Risk Stratification of Non-contrast CT Beyond the Coronary Calcium Scan

Overview

Journal J Cardiovasc Comput Tomogr

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
Radiology

Date 2012 Sep 18

PMID 22981856

Citations 11

Authors

Paul Madaj

Matthew J Budoff

Affiliations

Soon will be listed here.

Abstract

Coronary artery calcification (CAC) is a well-known marker for coronary artery disease and has important prognostic implications. CAC is able to provide clinicians with a reliable source of information related to cardiovascular atherosclerosis, which carries incremental information beyond Framingham risk. However, non-contrast scans of the heart provide additional information beyond the Agatston score. These studies are also able to measure various sources of fat, including intrathoracic (eg, pericardial or epicardial) and hepatic, both of which are thought to be metabolically active and linked to increased incidence of subclinical atherosclerosis as well as increased prevalence of type 2 diabetes. Testing for CAC is also useful in identifying extracoronary sources of calcification. Specifically, aortic valve calcification, mitral annular calcification, and thoracic aortic calcium (TAC) provide additional risk stratification information for cardiovascular events. Finally, scanning for CAC is able to evaluate myocardial scaring due to myocardial infarcts, which may also add incremental prognostic information. To ensure the benefits outweigh the risks of a scanning for CAC for an appropriately selected asymptomatic patient, the full utility of the scan should be realized. This review describes the current state of the art interpretation of non-contrast cardiac CT, which clinically should go well beyond coronary artery Agatston scoring alone.

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References

Rumberger J . Practical tips and tricks in cardiovascular computed tomography: non-contrast "heartscans"--beyond the calcium score. J Cardiovasc Comput Tomogr. 2009; 3(1):52-6. DOI: 10.1016/j.jcct.2008.11.002. View

Budoff M, Gupta M . Radiation exposure from cardiac imaging procedures: do the risks outweigh the benefits?. J Am Coll Cardiol. 2010; 56(9):712-4. DOI: 10.1016/j.jacc.2010.03.055. View

Takasu J, Katz R, Nasir K, Carr J, Wong N, Detrano R . Relationships of thoracic aortic wall calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2008; 155(4):765-71. PMC: 2323597. DOI: 10.1016/j.ahj.2007.11.019. View

Messika-Zeitoun D, Bielak L, Peyser P, Sheedy P, Turner S, Nkomo V . Aortic valve calcification: determinants and progression in the population. Arterioscler Thromb Vasc Biol. 2006; 27(3):642-8. DOI: 10.1161/01.ATV.0000255952.47980.c2. View

Ding J, Hsu F, Harris T, Liu Y, Kritchevsky S, Szklo M . The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2009; 90(3):499-504. PMC: 2728641. DOI: 10.3945/ajcn.2008.27358. View

Santos R, Rumberger J, Budoff M, Shaw L, Orakzai S, Berman D . Thoracic aorta calcification detected by electron beam tomography predicts all-cause mortality. Atherosclerosis. 2009; 209(1):131-5. DOI: 10.1016/j.atherosclerosis.2009.08.025. View

Mueller D, Kutscherenko A, Bartel H, Vlassenbroek A, Ourednicek P, Erckenbrecht J . Phantom-less QCT BMD system as screening tool for osteoporosis without additional radiation. Eur J Radiol. 2010; 79(3):375-81. DOI: 10.1016/j.ejrad.2010.02.008. View

Kang H, Greenson J, Omo J, Chao C, Peterman D, Anderson L . Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD. Am J Gastroenterol. 2006; 101(10):2247-53. DOI: 10.1111/j.1572-0241.2006.00719.x. View

Hamaguchi M, Kojima T, Takeda N, Nagata C, Takeda J, Sarui H . Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol. 2007; 13(10):1579-84. PMC: 4146902. DOI: 10.3748/wjg.v13.i10.1579. View

10.

Lee H, Kim Y, Hur J, Nam J, Kim T, Choe K . Coronary artery anomalies: detection on coronary artery calcium scoring scan. AJR Am J Roentgenol. 2010; 194(5):W382-7. DOI: 10.2214/AJR.09.3336. View

11.

Hadamitzky M, Hein F, Meyer T, Bischoff B, Martinoff S, Schomig A . Prognostic value of coronary computed tomographic angiography in diabetic patients without known coronary artery disease. Diabetes Care. 2010; 33(6):1358-63. PMC: 2875454. DOI: 10.2337/dc09-2104. View

12.

Sacks H, Fain J . Human epicardial adipose tissue: a review. Am Heart J. 2007; 153(6):907-17. DOI: 10.1016/j.ahj.2007.03.019. View

13.

Rodriguez-Granillo G, Rosales M, Renes P, Diez E, Pereyra J, Gomez E . Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions. J Cardiovasc Comput Tomogr. 2010; 4(2):99-107. DOI: 10.1016/j.jcct.2009.12.003. View

14.

Gupta M, Kadakia J, Hacioglu Y, Ahmadi N, Patel A, Choi T . Non-contrast cardiac computed tomography can accurately detect chronic myocardial infarction: Validation study. J Nucl Cardiol. 2010; 18(1):96-103. PMC: 3032183. DOI: 10.1007/s12350-010-9314-3. View

15.

Targher G, Bertolini L, Poli F, Rodella S, Scala L, Tessari R . Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes. 2005; 54(12):3541-6. DOI: 10.2337/diabetes.54.12.3541. View

16.

Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D . Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation. 2004; 110(22):3424-9. DOI: 10.1161/01.CIR.0000148131.41425.E9. View

17.

Schenker M, Dorbala S, Hong E, Rybicki F, Hachamovitch R, Kwong R . Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation. 2008; 117(13):1693-700. PMC: 3955029. DOI: 10.1161/CIRCULATIONAHA.107.717512. View

18.

Owens D, Budoff M, Katz R, Takasu J, Shavelle D, Carr J . Aortic valve calcium independently predicts coronary and cardiovascular events in a primary prevention population. JACC Cardiovasc Imaging. 2012; 5(6):619-25. PMC: 3376353. DOI: 10.1016/j.jcmg.2011.12.023. View

19.

Kim R, Fieno D, Parrish T, Harris K, Chen E, Simonetti O . Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999; 100(19):1992-2002. DOI: 10.1161/01.cir.100.19.1992. View

20.

Schindhelm R, Dekker J, Nijpels G, Bouter L, Stehouwer C, Heine R . Alanine aminotransferase predicts coronary heart disease events: a 10-year follow-up of the Hoorn Study. Atherosclerosis. 2006; 191(2):391-6. DOI: 10.1016/j.atherosclerosis.2006.04.006. View