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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting
S Altintas1, T Dinh1, N G H M Marcks1,2
1Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
Insights
Coronary artery disease (CAD) is common in cardiac syncope patients, with higher prevalence and severity than in non-cardiac syncope. These findings suggest CAD significantly contributes to cardiac syncope events.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is linked to poor prognosis in syncope patients.
- Limited data exists on CAD prevalence in syncope patients without prior cardiovascular disease.
Purpose of the Study:
- To investigate the presence and extent of CAD in syncope patients.
- To compare CAD in cardiac versus non-cardiac syncope.
Main Methods:
- 142 syncope patients underwent coronary computed tomography (CT) angiography.
- Syncope types were classified as cardiac (49 patients) or non-cardiac (93 patients).
- Cardiac syncope patients were compared to matched stable chest pain patients.
Main Results:
- Any CAD was present in 72% of cardiac syncope vs. 48% of non-cardiac syncope patients.
- Severe CAD was significantly higher in cardiac syncope patients (33% vs. 7%).
- Cardiac syncope patients showed significantly higher CAD presence and extent (p=0.001).
Conclusions:
- Cardiac syncope patients exhibit a high prevalence and extent of CAD.
- CAD is implicated as a significant factor in the development of cardiac syncope.
Background:
In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients.
Methods:
We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure.
Results:
Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD. Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%).
Conclusion:
Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.
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