scholarly journals Study of coronary artery calcium by multi-slice spiral CT as a tool for high risk cardiovascular screening

Author(s):  
Rajesh V. Gosavi ◽  
Madhuri P. Holey ◽  
Umesh A. Giradkar

Background: Strong relationship has been demonstrated between the presence of occlusive CAD and coronary artery calcification (CAC) detected at autopsy, fluoroscopy and computed tomography (CT scan). CT scan quantifies the relative burden of CAC deposits as a marker of atherosclerosis. We explored utility of multi-slice spiral CT scan for detection of CAC as a tool for screening in asymptomatic high-risk cases above 40 years of age.Methods: Fifty-eight asymptomatic cardiovascular high-risk cases were included as per selection criteria. Detailed clinical history was recorded in every case regarding age, sex, history of risk factors for CAD like systemic hypertension, diabetes mellitus, smoking and family history of CAD. Every case was evaluated for fasting and postprandial blood sugar and fasting lipid profile. Body mass index (BMI) was calculated. An ECG was also recorded. Coronary artery calcium was estimated in each patient by multi -slice spiral CT scan. Fifty age and gender matched consenting participants were enrolled as controls and comparisons drawn.Results: Out of 58 cases scanned, 41 had no detectable CAC by multi-slice CT scan whereas in 17 cases (29.2%), calcium was detected. Mean CAC score was observed to increase as number of risk factors increased.Conclusions: Multi-slice CT scan is a useful tool for detection of coronary artery calcium (CAC) when utilised for high risk screening in older adults having one or more known cardiovascular risk factors.

2017 ◽  
Vol 4 (5) ◽  
pp. 1293 ◽  
Author(s):  
Rajesh V. Gosavi ◽  
Milind Vyawahare ◽  
Shrigopal Mandhania

Background: Strong relationship has been demonstrated between the presence of occlusive CAD and coronary artery calcification (CAC) detected at autopsy, fluoroscopy and computed tomography (CT scan). CT scan quantifies the relative burden of CAC deposits as a marker of atherosclerosis. Study explored utility of multi-slice spiral CT scan for detection of CAC in post myocardial infarction cases.Methods: Fifty-one post myocardial infarction cases were enrolled in the study. Detailed clinical history was recorded in every case regarding age, sex, history of risk factors for CAD like systemic hypertension, diabetes mellitus, smoking and family history of CAD. Every case was evaluated for fasting and postprandial blood sugar and fasting lipid profile. Body mass index (BMI) was also calculated. Coronary artery calcium was estimated in each patient by multi -slice spiral CT scan. Conventional angiography was also undertaken in 18 patients. Co-relation of coronary calcium with different age groups, sex, risk factors, electrocardiography and angiography was drawn.Results: Out of 51 cases scanned, 40 cases (78.4%) had detectable CAC. In 30 cases (58.8%), CAC score ranged from 1 to 100 (mild score); 6 cases (11.8%) had score between 101-400 (moderate score) while in 4 cases (7.8%) CAC score was more than 400 (severe score %). For detection of angiographically detectable disease, the sensitivity of multi-slice CT was 100% and the specificity was 33.3%.Conclusions: CAC is a valid measure of atherosclerotic plaque burden and is recommended as a screening tool for demonstrating significant atherosclerosis in susceptible subjects.


2016 ◽  
Vol 3 (3) ◽  
pp. 220
Author(s):  
Umesh Giradkar ◽  
Sandesh Chaudhari ◽  
Mandar Ramchandra Sane ◽  
Anand B. Mugadlimath ◽  
Naresh Kumar

VASA ◽  
2013 ◽  
Vol 42 (6) ◽  
pp. 429-433 ◽  
Author(s):  
Martin E. Matsumura ◽  
Crystal Maksimik ◽  
Matthew W. Martinez ◽  
Michael Weiss ◽  
James Newcomb ◽  
...  

