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Current Vascular Pharmacology


ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

General Research Article

Mandatory Reporting of Coronary Artery Calcifications Incidentally Noted on Chest Multi-Detector Computed Tomography: A Multicentre Experience

Author(s): Salvatore Cappabianca, Maria Paola Belfiore*, Alfonso Reginelli, Raffaella Capasso, Alessandra Del Prete, Mario Petrillo, Paola Mascia, Claudia Rossi, Francesco Romano, Massimo De Filippo, Michele Scialpi, Felice Gragnano, Paolo Calabrò, Giuseppe Belfiore, Luca Brunese, Roberto Grassi and Antonio Rotondo

Volume 17 , Issue 1 , 2019

Page: [92 - 98] Pages: 7

DOI: 10.2174/1570161116666180117111856

Price: $65


Background: Coronary Artery Calcifications (CACs) are associated with coronary atherosclerosis and Cardiovascular (CV) events. In “non-cardiovascular” settings, CACs can be easily detected on chest Multi-Detector Computed Tomography (MDCT). Their evaluation may help to better stratify CV risk in the general population, especially for primary prevention.

Aims: We retrospectively evaluated the relationship between CAC distribution and CV risk, determined by Framingham Risk Score (FRS), in a cohort of patients who underwent chest MDCT performed for several clinical indications.

Method: We retrospectively recruited 305 patients (194 men, 111 women; mean age 70.5 years) from 3 different Italian centres. Patients with coronary stent, pacemaker and/or CV devices were excluded from the study. Circumflex Artery (LCX), Left Main Coronary Artery (LMCA), left Anterior Descending artery (LAD) and right coronary artery (RCA) were analysed.

Results: From a total population of 305 patients, 119 (39%) had low FRS (<10%), 115 (38%) had intermediate FRS (10-20%), and 71 (23%) had high FRS (>20%). The study identified 842 CACs located in decreasing order as follows: RCA (34.5%), LAD (32.3%), LCX (28%) and LMCA (13%). Statistical two-step analysis subdivided patients into two clusters according to FRS (risk threshold = 12.38%): cluster I (mean 9.34) and cluster II (mean 15.09). A significant association between CAC distribution and cluster II was demonstrated. CACs were mostly detected in patients with intermediate FRS. All patients (100%) with the highest CV risk showed intermediate RCA and LMCA involvement.

Conclusion: Radiologists can note the distribution of CACs on a chest MDCT and should mandatorily record them in their reports. Depending on CAC presence and location, these findings may have important clinical implications, mostly in asymptomatic patients with intermediate FRS. This information may reclassify a patients’ CV risk and improve clinical management.

Keywords: Coronary artery calcification, multi-detector computed tomography, cardiovascular risk, framingham risk score, radiological report, circumflex artery, clinical management.

