Clinical Significance of the Coronary Calcification Score by Multidetector Row Computed Tomography for the Evaluation of Coronary Stenosis in Japanese Patients

Abstract

oronary artery disease (CAD) is the most important cause of death in the industrialized world 1,2 and an efficient noninvasive method of detection is needed. Techniques for measuring coronary artery calcification (CAC) as a marker of atherosclerosis using electronbeam computed tomography (EBCT) have been developed. 3,4 Calcification as assessed by EBCT is associated with atherosclerosis at autopsy and the results of coronary angiography (CAG). 5 Multidetector row computed tomography (MDCT) has become more widely available in many general hospitals, and it is becoming increasingly likely that high-risk patients will undergo CAC scoring by MDCT as well as EBCT, because MDCT enables accurate assessment of coronary artery luminal narrowing 6,7 and several studies have shown a high correlation between CAC scores as assessed by MDCT and those determined by EBCT. 8,9 In addition, MDCT has emerged as a potential noninvasive method for imaging the coronary arteries and is a sensitive modality for the diagnosis of coronary artery stenosis. It can be very difficult to detect coronary artery stenosis if there is advanced calcification, although the CAC score has been shown to be a marker for predicting CAD. The presence of CAC can be assessed noninvasively using either EBCT or MDCT. Although several studies have revealed a correlation between CAC and angiographic stenosis, 10-16 few studies have used MDCT and it is unknown whether the CAC score is the most important predictor of significant coronary stenosis as assessed by CAG independent of other factors, such as age, body mass index and medication. To evaluate the clinical significance of the CAC score determined by MDCT, we compared coronary artery stenosis as assessed by CAG with the CAC score, coronary risk factors and medications. In addition, when it was difficult to assess the coronary artery lumen on MDCT because of severely calcified lesions, we analyzed whether a higher CAC score might be a helpful indicator of the need to perform CAG. Background The coronary artery calcification (CAC) score measured by multidetector row computed tomography (MDCT) has emerged as a marker for predicting coronary artery disease (CAD). To evaluate the clinical significance of the CAC score, coronary artery stenosis as assessed by coronary angiography (CAG) was compared with the CAC score determined by MDCT, risk factors and medications. Methods and ResultsSubjects included 374 consecutive patients who underwent ECG-gate CT angiography using MDCT. The accuracy in patients with a CAC score ≥400 was 84%, and significantly lower than that in patients with a CAC score =0. In addition 92 patients (68 males, 24 females; mean age, 63±11 years) who underwent both MDCT and CAG within a 1-month period were selected for further investigation. Patients with significant coronary stenosis had a significantly higher CAC score than those without stenosis. In addition, a higher number of stenosed vessels was associated with a higher CAC score. The subjects were divided into 3 groups according to the ...

Clinical Implications of the Coronary Artery Calcium Score in Japanese Patients

“…In addition, a previous study using a hybrid single photon emission computed tomography (SPECT)/CT camera showed that the extent of myocardial perfusion defects tends to worsen as the degree of coronary calcification increases 31) . Furthermore, in a study of 92 patients with 819 segments who underwent invasive CT angiography, the accuracy of a CAC score of 0 was excellent (93%) and a higher number of stenosed vessels was found to be associated with a higher CAC score 32) .…”

Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

“…About sixty 3mm-thick slices of the coronary arteries were obtained during a single breath hold (15-20 sec) using prospective ECG-gated axial scanning. Images from the examination were analyzed for the presence and extent of CAC by using coronary calcium quantification software (Aquarius workstation, TeraRecon, Inc., USA) according to the Agatston method [28,29].…”

Aortic Arch Calcification and Arterial Stiffness are Independent Factors for Diastolic Left Ventricular Dysfunction in Chronic Hemodialysis Patients

“…3,4 Vascular calcification is very common in end-stage renal disease (ESRD), especially in HD patients. 5 The mechanisms of vascular calcification are hyperphosphatemia and elevated calcium (Ca) × phosphate product. 6,7 Clinical studies have supported the association between vascular calcification and cardiac changes.…”