Echocardiography calcium score as predictive tools of severity of coronary artery disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Asmaa Ismail ◽  
Adham Abdeltawab ◽  
Alaa Roshdy
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Calcium Score ◽  
Syntax Score ◽  
Study Group ◽  
Non Invasive ◽  
Significant Difference ◽  
The Mean ◽  
Artery Disease

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk. Aim and Objectives to determine the correlation of echocardiography calcium score to severity of coronary artery disease. Patients and Methods Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups >27. Results The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score. Conclusion Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.

scholarly journals Evaluation of the Correlation between the rs4918 Polymorphism of AHSG Gene and Coronary Artery Calcification in Patients with Coronary Artery Disease

2020 ◽  
Vol 10 (2) ◽  
pp. 33-41
Author(s):  
Zeynab Ahmadihosseini ◽  
Morteza Moeinian ◽  
Saeed Nazemi ◽  
Sepideh Elyasi ◽  
Amir Hooshang Mohammadpour
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Calcium Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Artery Disease

Objectives: Fetuin-A is a circulating calcification inhibitor that prevents coronary artery calcification (CAC) by increasing calcium phosphate solubility and inhibiting VSMC differentiation and apoptosis. In this study, we investigated the correlation between rs4918 and CAC in patients with coronary artery disease (CAD). Methods: Forty-two healthy individuals and eighty-one CAD patients were recruited in the present study. The CAC score (CACS) was measured by CT angiography and the genotype analysis of rs4918 single-nucleotide polymorphism SNP was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Results: The CACS was significantly higher in CAD patients compared to healthy individuals (p < 0.001); however, there was no significant difference between the mean CACS in the presence and absence of rs4918 (p = 0.792). The mean calcium score of the left main coronary artery (LMCA) was significantly lower in carriers of the rs4918 allele (p = 0.036). The frequency of rs4918 SNP was almost similar in the control group and CAD patients (p = 0.846). Conclusions: in patients with CAD, we found no significant association between rs4918 SNP and CACS, indicating that carriers of this allele are not at increased risk of developing cardiovascular diseases compared with those without.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

scholarly journals Coronary Artery Calcium Score: Assessment of SYNTAX Score and Prediction of Coronary Artery Disease

Cureus ◽  
2021 ◽  
Author(s):  
Asma Shabbir ◽  
Sana T Virk ◽  
Jahanzeb Malik ◽  
Shabana Kausar ◽  
Talha B Nazir ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Syntax Score ◽  
Artery Disease

Computerized tomography: coronary angiography and cardiac imaging

2021 ◽  
pp. 224-245
Author(s):  
Jeff M Smit ◽  
Mohammed El Mahdiui ◽  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computerized Tomography ◽  
Acute Chest Pain ◽  
Non Invasive ◽  
Computerized Tomography Angiography ◽  
Artery Disease

Patients presenting with chronic and acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computerized tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department, particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computerized tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, non-invasive detection of coronary artery disease by computerized tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computerized tomography angiography. Conversely, implementation of coronary computerized tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computerized tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computerized tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as evaluation of coronary artery plaque composition, myocardial function and perfusion, and non-invasive assessment of fractional flow reserve from coronary computerized tomography angiography, are currently being developed and may also become valuable in the setting of chronic and acute chest pain in the future.

Epicardial fat study-AG: relationship between echocardiographic epicardial fat and coronary artery disease in patients after invasive coronary artery angiography

2020 ◽  
Author(s):  
Ilenia Alessandra Di Liberto ◽  
Gerlando Pilato ◽  
Sergio Buccheri ◽  
Salvatore Geraci ◽  
Diego Milazzo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Epicardial Fat ◽  
Clear Correlation ◽  
Syntax Score ◽  
Gensini Score ◽  
Coronary Artery Angiography ◽  
Artery Disease

Background: Epicardial fat increase has not yet a clear correlation with coronary artery disease (CAD). Aim: This study had as goal to demonstrate a relationship between an increase of epicardial fat thickness (EFT) and CAD. Materials & methods: In this observational study, we included 234 patients who underwent invasive coronary angiography. Before invasive coronary angiography, all patients underwent echocardiographic-2D for evaluation of EFT and they were divided into groups based on Gensini score and also on Syntax score. Results: EFT was significantly correlated to the presence and severity of CAD assessed by Gensini score with a cut-off value of 5.2 mm (sensitivity of 90.9%-specificity of 87.3%- area under the ROC curve = 92.1%). Conclusion: EFT increase (fat index ≥5.2 mm) evaluated by echocardiographic-2D could be considered as a risk factor for predicting CAD.