Graphical Abstract
Budoff MJ, Nasir K, McClelland RL, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2009; 53: 345-52.
Adler Y, Fisman EZ, Shemesh J, et al. Spiral computed tomography evidence of close correlation between coronary and thoracic aorta calcifications. Atherosclerosis 2004; 176: 133-8.
Al-Mallah MH, Nasir K, Katz R, et al. Thoracic aortic distensibility and thoracic aortic calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2010; 106: 575-80.
Peretto G, Lazzeroni D, Sartorio CL, Camici PG. Cardiotoxicity in oncology and coronary microcirculation: Future challenges in theranostics. Front Biosci 2017; 22: 1760-73.
Hecht H, Blaha MJ, Berman DS, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: Expert consensus statement from the society of cardiovascular computed tomography. J Cardiovasc Comput Tomogr 2017; 11: 157-68.
Shemesh J. Coronary artery calcification in clinical practice: What we have learned and why should it routinely be reported on chest CT? Ann Transl Med 2016; 4: 159.
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. J Am Coll Cardiol 2000; 36: 326-40.
Albiero M, Rattazzi M, Menegazzo L, et al. Myeloid calcifying cells promote atherosclerotic calcification via paracrine activity and allograft inflammatory factor-1 overexpression. Basic Res Cardiol 2013; 108: 1-14.
Fruchart JC, Nierman MC, Stroes ES, et al. New risk factors for atherosclerosis and patient risk assessment. Circulation 2004; 109: 3-15.
D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care the Framingham heart study. Circulation 2008; 117: 743-53.
Grundy SM, Balady GJ, Criqui MH, et al. Primary prevention of coronary heart disease: Guidance from framingham a statement for healthcare professionals from the AHA task force on risk reduction. Circulation 1998; 97: 1876-87.
Desai MY, Nasir K, Braunstein JB, et al. Underlying risk factors incrementally add to the standard risk estimate in detecting subclinical atherosclerosis in low-and intermediate-risk middle-aged asymptomatic individuals. Am Heart J 2004; 148: 871-7.
Rumberger JA. Using noncontrast cardiac CT and coronary artery calcification measurements for cardiovascular risk assessment and management in asymptomatic adults. Vasc Health Risk Manag 2010; 6: 579-91.
Souza AS, Bream PR, Elliott LP. Chest film detection of coronary artery calcification. The value of the CAC triangle 1. Radiology 1978; 129: 7-10.
McCarthy JH, Palmer FJ. Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499.
Horiguchi J, Yamamoto H, Akiyama Y, et al. Coronary artery calcium scoring using 16-MDCT and a retrospective ECG-gating reconstruction algorithm. Am J Roentgenology 2004; 183: 103-8.
Moore EH, Greenberg RW, Merrick SH, et al. Coronary artery calcifications: Significance of incidental detection on CT scans. Radiology 1989; 172: 711-6.
Sevrukov A, Jelnin V, Kondos GT. Electron beam CT of the coronary arteries: Cross-sectional anatomy for calcium scoring. Am J Roentgenology 2001; 177: 1437-45.
Callaway MP, Richards P, Goddard P, et al. The incidence of coronary artery calcification on standard thoracic CT scans. Br J Radiol 1997; 70: 572-4.
Sarwar A, Shaw LJ, Shapiro MD, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2009; 2: 675-88.
Rajani R, Dey D, Berman DS. Non-enhanced cardiac computed tomography still an open book. J Nucl Cardiol 2011; 18: 21-3.
Heussel CP, Voigtlaender T, Kauczor HU, et al. Detection of coronary artery calcifications predicting coronary heart disease: Comparison of fluoroscopy and spiral CT. Eur Radiol 1998; 8: 1016-24.
Masuda Y, Naito S, Aoyagi Y, et al. Coronary artery calcification detected by CT: Clinical significance and angiographic correlates. Angiology 1990; 41: 1037-47.
Nishida C, Okajima K, Yamamoto T, et al. The relationship between coronary artery calcification detected by non-gated multi-detector CT in patients with suspected ischemic heart disease and myocardial ischemia detected by thallium exercise stress testing. Ann Nucl Med 2005; 19: 647-53.
Kiliçkesmez KO, Kiliçkesmez Ö, Taşdelen N, et al. Incidental detection of coronary artery calcifications on non-cardiac thoracic CT examinations. Marmara Med J 2009; 22: 197-202.
De Filippo M, Capasso R. Coronary Computed Tomography Angiography (CCTA) and Cardiac Magnetic Resonance (CMR) imaging in the assessment of patients presenting with chest pain suspected for acute coronary syndrome. Ann Transl Med 2016; 4: 255.
Haberl R, Becker A, Leber A, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: Results of 1,764 patients. J Am Coll Cardiol 2011; 37: 451-7.
