CT Coronary Arteries Calcium Score

  • Indications

  • Current Guidelines for Calcium Score 2018
  • https://heart.thecommonvein.net/95h-normal-calcium-score-normal-coronaries/
  • 62 year old male with atypical chest pain
    CT calcium score shows heavy calcification in the LAD but also involving the left main with a total score 1203 which is the 96th percentile for his age and sex
    Ashley Davidoff MD
    thecommonvein.net

     

  • 41 year old male with significant family history

    41 year old male with significant family history
    CT calcium score shows spotty foci of calcification with a total score of 437 which is the 99th percentile for his age and sex
    Ashley Davidoff MD
    thecommonvein.net
  • Definition

    •  preventive tool
    • used to identify calcific atheroscleosis
  • BAckground

    • Approximately 50% of all cardiovascular disease (CVD)–related deaths
      • no prior cardiac symptoms or diagnoses,
  • Aim

    • Identify the presence of atherosclerosis in
    • patients in whom management may change
      • ie those wh would benefit for conservative preventive management
        • positive family history
        • ACC Risk Calculator
        • categorised
          • low-risk,
          • intermediate-risk, and h
          • igh-risk for future heart attacks.
  • Indications

  • Current Guidelines for Calcium Score 2018
    • Smoking,
    • Obesity,
    • hypercholesterolemia
    • hypertension,
    • diabetes
    • sedentary lifestyl
    • positive family history of myocardial infarction,
    • inflammatory diseases like rheumatoid arthritis, diabetes.
  • Calcium score should be considered in people between 45-70 years of age.
    • Under 40, the zero score’s negative predictive value is not high since there has not been enough time for the lipid-rich-plaques to calcify.
    • Above 70,
      • nearly everyone has calcification of the coronary arteries. 
        • positive unless significantly elevated,
          • not necessarily signify high risk. 
        • calcium score of 0
          • very high negative predictive value. 
  • Contraindications

    • Relative
      • very low pretest probability
      • very high  CV risk
        • since they prevention Rx anyway
  • Advantages

    • High sensitivity for atherosclerosis
    • low radiation 1mSV
    • the more burden the more benefit with conservative therapy
      • statins
  • Disadvantages

    • Radiation
  • Method

    • Patient Prep

    • Technique

      • Gated
      • Multi
  • Results

    • Report should include
      • the absolute Agatston score and the
      • age, sex, and race-specific CAC percentile;
      • the number of vessels with CAC;
      • the presence of CAC in the left main coronary artery;
      • specific highlighting of individuals with very high CAC scores of greater than 1000
    • Test of plaque burden
    • A calcium score of 20 in a
      • 70-year-old person is low but in a 
      • 35-40-year-old is significantly ele
        • should be considered considerably elevated.
  • Conclusions

  • Discussion
    • In a patient with negative calcium score – we do not know if there is fibrofatty plaque
    • Negative Calcium Score
      Occluded RCA Heart Care Sydney
    • A high coronary calcium score can change someone’s risk from low to high but not the other way. A low or even zero calcium score does not change the status of a high-risk patient to a low-risk. A “high risk” individual will remain “high risk” regardless of their calcium score.
    • calcium score should always be interpreted in the
      • context of other risk factors
      • never solely.
        • 0 in a low-risk patient is highly reassuring.
        • 0 in high risk patient
          •  smokes
          • high cholesterol or
          • high blood pressure
        • is less predictive.
    • Associated diseases with high calcium score
      • cancer
  • Incidental Finding

 

 

 

  • Links and References

    • Journal Articles
      • Patel, J et al Assessment of Coronary Artery Calcium Scoring to Guide Statin Therapy Allocation According to Risk-Enhancing FactorsThe Multi-Ethnic Study of Atherosclerosis JAMA Cardiol. 2021;6(10):1161-1170.  Abstract Only
    •  Videos
    • Guidelines
      • 2022