scholarly journals Do athletes play by different rules? Obstructive coronary artery disease in asymptomatic competitive Masters athletes: a case series

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
James McKinney ◽  
Nathaniel Moulson ◽  
Barbara N Morrison ◽  
Jobanjit S Phulka ◽  
Phillip Yeung ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Exercise Stress ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Masters Athletes ◽  
The Mean ◽  
Artery Disease

Abstract Background Both the age and number of endurance Masters athletes is increasing; this coincides with increasing cardiovascular risk. The vast majority of sports-related sudden cardiac deaths (SCDs) occur among athletes &gt;35 years of age. Coronary artery disease (CAD) is the most common cause of SCD amongst Masters athletes. Case summary In our prospective screening trial, six asymptomatic Masters athletes with ischaemia on electrocardiogram exercise stress testing had their coronary anatomy defined either by cardiac computed tomography or coronary angiography. Three patients underwent coronary angiography, with fractional flow reserve (FFR) testing performed when indicated. Subsequent percutaneous revascularization was performed in one patient after a shared-decision making process involving the patient and the referring cardiologist. All six athletes identified with obstructive CAD were male. The mean age and Framingham risk score was 61.8 years (±9.5) and 22.7% (±6.1), respectively. The mean metabolic equivalent of task achieved was 14.4 (±3.8). All athletes were treated with optimal medical therapy as clinically indicated. No cardiac events occured in 4.3 years of follow-up. Discussion Guidelines recommend revascularization of Masters athletes to alleviate the ischaemic substrate despite a paucity of evidence that revascularization will translate into a reduction in myocardial infarct or sudden cardiac arrest/death. Herein, although a limited study population, we demonstrate a lack of clinical events after 4.3 years of follow-up whether or not revascularization was performed. A prospective multicentre registry for asymptomatic Masters athletes with documented obstructive CAD is needed to help establish the role of revascularization in this population.

Abstract 15359: Cost-effectiveness of Different Strategies for the Diagnosis of Stable Coronary Artery Disease: Results from the Evinci Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Giuseppe Turchetti ◽  
Valentina Lorenzoni ◽  
Stefania Bellelli ◽  
Francesca Pierotti ◽  
Daniele Rovai ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Imaging Modalities ◽  
Fractional Flow ◽  
Stress Imaging ◽  
Non Invasive ◽  
Artery Disease

Introduction: In patients with suspected coronary artery disease (CAD) the comparative value of non invasive diagnostic imaging modalities or strategies is not yet defined. Hypothesis: We hypothesized that a comparative cost-effectiveness (CE) analysis of different non-invasive imaging strategies in a European population of patients with stable angina could identify the best approach for the diagnosis of significant CAD. Methods: In 475 pts (291 males, 60±9 yrs) with stable angina enrolled in the EVINCI multicenter study, CT coronary angiography (CTCA) and stress imaging were performed before invasive coronary angiography (ICA). Significant CAD was defined as >50% stenosis in the left main or >70% stenosis in a major coronary vessel or 30-70% stenosis with fractional flow reserve ≤0.8. Non-invasive imaging strategies included CTCA or stress imaging (ECHO, CMR, SPECT or PET) alone or in combination. Combinations were positive if both CTCA and the stress test were positive. CE analysis was performed using per patient data. Effectiveness was defined as percentage of correct diagnosis. Costs were calculated by country-specific reimbursements for each test considered plus ICA costs when non invasive tests were positive. Incremental cost-effectiveness ratios (ICERs) were obtained by regression analysis and using a propensity-score adjustment. Results: Significant CAD was diagnosed at ICA in 140 pts (29%). CTCA had the highest diagnostic performance among single imaging modalities and CTCA-PET among combinations (Table). At CE analysis, ECHO approach was the least costly but also the least effective, while CTCA alone or in combination with PET had increasingly higher effectiveness for a willingness to pay (WTP) exceeding 2,000 Euro and 5,000 Euro, respectively (Table). Conclusion: Stress ECHO is a cost-effective approach to diagnose stable CAD when the WTP is low. CTCA alone or combined with stress PET allows a more effective diagnostic workflow for higher WTP.

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