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Caffarelli C, Al Refaie A, Baldassini L, Carrai P, Pondrelli CR, Gonnelli S. Bone fragility, sarcopenia and cardiac calcifications in an elderly population: a preliminary study. Aging Clin Exp Res 2023; 35:1097-1105. [PMID: 36988828 DOI: 10.1007/s40520-023-02393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Cardiovascular disease, osteoporosis and sarcopenia are very common age-related conditions. This study aimed at investigating the relationships of cardiac calcifications, as assessed by using GCCS with BMD, fragility fractures and sarcopenia in elderly subjects. METHODS In a cohort of 106 subjects (age 70.4 ± 5.8 yrs) we measured lumbar (BMD-LS), femoral BMD (femoral neck: BMD-FN, total femur: BMD-TH) and body composition (BMD-WB) with Dual-energy X-ray Absorptiometry (DXA) method. We also evaluated the presence of sarcopenia on the basis of the EWGSOP Consensus. All subjects, simultaneously, underwent to a transthoracic color doppler echocardiography exam to assess the presence of cardiac calcifications. The degree of non coronaric cardiac calcifications was evaluated using the Global Cardiac Calcium Score (GCCS). RESULTS The degree of cardiac calcification assessed by GCCS was significantly higher in osteoporotic patients (p < 0.001). Furthermore, an inverse correlation emerged between BMD and GCCS, statistical significance was found at lumbar spine and femoral sub-regions in female population (p < 0.01). Moreover by dividing population according to the presence of fragility fractures, we observed that GCCS values were significantly higher in subjects with fractures in respect of non-fractured ones (p < 0.05). Multiple regression models showed that BMD-LS and BMD-FT were independently associated with cardiac calcification. GCCS values were significantly associated with BMI and ASMM in women (p < 0.01 and p < 0.05, respectively) and with handgrip strength in men (p < 0.05). CONCLUSIONS Our data confirm the presence of a relationship between cardiac calcifications and decreased BMD values. It's also the first study that relates sarcopenia and valvular calcifications.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Antonella Al Refaie
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Leonardo Baldassini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Paolo Carrai
- Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Carlo Renato Pondrelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
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2
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Horbal SR, Rossman AH, Brown E, Shah NV, Ross BE, Bidulescu A, Sullivan JA, Su GL, Wang SC. Morphomic calcification score from clinical CT scans: A proxy for coronary artery calcium. Clin Imaging 2020; 66:57-63. [PMID: 32450484 DOI: 10.1016/j.clinimag.2020.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening of cardiovascular risk is essential in preventing cardiac events and quantifying asymptomatic risk. Coronary artery calcium (CAC) scores are a well-established in predicting cardiovascular risk, but require specialized computed tomography (CT) scans. Given the relationship of aortic calcification with cardiovascular risk, we sought to determine whether aortic calcification measures from incidental CT scans may approximate CAC. STUDY DESIGN Retrospective CT scans and corresponding volumetric CAC scores were obtained from patients at the University of Michigan. Aortic calcifications were measured in 166 scans. Correlations between a novel morphomic calcium (MC) percent score and CAC score were evaluated using Kendall's correlation coefficients. Comparison of receiver operating characteristic (ROC) curves based on MC at different vertebral levels showed the highest predictive values for measures taken at L4. RESULTS MC at L4 shows promise in predicting CAC (AUC 0.90 in non-contrast scans, 0.70 in post-contrast scans). Proposed MC threshold are (4.21% for best sensitivity, B 12.93% for balance, C = 19.26% for specificity) in scans without contrast enhancement and (D = 7.31 for sensitivity, E 8.06 for specificity) in scans with contrast enhancement. CONCLUSION The MC score demonstrates promising potential in approximating CAC, particularly at the L4 level. The utilization of MC from incidental CT scans may be useful for assessment of cardiovascular risk. The ability to extract MC from contrast scans makes it especially valuable to patients receiving additional medical or surgical care. Recognition of high-risk patients would allow the use of indicated preventative strategies to avoid hard cardiovascular events in at risk patients.
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Affiliation(s)
- Steven R Horbal
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Andrea H Rossman
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Edward Brown
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Nidhi V Shah
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian E Ross
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | | | - June A Sullivan
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Grace L Su
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Stewart C Wang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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3
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Effect of Elevated Calcium Score on Normal Myocardial Perfusion Study on Clinician Management of Coronary Artery Disease Risk Factors. Crit Pathw Cardiol 2020; 19:58-61. [PMID: 31939754 DOI: 10.1097/hpc.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elevated coronary artery calcification (CAC) scores are associated with higher cardiovascular (CV) risk even with normal stress myocardial perfusion imaging (MPI). Whether referring providers appropriately manage subclinical CV disease is unclear. We hypothesized that ordering clinicians would intensify medical therapy for CV disease in response to normal MPI and CAC ≥ 300. We conducted a cohort study on patients without known CV disease who underwent MPI and CAC scoring. Medical management of CV disease and clinical outcomes were assessed. Of 299 patients who underwent stress MPI, 62 patients had normal MPI and CAC ≥ 300. Documentation of elevated CAC score was noted in the final interpretation for 52% (n = 32) of MPI reports. During follow-up, treatment change in aspirin, cholesterol medications, and/or antihypertensive medication was made in 40% of these patients. Aspirin use increased from 71% to 82% (P < 0.001); statin use increased from 68% to 76% (P < 0.001). Several patients remained on suboptimal lipid or antiplatelet regimens without documented contraindication. Among patients with normal MPI, many have CAC ≥ 300. Not all MPI reports adequately call attention to this finding associated with elevated CV risk. Despite the elevated CAC score, some patients were not optimized medically.
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Ambrose JA, Najafi A. Strategies for the Prevention of Coronary Artery Disease Complications: Can We Do Better? Am J Med 2018; 131:1003-1009. [PMID: 29729244 DOI: 10.1016/j.amjmed.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
Billions of dollars have been spent over the past 25 years on developing new therapies for the prevention/treatment of adverse cardiac events related to atherosclerotic cardiovascular disease. Although some therapies have been lifesaving, several mega-randomized studies have shown only a <2% absolute reduction in adverse events with a large residual event rate. Is all this money well spent? Atherosclerosis develops decades before an adverse event, and the trials previously alluded to have nearly always been applied to secondary prevention, decades after disease initiation. Will earlier intervention result in a lower incidence of events? Individuals with an absence of the usual cardiac risk factors have a lifelong low incidence of events. Early initiation of strategies against the common cardiovascular risk factors in primary or primordial prevention will lower the incidence of adverse events, although many groups have not been well studied, including individuals younger than 40 years of age. New strategies are required to realize a radical reduction in events, and this article proposes new methods of prevention/treatment for coronary artery disease complications.
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Affiliation(s)
| | - Amir Najafi
- University of California San Francisco, Fresno
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5
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Tesche C, Duguay TM, Schoepf UJ, van Assen M, De Cecco CN, Albrecht MH, Varga-Szemes A, Bayer RR, Ebersberger U, Nance JW, Thilo C. Current and future applications of CT coronary calcium assessment. Expert Rev Cardiovasc Ther 2018; 16:441-453. [PMID: 29734858 DOI: 10.1080/14779072.2018.1474347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Computed tomographic (CT) coronary artery calcium scoring (CAC) has been validated as a well-established screening method for cardiovascular risk stratification and treatment management that is used in addition to traditional risk factors. The purpose of this review is to present an update on current and future applications of CAC. Areas covered: The topic of CAC is summarized from its introduction to current application with focus on the validation and clinical integration including cardiovascular risk prediction and outcome, cost-effectiveness, impact on downstream medical testing, and the technical advances in scanner and software technology that are shaping the future of CAC. Furthermore, this review aims to provide guidance for the appropriate clinical use of CAC. Expert commentary: CAC is a well-established screening test in preventive care that is underused in daily clinical practice. The widespread clinical implementation of CAC will be decided by future technical advances in CT image acquisition, cost-effectiveness, and reimbursement status.
