Escore de cálcio e angiotomografia coronariana na estratificação do risco cardiovascular

Abstract

Cardiovascular disease is the leading mortality cause worldwide. The capacity to identify among the asymptomatic individuals the subgroup at greater risk for developing cardiovascular events is fundamental in any strategy aimed at reducing the rate of cardiovascular events. The first step in cardiovascular risk stratification is the use of global risk scores, the Framingham risk score being the most frequently used. However, previous studies have shown that, although very useful, clinical scores, when used alone, have a limited capacity for stratifying cardiovascular risk in a significant part of the population.In that context, coronary artery calcium score (CACS) and coronary computed tomographic angiography might play an important role as complementary tools for risk stratification of asymptomatic patients. The CACS provides important prognostic information that is incremental to clinical scores based on traditional risk factors and other diagnostic modalities, such as C-reactive protein measurement. In addition, CACS has the potential to change and help the patients' clinical management. On the other hand, coronary computed tomographic angiography provides a detailed assessment of the anatomy of the coronary arteries, allowing visualizing not only the lumen, but also the coronary arterial walls. Compared with conventional invasive coronary angiography, coronary computed tomographic angiography has excellent accuracy to identify and mainly exclude the presence of significant obstructive lesions. In addition, it proved to be able to provide incremental prognostic information to traditional risk factors and CACS.

Impaired Aortic Elasticity and Diastolic Functions Are Associated with Findings of Coronary Computed Tomographic Angiography

“…Coronary computed tomographic angiography (CTA) has evolved as an emerging diagnostic modality and is increasingly used in medical practice. Parameters derived from CTA (e.g., coronary calcium score, plaque area, and epicardial fat) have been studied and used for cardiovascular risk stratification [15]. Although the relation of calcium score with aortic stiffness has been known, knowledge about the relation between stiffness and epicardial fat volume (EFV) is limited.…”

Relationship between Calcium Score and Myocardial Scintigraphy in the Diagnosis of Coronary Disease

“…It has thus arisen great interest in its possibilities of diagnostic and prognostic application since it was described and used as a coronary disease detection technique, initially through fluoroscopy and electron beam CT in the 70's. 31-33 …”

“…31,32,36 Throughout the years, the focus switched to prognostic power and cardiovascular event occurrence prediction ability. 33,37-40 …”

“…Several studies have shown that, as an indicator of atherosclerosis and cardiovascular risk, that is independent and superior to other methods and clinical scores, 33,37-40 the presence of coronary calcification is correlated to cardiovascular events.…”

Tráfego veicular e a espessura da camada íntima média das carótidas no Estudo Longitudinal da Saúde do Adulto-ELSA Brasil

“…Comparada à coronariografia invasiva convencional, a angiotomografia apresenta excelente acurácia para identificar e, principalmente, excluir a presença de lesões obstrutivas significativas. Adicionalmente, demonstrou-se ser capaz de proporcionar informações quando associadas a fatores de risco tradicionais e ao EC coronariano (Azevedo et al, 2012). Destaca-se, então, como método propedêutico na estratificação de risco e predição de eventos cardíacos adversos, especialmente em grupos de risco intermediário (Oudkerk et al, 2008), mas possui valor limitado como desfecho em estudos de progressão/regressão seriados, além de não se haver, ainda, valores de referência estabelecidos para a população brasileira (Budoff & Gul, 2008).…”