Background: The relationship between breast artery calcification (BAC) noted on mammography and both coronary artery disease and cardiovascular risk remains controversial. Few studies have examined the clinical significance of BAC in asymptomatic women. In the present study we evaluated the relationship between BAC and coronary artery calcium (CAC) as identified by multi-slice CT scanning (MSCT). Patients and methods: Consecutive women (n = 98) with BAC noted on routine mammography but without known coronary artery disease (CAD) were assessed for CAD risk factors and had assessment of coronary calcium by MSCT. A control cohort of consecutive women who were BAC(-) (n = 104) underwent an identical assessment. Results: Women who were BAC(+) were older than those who were BAC(-); otherwise, there were no differences between the 2 groups with regard to traditional cardiac risk factors. Significantly more BAC(+) vs. BAC(-) women were found to have “high risk” CAC scores, defined as CAC > 400 (11.2 % vs. 1.0 %, p = 0.006). However, the rates of CAC scores of 0 were not different between the two groups (50.0 % vs. 54.8 % for BAC(+) and BAC(-) , respectively, p = 0.586). When examined in a multivariate model including the traditional risk factors of diabetes, increasing age, smoking, hyperlipidemia, and family history of CAD, the presence of BAC remained significantly associated with CAC > 400 (OR = 22.6, 95 % CI = 2.1 - 237.1). Conclusions: The presence of breast artery calcium on screening mammography was a strong independent predictor (odds ratio > 22) of high risk coronary artery calcium scores (defined as CAC > 400). The presence of BAC in those with significant CAD risk factors may warrant further evaluation.


2021 ◽  
Vol 16 (1) ◽  
pp. 134-149
Author(s):  
Hamat Hamdi Che Hassan ◽  

Acute Coronary Syndrome (ACS) events can be accelerated by positive family history of young coronary artery disease (CAD). Risk factors assessment sometimes fail to predict ACS occurrence. Additional investigations with coronary artery calcium (CAC) score can be used independently in screening for primary prevention in some population. This was a cross-sectional study in asymptomatic population with first degree relatives (FDR) having premature CAD compared with a matched population with no family history of CAD from September 2017 to March 2018 at the Cardiology Clinic of Univeristi Kebangsaan Malaysia Medical Centre. A total of 36 subjects were recruited with equal number in each group. Female were the majority in each group (66.7%). The FDR group were slightly younger compared to the control group [mean (SD) age 36.9 (4.9) against 38 (3.8), respectively). Both groups represent high risk factors including overweight and obesity, abdominal obesity as well as dyslipidemia. Newly diagnosed dyslipidemia was significant in the group with family history (83.3% versus 44.4%, P<0.01). Both groups were screened either into the low or moderate risk Framingham Risk Score group. CAC score was higher in family history group (11.1% vs 0%, P>0.05). In conclusion, CAC may be irrelevant for screening in younger population. However, the yield of other risk factor is still alarming.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S E Lee ◽  
G Pontone ◽  
I Gottlieb ◽  
M Hadamitzky ◽  
J A Leipsic ◽  
...  

Abstract Background It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP. Purpose We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP. Methods Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05). Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use. Conclusion The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline. Acknowledgement/Funding This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).


Author(s):  
Bijan Zamani ◽  
Behzad Babapour ◽  
Firouz Amani ◽  
Mohsen Ghasemian

Background: Coronary artery ectatic usually have relation with hyperlipidemia, systemic hypertension and male gender and its diagnosis done by angiography. Due to lack of proved risk factors for incidence of coronary artery ectatic lesions and also its important. The aim of this study was to compare the risk factors of coronary artery in patients with ectatic and stenotic lesions. Methods: This is a descriptive and analytical study that has been done on 300 patients hospitalized in Ardabil city hospital. Patients were enrolled according to the criteria and undergone to angiography. According to result of angiography, patients who have ectatic lesions as the first group and patients whose lesions were stenotic were named as the second group. Information obtained from patients entered in the checklist and analyzed by statistical methods in SPSS.16. Results: 22% of patients with ectatic lesions and 78% with stenotic lesions in patients with ectatic lesions. The mean age was 58.7 years and 74.2% were male and in patients with lesions stenotic the mean age was 60.7 years and 54.3% were male. Based on angiography results, in patients with ectatic lesions 42.4% have engaged in a carotid and 44.4% were two clashes coronary arteries in group stenotic. 34.7% of patients have history of previous mi, 32.9% history of coronary artery disease, 54.7% history of smoking, 56% had diabetes mellitus and 56% had hypertension. History of previous MI (p=0.028), smoking (p=0.04) and diabetes mellitus (p=0.001) and history of coronary artery disease are effective risk factors in two groups. Conclusions: The results showed that previous history of myocardial infarction, smoking and DM have significant relation with type of lesions. 


Lung Cancer ◽  
2005 ◽  
Vol 49 ◽  
pp. S184
Author(s):  
S. Novelle ◽  
C. Fava ◽  
P. Lausi ◽  
L. Cardinale ◽  
M. Brizzi ◽  
...  

