Non-traditional tools for predicting coronary artery disease

Area of Science:

• Cardiology
• Radiology
• Preventive Medicine

Background:

• Coronary calcium score (CCS) is a traditional tool for assessing coronary atherosclerosis and predicting cardiovascular events.
• Non-traditional risk factors like epicardial fat volume (EFV) and thoracic extracoronary calcium (ECC) may aid in detecting subclinical coronary artery disease (CAD).

Purpose of the Study:

• To evaluate the role of CCS, EFV, and ECC in assessing subclinical CAD.
• To compare the diagnostic performance of these markers, individually and in combination, for CAD detection.

Main Methods:

• A cross-sectional observational study involving 950 Indian patients with suspected CAD.
• Coronary computed tomography angiography was used to estimate CCS, EFV, and thoracic ECC.
• Statistical analysis compared marker values between patients with and without CAD.

Main Results:

• A significant number of patients (61.4%) had a CCS of 0, with some having underlying CAD.
• Median EFV was significantly higher in patients with CAD and CCS 0 compared to those without CAD and CCS 0 (p<0.001).
• Combining EFV and CCS improved sensitivity and negative predictive value (NPV) for CAD detection compared to using either marker alone.

Conclusions:

• The combination of traditional CCS and non-traditional EFV enhances cardiovascular risk profiling.
• This combined approach can supplement existing cardiovascular risk assessment tools, particularly in cases with a zero CCS.
• Thoracic ECC did not significantly improve diagnostic performance when added to CCS and EFV.