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Affiliation(s)
- Christian Tesche
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,b Department of Cardiology and Intensive Care Medicine , Heart Center Munich-Bogenhausen , Munich , Germany
| | - Taylor M Duguay
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - U Joseph Schoepf
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Marly van Assen
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,d Center for Medical Imaging North East Netherlands , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Carlo N De Cecco
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Moritz H Albrecht
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,e Department of Diagnostic and Interventional Radiology , University Hospital Frankfurt , Frankfurt , Germany
| | - Akos Varga-Szemes
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Richard R Bayer
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Ullrich Ebersberger
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,b Department of Cardiology and Intensive Care Medicine , Heart Center Munich-Bogenhausen , Munich , Germany
| | - John W Nance
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Christian Thilo
- f Department of Internal Medicine I - Cardiology , Central Hospital of Augsburg , Augsburg , Germany
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6
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Ambrose JA, Acharya T, Roberts MJ. Finding the High-Risk Patient in Primary Prevention Is Not as Easy as a Conventional Risk Score! Am J Med 2016; 129:1329.e1-1329.e7. [PMID: 27566505 DOI: 10.1016/j.amjmed.2016.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
Patients with coronary artery disease or its equivalent are an appropriate target for guideline-directed therapy. However, finding and treating the individuals at risk for myocardial infarction or sudden death in primary prevention has been problematic. Most initial cardiovascular events are acute syndromes, and only a minority of these occurs in those deemed high risk by contemporary algorithms. Even newer noninvasive modalities cannot detect a majority of those at risk. Furthermore, accurate and early detection of high risk/vulnerability does not guarantee event prevention. Until new tools can be identified, one should consider a few simplistic solutions. In addition to a greater emphasis on lifestyle, earlier use of statins than currently recommended and a direct assault on tobacco could go a long way in reducing acute syndromes and cardiovascular mortality. To achieve the tobacco goal, the medical community would have to be directly and communally engaged.
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7
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Jelnin V, Kliger C, Zucchetta F, Ruiz CE. Use of Computed Tomography to Guide Mitral Interventions. Interv Cardiol Clin 2016; 5:33-43. [PMID: 27852480 DOI: 10.1016/j.iccl.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With increasing utilization of cardiac computed tomographic angiography (CTA) and widespread adoption of fusion imaging technology allowing the merger of pre-procedural CTA with fluoroscopy, the ability of CTA to guide structural heart interventions has evolved significantly. It has opened new possibilities in mitral valve (MV) interventions with improved pre-procedural planning and intra-procedural guidance. Given the lack of fluoroscopic landmarks of the mitral apparatus and continued growth of native MV device technologies, the value of CTA will continue to develop. The goal of this chapter is to detail the role of CTA in MV imaging and support for transcatheter therapies.
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Affiliation(s)
- Vladimir Jelnin
- Division of Structural and Congenital Heart Disease, Heart and Vascular Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Chad Kliger
- Department of Cardiothoracic Surgery, Division of Structural and Congenital Heart Disease, Hofstra University School of Medicine, Lenox Hill Hospital, North Shore LIJ Health System, 130 East 77th Street, 4th Floor Black Hall, New York, NY 10075, USA
| | - Fabio Zucchetta
- Department of Cardiology, Thoracic and Vascular Sciences, Division of Cardiac Surgery, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Carlos E Ruiz
- Division of Structural and Congenital Heart Disease, Heart and Vascular Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA
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8
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Han D, Lee JH, Hartaigh BÓ, Min JK. Role of computed tomography screening for detection of coronary artery disease. Clin Imaging 2015; 40:307-10. [PMID: 26342860 DOI: 10.1016/j.clinimag.2015.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/10/2015] [Indexed: 01/21/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in Western populations, and the prediction and prevention of CAD is an inherent challenge facing current health care societies. Computed tomography (CT) has emerged as a noninvasive imaging tool in the field of cardiovascular disease. Notably, CT scanning for detection of coronary artery calcium (CAC) has proven useful in predicting adverse cardiovascular outcomes as well as early identification of CAD. In asymptomatic persons undergoing screening for CAD, CAC is well established as a surrogate of CAD risk and has demonstrated incremental benefit over and above traditional risk prediction tools. In addition, a zero CAC score has shown to reflect a substantially lower risk of CAD and may therefore be considered an important marker of CAD protection. Irrespective of screening in the asymptomatic population, CAC scanning has also displayed a beneficial role in the symptomatic population, specifically as gatekeeper in guiding further treatment decision making. Further still, the combination of alternative CT screening strategies such as CT screening for lung cancer with CAC scanning may hold particular promise as an effective screening approach by lowering overall health costs as well as limiting radiation exposure.
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Affiliation(s)
- Donghee Han
- Department of Radiology, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, NY
| | - Ji Hyun Lee
- Department of Radiology, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, NY
| | - Bríain Ó Hartaigh
- Department of Radiology, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, NY
| | - James K Min
- Department of Radiology, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, New York.
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9
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Lonardo A, Ballestri S, Targher G, Loria P. Diagnosis and management of cardiovascular risk in nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 2015; 9:629-650. [PMID: 25327387 DOI: 10.1586/17474124.2015.965143] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as an important cardiovascular risk (CVR) factor. This is a narrative clinical review aimed at answering how diagnosis and management of CVR should be conducted in the individual patient with NAFLD. To this end, the authors performed an extensive search of the existing literature on PubMed (1993-2014) using pertinent keywords. To date, CVR among patients with NAFLD might be assessed with the Framingham risk score equation or other risk calculators, to be adapted to the true CVR in the specific population being assessed; however, the use of these CVR calculators needs to be validated by future studies in larger cohorts of NAFLD patients of various ethnic backgrounds in order to substantiate their clinical relevance as a foundation for the primary prevention of cardiovascular diseases in this group of patients. Early and aggressive drug treatment of CVR should be started in NAFLD patients with a history of cardiovascular events, established diabetes or who are at high (calculated) CVR. Whether such an aggressive pharmacological approach is also justified in patients with NAFLD, who are at intermediate or low CVR, remains debatable. Currently, there are no clinical trials showing that the treatment of NAFLD per se (either associated or unassociated with traditional CVR factors) will result in decreased risk of cardiovascular events. Accordingly, drug treatment should be better individualized, aiming at correcting all the coexisting cardio-metabolic risk factors of the individual patient with NAFLD. To this end, an overview of the lifestyle interventions and the available drugs is offered, emphasis being conveyed to statins and metformin, which promise to cover worrying complications of NAFLD such as the risk of developing hepatocellular carcinoma.
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Affiliation(s)
- Amedeo Lonardo
- Department of Medicine, Division of Internal Medicine, Pavullo Hospital, Pavullo 41026, Italy
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10
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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11
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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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Chillarón JJ, Roux JAFL, Benaiges D, Pedro-Botet J. Subclinical cardiovascular disease in type 2 diabetes mellitus: To screen or not to screen. World J Clin Cases 2014; 2:415-421. [PMID: 25232543 PMCID: PMC4163762 DOI: 10.12998/wjcc.v2.i9.415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/30/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) has risen in recent decades, and cardiovascular disease remains the leading cause of death in this population. Several clinical trials have demonstrated the benefit of tight control of risk factors on the incidence and mortality of cardiovascular disease. However, in clinical practice, few patients achieve the therapeutic goals. The current diagnostic procedures for subclinical cardiovascular disease in T2DM patients have not been shown to improve prognosis or mortality, probably because they do not categorize cardiovascular risk. Thus, clinical practice guidelines do not systematically recommend screening for subclinical atherosclerosis in these patients, although it is known that patients with extra-coronary atherosclerosis, microangiopathy and poorly-controlled cardiovascular risk factors are at high risk for cardiovascular disease. Improvements in the reliability of diagnostic tests, with fewer side effects and better cost efficiency, may better help to stratify cardiovascular risk in this group of patients, and further evaluation on this topic should be considered.
