1007/bf03091744] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hybrid imaging of positron emission tomography (PET) together with computed tomography (CT) is rapidly emerging. In cardiology, this new advanced hybrid imaging modality allows quantification of cardiac perfusion in combination with assessment of coronary anatomy within a single scanning session of less than 45 minutes. The near-simultaneous anatomical evaluation of coronary arteries using CT and corresponding functional status using PET provides a wealth of complementary information in patients who are being evaluated for (suspected) coronary artery disease, and could help guide clinical patient management in a novel manner. Clinical experience gained with this recently introduced advanced hybrid imaging tool, however, is still limited and its implementation into daily clinical practice remains largely unchartered territory. This review discusses principles of perfusion PET, its diagnostic accuracy, and potential clinical applications of cardiac PET-CT in patients with ischaemic heart disease. (Neth Heart J 2010;18:90-8.).
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Affiliation(s)
- P. Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - S. de Haan
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - O.S. Hoekstra
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - R. Halbmeijer
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Y.E. Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - J.G.J. Groothuis
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - E.F. Comans
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.R. Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.A. Lammertsma
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M. Lubberink
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.J.W. Götte
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.C. van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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Rosen BD, Fernandes V, McClelland RL, Carr JJ, Detrano R, Bluemke DA, Lima JAC. Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up MESA (Multi-Ethnic Study of Atherosclerosis). JACC Cardiovasc Imaging 2010; 2:1175-83. [PMID: 19833306 DOI: 10.1016/j.jcmg.2009.06.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 06/18/2009] [Accepted: 06/24/2009] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The MESA (Multi-Ethnic Study of Atherosclerosis) is a population-based study of 6,814 men and women. We sought to analyze the relationship between the extent of coronary artery calcium (CAC) at baseline and the severity of coronary stenoses in clinically indicated coronary angiography studies during follow-up. BACKGROUND CAC is an established predictor of major cardiovascular events. Yet, the relationship between CAC and the distribution and severity of coronary artery stenoses has not been widely explored. METHODS All MESA participants underwent noncontrast enhanced cardiac computed tomography during enrollment to determine baseline CAC. We analyzed 175 consecutive angiography reports from participants who underwent coronary catheterization for clinical indications during a median follow-up period of 18 months. The relationship between baseline CAC and the severity of coronary stenosis detected in coronary angiographies was determined. RESULTS Baseline Agatston score was 0 in only 7 of 175 (4%) MESA participants who underwent invasive angiography during follow-up. When coronary arteries were studied separately, 13% to 18% of coronary arteries with >or=75% stenosis had 0 calcium mass scores at baseline. There was close association between baseline calcium mass score and the severity of stenosis in each of the coronary arteries (test for trend, p < 0.001). For example, mean calcium mass scores for <50%, 50% to 74%, and >or=75% stenosis in the left anterior descending coronary artery were 105.1 mg, 157.2 mg, and 302.2 mg, respectively (p < 0.001). Finally, there was a direct relationship between the total Agatston Score at baseline and the number of diseased vessels (test for trend, p < 0.001). CONCLUSIONS The majority of patients with clinically indicated coronary angiography during follow-up had detectable coronary calcification at baseline. Although there is a significant relationship between the extent of calcification and mean degree of stenosis in individual coronary vessels, 16% of the coronary arteries with significant stenoses had no calcification at baseline.
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Affiliation(s)
- Boaz D Rosen
- Cardiology Division, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Sun Z, Dimpudus FJ, Nugroho J, Adipranoto JD. CT virtual intravascular endoscopy assessment of coronary artery plaques: a preliminary study. Eur J Radiol 2009; 75:e112-9. [PMID: 19781885 DOI: 10.1016/j.ejrad.2009.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 06/17/2009] [Accepted: 09/03/2009] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to investigate the potential value of CT virtual intravascular endoscopy (VIE) in the visualization and assessment of coronary plaques in patients suspected of coronary artery disease. MATERIALS AND METHODS 20 (13 men, 7 women, mean age 54 years) consecutive patients with suspected coronary artery disease undergoing 64-slice CT angiography were included in the study. Four main coronary artery branches were assessed with regard to the presence of coronary plaques based on 2D axial, multiplanar reformation, 3D volume rendering and VIE visualizations. The coronary plaques were characterized into calcified, noncalcified and mixed plaques. The intraluminal appearances of these coronary plaques were demonstrated with VIE images and correlated with 2D and 3D images to determine the diagnostic value of VIE for the assessment of the plaques. RESULTS VIE was able to identify and demonstrate the intraluminal appearances of coronary plaques in 18 patients involving 32 coronary artery branches which were shown as an irregularly intraluminal protruding sign in extensively calcified plaques and smooth protruding appearance in noncalcified or focally calcified plaques. An irregular intraluminal appearance was also noticed in the presence of mixed plaques due to variable components with different CT attenuations contained within the plaques. VIE accurately confirmed the degree of coronary stenosis or occlusion despite the presence of heavy calcification. CONCLUSION VIE could be used as a complementary tool to conventional CT visualizations for the analysis of luminal changes and assessment of disease extent caused by the coronary plaques.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, GPO Box, U1987, Perth 6845, Australia.
