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

Author(s): Hala T. Salem, Eman A.S. Sabek*

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 17 , Issue 4 , 2021


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Graphical Abstract:


Abstract:

Aim and Objective: The study aimed to estimate the relationship between Coronary Calcium Scoring (CCS) and the presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection.

Background: Coronary Calcium Scoring (CCS) is a test that uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep “patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information”.

Methods: Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, and measures to keep them as low as possible were presented. CCS and Framingham risk estimates were compared to obtain the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions.

Results: CCS is a strong discriminator for obstructive CAD with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate, which has high sensitivity and low specificity.

Conclusion: CCS helps to reduce the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions are unlikely, and this as a test does not use contrast material, thus harmful effect on the kidney will be avoided as most of the coronary atherosclerotic patients have renal problems.

Keywords: Coronary angiography, coronary calcium score, effective radiation dose, cardiac imaging, coronary heart disease, framingham risk estimates, national cholesterol education program risk categories.

[1]
Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. Radiol Bras 2017; 50(3): 182-9.
[http://dx.doi.org/10.1590/0100-3984.2015.0235] [PMID: 28670030]
[2]
van der Bijl N, Joemai RM, Geleijns J, et al. Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary angiography. AJR Am J Roentgenol 2010; 195(6): 1299-305.
[http://dx.doi.org/10.2214/AJR.09.3734] [PMID: 21098187]
[3]
Vizzuso A, Righi R, Carnevale A, Zerbini M, Benea G, Giganti M. Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis: how the plaque type influences the diagnostic performance. Pol J Radiol 2019; 84: e522-9.
[http://dx.doi.org/10.5114/pjr.2019.91259] [PMID: 32082450]
[4]
McCullough P. Outcomes of contrast-induced nephropathy: experience in patients undergoing cardiovascular intervention. Catheter Cardiovasc Interv 2006; 67(3): 335-43.
[http://dx.doi.org/10.1002/ccd.20658 ]
[5]
Einstein AJ, Berman DS, Min JK, et al. Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation. J Am Coll Cardiol 2014; 63(15): 1480-9.
[http://dx.doi.org/10.1002/ccd.20658 ]
[6]
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15(4): 827-32.
[http://dx.doi.org/10.1016/0735-1097(90)90282-T] [PMID: 2407762]
[7]
Sabarudin A, Sun Z. Radiation dose measurements in coronary CT angiography. World J Cardiol 2013; 5(12): 459-64.
[http://dx.doi.org/10.4330/wjc.v5.i12.459] [PMID: 24392190]
[8]
Kalra DK, Heo R, Valenti V, Nakazato R, Min JK. Role of computed tomography for diagnosis and risk stratification of patients with suspected or known coronary artery disease. Arterioscler Thromb Vasc Biol 2014; 34(6): 1144-54.
[http://dx.doi.org/10.1161/ATVBAHA.113.302074] [PMID: 24723554]
[9]
Cleeman JI, Grundy SM, Becker D. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285(19): 2486-97.
[http://dx.doi.org/10.1001/jama.285.19.2486] [PMID: 11368702]
[10]
Johnson KM, Dowe DA, Brink JA. Traditional clinical risk assessment tools do not accurately predict coronary atherosclerotic plaque burden: a CT angiography study. AJR Am J Roentgenol 2009; 192(1): 235-43.
[http://dx.doi.org/10.2214/AJR.08.1056] [PMID: 19098205]
[11]