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13
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Patel AA, Budoff MJ. Screening for heart disease: C-reactive protein versus coronary artery calcium. Expert Rev Cardiovasc Ther 2014; 8:125-31. [DOI: 10.1586/erc.09.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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14
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Pundziute G, Schuijf JD, Jukema JW, de Roos A, van der Wall EE, Bax JJ. Advances in the noninvasive evaluation of coronary artery disease with multislice computed tomography. Expert Rev Med Devices 2014; 3:441-51. [PMID: 16866641 DOI: 10.1586/17434440.3.4.441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current noninvasive detection of coronary artery disease (CAD) is based on the demonstration of ischemia using stress-rest imaging, which is an indirect way of identifying CAD by demonstration of the hemodynamic consequences, rather than direct visualization of the obstructive lesions in the coronary arteries. Multislice computed tomography (MSCT) has recently emerged as an extremely rapidly developing noninvasive imaging modality, which allows anatomical imaging of the coronary arteries or noninvasive coronary angiography. In addition, total plaque burden, plaque morphology and (to some extent) plaque constitution can be assessed by MSCT. The technique also provides information on resting left ventricular systolic function, and possibly resting perfusion. Ideally, stress function and perfusion should also be evaluated, since this would allow detection of ischemia and would complete the picture of CAD. However, this is not routinely performed, since sequential acquisitions are associated with high radiation doses and thus pose a limitation for cardiovascular applications of MSCT. It is anticipated that, with a reduction in radiation, MSCT may become an important player in the diagnostic and prognostic work-up of patients with known or suspected CAD.
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Affiliation(s)
- Gabija Pundziute
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
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15
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Abstract
Calcium artery calcium (CAC) scoring has become an integral part in the era of preventive cardiology, it has been extensively studied and been validated as a powerful tool for cardiovascular risk assessment in conjunction with other traditional well established scoring systems such as Framingham risk score. In addition, CAC testing has found its way into emergency department algorithms assessing low to intermediate risk patients presenting with chest pain, this strategy was recently adopted by the UK NICE guidelines, confidently ruling out cardiac origin of chest pain. Several studies have demonstrated that risk assessment using CAC was motivational to patients leading to better adherence to their preventive practices as well as to medications. Accordingly, this test has several recommendations for use by national and international guidelines.
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16
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IYENGAR S, ROOBOTTOM CA. Cardiac multidetector CT: method, indications and applications. IMAGING 2013. [DOI: 10.1259/imaging.20100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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17
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Tehrani DM, Malik S, Wong ND. Coronary artery calcium screening in persons with metabolic syndrome and diabetes: implications for prevention. Metab Syndr Relat Disord 2013; 11:143-8. [PMID: 23438153 DOI: 10.1089/met.2012.0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract Diabetes and metabolic syndrome are major risk factors for coronary heart disease (CHD). Many patients suffering CHD events are not adequately identified by traditional risk assessment, suggesting the need for early detection of subclinical CHD to identify those at highest risk. Coronary artery calcium (CAC) screening has added utility in categorizing patients with intermediate and high risk of CHD events, and a growing body of evidence suggests its use for CHD risk assessment in persons with metabolic syndrome and diabetes mellitus. These studies demonstrate the presence and extent of CAC to be greater in those with these conditions, compared to those without, and that CHD risk varies greatly according to the extent of CAC both in persons with and without metabolic syndrome and diabetes mellitus. More recently, guidelines regarding the use of CAC screening have been extended to those with diabetes mellitus, helping to further stratify those patients that may benefit from more intensive therapy. This review evaluates the role and possible benefits of CAC screening, with a focus on those with metabolic syndrome and diabetes mellitus for evaluating the risk for CHD.
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Affiliation(s)
- David M Tehrani
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA 92697, USA
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18
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Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology 2012; 264:637-49. [PMID: 22919038 DOI: 10.1148/radiol.12110810] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.
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Affiliation(s)
- Khurram Nasir
- Center for Prevention and Wellness, Baptist Health South Florida, 1691 Michigan Ave, Suite 500, Miami Beach, FL 33139, USA.
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Juan Ramón SS. Rol del laboratorio cardiovascular en la detección precoz de enfermedad coronaria. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Iino R, Yokoyama N, Konno K, Naito K, Isshiki T. Impact of combined assessment of coronary artery calcium score, carotid artery plaque score, and brachial-ankle pulse wave velocity for early coronary revascularization in patients with suspected coronary artery disease. Int Heart J 2012; 53:154-9. [PMID: 22790682 DOI: 10.1536/ihj.53.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary artery calcium score (CACS) measured by multi-detector computed tomography, carotid plaque score (CPS) measured by carotid artery ultrasound, and brachial-ankle pulse wave velocity (baPWV) are noninvasive screening tools for coronary artery disease. The aim of this study was to determine whether the combination of CACS, CPS, and baPWV improves the prognostic value for future cardiac events. CACS, CPS, and baPWV were assessed in 77 patients (mean age, 65 years, 49 males) undergoing invasive coronary angiography. ECG-triggered MSCT was used to assess CACS. CPS was defined as the sum of all plaque heights in bilateral carotid arteries. The highest baPWV was used for analysis. Cardiac events were defined as cardiac death, nonfatal myocardial infarction, or coronary revascularization. Thirty-two cardiac events (41.6%) occurred during follow-up (23.6 ± 20.8 months), consisting of 28 PCIs and 4 CABGs. The best cutoff values of positive CACS, CPS, and baPWV for predicting cardiac events were ≥ 50, ≥ 5, and ≥1.6 m/second, respectively. For the combination of the 3 modalities, the positive test was defined as having at least 1 positive result by each method. The negative predictive value of all 3 modalities combined was better than that of CACS alone. The event-free rate was higher in patients with negative results for all 3 parameters compared with those that were positive (100% versus 44.8%, P < 0.0001). The prognostic value of using combined assessment of CACS, CPS, and baPWV is more effective for predicting cardiac events than CACS alone.
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Affiliation(s)
- Ryu Iino
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
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Youssef G, Budoff MJ. Coronary artery calcium scoring, what is answered and what questions remain. Cardiovasc Diagn Ther 2012; 2:94-105. [PMID: 24282703 PMCID: PMC3839142 DOI: 10.3978/j.issn.2223-3652.2012.06.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/11/2012] [Indexed: 02/05/2023]
Abstract
Coronary artery calcification (CAC) is a widely used imaging modality for cardiovascular risk assessment in moderate risk patients. It has been shown to have a superior role predicting future cardiac events and survival rates when combined with other traditional risk factor scoring systems as Framingham risk score (FRS). Furthermore, it significantly reclassifies moderate risk patients into lower or higher risk categories. Higher risk groups like patients with diabetes, a higher prevalence of CAC has been shown to impart a high short term risk of CV events, while those with zero calcium score had excellent event-free survival, similar to non-diabetic patients. Having a zero calcium score is currently used in United Kingdom practice guidelines (NICE) as a gatekeeper for any further investigations in patients presenting to the emergency department (ED) with chest pain. Unanswered questions include the concept of CAC progression that need to be standardized with respect to technique, interpretation and subsequent management strategies. Studies also demonstrated that risk assessment using CAC was motivational to patients leading to better adherence to their preventive practices as well as medications. However, statin did not consistently prove beneficial in slowing the CAC progression rate, but did reduce CV events significantly in patients with increased CAC. Accordingly, more studies need to be conducted to further help understand the ideal way to utilize this imaging tool and decreasing downstream utilization.