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Abu Assi E, Vidal Pérez R, González-Juanatey J. Aportaciones de las técnicas de imagen cardíaca en la valoración del paciente de alto riesgo cardiovascular. Rev Clin Esp 2009. [DOI: 10.1016/s0014-2565(09)73257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PMA, Wexler L, Raggi P. Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 2008; 18:2785-807. [DOI: 10.1007/s00330-008-1095-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/05/2008] [Accepted: 05/19/2008] [Indexed: 01/07/2023]
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Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Int J Cardiovasc Imaging 2008; 24:645-71. [PMID: 18504647 PMCID: PMC2493606 DOI: 10.1007/s10554-008-9319-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 05/06/2008] [Indexed: 01/07/2023]
Abstract
Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.
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Nixdorff U, Küfner C, Achenbach S, Stilianakis N, Voigt JU, Flachskampf FA, Daniel WG, Ropers D. Head-to-head comparison of dobutamine stress echocardiography and cardiac computed tomography for the detection of significant coronary artery disease. Cardiology 2007; 110:81-6. [PMID: 17971656 DOI: 10.1159/000110484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 04/24/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Dobutamine stress echocardiography (DSE) and contrast-enhanced electron beam tomography (EBCT) both have the potential to noninvasively detect coronary artery disease (CAD). We compared the accuracy of both methods to detect significant CAD in a direct comparison. METHODS 79 patients (32 women, 47 men, mean age 62 years) who were admitted for coronary angiography due to suspected CAD were studied. By EBCT coronary calcification (CAC) as well as angiography (CTA) was assessed. Presence of significant CAD was assumed if the calcium score exceeded 400 or the contrast-enhanced images displayed significant lumen reduction. DSE was performed using a standard protocol (5-40 microg/kg/min dobutamine plus 0.25-1.0 mg atropine if necessary). DSE and EBCT were independently evaluated concerning the presence of significant CAD. Results were compared to invasive, quantitative coronary angiography. RESULTS 6 patients (8%) in DSE and 2 patients (3%) in EBCT were unevaluable for various reasons and therefore excluded from further analysis. In the remaining 71 patients, 33 patients (46%) showed significant CAD. DSE demonstrated a sensitivity of 70% (23/33) and a specificity of 84% (32/38). EBCT showed a sensitivity of 91% (30/33) and a specificity of 74% (28/38). By combining DSE and EBCT sensitivity increased to 97% with a specificity of 63%. CONCLUSIONS In a blinded comparison, DSE demonstrated lower sensitivity but higher specificity than EBCT for the detection of significant CAD. Sensitivity was improved by combining both modalities.
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Affiliation(s)
- Uwe Nixdorff
- Leibniz Institute of Arteriosclerosis Research, Westfälische Wilhelms University, Münster, Germany.
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Geluk CA, Dikkers R, Perik PJ, Tio RA, Götte MJW, Hillege HL, Vliegenthart R, Houwers JB, Willems TP, Oudkerk M, Zijlstra F. Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease. Eur Radiol 2007; 18:244-52. [PMID: 17901959 PMCID: PMC2668594 DOI: 10.1007/s00330-007-0755-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 07/26/2007] [Accepted: 08/23/2007] [Indexed: 11/27/2022]
Abstract
We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS>or=400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12+/-4 months, CCS>or=400, 10-399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.
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Affiliation(s)
- Christiane A Geluk
- Thoraxcenter, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, PB 30001, 9700 RB, Groningen, The Netherlands.
