Usefulness of calcium scoring using electron beam computed tomography and noninvasive coronary angiography in patients with suspected coronary artery disease

Leber, Alexander; Knez, Andreas; Mukherjee, Rahul; White, Carl W.; Huber, Armin; Becker, Alexander; Becker, Christoph; Reiser, Maximilian; Haberl, Ralph; Steinbeck, Gerhard

doi:10.1016/s0002-9149(01)01629-0

Cited by 42 publications

(23 citation statements)

References 24 publications

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“…However, other studies have demonstrated modest sensitivity (80%-85%) when using calcium score cut point values of 45-310 [26,27] . Diagnostic accuracy, sensitivity and negative predictive values were high for CCTA detection of significant and severe coronary stenoses on a persegment level.…”

Section: Discussionmentioning

confidence: 93%

Dual source computed tomography coronary angiography in new onset cardiomyopathy

Srichai

Fisch²,

Hecht³

et al. 2012

WJR

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AIM:To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy. METHODS:Eighteen patients (mean age 56.5 years, 10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction (ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled. Patients with known coronary artery disease, atrial fibrillation, creatinine > 1.5 g/dL, and contraindication to intravenous contrast administration were excluded. CCTA was performed using a dual source 64-slice scanner. Mean heart rate was 75 beats per minute. Stenosis was graded for each coronary segment as: none, mild (< 50%), moderate (50%-70%), severe (> 70%), or non-evaluable. Ischemic cardiomyopathy (ICM) was diagnosed if severe stenosis was present in the left main, proximal left anterior descending artery, or two or more major arteries. RESULTS:Two patients were diagnosed with ICM by ICA. CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM. CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%, sensitivity 70%, specificity 98.7%, positive predictive value of 70%, and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level. CONCLUSION:Dual source 64-slice multi-detector CCTA is a safe, accurate, and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.

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Section: Discussionmentioning

confidence: 93%

Dual source computed tomography coronary angiography in new onset cardiomyopathy

Srichai

Fisch²,

Hecht³

et al. 2012

WJR

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“…In clinical routine, a wide range of examination protocols with varying spatial resolution are used for coronary calcium scoring. While most studies use a slice thickness of 3 mm (z-axis resolution), the FOV size varies from 180×180 mm 2 to 430×430 mm 2 [8,[17][18][19][20][21], resulting in a broad bandwidth of spatial resolution in the x/y-plane. Some studies even used different FOV sizes in the same patient group [20,22].…”

Section: Discussionmentioning

confidence: 99%

Influence of a small field-of-view size on the detection of coronary artery calcifications with MSCT: in vitro and in vivo study

et al. 2005

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The purpose of this study is to asses the impact of small field-of-view (FOV) sizes on the detection of coronary artery calcifications using multislice-spiral computed tomography (MSCT). First, a static chest phantom containing calcium inserts was scanned 10 times using a standardized scan protocol. Secondly, 50 patients (28 male, 63.6+/-10.6 years) underwent cardiac MSCT using the same protocol. Images were reconstructed with three different FOV sizes (180x180, 220x220, 380x380 mm(2)). Coronary calcium scoring and risk stratification were performed for each image series. In the phantom study, the Agatston score calculated with a FOV size of 180x180 mm(2) was 657.80+/-20.05. At a FOV of 220x220 mm(2) and 380x380 mm(2), the corresponding values were 657.04+/-21.36 and 655.04+/-20.74, respectively. The corresponding values in the patient study were 541.65+/-869.87, 541.91+/-872.57 and 536.61+/-867.81. No statistically significant differences in the calcium score were found comparing different FOV sizes. Significantly more lesions (p=0.00149) were detected in the patient study. Comparing the different FOV sizes of 180x180 mm(2) and 220x220 mm(2) (380x380 mm(2)), four (six) patients had to be assigned to different risk groups. The use of small FOV sizes resulted in an improved detection of coronary calcifications influencing the risk stratification for further cardiac events in MSCT coronary calcium scoring.