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Affiliation(s)
- George Youssef
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
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Statin Therapy for Subclinical Atherosclerosis in Primary Prevention. JACC Cardiovasc Imaging 2012; 5:261-3. [DOI: 10.1016/j.jcmg.2011.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/21/2011] [Indexed: 11/18/2022]
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Cardiac CT and Coronary CTA: Early Medicare Claims Analysis of National and Regional Utilization and Coverage. J Am Coll Radiol 2011; 8:549-55. [DOI: 10.1016/j.jacr.2010.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 12/29/2010] [Indexed: 11/20/2022]
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Sahni S, Vaishnava P, Darrow B. Coronary heart disease in the elderly: identifying established and subclinical disease with stress testing. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2011; 78:583-589. [PMID: 21748746 DOI: 10.1002/msj.20273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although cardiovascular disease is a major cause of mortality, morbidity, and healthcare expense in the United States, diagnosis in elderly patients, especially those who are asymptomatic, can be challenging. Noninvasive testing offers an opportunity to identify these patients, but guidelines reflect uncertainty of the impact of diagnosis on long-term outcomes. We review the role of different forms of noninvasive testing in both symptomatic and asymptomatic patients, as well as patients under consideration for elective surgery.
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Affiliation(s)
- Sheila Sahni
- Mount Sinai School of Medicine, New York, NY, USA
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Radiation dose threshold for coronary artery calcium score with MDCT: how low can you go? Eur Radiol 2011; 21:2121-9. [PMID: 21633825 DOI: 10.1007/s00330-011-2159-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/16/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the lowest radiation exposure threshold at which coronary calcium scoring (CCS) remains accurate. METHODS A prospective study of 43 consecutive eligible patients referred for CCS underwent imaging in accordance with the manufacturer's recommended protocol. Dedicated software was used to generate 8 series of images simulating tube currents ranging from 20 to 300 mA. These images were randomised and read in blinded fashion to determine the lowest tube current at which the CCS remained accurate. The minimum mA was correlated with 6 different patients' biometric parameters: bodyweight, body mass index, AP and lateral thoracic diameters, average thoracic diameter and the scout attenuation coefficient (SAC). The 95% confidence interval for each parameter was used to calculate tube current threshold levels and hence stratified CCS protocols were derived. RESULTS Spearman's correlation coefficients of the minimum tube current for the 6 parameters were: 0.66, 0.63, 0.65, 0.74, 0.77 and 0.86 respectively (p < 0.001). SAC offered the largest potential reduction in mean effective dose from 1.86 mSv to 0.88 mSv. CONCLUSION CCS with at least 50% reduction in radiation exposure and below 1 mSv is feasible if CT scout projections are utilised effectively.
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, Smith SC, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Nishimura R, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 56:e50-103. [PMID: 21144964 DOI: 10.1016/j.jacc.2010.09.001] [Citation(s) in RCA: 1026] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Salem M, Moneir I, Adly AM, Esmat K. Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes. Acta Diabetol 2011; 48:41-53. [PMID: 20706852 DOI: 10.1007/s00592-010-0214-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
The objective of the study is to assess coronary artery calcification (CAC) among adolescents with type-1 diabetes and to determine its relation with high-sensitivity C-reactive protein (hs-CRP), dyslipidaemia, glycaemic control and microvascular complications. The study included sixty patients with type-1 diabetes. Their ages ranged from 12 to 18 years and their diabetes duration ranged between 10 and 15 years. Patients were compared with 60 healthy subjects who served as controls. Clinical examination and laboratory investigations were done for evaluation of glycaemic control and presence of microvascular complications. Lipid profile, hs-CRP and multislice spiral computed tomography were done. Hs-CRP, total cholesterol, triglycerides and low-density lipoproteins levels were significantly higher in patients with diabetes compared to controls (P < 0.001). Twelve patients with diabetes (20%) had positive CAC. The mean calcium score was significantly higher in patients with diabetes compared to controls (P < 0.05). Smoking significantly affects CAC as 50% of smokers with diabetes had evidence of CAC compared to 9.1% of non-smokers with diabetes (P < 0.001). Fifty percent of patients with diabetes on angiotensin-converting enzyme inhibitor (ACEI) had evidence of CAC compared to 0% of patients without history of ACEI therapy (P < 0.001). Diabetics with CAC had significantly elder age, longer disease duration and higher mean glycosylated hemoglobin compared to diabetics without CAC (P < 0.05). Blood pressure percentiles, albumin creatinine ratio and serum lipids were significantly higher in patients with CAC compared to those without CAC (P < 0.001). All diabetics with severe retinopathy had positive CAC compared to 0% with normal Fundus (P < 0.001). All diabetics with overt nephropathy had positive CAC compared to 13.3% and 0% in micro- and normo-albuminuric patients (P < 0.001). Young patients with diabetes have evidence of CAC. Smoking, microvascular complications and dyslipidaemia might contribute to this risk.
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Affiliation(s)
- M Salem
- Paediatric Department, Ain Shams University, Cairo, Egypt.
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122:e584-636. [PMID: 21098428 DOI: 10.1161/cir.0b013e3182051b4c] [Citation(s) in RCA: 403] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tseng PH, Mao S, Chow DZ, Gao Y, Chang WW, Schiff MM, Kim KY, Kwan JY, Budoff MJ. Accuracy in quantification of coronary calcification with CT: a cork-dog heart phantom study. Acad Radiol 2010; 17:1249-53. [PMID: 20621526 DOI: 10.1016/j.acra.2010.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/09/2010] [Accepted: 05/20/2010] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Coronary artery calcium is a sensitive risk predictor of cardiac events. However, measurement of calcium foci is affected by partial-volume effects, which ultimately have an effect on accuracy and reproducibility of calcium scores. In this study, we describe the accuracy of quantification of calcium foci of known size and density using cork-dog heart phantoms. MATERIALS AND METHODS Five study phantoms were constructed from cork chests and dog hearts containing 135 calcium hydroxyapatite (CaHA) foci of known volume, mass, and concentration located in the coronary arteries or the myocardium. Hearts were separated into two groups: (1) three hearts containing large, high-density foci and (2) two hearts containing small, low-density foci. The phantoms were scanned using a standard coronary artery calcium (CAC) protocol and the volume and mean intensity of foci were measured. RESULTS In group 1, the total volume of 87 CaHA foci measured was 4284 and 3779 mm(3) with electron beam computed tomography (EBCT); multidetector computed tomography (MDCT), respectively (P < .001). Both were significantly larger than the true volume (2713.9 mm(3), P < .001). In Group 2, the total volume of 57 CaHA foci measured was 592.6 and 702.9 mm(3) with EBT and MDCT, respectively (P < .001). Both were significantly smaller than the true volume (1733.2 mm(3), P < .001). We found that EBCT values for volume were approximately generally higher than MDCT values, but strongly correlated (r = 0.95, P < .0001). Agatston scores were found to be nearly equivalent between EBCT and MDCT and were similarly strongly correlated (r = 0.97, P < .0001). CONCLUSIONS Computed tomography images overestimate the volume of large, dense CaHA foci while underestimating the volume of smaller (<6.6 mm(3)), less dense foci. This may have significant implications on CAC scoring and volume measurement. EBCT overestimated calcium more than MDCT, most likely from increased image noise.
