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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
Association of coronary atherosclerosis detected by multislice computed tomography and traditional risk-factor
Deepu Nair1, Thomas P Carrigan, Ronan J Curtin
1Department of Cardiovascular Medicine, Cardiovascular Imaging Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
The Framingham Risk Score may underestimate coronary heart disease risk. Many patients with low or intermediate scores have significant coronary artery plaque or disease, indicating a need for advanced imaging.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- The Framingham Risk Score (FRS) is a standard tool for assessing long-term coronary heart disease (CHD) risk.
- Acute coronary events often arise from nonobstructive atherosclerotic plaque in proximal coronary arteries.
- Multislice computed tomography (MSCT) accurately detects both obstructive coronary artery disease (CAD) and proximal atherosclerotic plaque.
Purpose of the Study:
- To evaluate the association between the Framingham Risk Score and the presence of obstructive CAD and proximal atherosclerotic plaque.
- To determine if the FRS adequately identifies individuals with subclinical atherosclerosis requiring further investigation.
- To assess the prevalence of proximal atherosclerotic plaque and obstructive CAD across different FRS risk categories.
Main Methods:
- Coronary MSCT angiography was performed in 295 patients without known CAD presenting with cardiac symptoms.
- Patients' 10-year CHD risk was calculated using the Framingham Risk Score and categorized as low, intermediate, or high.
- Obstructive CAD was defined as ≥50% stenosis; proximal atherosclerotic plaque included calcified or noncalcified plaque in the left main or proximal LAD artery.
Main Results:
- A significant proportion of patients in the low (44% plaque, 16% obstructive CAD) and intermediate (75% plaque, 34% obstructive CAD) FRS groups exhibited proximal atherosclerotic plaque or obstructive CAD.
- These findings were even more prevalent in the high FRS group (63% plaque, 88% obstructive CAD).
- In women and younger patients (all with low FRS), a substantial number had proximal plaque, with only 40% on statin therapy.
Conclusions:
- The Framingham Risk Score may underestimate the prevalence of coronary atherosclerosis, particularly proximal plaque and obstructive CAD, in patients with low and intermediate risk.
- MSCT imaging reveals significant coronary pathology in a considerable number of patients who are stratified as low or intermediate risk by FRS.
- These findings suggest that advanced imaging like MSCT may be valuable for risk stratification beyond traditional risk scores, especially in symptomatic individuals.
Abstract:
Framingham risk score is an office-based tool used for long-term coronary heart disease risk stratification. Most acute coronary events occur in association with proximal nonobstructive atherosclerotic plaque. Multislice computed tomography detects both obstructive coronary artery disease (CAD) and proximal atherosclerotic plaque with high accuracy. The association of Framingham risk score with obstructive CAD and proximal atherosclerotic plaque was tested. Coronary multislice computed tomography was performed in 295 patients (61% men, mean age 54 +/- 13 years) without documented CAD referred for evaluation of cardiac symptoms. Framingham risk score was computed and patients were stratified according to 10-year risk (n = 213 [72%] low, n = 74 [25%] intermediate, and n = 8 [3%] high). Obstructive CAD was defined as > or =50% stenosis in > or =1 epicardial coronary artery. Proximal atherosclerotic plaque was defined as calcified or noncalcified plaque in the left main or proximal left anterior descending artery. In the low- and intermediate-Framingham risk score groups, there was a high frequency of proximal atherosclerotic plaque (44% and 75%) and obstructive CAD (16% and 34%), although both findings were more prevalent in the high-Framingham risk score group (63% for atherosclerotic plaque, 88% for obstructive CAD), respectively. Proximal atherosclerotic plaque was noncalcified in approximately 13 of patients. In women (n = 114) and younger (<55 years) patients (n = 148), most (93% and 91%, respectively) had a low Framingham risk score. There were 48 women and 51 younger patients with proximal atherosclerotic plaque, of whom only 40% (in each group) were on statin therapy. In conclusion, of patients with a low and intermediate Framingham risk score, a significant proportion had proximal atherosclerotic plaque or obstructive CAD.
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