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Affiliation(s)
- Marcelo F Di Carli
- Division of Nuclear Medicine/PET, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Fernández-Miranda C. Nuevas perspectivas en la medición del riesgo cardiovascular: exploraciones para detectar la aterosclerosis subclínica y marcadores de inflamación. Med Clin (Barc) 2007; 128:344-51. [PMID: 17376362 DOI: 10.1157/13099803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among the new technologies for the detection of subclinical atherosclerosis, ankle-brachial index, carotid ultrasonography, computed tomography detection of coronary calcifications and high-resolution nuclear magnetic resonance are those of greatest clinical usefulness. These explorations are especially useful for patients with an intermediate cardiovascular risk, or a 10-20% risk according to the National Cholesterol Education Program-Adult Treatment Panel III or 3-4% according to the SCORE project. This is because they allow the identification of high-risk patients who need a more intense treatment. In addition, high-sensitivity C-reactive protein concentrations may be considered as a new marker for the evaluation of cardiovascular risk. In this article, the current state of knowledge about these explorations and the guidelines of the main scientific societies are reviewed, and the practical conclusions of the working group are provided.
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Affiliation(s)
- Consuelo Fernández-Miranda
- Unidad de Lípidos y Aterosclerosis, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
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Computed Tomographic Cardiovascular Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mahnken AH, Mühlenbruch G, Günther RW, Wildberger JE. Cardiac CT: coronary arteries and beyond. Eur Radiol 2006; 17:994-1008. [PMID: 17066290 DOI: 10.1007/s00330-006-0433-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 08/01/2006] [Accepted: 08/07/2006] [Indexed: 10/24/2022]
Abstract
Multi-detector-row computed tomography (MDCT) has emerged as a rapidly developing method for non-invasive imaging of the heart. An understanding of ECG synchronization, contrast material administration, patient preparation and image post-processing is needed to optimize image quality. The basic technical principles and essentials of these technical basics are described here. Correctly applied cardiac MDCT allows imaging of the coronary arteries including coronary anatomy and stenosis detection. The same is true for evaluation of coronary artery bypass grafts and, to some extent, coronary artery stents. While quantification of total calcified plaque burden has been long established, coronary MDCT allows assessing plaque morphology and constitution. Recent approaches go beyond the coronaries and include evaluation of left ventricular function at rest and myocardial viability. In combination with experimental approaches for assessing aortic valve function and myocardial perfusion imaging, cardiac MDCT offers the potential for a comprehensive examination of the heart using a single breath-hold examination.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Califf RM. Evaluation of diagnostic imaging technologies and therapeutics devices: better information for better decisions: proceedings of a multidisciplinary workshop. Am Heart J 2006; 152:50-8. [PMID: 16824831 DOI: 10.1016/j.ahj.2005.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022]
Abstract
We are entering an era in which the success of biomedical science and the increasing understanding of the value of evidence for practice are in a state of tension. This tension is especially notable in the device arena, in which the short life cycles and iterative nature of development are at odds with current design constructs of the types of clinical trials that provide evidence for medical decision making. The financial pressure arising from strained budgets and expanding costs from the aging of the population and the continued development of new technology heightens the need for a focus on new approaches. Given this background, a group of experts representing constituencies with different perspectives were convened for a day and a half to discuss key issues and their potential solutions. Because of the complex and heterogeneous nature of the environments in which devices are used, the meeting focused on 3 broad, general uses of devices: imaging, risk stratification, and therapeutics. The goal of the meeting was to develop a preliminary list of ideas that could be framed as researchable questions or constructs for consideration by policy makers that ultimately might lead to improvements in the current system. Across diagnostic imaging, risk stratification devices, and therapeutic devices, the crosscutting issues can be identified: We need better methods of collaborative funding and priority setting, improved and more flexible methods, and new approaches to the integration of federal agencies in overseeing the system.
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LaMonte MJ, Fitzgerald SJ, Levine BD, Church TS, Kampert JB, Nichaman MZ, Gibbons LW, Blair SN. Coronary artery calcium, exercise tolerance, and CHD events in asymptomatic men. Atherosclerosis 2006; 189:157-62. [PMID: 16438976 DOI: 10.1016/j.atherosclerosis.2005.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 12/07/2005] [Accepted: 12/14/2005] [Indexed: 11/28/2022]
Abstract
Coronary artery calcium (CAC) scores >/=100 are predictive of CHD events in asymptomatic men. Exercise tolerance of >/=10METs predicts lower event rates in CHD patients; however, its relationship with events in individuals with subclinical atherosclerosis is less known. Participants were 710 asymptomatic men from the Aerobics Center Longitudinal Study whose exercise tolerance (ET) was quantified (<10 or >/=10METs) and whose CAC score was >/=100 as measured by electron beam tomography. During 3.5 years of follow-up 59 CHD events occurred. The age-adjusted hazard ratio (HR) of CHD events was 0.26 (95% CI=0.15-0.45) in men whose ET was >/=10METs compared with men whose ET was <10METs. Adjustment for CHD risk factors and abnormal exercise ECG did not change the association between ET and CHD. The extent of underlying atherosclerosis did not influence the association between ET and CHD; for example, the HR for CHD events in the >/=10MET group among men with CAC scores <400 and >/=400 was 0.16 (95% CI=0.05-0.56) and 0.23 (95% CI=0.11-0.46), respectively. In asymptomatic men with subclinical coronary atherosclerosis, an ET of >/=10METs identifies patients at lower risk for manifest CHD.