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Affiliation(s)
- Philip H Tseng
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA
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Abstract
INTRODUCTION Cardiac imaging is an emerging application of multidetector computed tomography (MDCT). This review summarizes the current capabilities, possible applications, limitations and developments of cardiac CT. SOURCES OF DATA Relevant publications in peer reviewed literature and national and international guidelines are used to discuss important issues in cardiac CT imaging. AREAS OF AGREEMENT AND CONTROVERSY There is broad consensus that coronary CT angiography is indicated in patients with an intermediate pre-test probability of coronary artery disease (CAD) when other non-invasive tests have been equivocal. In this context, CT can reliably exclude significant CAD. Cardiac CT also has an established role in the evaluation of bypass grafts and suspected coronary anomalies. Radiation exposure from CT procedures remains a concern, although techniques are now available to reduce the X-ray dosage without significantly compromising the image quality. However, with the current level of knowledge, the cardiac CT examinations are not justified to screen for CAD in asymptomatic individuals. Neither is it considered appropriate in patients with a high pre-test probability of CAD, for whom invasive catheter coronary angiography is usually of more benefit. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH The ability to reconstruct the volumetric cardiac CT data set opens up avenues for advanced physiological analyses of the heart. For example, if CT myocardial perfusion assessment becomes a reality, there is potential to revolutionize the practice of MDCT imaging. Research is also ongoing to investigate whether cardiac CT has a role in the appropriate triage of patients with chest pain in the emergency department.
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Affiliation(s)
- Nevin T Wijesekera
- Department of Radiology, Royal Brompton Hospital, Sydney Street, London, UK
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Abstract
While there is no doubt that high risk patients (those with >20% ten year risk of future cardiovascular event) need more aggressive preventive therapy, a majority of cardiovascular events occur in individuals at intermediate risk (10%–20% ten year risk). Accurate risk assessment may be helpful in decreasing cardiovascular events through more appropriate targeting of preventive measures. It has been suggested that traditional risk assessment may be refined with the selective use of coronary artery calcium (CAC) or other methods of subclinical atherosclerosis measurement. Coronary calcification is a marker of atherosclerosis that can be quantified with the use of cardiac CT and it is proportional to the extent and severity of atherosclerotic disease. The published studies demonstrate a high sensitivity of CAC for the presence of coronary artery disease but a lower specificity for obstructive CAD depending on the magnitude of the CAC. Several large clinical trials found clear, incremental predictive value of CAC over the Framingham risk score when used in asymptomatic patients. Based on multiple observational studies, patients with increased plaque burdens (increased CAC) are approximately ten times more likely to suffer a cardiac event over the next 3–5 years. Coronary calcium scores have outperformed conventional risk factors, highly sensitive C-reactive protein (CRP) and carotid intima media thickness (IMT) as a predictor of cardiovascular events. The relevant prognostic information obtained may be useful to initiate or intensify appropriate treatment strategies to slow the progression of atherosclerotic vascular disease. Current data suggests intermediate risk patients may benefit most from further risk stratification with cardiac CT, as CAC testing is effective at identifying increased risk and in motivating effective behavioral changes. This article reviews information pertaining to the clinical use of CAC for assessing coronary atherosclerosis as a useful predictor of coronary artery disease (CAD) in certain population of patients.
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Affiliation(s)
- Matthew J Budoff
- Division of Cardiology, Saint John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA,Torrance, California 90502, USA.
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Sabour S, Atsma F, Rutten A, Grobbee D, Mali W, Prokop M, Bots M. Multi Detector-Row Computed Tomography (MDCT) had excellent reproducibility of coronary calcium measurements. J Clin Epidemiol 2008; 61:572-9. [DOI: 10.1016/j.jclinepi.2007.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 06/27/2007] [Accepted: 07/12/2007] [Indexed: 11/30/2022]
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Guzman RJ, Brinkley DM, Schumacher PM, Donahue RMJ, Beavers H, Qin X. Tibial artery calcification as a marker of amputation risk in patients with peripheral arterial disease. J Am Coll Cardiol 2008; 51:1967-74. [PMID: 18482666 PMCID: PMC2836514 DOI: 10.1016/j.jacc.2007.12.058] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between calcification in tibial arteries, the degree of limb ischemia, and the near-term risk of amputation. BACKGROUND Determining the amputation risk in patients with peripheral arterial disease (PAD) remains difficult. Developing new measures to identify patients who are at high risk for amputation would allow for targeted interventions and focused trials aimed at limb preservation. METHODS Two hundred twenty-nine patients underwent evaluation by history, arterial Doppler, and multislice computed tomography of the lower extremities. We then explored the relationship between a tibial artery calcification (TAC), traditional risk factors for PAD, limb status at presentation, and near-term amputation risk. RESULTS Increased age and traditional atherosclerosis risk factors were associated with higher TAC scores. Patients with critical limb ischemia had the highest TAC scores, and increasing TAC scores were associated with worsening levels of limb ischemia in ordinal regression analysis. Receiver-operator characteristic analysis suggested that the TAC score predicted amputation better than the ankle-brachial index (ABI). Symptomatic patients with a TAC score greater than 400 had a significantly increased risk of amputation. In Cox regression analysis, there was a strong association between the TAC score and the risk of major amputation that remained after adjustment for traditional risk factors and the ABI. CONCLUSIONS In patients presenting with PAD, the TAC score is associated with the stage of disease and it identifies those who are at high risk for amputation better than traditional risk factors and an abnormal ABI.
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Affiliation(s)
- Raul J Guzman
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
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Masuda H, Okano HJ, Maruyama T, Yoshimura Y, Okano H, Matsuzaki Y. In vivo imaging in humanized mice. Curr Top Microbiol Immunol 2008; 324:179-96. [PMID: 18481461 DOI: 10.1007/978-3-540-75647-7_12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The radiological modalities that are currently utilized as critical components in clinical medicine have also been adapted to small-animal imaging, among which are ultrasound imaging, X-ray computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT). Optical imaging techniques such as bioluminescence imaging (BLI) and fluorescence imaging (FLI) are approaches that are commonly used in small animals. Longitudinal surveys of living (i.e., nonsacrificed) animal models with these modalities provide some clues for the development of clinical applications. The techniques are absolutely essential for translational research. However, there are currently few tools available with sufficient spatial or temporal resolution ideal for all experimental studies. In this chapter, we provide a rationale and techniques for visualizing target cells in living small animals and an overview of the advantages and limitations of current imaging technology. Finally, we introduce a humanized mouse and a novel in vivo imaging system that we have developed. We also discuss real-time observations of reconstructs and clinical manifestations.