Thilo C, Gebregziabher M, Mayer FB, et al. Correlation of regional distribution and morphological pattern of calcification at CT coronary artery calcium scoring with non-calcified plaque formation and stenosis. Eur Radiol 2010; 20: 855-61.
Almoudi M, Sun Z. Coronary artery calcium score: Re-evaluation of its predictive value for coronary artery disease. World J Cardiol 2012; 4: 284.
Okwuosa TM, Greenland P, Ning H, et al. Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary risk assessment. J Am Coll Cardiol 2011; 57: 1838-45.
Calabrò P, Limongelli G, Pacileo G, et al. The role of adiposity as a determinant of an inflammatory milieu. J Cardiovasc Med 2008; 9: 450-60.
Forte L, Cimmino G, Loffredo F, et al. C-reactive protein is released in the coronary circulation and causes endothelial dysfunction in patients with acute coronary syndromes. Int J Cardiol 2011; 152: 7-12.
Calabrò P, Golia E, Yeh ET. Role of C-reactive protein in acute myocardial infarction and stroke: Possible therapeutic approaches. Curr Pharm Biotechnol 2012; 13: 4-16.
Memoli B, Procino A, Calabrò P, et al. Inflammation may modulate IL-6 and C-reactive protein gene expression in the adipose tissue: The role of IL-6 cell membrane receptor. Am J Physiol Endocrinol Metab 2007; 293: 1030-5.
Cirillo P, Pacileo M, De Rosa S, et al. HMG-CoA reductase inhibitors reduce nicotine-induced expression of cellular adhesion molecules in cultured human coronary endothelial cells. J Vasc Res 2007; 44: 460-70.
Marfella R, Sasso FC, Siniscalchi M, et al. Peri-procedural tight glycemic control during early percutaneous coronary intervention is associated with a lower rate of in-stent restenosis in patients with acute ST-elevation myocardial infarction. J Clin Endocrinol Metab 2012; 97: 2862-71.
Jacobs PC, Gondrie MJ, van der Graaf Y, et al. Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol 2012; 198: 505-11.
Išgum I, Rutten A, Prokop M, et al. Detection of coronary calcifications from computed tomography scans for automated risk assessment of coronary artery disease. Med Phys 2007; 34: 1450-61.
Hermann DM, Gronewold J, Lehmann N, et al. Coronary artery calcification is an independent stroke predictor in the general population. Stroke 2013; 44: 1008-13.
Saremi A, Bahn G, Reaven PD. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care 2012; 35: 2390-2.
Kolte D, Aronow WS, Banach M. Polypills for the prevention of cardiovascular diseases. Expert Opin Investig Drugs 2016; 25: 1255-64.
Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: The task force on the management of stable coronary artery disease of the European society of cardiology. Eur Heart J 2013; 34: 2949-3003.
Tresoldi S, Flor N, Luciani A, Lombardi MA, Colombo B, Cornalba G. Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions. Eur Radiol 2015; 25: 3200-6.
Chargari C, Riet F, Mazevet M, Morel E, Lepechoux C, Deutsch E. Complications of thoracic radiotherapy. Presse Med 2013; 42: 342-51.
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: Cardio-oncology. Mayo Clin Proc 2014; 89: 1287-306.
Hecht HS. Coronary artery calcium analysis and reporting on noncontrast chest CT scans: A paradigm shift in prevention. Cardiac Comp Tomograp 2016; 9: 11.
Biswas G. Review of forensic medicine and toxicology. 2nd ed. New Delhi: JP Medical Ltd 2012.
Thompson GR, Partridge J. Coronary calcification score: The coronary-risk impact factor. Lancet 2004; 363: 557-9.
Taylor J. Patients visualizing their calcified coronary arteries may be wake-up call to change lifestyle. Eur Heart J 2015; 36: 2482.
La Grutta L, Malagò R, Maffei E, et al. Collateral non cardiac findings in clinical routine CT coronary angiography: Results from a multi-center registry. Radiol Med 2015; 120: 1122-9.
Cademartiri F, Di Cesare E, Francone E, et al. Italian registry of cardiac computed tomography. Radiol Med 2015; 120: 919-29.
Grassi R, Cavaliere C, Cozzolino S, Mansi L. Small animal imaging facility: New perspectives for the radiologist. Radiol Med 2009; 114: 152-67.
Wichmann JL, Hu X, Engler A, et al. Dose levels and image quality of second-generation 128-slice dual-source coronary CT angiography in clinical routine. Radiol Med 2015; 120: 1112-21.
Hu X, Frellesen C, Bauer RW, et al. Computed tomography of dynamic changes of the aortic root during systole and diastole in patients with coronary artery calcification. Radiol Med 2015; 120: 595-602.
Centonze M, Lorenzin G, Francesconi A, et al. Cardiac-CT and Cardiac-MR examinations cost analysis, based on data of four Italian centres. Radiol Med 2016; 121: 12-8.

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