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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Preliminary Observations on Discordance Between Coronary Artery Calcium Score of Zero and Coronary Computed
Farhan Ashraf1, Mohammad Raza Qureshi1, Masoud Alam1
1Life Core Private Clinic, Abu Dhabi, United Arab Emirates.
Background:
Coronary artery calcium (CAC) scoring is widely used to screen for coronary artery disease (CAD) in asymptomatic individuals. However, it detects calcified plaques and may miss non-calcified or soft plaques. This study compared the diagnostic accuracy of CAC scoring with coronary computed tomography angiography (CCTA) for detecting CAD in asymptomatic individuals with risk factors.
Methods:
Eighteen asymptomatic adults with a CAC score of 0 underwent CCTA to evaluate for subclinical CAD. Clinical, biochemical, and lifestyle risk factors were assessed. Diagnostic agreement between CAC and CCTA was analyzed using the Wilcoxon signed rank test.
Results:
The cohort had a mean age of 51.4 ± 10.6 years, 88.8% were male, and mean body mass index (BMI) was 27.7 ± 3.6 kg/m2. Smoking (70.5%) and family history of CAD (56.25%) were prevalent. Biochemical analyses showed preserved renal function and non-diabetic glycemic profiles. Despite the absence of calcification on CAC, CCTA revealed CAD in 72.2% (13/18) of participants, detecting non-calcified plaques missed by CAC scoring. Elevated cardiac and inflammatory markers, including high-sensitivity cardiac troponin T, apolipoprotein B (apoB), and lipoprotein(a) (Lp(a)), were observed in those with positive CCTA findings. The Wilcoxon signed rank test indicated a significant difference between the modalities (Z = -3.606, P < 0.001).
Conclusions:
CCTA detected non-calcified atherosclerosis missed by CAC and demonstrated superior sensitivity for early CAD detection in asymptomatic individuals.
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