Coronary calcium screening in asymptomatic patients as a guide to risk factor modification and stress myocardial perfusion imaging

Kevin Moser, James H. O'Keefe, Timothy M. Bateman, Iain A. McGhie

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background. Previous studies have demonstrated a correlation between the extent of coronary artery calcification (CAC) and atherosclerotic plaque. As a result, CAC screening could be useful in predicting cardiovascular risk in individuals in whom atherosclerosis is developing. One possible method of detecting and quantifying CAC is by x-ray computed tomography, which potentially allows one to stratify patients into groups requiring risk factor modification or follow-up testing such as myocardial perfusion single photon emission computed tomography (SPECT). Methods and Results. This study was designed to evaluate the clinical utility of multidetector computed tomography (MDCT) in a cardiology practice setting. A retrospective analysis was performed on data from 794 asymptomatic patients who underwent CAC screening over an 8-month period. On the basis of the CAC score and physician consultation, 102 patients underwent subsequent myocardial perfusion SPECT imaging. A substudy was also conducted in 306 patients to measure the interscan variability of MDCT across different CAC score ranges. CAC was detected in 422 of 794 patients. Of these, the CAC was moderate (Agatston score = 101-400) in 14% and severe (>400) in 9%. Patients with 3 or more cardiac risk factors were most likely to exhibit moderate to severe CAC. In myocardial perfusion SPECT testing, no patient with an Agatston score lower than 100 had an abnormal study. In contrast, 41% of patients with severe CAC had an abnormal SPECT study. In the reproducibility substudy the minimal CAC group had the largest variability (86.0%) whereas the severe CAC group had the lowest variability (9.5%). Conclusion. CAC screening with MDCT is justified for asymptomatic patients with 3 or more cardiac risk factors. However, risk factor assessment is poor at predicting which individuals will have CAC if fewer risk factors are present. In terms of the interscan variability, MDCT is capable of following changes in CAC for patients with Agatston scores greater than 100. Finally, this study demonstrated that an Agatston score of 400 is a logical threshold to initiate follow-up myocardial perfusion SPECT testing.

Original languageEnglish (US)
Pages (from-to)590-598
Number of pages9
JournalJournal of Nuclear Cardiology
Volume10
Issue number6
DOIs
StatePublished - Jan 1 2003

Fingerprint

Myocardial Perfusion Imaging
Coronary Vessels
Calcium
Single-Photon Emission-Computed Tomography
Multidetector Computed Tomography
Perfusion
Atherosclerotic Plaques
Cardiology

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{1abf7df356d049079bf91b47c7836bab,
title = "Coronary calcium screening in asymptomatic patients as a guide to risk factor modification and stress myocardial perfusion imaging",
abstract = "Background. Previous studies have demonstrated a correlation between the extent of coronary artery calcification (CAC) and atherosclerotic plaque. As a result, CAC screening could be useful in predicting cardiovascular risk in individuals in whom atherosclerosis is developing. One possible method of detecting and quantifying CAC is by x-ray computed tomography, which potentially allows one to stratify patients into groups requiring risk factor modification or follow-up testing such as myocardial perfusion single photon emission computed tomography (SPECT). Methods and Results. This study was designed to evaluate the clinical utility of multidetector computed tomography (MDCT) in a cardiology practice setting. A retrospective analysis was performed on data from 794 asymptomatic patients who underwent CAC screening over an 8-month period. On the basis of the CAC score and physician consultation, 102 patients underwent subsequent myocardial perfusion SPECT imaging. A substudy was also conducted in 306 patients to measure the interscan variability of MDCT across different CAC score ranges. CAC was detected in 422 of 794 patients. Of these, the CAC was moderate (Agatston score = 101-400) in 14{\%} and severe (>400) in 9{\%}. Patients with 3 or more cardiac risk factors were most likely to exhibit moderate to severe CAC. In myocardial perfusion SPECT testing, no patient with an Agatston score lower than 100 had an abnormal study. In contrast, 41{\%} of patients with severe CAC had an abnormal SPECT study. In the reproducibility substudy the minimal CAC group had the largest variability (86.0{\%}) whereas the severe CAC group had the lowest variability (9.5{\%}). Conclusion. CAC screening with MDCT is justified for asymptomatic patients with 3 or more cardiac risk factors. However, risk factor assessment is poor at predicting which individuals will have CAC if fewer risk factors are present. In terms of the interscan variability, MDCT is capable of following changes in CAC for patients with Agatston scores greater than 100. Finally, this study demonstrated that an Agatston score of 400 is a logical threshold to initiate follow-up myocardial perfusion SPECT testing.",
author = "Kevin Moser and O'Keefe, {James H.} and Bateman, {Timothy M.} and McGhie, {Iain A.}",
year = "2003",
month = "1",
day = "1",
doi = "10.1016/S1071-3581(03)00653-6",
language = "English (US)",
volume = "10",
pages = "590--598",
journal = "Journal of Nuclear Cardiology",
issn = "1071-3581",
publisher = "Springer New York",
number = "6",

}

Coronary calcium screening in asymptomatic patients as a guide to risk factor modification and stress myocardial perfusion imaging. / Moser, Kevin; O'Keefe, James H.; Bateman, Timothy M.; McGhie, Iain A.

