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Semi-Automatic Graphical Tool for Measuring Coronary Artery Spatially Weighted Calcium Score from Gated Cardiac Computed Tomography Images
Published on: September 22, 2023
[Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a
César Morcillo1, José M Valderas, Joan M Roca
1Departamento de Medicina Interna, Cardiología y Medicina Preventiva, Clínica CIMA, Barcelona, Spain. cesar.morcillo@cimaclinic.com
Insights
Coronary artery calcification (CAC) screening identifies more high-risk patients than traditional charts. This cardiovascular risk assessment method can increase eligibility for preventative treatments.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- Coronary artery calcification (CAC) measurement aids cardiovascular risk evaluation.
- Traditional risk charts include European Task Force (ETF), REGICOR, and Systematic Coronary Risk Evaluation (SCORE).
Purpose of the Study:
- To compare the effectiveness of CAC assessment against established cardiovascular risk charts.
- To determine if CAC improves identification of high-risk individuals for preventative therapies.
Main Methods:
- Cardiovascular risk was assessed using 1998 ETF, REGICOR, and SCORE charts in 331 patients without known atherosclerosis.
- Coronary artery calcification (CAC) was measured via computed tomography, with risk stratified as low (<1), intermediate (1-100), or high (>100).
Main Results:
- CAC was detected in 44.1% of patients; 89% were male, with a mean age of 54.
- Agreement between CAC scores and SCORE/ETF charts was acceptable (kappa=.33/.28), but poor with REGICOR (kappa=.02).
- CAC identified more high-risk patients than charts; specifically, 45.0% (SCORE) and 38.3% (ETF) of patients with CAC >100 were classified as high risk, compared to 0% by REGICOR.
Conclusions:
- CAC screening identified significant calcification in nearly half of patients without known atherosclerosis.
- Utilizing a CAC score >100 reclassified 10.4% (SCORE), 11.6% (ETF), and 18.9% (REGICOR) more patients into high-risk categories.
- CAC assessment enhances identification of individuals benefiting from preventative cardiovascular treatment.
Introduction And Objectives:
Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts.
Methods:
We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score <1), intermediate risk (i.e., score 1-100), or high risk (i.e., score >100).
Results:
The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: kappa=.33 (P<.05) and kappa=.28 (P<.05), respectively, but agreement was poor with the REGICOR chart: kappa=.02 (P=.32). The SCORE and ETF charts, respectively, classified 45.0% and 38.3% of patients with a CAC score >100 as high risk, whereas the REGICOR chart did not classify any of these patients as high risk. Male sex, older age, smoking history, and a family history of coronary heart disease were all associated with the detection of CAC.
Conclusions:
Measurement of CAC demonstrated calcification in 44.1% of patients without known atherosclerosis. By regarding those with a CAC score > 100 as high-risk, 10.4% of patients evaluated using the SCORE chart would be reclassified as high risk, as would 11.6% of those evaluated using the ETF chart, and 18.9% of those evaluated using the REGICOR chart. Consequently, more patients would be eligible for preventative treatment.
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