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Edvardsen T, Detrano R, Rosen BD, Carr JJ, Liu K, Lai S, Shea S, Pan L, Bluemke DA, Lima JAC. Coronary artery atherosclerosis is related to reduced regional left ventricular function in individuals without history of clinical cardiovascular disease: the Multiethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2005; 26:206-11. [PMID: 16269666 DOI: 10.1161/01.atv.0000194077.23234.ae] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We investigated whether regional coronary calcium score by computed tomography is related to regional left ventricular systolic function measured by MRI tagging in participants of the Multiethnic Study of Atherosclerosis. METHODS AND RESULTS The Multiethnic Study of Atherosclerosis is a prospective observational study of men and women without a history of previous heart disease from 4 ethnic groups. Calcium scores were measured separately for the left anterior descendent (LAD), left circumflex (LCX), and right (RCA) coronary arteries. Left ventricular strain and strain rate were determined by tagged MRI in the corresponding vascular territories of the coronary vessels in 509 participants. Greater coronary calcification in the LAD, LCX, and right RCA coronary arteries were related to worse function in their respective perfusion. Anterior wall strain rate was -1.37+/-0.41 when LAD calcium was zero versus -1.17+/-0.24 1/s in the highest quartile of calcium score (P<0.001). Similar relationships were evident in the LCX and RCA regions. Participants with 1- and 2-vessel coronary artery calcium had better myocardial function in the remote area compared with the territory supplied by the diseased artery. CONCLUSIONS High-local calcium score is related to regional dysfunction in the corresponding coronary territory among individuals without a history of previous heart disease. These results indicate a link between atherosclerosis and subclinical regional left ventricular dysfunction.
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Affiliation(s)
- Thor Edvardsen
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287-0409, USA
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26
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Thompson RC, McGhie AI, Moser KW, O'Keefe JH, Stevens TL, House J, Fritsch N, Bateman TM. Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging. J Nucl Cardiol 2005; 12:392-400. [PMID: 16084427 DOI: 10.1016/j.nuclcard.2005.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 02/10/2005] [Accepted: 02/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach. METHODS AND RESULTS We reviewed 200 consecutive patients without known CAD who were referred for CAC scoring shortly after nonischemic MPI. Of these, 13 (6.5%) had CAC scores greater than 400, indicating significant CAD; 22 (11%) had CAC scores of 101 to 400; 27 had CAC scores of 11 to 100; and the remainder (n = 138) has CAC scores of 1 to 10. Traditional risk factors and patient characteristics were not significant predictors of CAC scores of 101 or greater. However, age and the Framingham risk score were predictors of CAC scores greater than 0. At follow-up, significantly more patients with CAC scores of 101 or greater had been given the advice to take lipid-lowering medication and aspirin compared with those with CAC scores of 0. CONCLUSIONS Of patients referred for CAC scoring after nonischemic MPI, 17.5% were identified as having CAD based on a CAC score greater than 100, allowing intervention with aggressive medical therapy. Patients who were reclassified were not easily identifiable by traditional risk factors, but Framingham risk score did predict the presence of CAC. Clinicians modified medical therapy based on the results of CAC scoring.
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Affiliation(s)
- Randall C Thompson
- Cardiovascular Consultants PC, 4330 Wornall Road, Suite 2000, Kansas City, MO 64111, USA.