2004 ◽  
Vol 27 (8) ◽  
pp. 527-533 ◽  
Author(s):  
Kosaku NITTA ◽  
Takashi AKIBA ◽  
Koichi SUZUKI ◽  
Keiko UCHIDA ◽  
Tetsuya OGAWA ◽  
...  

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthijs F Meijs ◽  
Michiel L Bots ◽  
Maarten J Cramer ◽  
Evert J Vonken ◽  
Birgitta K Velthuis ◽  
...  

Unrecognized myocardial infarction (UMI), generally assessed by the presence of a Q-wave on the electrocardiogram, is commonly found. Furthermore, mortality associated with UMI appears to be similar as for recognized myocardial infarction. With delayed enhancement cardiac MRI (DE-CMR) both Q-wave and non-Q wave infarctions can be identified. The aim of this study was to investigate the prevalence and determinants of UMI in high risk subjects without symptomatic coronary artery disease using DE-CMR. A DE-CMR was performed in 502 subjects with clinically manifest non-coronary atherosclerotic disease or marked risk factors for atherosclerosis. As all subjects had no known history of coronary artery disease, subendocardial and transmural scar tissue on DE-CMR was considered an UMI. In all subjects information on atherosclerotic risk factors was collected. Multivariable logistic regression was used to study the relation of risk factors with UMI. DE-CMR was of sufficient image quality in 480 (95.6%) subjects. Interobserver agreement was excellent (weighted kappa = 95%). An UMI was present in 45 (9.4%) of all subjects, and in 38 (13.1%) of 291 men and in 7 (3.7%) of 189 women. The risk of UMI increased from 6.0% (95%CI 2.2 – 9.8%) in those with two risk factors up to 26.2% (95%CI 15.2 – 37.3%) in those with 4 or 5 risk factors (male gender, age above mean of 53 years, ever smoking, history of stroke, and history of aneurysm of the abdominal aorta (AAA)). In multivariable analysis the risk of UMI was related to male gender (OR 2.6 (95%CI 1.1– 6.3)), age (OR 1.0 (95%CI 1.0 –1.1) per year), ever smoking (OR 3.1 (95%CI 1.0 –9.0), history of stroke (OR 2.1 (95%CI 1.0 – 4.4)) and history of AAA (OR 2.3 (95%CI 0.9 –5.9)). In high risk cardiac asymptomatic subjects UMI is common. The risk of UMI increases with increasing presence of risk factors.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laurits Juhl Heinsen ◽  
Gokulan Pararajasingam ◽  
Thomas Rueskov Andersen ◽  
Søren Auscher ◽  
Hussam Mahmoud Sheta ◽  
...  

Abstract Background High-risk coronary artery plaque (HRP) is associated with increased risk of acute coronary syndrome. We aimed to investigate the prevalence of HRP in asymptomatic patients with type 2 diabetes (T2D), and its relation to patient characteristics including cardiovascular risk factors, diabetes profile, and coronary artery calcium score (CACS). Methods Asymptomatic patients with T2D and no previous coronary artery disease (CAD) were studied using coronary computed tomography angiography (CCTA) in this descriptive study. Plaques with two or more high-risk features (HRP) defined by low attenuation, positive remodeling, spotty calcification, and napkin-ring sign were considered HRP. In addition, total atheroma volume (TAV), proportions of dense calcium, fibrous, fibrous-fatty and necrotic core volumes were assessed. The CACS was obtained from non-enhanced images by the Agatston method. Cardiovascular and diabetic profiles were assessed in all patients. Results In 230 patients CCTA was diagnostic and 161 HRP were detected in 86 patients (37%). Male gender (OR 4.19, 95% CI 1.99–8.87; p < 0.01), tobacco exposure in pack years (OR 1.02, 95% CI 1.00–1.03; p = 0.03), and glycated hemoglobin (HbA1c) (OR 1.04, 95% CI 1.02–1.07; p < 0.01) were independent predictors of HRP. No relationship was found to other risk factors. HRP was not associated with increased CACS, and 13 (23%) patients with zero CACS had at least one HRP. Conclusion A high prevalence of HRP was detected in this population of asymptomatic T2D. The presence of HRP was associated with a particular patient profile, but was not ruled out by the absence of coronary artery calcium. CCTA provides important information on plaque morphology, which may be used to risk stratify this high-risk population. Trial registration This trial was retrospectively registered at clinical trials.gov January 11, 2017 trial identifier NCT03016910.


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