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Affiliation(s)
- H Masuda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Sabour S, Rutten A, van der Schouw YT, Atsma F, Grobbee DE, Mali WP, Bartelink MEL, Bots ML, Prokop M. Inter-scan reproducibility of coronary calcium measurement using Multi Detector-Row Computed Tomography (MDCT). Eur J Epidemiol 2007; 22:235-43. [PMID: 17427036 PMCID: PMC1914270 DOI: 10.1007/s10654-007-9123-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 03/12/2007] [Indexed: 11/26/2022]
Abstract
Purpose To assess inter-scan reproducibility of coronary calcium measurements obtained from Multi Detector-Row CT (MDCT) images and to evaluate whether this reproducibility is affected by different measurement protocols, slice thickness, cardiovascular risk factors and/or technical variables. Design Cross-sectional study with repeated measurements. Materials and methods The study population comprised 76 healthy women. Coronary calcium was assessed in these women twice in one session using 16-MDCT (Philips Mx 8000 IDT 16). Images were reconstructed with 1.5 mm slice thickness and 3.0 mm slice thickness. The 76 repeated scans were scored. The Agatston score, a volume measurement and a mass measurement were assessed. Reproducibility was determined by estimation of mean, absolute, relative difference, the weighted kappa value for agreement and the Intra-class correlation coefficient (ICCC). Results Fifty-five participants (72.4%) had a coronary calcification of more than zero in Agatston (1.5 mm slice thickness). The reproducibility of coronary calcium measurements between scans in terms of ranking was excellent with Intra-class correlation coefficients of >0.98, and kappa values above 0.80. The absolute difference in calcium score between scans increased with increasing calcium levels, indicating that measurement error increases with increasing calcium levels. However, no relation was found between the mean difference in scores and calcium levels, indicating that the increase in measurement error is likely to result in random misclassification in calcium score. Reproducibility results were similar for 1.5 mm slices and for 3.0 mm slices, and equal for Agatston, volume and mass measurements. Conclusion Inter-scan reproducibilility of measurement of coronary calcium using images from MDCT is excellent, irrespective of slice thickness and type of calcium parameter.
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Affiliation(s)
- Siamak Sabour
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Ministry of Health and Medical Education, Tabriz University of Medical Sciences, Tabriz, I.R. Iran
| | - A. Rutten
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y. T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - F. Atsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D. E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - W. P. Mali
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. E. L. Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M. L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M. Prokop
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
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Mühlenbruch G, Hohl C, Das M, Wildberger JE, Suess C, Klotz E, Flohr T, Koos R, Thomas C, Günther RW, Mahnken AH. Evaluation of automated attenuation-based tube current adaptation for coronary calcium scoring in MDCT in a cohort of 262 patients. Eur Radiol 2007; 17:1850-7. [PMID: 17308926 DOI: 10.1007/s00330-006-0543-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2006] [Revised: 10/23/2006] [Accepted: 11/24/2006] [Indexed: 11/26/2022]
Abstract
The aim of our study was to evaluate attenuation-based tube current adaptation in coronary calcium scoring using ECG-gated multi-detector-row CT (MDCT). A total of 262 patients underwent non-enhanced cardiac MDCT. Group 1 was scanned using a standard protocol with 120 kV and 150 mAs(eff). Groups 2-4 were scanned using an attenuation-based dose-adaptation template (CARE Dose) with different effective reference mAs settings (150, 180, 210 mAs(eff)). Body-mass index (BMI) and CT-dose index values were calculated for each patient. Image noise and subjective image quality were assessed. Regression analysis was performed, and the variation coefficient of image noise was determined. Compared to the standard scan protocol a dose reduction of 31.1% for group 2 and 20.1% for group 3 was observed. Measurement variation of image noise was smaller for the attenuation-based dose adaptation protocols (group 2-4) (16.2-17.1%) compared to the standard scan protocol (32.3%). Regression analysis of groups 2-4 showed better correlation with improved dose usage based on BMI (all P <or= 0.001). Median image quality was "excellent" in groups 2-4 and "good" in group 1. Automated attenuation-based tube current adaptation in coronary calcium scoring is technically feasible, can decrease patient dose, and reduces variation in image noise as a sign of improved dose usage.
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Affiliation(s)
- Georg Mühlenbruch
- Department of Diagnostic Radiology, University Hospital (RWTH) Aachen, Germany.
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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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Becker A, Leber A, White CW, Becker C, Reiser MF, Knez A. Multislice computed tomography for determination of coronary artery disease in a symptomatic patient population. Int J Cardiovasc Imaging 2006; 23:361-7. [PMID: 17160425 DOI: 10.1007/s10554-006-9189-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multislice computed tomography (MSCT) has started to replace Electron beam CT for quantitation of coronary artery calcium. However no study has evaluated the diagnostic accuracy of MSCT for prediction of coronary artery disease (CAD) in a symptomatic patient population using the volume score. METHODS AND RESULTS 1347 symptomatic subjects (male = 803, mean age = 62 years) with suspected CAD underwent MSCT studies 1 +/- 2 days before the coronary angiogram. The Agatston (ACS) and Volumetric calcium score (VCS) were calculated using a proprietary workstation. Statistical analyses included the Pearson's correlation coefficient and the nonparametric Mann-Whitney U-test to compare the calcium score in different age groups and between men and women. Sensitivity, specificity and predictive accuracy were calculated for different calcium thresholds for prediction of CAD. ROC curve analyses were used to establish relations between the coronary calcium score and presence or absence of CAD. In 720 (53%) subjects (male = 419) angiography revealed a minimal lumen diameter stenosis greater than 50%. Patients with significant CAD had significantly higher total calcium score values than patients without CAD (P = 0.001). ACS and VCS demonstrate a close correlation for the whole study group, r = 0.99. The overall sensitivity of any calcium to predict stenosis was 99%, specificity = 32%. Exclusion of calcium was highly accurate for exclusion of CAD in subjects older than 50 years (predictive accuracy = 98%). An absolute cutoff >100 and an age and sex specific threshold (score over 75th percentile) were identified as the cutoff levels with the highest sensitivities (86-89%) and lowest false positive rates (20-22%). ROC analyses revealed MSCT calcium scanning as a good clinical test which can be performed with similar accuracy in all age groups with an area under the curve of 0.84. CONCLUSION Determination of coronary calcium with MSCT is an accurate imaging modality for prediction of significant CAD in a patient population with intermediate likelihood of CAD. Exclusion of any calcium provided strong evidence that patients older than 50 years did not have obstructive CAD. ACS and VCS show an equivalent diagnostic accuracy.
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Affiliation(s)
- Alexander Becker
- Department of Cardiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, D-81377 Grosshadern, Munich, Germany.
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Budoff MJ, Gopal A, Gopalakrishnan D. Cardiac computed tomography: diagnostic utility and integration in clinical practice. Clin Cardiol 2006; 29:I4-14. [PMID: 17009573 PMCID: PMC6654427 DOI: 10.1002/clc.4960291303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cardiac applications of computed tomography (CT) is a rapidly growing diagnostic area because of the ability to visualize plaque burden (coronary artery calcification [CAC]) and luminal obstruction (computed tomographic angiography [CTA]) noninvasively. Coronary artery calcification has been validated in over 1,000 studies over the last 20 years, primarily with electron beam tomography. Studies demonstrate several indications that could aid physicians in the management of symptomatic and asymptomatic patients. Determining that a symptomatic patient has no CAC is associated with both a lower risk of an abnormal nuclear study and angiographic obstruction. The ability to detect subclinical atherosclerosis (CAC) with minimal radiation and no contrast makes this an attractive method for risk stratification. New studies demonstrate a 10-fold risk of cardiovascular events with increasing amounts of coronary calcification. The invasive nature, expense, and risk resulting from invasive angiography have been instrumental in encouraging the development of new diagnostic methods that allow the coronary arteries to be visualized noninvasively. Multislice CT, with its advanced spatial and temporal resolution, has opened up new possibilities in the imaging of the heart and major vessels of the chest, including the coronary arteries. The last decade has seen great strides in the field of cardiac imaging, particularly in the ability to visualize the coronary lumen with sufficient diagnostic accuracy. Possessing that qualification, CTA is now being used increasingly in clinical practice. As a result of having high spatial and improved temporal resolutions, this imaging modality not only allows branches of the coronary artery to be evaluated, but also allows simultaneous analysis of other cardiac structures, making it extremely useful for other cardiac applications. This paper reviews the diagnostic utility and limitations of cardiac CT and how it could be integrated into clinical practice.