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“…Noncalcified plaque can also be visualized by MDCT but requires the aid of injected contrast-enhancing dyes, and individual plaque components cannot be distinguished and quantified. Studies have been conducted to understand the differences in signal between stable and unstable angina 57,58 and within plaques to differentiate composition, 59 but CT is not yet a reliable source for quantifying calcification relative to other plaque components.…”

Section: Electron Beam Ctmentioning

confidence: 99%

Quantification of Calcification in Atherosclerotic Lesions

Higgins

Marvel

Morrisett

2005

ATVB

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Abstract-Calcification can be deposited throughout the vasculature in several forms of calcium phosphate, including calcium hydroxyapatite (CHA). Calcium accumulation in arteries by mineralization and calcium loss from bone by osteoporosis often coexist, and vascular calcification may share common mechanisms with bone remodeling. Deposition of calcification in valves and arteries diminishes the valvular or arterial wall elasticity, a major cause of aneurysm and stenosis. Obstruction of arteries by calcification and other components can lead to heart attack and stroke. Mineralization in the femoral arteries can cause intermittent claudication in the legs, causing decreased mobility. Key Words: calcification Ⅲ atherosclerosis Ⅲ MRI, micro-computed tomography Ⅲ ultrasound C alcium and phosphorus are the most abundant minerals in the body and are involved in a wide range of biochemical pathways, but mostly in the formation of calcium hydroxyapatite (CHA; Ca 10 (PO 4 ) 6 (OH) 2 ). Although CHA is the major natural component of bones and teeth, it can also deposit along with other forms of calcium phosphate in the vasculature with adverse affects. This type of deposit, known as vascular calcification, can ultimately lead to blood vessel stenosis, ischemia, and death. Approximately 90% of patients with cardiovascular disease (CVD) have vascular calcification. Because CVDs are the leading cause of death in the United States, there is considerable interest in understanding the mechanism(s) of vascular calcification and the implications for CVD.Healthy bone exists in a dynamic state of remodeling, requiring osteoblasts that build bone under alkaline conditions and osteoclasts that degrade it under acidic conditions. 1 Cytokines, such as bone morphogenetic proteins (BMPs), interleukin-6, insulin-like growth factor-1, as well as various hormones, regulate bone remodeling. 2 As a consequence of remodeling, bone calcium and phosphate turnover occurs. In this turnover process, resorbed minerals are used to regenerate bone. When the calcium lost in degradation exceeds the calcium deposited in remodeling, there is a net loss of bone mass. With increasing age, the rate of bone degradation exceeds the rate of formation, resulting in osteoporosis, particularly in postmenopausal women, with decreased estrogens, which inhibit cytokines. 3 Some of the calcium and phosphate mobilized by remodeling may become deposited in the arterial wall, leading to atherosclerosis in Ն1 arterial bed.CHA is the most stable form of insoluble calcium phosphate. 4 Under biological conditions, formation of CHA proceeds through noncrystalline amorphous calcium phosphate (ACP), which is stable under alkaline conditions (pH Ն8). Formation of ACP and CHA can be inhibited by many ions and other factors at their normal tissue concentrations. Osteoblast activity regulates formation of CHA, and alkaline phosphatase, which operates under alkaline conditions, is a marker for formation of ACP and its conversion to CHA. 4 Although the mechanism of nucleation of ACP a...

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Usefulness of calcium scoring using electron beam computed tomography and noninvasive coronary angiography in patients with suspected coronary artery disease

Cited by 42 publications

References 24 publications

Dual source computed tomography coronary angiography in new onset cardiomyopathy

Dual source computed tomography coronary angiography in new onset cardiomyopathy

Influence of a small field-of-view size on the detection of coronary artery calcifications with MSCT: in vitro and in vivo study

Quantification of Calcification in Atherosclerotic Lesions

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