Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Hala T. Salem ◽  
Eman A.S. Sabek
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
High Sensitivity ◽  
Coronary Calcium ◽  
Risk Estimate ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring ◽  
Framingham Risk ◽  
Artery Disease

Aim and Objective: To estimate the relationship between Coronary Calcium Scoring (CCS)and presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. Background: Coronary Calcium Scoring (CCS) is a test uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep “patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information”. Methods: Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, measures to keep it as low as possible were presented, CCS and Framingham risk estimate were compared to the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. Results: CCS is a strong discriminator for obstructive CAD and can with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate which has high sensitivity and low specificity. Conclusion: CCS helps reducing the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions was unlikely, and as a test does not use contrast material, harmful effect on the kidney will be avoided as most of coronary atherosclerotic patients have renal problems.

Contrast Enhanced Cardiac CT Detects Coronary Artery Disease In 44% Of Asymptomatic Long-Term Adult Allogeneic Stem Cell Transplant Survivors

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2080-2080
Author(s):  
Natasha A Jain ◽  
Marcus Y Chen ◽  
Sujata Shanbhag ◽  
Kit Lu ◽  
Priyanka A Pophali ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Calcium Score ◽  
Low Risk ◽  
Coronary Calcium ◽  
Coronary Calcium Score ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring ◽  
Coronary Ct ◽  
Ct Angiogram ◽  
Artery Disease

Abstract Long term allogeneic stem cell transplantation (allo-SCT) survivors face a 2.3 fold increase risk of premature cardiovascular (CV) related death compared to the general population. A reliable screening strategy to identify allo-SCT survivors at risk for CV-related disease is therefore warranted to minimize future events. Cardiac CT is an emerging non-invasive imaging technology with high sensitivity for detecting coronary artery disease (CAD) and high negative predictive value to exclude the presence of CAD. We conducted the first prospective non-randomized single institution study to evaluate Agatston coronary calcium scoring by CT with concomitant coronary CT angiograms as a tool to identify the survivors at risk for CV disease. Sixteen asymptomatic post allo-SCT survivors (11 males; 5 females) with median age of 45 years (range 22-66) at transplant underwent coronary calcium scoring and contrast enhanced coronary CT angiograms at a median follow up of 5 years post transplant. 10-year Framingham cardiovascular risk scores (incorporating age, sex, total cholesterol, HDL cholesterol, systolic BP, HTN, smoking status) were also calculated at time of screening. Two were classified as high risk, 1 intermediate and 13 as low risk. Iodinated IV contrast was administered for coronary artery visualization and IV hydration given to patients with decreased creatinine clearance. Non-obstructive CAD was detected in seven (44%) patients. Additionally, four (25%) of these subjects had aortic root calcification. Lesion distributions by arterial territory were: left main 5.8%, left anterior descending 35.3%, left circumflex 29.4% and right coronary artery 29.4%. Characteristics of coronary plaques were: 47% calcified, 47% mixed calcified / non-calcified, and 6% non-calcified. In those with CAD, the median coronary calcium score was 55 (range: 0-992) (p<0.001), corresponding to the 75th percentile (range: 33rd to 97th percentile) (p < 0.001) adjusted for age, gender, and ethnicity. In comparison, those without any CAD had a median coronary calcium score of 0, < 1 percentile. There was one patient with <1% Framingham cardiovascular risk score who had a zero coronary calcium score with non-obstructive CAD on the CT angiogram. The radiation exposure during the procedure was acceptable, at a median of 0.60 mSv (range 0.18 to 3.12 mSv) for the coronary calcium score and 0.85 mSv (range 0.34 to 8.01) for the coronary CT angiogram. There were no complications related to the procedure. Current (2010 AHA/ACC) guidelines suggest a role for coronary calcium scoring for screening asymptomatic non-transplant individuals with intermediate Framingham risk. However, we detected CAD in 4 of 13 (30.8%) low risk transplant survivors. Coronary calcium scoring alone (sensitivity of 85.7% and specificity of 100%) may be adequate for screening and avoids the use of IV contrast. In conclusion, coronary calcium score with or without CT angiogram is a safe, feasible, highly sensitive study in transplant survivors; even asymptomatic, low-risk survivors may benefit from screening.Table 1Coronary Calcium Scoring in Subjects With and Without CAD by AngiographyPresent CAD by CT angiographyAbsent CAD by CT angiographyp-valueAgatston coronary calcium scoreMedian 55 (range 0 to 992)0 (range 0 to 0)< 0.001Coronary Calcium score percentileMedian 75th % ile (range 0 to 97)< 1st % ile (range 0 to 0 )<0.001 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Bicuspid Aortic Valve Is Associated with Less Coronary Calcium and Coronary Artery Disease Burden

2021 ◽  
Vol 10 (14) ◽  
pp. 3070
Author(s):  
Gudrun Feuchtner ◽  
Sven Bleckwenn ◽  
Leon Stoessl ◽  
Fabian Plank ◽  
Christoph Beyer ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Retrospective Case ◽  
Artery Disease

(1) Background. Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5) and aortopathy. Differences in the flow patterns and a genetic predisposition could also affect coronary arteries. The objective was to assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to stenotic tricuspid aortic valves (TAV). (2) Methods. A retrospective case–control study. A total of 47 patients with BAV stenosis (68.9 years ± 12.9, 38.3% females) who underwent CTA were matched with 47 TAV stenosis patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. (3) Results. The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p < 0.001) than in TAV, and stenosis severity was less (CAD-RADTM: p < 0.001). More patients with BAV had CACS zero (27.7% vs. 0%; p < 0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of TAV (p < 0.001). Obstructive CAD (>50% stenosis) by CTA was more frequently observed in patients with TAV (68.1%; p < 0.001). (4) Conclusions and Relevance. Patients with BAV stenosis have markedly less coronary calcium and less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of BAV, with adherent implications for TAVR planning.

Sign in / Sign up

Export Citation Format

Share Document