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Affiliation(s)
- Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
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Crouse JR. Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art. J Lipid Res 2006; 47:1677-99. [PMID: 16705212 DOI: 10.1194/jlr.r600012-jlr200] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The ability to image obstructive arterial disease brought about a revolution in clinical cardiovascular care; the development of newer technologies that image arterial wall thicknesses, areas, volumes, and composition allows valid imaging of atherosclerosis for the first time. Development of noninvasive imaging of atherosclerosis has further led to a quantum shift in research in the field by enabling the study of asymptomatic populations and thus allowing investigators to focus on preclinical disease without the many biases associated with the study of symptomatic patients. These noninvasive investigations have broad implications for clinical care as well. Coronary angiography, computed tomographic (CT) imaging of coronary calcium, intravascular ultrasound, multidetector CT angiography, B mode ultrasound of the carotid arteries, and MRI of the carotid arteries all have unique strengths and weaknesses for imaging atherosclerosis. Certain of these techniques are extremely useful as outcome variables for clinical trials, and others are uniquely useful as predictors of the risk of cardiovascular disease. All are informative in one way or another with regard to the role of plaque remodeling and composition in disease causation. CT and MRI technology are advancing very rapidly, and research and clinical uses of these imaging modalities promise to further advance our understanding of atherosclerosis and its prevention.
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Affiliation(s)
- John R Crouse
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Abstract
Cardiovascular disease and stroke account for 60-70% of all deaths in patients with end-stage renal disease (ESRD), at a risk that is 10-20-fold the age- and sex-matched general population. There is also increased coronary artery calcification and increased cardiovascular mortality in chronic kidney disease (CKD) and dialysis patients compared with the general population. Bone is similarly abnormal in CKD. There is an increased incidence of low bone mass and fractures in dialysis patients compared with the general population. Furthermore, a hip fracture in a dialysis patient is associated with a doubling of the mortality observed in nondialysis patients with a hip fracture. These two problems may be linked, as cross-sectional studies have demonstrated an inverse relationship between osteoporosis and coronary artery calcification in the general population and in ESRD patients. In vitro and ex vivo, there is clear evidence that vascular calcification is an active cell-mediated process, made worse by disorders of mineral metabolism. Many factors known to be associated with cardiovascular disease in CKD patients can directly increase calcification in vitro. In addition, in CKD, there are many mechanisms by which bone may adversely affect vascular calcification including disorders of bone remodelling, altered secretion of parathyroid hormone (PTH), hyperphosphatemia, hypercalcaemia, use of calcium based binders, and excessive vitamin D therapy. The coexistence of vascular risk factors and abnormal bone represent a double threat to the well being of patients with CKD.
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Affiliation(s)
- S M Moe
- Indiana University School of Medicine and Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA.
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Kalia NK, Miller LG, Nasir K, Blumenthal RS, Agrawal N, Budoff MJ. Visualizing coronary calcium is associated with improvements in adherence to statin therapy. Atherosclerosis 2006; 185:394-9. [PMID: 16051253 DOI: 10.1016/j.atherosclerosis.2005.06.018] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Revised: 05/15/2005] [Accepted: 06/17/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many patients lack motivation to control cardiovascular risk factors and clinicians have long sought ways to activate apathetic patients. Despite significant and consistent data on the benefits of lipid-lowering agents to reduce cardiovascular events, adherence and utilization of these agents remains low. We evaluated whether visualization of coronary calcium would positively affect patients' adherence rates. METHODS We evaluated patients who underwent electron beam tomography (EBT) coronary calcium evaluation at least 1 year prior with a survey questioning them about health behaviors. Patients filled out baseline and follow-up questionnaires relating to lifestyle modifications, including statin utilization, diet, exercise, tobacco cessation and vitamin/antioxidant utilization. RESULTS The study population consisted of 505 individuals on statin therapy on baseline who were followed for a mean of 3 +/- 2 years. Overall the statin compliance was lowest (44%) among those with CAC score in the first quartile (0-30), whereas 91% of individuals with baseline CAC score in the fourth quartile (>or= 526) adhered to statin therapy. In multivariable analysis, after adjusting for cardiovascular risk factors, age, and gender, higher baseline CAC scores were strongly associated with adherence to statin therapy. CONCLUSIONS In addition to risk stratification for the asymptomatic person, patients visualizing coronary artery calcium may improve utilization and adherence to lipid-lowering therapy. Outcome studies and randomized trials need to be done to quantify the true value and cost-effectiveness of this approach.
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Affiliation(s)
- Nove K Kalia
- Division of Cardiology, Harbor-UCLA Medical Center, Research and Education Institute, Torrance, CA, USA
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Abstract
While there is no doubt that high-risk patients (those with more than a 20% 10-year risk of a future cardiovascular event) need more aggressive preventive therapy, a majority of cardiovascular events occur in individuals at intermediate risk (10%-20% 10-year risk). Data suggest that it will be most cost-effective to concentrate screening efforts on this group of patients. Coronary artery calcium has been shown to be highly specific for atherosclerosis, occurring only in the intima of the coronary arteries. There is evidence to show that elevated coronary calcium scores are predictive of cardiovascular events, both independently of and incrementally to conventional cardiovascular risk factors. Based on current available data, patients with increased plaque burdens (increased coronary calcium scores) are approximately 10 times more likely to suffer a cardiac event over the next 3-5 years. Coronary calcium scores have outperformed conventional risk factors, high sensitivity C-reactive protein, and carotid intima-media thickness as a predictor of cardiovascular events. Both electron beam tomography and multidetector computed tomography can accurately detect and quantify the coronary calcium scores. In summary, coronary calcium detection significantly improves the accuracy of global cardiovascular risk prevention, the noninvasive tracking of the atherosclerotic burden, and the prediction of cardiovascular events.
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Affiliation(s)
- Ambarish Gopal
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Research and Education Institute, Torrance, CA 90502, USA
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Beier UH, Jelnin V, Jain S, Ruiz CE. Cardiac computed tomography compared to transthoracic echocardiography in the management of congenital heart disease. Catheter Cardiovasc Interv 2006; 68:441-9. [PMID: 16897779 DOI: 10.1002/ccd.20817] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare cardiac CT and transthoracic echocardiography (TTE) as diagnostic utilities in congenital heart disease (CHD) and to determine their advantages and limitations. BACKGROUND TTE is widely used in the evaluation of CHD. Recent reports suggested an increasing role of CT. However, there are few quantitative data on its diagnostic accuracy. METHODS We investigated a total of 162 patients (51.24% male; mean age: 16.06 +/-+/- 17.92) with congenital heart defects, who underwent electron beam CT (EBCT) and TTE between March 2002 and June 2005. We retrospectively analyzed a total of 667 findings, stratified for age and anatomic categories. RESULTS EBCT and TTE findings are concordant in patients below 1 year of age (85.43% agreement). EBCT had poor sensitivity and specificity in detecting anomalies of cardiac chambers (0.68, 0.58), but was useful for great arteries (0.91, 0.85). Furthermore, sensitivity and specificity were remarkably different in systemic venous return (0.93, 0.3) and coronary vessels (0.8, 0.33) because of "false positive" findings, which were later found to be most likely real findings not detectable by reference standard. The opposite was true for cardiac valves (0.66, 0.89) and septa (0.76, 0.91). CONCLUSIONS EBCT delineates findings related to systemic venous return and coronary vessels well due to simultaneous visualization of complex anatomy. This advantage does not seem to apply in patients below 1 year of age with better acoustic windows. TTE was found more suitable for cardiac valves and septal defects because of the availability of flow imaging.