Idée JM, Pinès E, Prigent P, Corot C. Allergy-like reactions to iodinated contrast agents. A critical analysis. Fundam Clin Pharmacol 2005; 19(3): 263-81.
[http://dx.doi.org/10.1111/j.1472-8206.2005.00326.x] [PMID: 15910651]
[12]
Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BioMed Res Int 2014; 2014741018
[http://dx.doi.org/10.1155/2014/741018] [PMID: 24895606]
[13]
Singh J, Daftary A. Iodinated contrast media and their adverse reactions. J Nucl Med Technol 2008; 36(2): 69-74.
[http://dx.doi.org/10.2967/jnmt.107.047621] [PMID: 18483141]
[14]
O’Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000; 102(1): 126-40.
[http://dx.doi.org/10.1161/01.CIR.102.1.126] [PMID: 10880426]
[15]
Torres FS, Venkatesh V, Nguyen ET, Jimenez-Juan L, Crean AM. Coronary calcium scan acquisition before coronary CT angiography: limited benefit or useful addition? AJR Am J Roentgenol 2013; 200(1): 66-73.
[http://dx.doi.org/10.2214/AJR.12.8643] [PMID: 23255743]
[16]
Andreucci M, Faga T, Serra R, De Sarro G, Michael A. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf 2017; 9: 25-37.
[http://dx.doi.org/10.2147/DHPS.S122207] [PMID: 28579836]
[17]
Valdivielso JM, Rodríguez-Puyol D, Pascual J, et al. Atherosclerosis in chronic kidney disease: more, less, or just different? Arterioscler Thromb Vasc Biol 2019; 39(10): 1938-66.
[http://dx.doi.org/10.1161/ATVBAHA.119.312705] [PMID: 31412740]
[18]
Woolfson RG. Renal failure in atherosclerotic renovascular disease: pathogenesis, diagnosis, and intervention. Postgrad Med J 2001; 77(904): 68-74.
[http://dx.doi.org/10.1136/pmj.77.904.68] [PMID: 11161070]
[19]
Hunold P, Vogt FM, Schmermund A, et al. Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT. Radiology 2003; 226(1): 145-52.
[http://dx.doi.org/10.1148/radiol.2261011365] [PMID: 12511683]
[20]
Baron KB, Choi AD, Chen MY. Low radiation dose calcium scoring: Evidence and techniques. Curr Cardiovasc Imaging Rep 2016; 9: 12.
[http://dx.doi.org/10.1007/s12410-016-9373-1] [PMID: 27057268]
[21]
Palumbo AA, Maffei E, Martini C, et al. Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis. Eur Radiol 2009; 19(9): 2127-35.
[http://dx.doi.org/10.1007/s00330-009-1398-2] [PMID: 19387651]
[22]
Lau GT, Ridley LJ, Schieb MC, et al. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology 2005; 235(2): 415-22.
[http://dx.doi.org/10.1148/radiol.2352031813] [PMID: 15858083]
[23]
Akram K, O’Donnell RE, King S, Superko HR, Agatston A, Voros S. Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. Atherosclerosis 2009; 203(2): 533-7.
[http://dx.doi.org/10.1016/j.atherosclerosis.2008.07.008] [PMID: 18774135]
[24]
Akosah KO, Schaper A, Cogbill C, Schoenfeld P. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003; 41(9): 1475-9.
[http://dx.doi.org/10.1016/S0735-1097(03)00187-6] [PMID: 12742284]
[25]
Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology 2012; 264(3): 637-49.
[http://dx.doi.org/10.1148/radiol.12110810] [PMID: 22919038]
[26]
Sara L, Szarf G, Tachibana A, et al. II diretriz de ressonância magnética e tomografia computadorizada cardiovascular da sociedade brasileira de cardiologia e do colégio brasileiro de radiologia. Arq Bras Cardiol 2014; 103(6)(Suppl. 3): 1-86.
[http://dx.doi.org/10.5935/abc.2014S006] [PMID: 25594284]
[27]
Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004; 291(2): 210-5.
[http://dx.doi.org/10.1001/jama.291.2.210] [PMID: 14722147]


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Article Details

VOLUME: 17
ISSUE: 4
Year: 2021
Published on: 23 October, 2020
Page: [517 - 523]
Pages: 7
DOI: 10.2174/1573405616666201023142030

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