In: Journal of Nuclear Cardiology, Vol. 10, No. 6, 01.01.2003, p. 590-598.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronary calcium screening in asymptomatic patients as a guide to risk factor modification and stress myocardial perfusion imaging

AU - Moser, Kevin

AU - O'Keefe, James H.

AU - Bateman, Timothy M.

AU - McGhie, Iain A.

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background. Previous studies have demonstrated a correlation between the extent of coronary artery calcification (CAC) and atherosclerotic plaque. As a result, CAC screening could be useful in predicting cardiovascular risk in individuals in whom atherosclerosis is developing. One possible method of detecting and quantifying CAC is by x-ray computed tomography, which potentially allows one to stratify patients into groups requiring risk factor modification or follow-up testing such as myocardial perfusion single photon emission computed tomography (SPECT). Methods and Results. This study was designed to evaluate the clinical utility of multidetector computed tomography (MDCT) in a cardiology practice setting. A retrospective analysis was performed on data from 794 asymptomatic patients who underwent CAC screening over an 8-month period. On the basis of the CAC score and physician consultation, 102 patients underwent subsequent myocardial perfusion SPECT imaging. A substudy was also conducted in 306 patients to measure the interscan variability of MDCT across different CAC score ranges. CAC was detected in 422 of 794 patients. Of these, the CAC was moderate (Agatston score = 101-400) in 14% and severe (>400) in 9%. Patients with 3 or more cardiac risk factors were most likely to exhibit moderate to severe CAC. In myocardial perfusion SPECT testing, no patient with an Agatston score lower than 100 had an abnormal study. In contrast, 41% of patients with severe CAC had an abnormal SPECT study. In the reproducibility substudy the minimal CAC group had the largest variability (86.0%) whereas the severe CAC group had the lowest variability (9.5%). Conclusion. CAC screening with MDCT is justified for asymptomatic patients with 3 or more cardiac risk factors. However, risk factor assessment is poor at predicting which individuals will have CAC if fewer risk factors are present. In terms of the interscan variability, MDCT is capable of following changes in CAC for patients with Agatston scores greater than 100. Finally, this study demonstrated that an Agatston score of 400 is a logical threshold to initiate follow-up myocardial perfusion SPECT testing.

AB - Background. Previous studies have demonstrated a correlation between the extent of coronary artery calcification (CAC) and atherosclerotic plaque. As a result, CAC screening could be useful in predicting cardiovascular risk in individuals in whom atherosclerosis is developing. One possible method of detecting and quantifying CAC is by x-ray computed tomography, which potentially allows one to stratify patients into groups requiring risk factor modification or follow-up testing such as myocardial perfusion single photon emission computed tomography (SPECT). Methods and Results. This study was designed to evaluate the clinical utility of multidetector computed tomography (MDCT) in a cardiology practice setting. A retrospective analysis was performed on data from 794 asymptomatic patients who underwent CAC screening over an 8-month period. On the basis of the CAC score and physician consultation, 102 patients underwent subsequent myocardial perfusion SPECT imaging. A substudy was also conducted in 306 patients to measure the interscan variability of MDCT across different CAC score ranges. CAC was detected in 422 of 794 patients. Of these, the CAC was moderate (Agatston score = 101-400) in 14% and severe (>400) in 9%. Patients with 3 or more cardiac risk factors were most likely to exhibit moderate to severe CAC. In myocardial perfusion SPECT testing, no patient with an Agatston score lower than 100 had an abnormal study. In contrast, 41% of patients with severe CAC had an abnormal SPECT study. In the reproducibility substudy the minimal CAC group had the largest variability (86.0%) whereas the severe CAC group had the lowest variability (9.5%). Conclusion. CAC screening with MDCT is justified for asymptomatic patients with 3 or more cardiac risk factors. However, risk factor assessment is poor at predicting which individuals will have CAC if fewer risk factors are present. In terms of the interscan variability, MDCT is capable of following changes in CAC for patients with Agatston scores greater than 100. Finally, this study demonstrated that an Agatston score of 400 is a logical threshold to initiate follow-up myocardial perfusion SPECT testing.

UR - http://www.scopus.com/inward/record.url?scp=0347460669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0347460669&partnerID=8YFLogxK

U2 - 10.1016/S1071-3581(03)00653-6

DO - 10.1016/S1071-3581(03)00653-6

M3 - Article

C2 - 14668770

AN - SCOPUS:0347460669

VL - 10

SP - 590

EP - 598

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

SN - 1071-3581

IS - 6

ER -