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Affiliation(s)
- Ulf H Beier
- Department of Pediatrics, Division of Pediatric Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
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Abstract
Non-invasive methods for detection of coronary atherosclerosis have been limited to indirect markers, such as myocardial perfusion or wall motion during exercise or pharmacological stress. However, advances in multislice computed tomography (MSCT) not allow sufficient spatial resolution for direct non-invasive imaging of the coronary arteries. This review focuses on imaging techniques and clinical applications of MSCT in human studies. Published studies of the diagnostic accuracy of MSCT in native coronary arteries and bypass grafts indicate excellent sensitivity and specificity for detection of 50% diameter stenosis. MSCT is particularly good for evaluating the origin and course of anomalous coronary arteries. MSCT offers the ability to visualise both the lumen and wall of artery, as well as to quantify coronary classification. Further technical developments promise to render MSCT the ideal non-invasive tool for direct visualisation of the coronary arteries.
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Affiliation(s)
- Jeffrey M Schussler
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
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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: 2.7] [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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Schussler JM, Dockery WD, Moore TR, Johnson KB, Rosenthal RL, Stoler RC. Computed tomographic coronary angiography: experience at Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital. Proc (Bayl Univ Med Cent) 2005; 18:228-33. [PMID: 16200178 PMCID: PMC1200730 DOI: 10.1080/08998280.2005.11928073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Noninvasive cardiac computed tomographic imaging using multislice or electron beam technology has been shown to be highly specific and sensitive in diagnosing coronary heart disease. It is about a fifth of the cost of coronary angiography and is particularly well suited for evaluating patients with a low or low to moderate probability of having obstructive coronary atherosclerosis. In addition, it offers more information than calcium scoring: because of the intravenous contrast used, it temporarily increases the density of the lumen and allows differentiation of soft plaque from calcified plaque. The Baylor Hamilton Heart and Vascular Hospital now uses this modality to define coronary atherosclerosis in patients who would otherwise have needed invasive coronary angiography; several research protocols with the technique are also under way. Baylor has recently upgraded to the 64-slice scanner. It is expected that computed tomographic coronary angiography will replace a significant percentage of invasive cardiac catheterizations.
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Affiliation(s)
- Jeffrey M Schussler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA.
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Fuster V, Fayad ZA, Moreno PR, Poon M, Corti R, Badimon JJ. Atherothrombosis and High-Risk Plaque. J Am Coll Cardiol 2005; 46:1209-18. [PMID: 16198833 DOI: 10.1016/j.jacc.2005.03.075] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Revised: 12/23/2004] [Accepted: 03/04/2005] [Indexed: 11/28/2022]
Abstract
This second part of the review on atherothrombosis highlights the diffuse nature of the disease analyzing the feasibility and potential of the noninvasive imaging modalities, including computed tomography (electron-beam computed and multi-detector computed tomography) and magnetic resonance imaging for its detection and monitoring. These imaging modalities are being established as promising tools in high-risk cardiovascular patients for identification and/or management of coronary calcification, stenotic or obstructive disease, high-risk plaques (not necessarily stenotic), and overall burden of the disease. In addition, such technology facilitates the understanding of the processes involved in the development and progression of atherothrombosis responsible for coronary, cerebral, and peripheral ischemic events.
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Affiliation(s)
- Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josee and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, New York, New York 10029, USA
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Adler Y, Fisman EZ, Shemesh J, Tanne D, Hovav B, Motro M, Schwammenthal E, Tenenbaum A. Usefulness of helical computed tomography in detection of mitral annular calcification as a marker of coronary artery disease. Int J Cardiol 2005; 101:371-6. [PMID: 15907403 DOI: 10.1016/j.ijcard.2004.03.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Revised: 01/27/2004] [Accepted: 03/03/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mitral annulus calcification (MAC) may be a form of atherosclerosis. The goal of the present work was to investigate whether helical CT can determine the presence of MAC and to clarify its possible association with coronary artery disease (CAD) in elderly patients. DESIGN AND METHODS Three hundred and twenty-nine consecutive elderly patients (165 men and 164 women, age range 60-79 years) underwent double helical CT of the heart to determine MAC and coronary calcifications (CC) according to a previously described protocol. RESULTS MAC was documented in 60 patients (25 men, 35 women; mean age 69 +/- 4.5 years, range 60-78 years). The non-MAC group (control) included 269 patients (140 men, 129 women; mean age 67 +/- 4.6 years, range 60-79 years). Age was the only risk factor which had significant association with MAC (p = 0.01). A significant difference was found between MAC and control group for mean total CC score and advanced CC (total CC > 300) (323 +/- 565 vs. 184 +/- 429, p = 0.033 and 30% vs. 16%, p = 0.017, respectively). A significant difference was also found between groups for the prevalent proven CAD (30% vs. 16%, p = 0.008). Stepwise logistic regression analysis identified age [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.7-6.4, p < 0.001)], gender (male) (OR 3.1, 95% CI 1.6-6.0, p = 0.001), and MAC (OR 2.4, 95% CI 1.2-5.0, p = 0.016) as the independent variables significantly associated with CAD. The independent variables significantly associated with advanced CC (TCS > 300) were MAC (OR 2.6, 95% CI 1.3-5.2, p = 0.005), gender (male) (OR 2.3, 95% CI 1.2-4.2, p = 0.012) and age (OR 1.9, 95% CI 1.0-3.7, p = 0.052). CONCLUSIONS Our study demonstrated the usefulness of helical computed tomography in the detection of mitral annular calcification as an additional marker of prevalent CAD. However, the diagnostic significance of the MAC detection is relatively minor and should not be considered as a direct proof for coronary atherosclerosis.
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Affiliation(s)
- Yehuda Adler
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Alkadhi H, Bettex D, Wildermuth S, Baumert B, Plass A, Grunenfelder J, Desbiolles L, Marincek B, Boehm T. Dynamic Cine Imaging of the Mitral Valve with 16-MDCT: A Feasibility Study. AJR Am J Roentgenol 2005; 185:636-46. [PMID: 16120911 DOI: 10.2214/ajr.185.3.01850636] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to assess the feasibility and image quality of dynamic cine-mode imaging of the mitral valve using retrospectively ECG-gated 16-MDCT. SUBJECTS AND METHODS Contrast-enhanced MDCT was performed in 37 patients who have a normal mitral valve, as shown on transesophageal echocardiography. Twenty CT data sets covering the valve apparatus were reconstructed every 5% step of the R-R interval. Multiplanar reconstructions were performed in the parallel short axis and perpendicular long axis of the left ventricle. Two independent blinded reviewers evaluated the image quality for dynamic cine-mode visualization of the valve components in systole and diastole and during the transitional phases in between. RESULTS Interobserver agreement for image quality ratings of valve components in all cardiac cycle phases ranged from good to excellent. Image quality for the visualization of valve leaflets, apposition zone, commissures, and mitral annulus (ranging from adequate to excellent) was significantly superior on perpendicular plane images than on parallel plane images for all cardiac phases (p < 0.05). Tendinous cords were visualized on both perpendicular and parallel planes with bad to adequate quality, whereas visualization of the papillary muscles was adequate to excellent on both imaging planes. Visualization of each valve component was superior in systole and diastole in both imaging planes as compared with the transitional phases (p <0.001). CONCLUSION Noninvasive cine-mode imaging of the mitral valve using retrospectively ECG-gated MDCT is feasible and allows accurate visualization of the moving valve. Perpendicular long-axis reconstructions yield images of superior quality when compared with the short-axis reconstructions and enable a determination of its functional morphology.
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Affiliation(s)
- Hatem Alkadhi
- Department of Medical Radiology, Institute of Diagnostic Radiology, University Hospital Zurich, Zurich 8091, Switzerland
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