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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
The utility of coronary computed tomography angiography in elderly patients
Jordan Laggoune1, Nitesh Nerlekar1, Kiran Munnur1
1Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
Insights
Coronary computed tomography angiography (CCTA) is a feasible tool for assessing elderly patients with stable chest pain, providing good image quality in most cases. However, male, diabetic patients over 78 years old are less likely to have interpretable CCTA scans.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Geriatric Medicine
Background:
- Coronary computed tomography angiography (CCTA) is often underutilized in elderly patients due to concerns about heavily calcified plaque impacting image accuracy.
- Assessing the utility of CCTA in this demographic is crucial for accurate diagnosis of coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the image quality, luminal stenosis assessment, and overall clinical utility of CCTA in elderly patients presenting with suspected CAD and stable chest pain.
- To identify factors associated with non-interpretable CCTA scans in this population.
Main Methods:
- Retrospective analysis of 1011 elderly patients (> 75 years) who underwent 320-detector row CCTA.
- CCTA scans were assessed for maximal coronary stenosis using CAD-RADS classification and image quality via a 5-point Likert scale.
- Factors influencing scan interpretability, including plaque calcification and motion artefact, were analyzed.
Main Results:
- CCTA was evaluable in 68% of patients, revealing non-obstructive CAD in 52% and obstructive CAD in 48%.
- Good image quality (mean Likert score 3.1 ± 0.6) was achieved overall.
- 32% of scans were non-interpretable, primarily due to calcified plaque (80%) and motion artefact (20%).
- Male gender, older age, excess motion, and diabetes mellitus were associated with non-interpretable scans.
Conclusions:
- CCTA is a feasible non-invasive imaging tool for elderly patients with stable chest pain, offering good image quality.
- Clinicians should exercise caution when referring elderly patients, particularly males over 78 years old and those with diabetes, for CCTA due to lower interpretability rates.
- Further research may refine patient selection criteria for CCTA in the geriatric population.
Background:
Coronary computed tomography angiography (CCTA) is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment. We sought to assess the image quality, luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease (CAD) and stable chest pain.
Methods:
Retrospective analysis of elderly patients (> 75 years) who underwent 320-detector row CCTA between 2012-2017 at MonashHeart. The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification, image quality by a 5-point Likert score (1-poor, 2-adequate, 3-good, 4-very good, 5-excellent) and presence of artefact limiting interpretability.
Results:
1011 elderly patients (62% females, 78.8 ± 3.3 years) were studied. Cardiovascular risk factor prevalence included: hypertension (65%), hyperlipidaemia (48%), diabetes (19%) and smoking (21%). The CCTA was evaluable in 68% of patients which included 52% with non-obstructive CAD (< 50% stenosis), 48% with obstructive CAD (> 50%) stenosis. Mean Likert score was 3.1 ± 0.6 corresponding to good image quality. Of the 323 (32%) of patients with a non-interpretable CCTA, 80% were due to calcified plaque and 20% due to motion artefact. Male gender (P = 0.009), age (P = 0.02), excess motion (P < 0.01) and diabetes mellitus (P = 0.03) were associated with non-interpretable CCTA.
Conclusion:
Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain, clinicians should still be cautious about referring elderly patients for CCTA. Patients who are male, diabetic and >78 years of age are significantly less likely to have interpretable scans.
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