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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
Measurement of coronary calcium scores or exercise testing as initial screening tool in asymptomatic subjects with
Christiane A Geluk1, Riksta Dikkers, Jan A Kors
1Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands. c.a.geluk@thorax.umcg.nl
Insights
Coronary calcium scores are a superior initial diagnostic test for asymptomatic individuals at intermediate coronary risk compared to exercise testing. This non-invasive method effectively identifies coronary artery disease (CAD).
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Intermediate coronary risk asymptomatic subjects require risk stratification.
- Coronary calcium scores and exercise testing are established diagnostic methods.
- The optimal initial diagnostic test remains unclear.
Purpose of the Study:
- To evaluate the prevalence of documented coronary artery disease (CAD).
- To compare the diagnostic yield of coronary calcium scores versus exercise testing.
- To determine the preferred initial non-invasive test for risk stratification.
Main Methods:
- 153 asymptomatic subjects with ST-T changes on resting ECG were enrolled.
- Electron beam tomography for calcium scoring and exercise testing were performed.
- Obstructive CAD (>=50% stenosis) was the primary endpoint, confirmed by myocardial perfusion imaging or coronary angiography.
Main Results:
- Coronary calcium scores showed a superior diagnostic yield (AUC 0.91) compared to exercise testing (AUC 0.74).
- Higher calcium scores correlated with increased prevalence of obstructive CAD.
- Exercise testing also identified CAD, but with lower diagnostic accuracy.
Conclusions:
- Coronary calcium scoring is an appropriate initial non-invasive test for asymptomatic individuals at increased coronary risk.
- This method offers superior diagnostic performance over exercise testing for CAD detection.
- Calcium scoring aids in effective risk stratification for preventive cardiology.
Background:
Asymptomatic subjects at intermediate coronary risk may need diagnostic testing for risk stratification. Both measurement of coronary calcium scores and exercise testing are well established tests for this purpose. However, it is not clear which test should be preferred as initial diagnostic test. We evaluated the prevalence of documented coronary artery disease (CAD) according to calcium scores and exercise test results.
Methods:
Asymptomatic subjects with ST-T changes on a rest ECG were selected from the population based PREVEND cohort study and underwent measurement of calcium scores by electron beam tomography and exercise testing. With calcium scores > or =10 or a positive exercise test, myocardial perfusion imaging (MPS) or coronary angiography (CAG) was recommended. The primary endpoint was documented obstructive CAD (>/=50% stenosis).
Results:
Of 153 subjects included, 149 subjects completed the study protocol. Calcium scores > or =400, 100-399, 10-99 and <10 were found in 16, 29, 18 and 86 subjects and the primary endpoint was present in 11 (69%), 12 (41%), 0 (0%) and 1 (1%) subjects, respectively. A positive, nondiagnostic and negative exercise test was present in 33, 27 and 89 subjects and the primary endpoint was present in 13 (39%), 5 (19%) and 6 (7%) subjects, respectively. Receiver operator characteristics analysis showed that the area under the curve, as measure of diagnostic yield, of 0.91 (95% CI 0.84-0.97) for calcium scores was superior to 0.74 (95% CI 0.64-0.83) for exercise testing (p = 0.004).
Conclusion:
Measurement of coronary calcium scores is an appropriate initial non-invasive test in asymptomatic subjects at increased coronary risk.
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