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Mahnken AH, Wildberger JE, Koos R, Günther RW. Multislice Spiral Computed Tomography of the Heart: Technique, Current Applications, and Perspective. Cardiovasc Intervent Radiol 2005; 28:388-99. [PMID: 15959701 DOI: 10.1007/s00270-003-9218-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Multislice spiral computed tomography (MSCT) is a rapidly evolving, noninvasive technique for cardiac imaging. Knowledge of the principle of electrocardiogram-gated MSCT and its limitations in clinical routine are needed to optimize image quality. Therefore, the basic technical principle including essentials of image postprocessing is described. Cardiac MSCT imaging was initially focused on coronary calcium scoring, MSCT coronary angiography, and analysis of left ventricular function. Recent studies also evaluated the ability of cardiac MSCT to visualize myocardial infarction and assess valvular morphology. In combination with experimental approaches toward the assessment of aortic valve function and myocardial viability, cardiac MSCT holds the potential for a comprehensive examination of the heart using one single examination technique.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, Aachen University of Technology, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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28
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McKie SJ, Hardwick DJ, Reid JH, Murchison JT. Features of cardiac disease demonstrated on CT pulmonary angiography. Clin Radiol 2005; 60:31-8. [PMID: 15642290 DOI: 10.1016/j.crad.2004.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2003] [Revised: 07/06/2004] [Accepted: 07/16/2004] [Indexed: 11/28/2022]
Abstract
The heart and mediastinal structures can be overlooked at CT pulmonary angiogram (CTPA). This pictorial review will demonstrate the features of cardiac disease that may be evident on a CTPA. CTPA allows assessment of not only the pulmonary arteries for embolism, but also of the bronchi, lung parenchyma, mediastinum and heart. Co-existent underlying or incidental cardiac disease is often present. Potentially life-threatening alternative diagnoses in a patient with chest symptoms can be reliably identified. Pathologies of the myocardium including hypertrophic cardio myopathy, pericardial disease, valvular disease, coronary artery disease, and intracardiac abnormalities are demonstrated pictorially. CTPA is increasingly used for the detection of pulmonary embolism. Most patients investigated have pathology other than PE as a cause of their symptoms. Frequently information about the heart is produced that provides important clues to determine the cause for the presenting symptoms and signs or reveals co-existing pathology. It is important to have a clear understanding of the features of cardiac disease which may be seen on a CTPA.
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Affiliation(s)
- S J McKie
- Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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Nikolaou K, Becker CR, Wintersperger BJ, Rist C, Trumm C, Leber A, Babaryka G, Reiser MF. [Evaluating multislice computed tomography for imaging coronary atherosclerosis]. Radiologe 2004; 44:130-9. [PMID: 14991131 DOI: 10.1007/s00117-003-1004-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was the evaluation of multidetector-row computed tomography (MDCT) for the assessment of atherosclerotic coronary artery vessel wall changes. METHODS In an ex vivo study, 17 human hearts were scanned with MDCT and results were compared to histopathology. Morphologic imaging criteria of MDCT for various plaque-types were developed. In a following in vivo study, 94 coronary MDCT angiograms (MDCTA) of patients with suspected coronary artery disease (CAD) were reviewed retrospectively, assessing the diagnostic value of the coronary MDCTA, and determining the number and correlations of the various plaques types as described in the ex vivo study. Additionally, volumetry of calcified and noncalcified plaque components was performed. RESULTS In the ex vivo study, MDCT showed a high sensitivity for calcified and non-calcified plaques. Comparing the results with histopathology, characteristic image criteria could be determined for lipid-rich, fibrous and calcified plaque components. Reviewing the contrastenhanced in-vivo MDCT coronary angiographies, presence of noncalcified plaques was proven in 38% of the patients. In 5 patients with a calcium score of 0, presence of coronary atherosclerosis was proven in the contrastenhanced scan. CONCLUSIONS MDCT is able to differentiate various plaque components in an ex vivo setting as well as invivo. Contrastenhanced MDCT of the coronary arteries allows for the detection of noncalcified plaques. In vivo volumetry of noncalcified plaques is feasible.
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Affiliation(s)
- K Nikolaou
- Institut für Klinische Radiologie, Klinikum der Universität München - Standort Grosshadern.
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30
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Sanz J, Poon M. Evaluation of ischemic heart disease with cardiac magnetic resonance and computed tomography. Expert Rev Cardiovasc Ther 2004; 2:601-15. [PMID: 15225119 DOI: 10.1586/14779072.2.4.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ischemic heart disease is the most common cardiac problem encountered by physicians in their daily practice. In the last few years, computed tomography and magnetic resonance have emerged as robust imaging modalities with great potential for the comprehensive evaluation of patients with this disorder. This article reviews current evidence of the applications where these techniques have demonstrated their usefulness and provides guidance for their use in the clinical management of coronary artery disease.
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Affiliation(s)
- Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, NY 10003, USA.
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31
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Schisterman EF, Whitcomb BW. Coronary age as a risk factor in the modified Framingham risk score. BMC Med Imaging 2004; 4:1. [PMID: 15109400 PMCID: PMC415549 DOI: 10.1186/1471-2342-4-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 04/26/2004] [Indexed: 11/24/2022] Open
Abstract
Background Clinical guidelines emphasize risk assessment as vital to patient selection for medical primary intervention. However, risk assessment methods are restricted in their ability to predict further coronary events. The most widely accepted tool in the United States is the Framingham risk score. In these equations age is a powerful risk factor. Although the extent of coronary atherosclerosis increases with age, there is large inter-individual variability in the rate of development and progression of this disease. This fact limits the utility of Framingham scoring when applied to individuals. Electron beam tomography (EBT), which measures coronary calcium, provides a non-invasive method for assessing coronary plaque burden, thus offering the possibility of providing a more accurate estimate of an individual's "arterial age" than from chronological age alone. Methods In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS) to modify the Framingham Risk Assessment (FRA). Using this method, a coronary artery calcium (CAC) age equivalent is generated that replaces chronological age in Framingham scoring. Results and discussion Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%. Conclusion Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only may increase the predicted risk for some patients, but also may decrease the predicted risk for others, making it a more precise adjustment than other methods.
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Affiliation(s)
- Enrique F Schisterman
- Division of Epidemiology, Statistics and Prevention, National Institute of Child Health and Human Development, National Institute of Health, Department of Human Health Services, Bethesda, Maryland, USA
- Division of Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brian W Whitcomb
- Division of Epidemiology, Statistics and Prevention, National Institute of Child Health and Human Development, National Institute of Health, Department of Human Health Services, Bethesda, Maryland, USA
- Division of Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Leta R, Carreras F, Alomar X, Monell J, García-Picart J, Augé JM, Salvador A, Pons-Lladó G. Coronariografía no invasiva mediante tomografía computarizada con 16 detectores: estudio comparativo con la angiografía coronaria invasiva. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77093-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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De Backer G, Ambrosioni E, Broch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, Ebrahim S, Faergeman O, Graham I, Mancia G, Cats VM, Orth-Gom??r K, Perk J, Py??r??l?? K, Rodicio JL, Sans S, Sansoy V, Sechtem U, Silber S, Thomsen T, Wood D. European guidelines on cardiovascular disease prevention in clinical practice Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). ACTA ACUST UNITED AC 2003. [DOI: 10.1097/00149831-200312001-00001] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nikolaou K, Sagmeister S, Knez A, Klotz E, Wintersperger BJ, Becker CR, Reiser MF. Multidetector-row computed tomography of the coronary arteries: predictive value and quantitative assessment of non-calcified vessel-wall changes. Eur Radiol 2003; 13:2505-12. [PMID: 12920562 DOI: 10.1007/s00330-003-2053-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2003] [Revised: 07/07/2003] [Accepted: 07/14/2003] [Indexed: 01/08/2023]
Abstract
The aim of this study was to quantitatively assess non-calcified coronary artery plaques and to determine their predictive value for the detection of coronary artery disease (CAD). A total of 179 patients underwent a calcium screening examination and a contrast-enhanced multidetector-row computed tomography angiography (MDCT) of the coronary arteries for various indications. The traditional calcium scores were evaluated and all examinations were reviewed for the presence of non-calcified plaques with an attenuation of 0-130 Hounsfield units (HU). The number, mean attenuation, and volume of these non-calcified plaques were recorded. All patients also underwent conventional catheter angiography. Coronary calcium was detected in 73% (131 of 179) of the patients. Overall incidence of purely non-calcified plaques was 30% (53 of 179). In 27% of the patients (48 of 179) no calcium was detected; however, 15% of these patients without calcifications showed non-calcified plaques (7 of 48). Significant correlations were found between the volume of calcified plaques, volume of non-calcified plaques, and total plaque volume. There were significant differences in plaque composition comparing different risk factor profiles and different stages of CAD. Volumetric assessment of non-calcified coronary artery plaques is feasible using contrast-enhanced MDCT. Screening for non-calcified plaques identifies patients with signs of CAD that are missed in a calcium screening examination.
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Affiliation(s)
- Konstantin Nikolaou
- Department of Clinical Radiology, University of Munich Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany,
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