Quantification of coronary artery calcium using ultrafast computed tomography

Mount Sinai Medical Center, Miami Beach, Florida 33140.

Ultrafast computed tomography was used to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with (n = 109) and without (n = 475) clinical coronary artery disease. Fifty patients who underwent fluoroscopy and ultrafast computed tomography were also evaluated. Twenty contiguous 3 mm slices were obtained of the proximal coronary arteries. Total calcium scores were calculated based on the number, areas and peak Hounsfield computed tomographic numbers of the calcific lesions detected. In 88 subjects scored by two readers independently, interobserver agreement was excellent with identical total scores obtained in 70. Ultrafast computed tomography was more sensitive than fluoroscopy, detecting coronary calcium in 90% versus 52% of patients. There were significant differences (p less than 0.0001) in mean total calcium scores for those with versus those without clinical coronary artery disease by decade: 5 versus 132, age 30 to 39 years; 27 versus 291, age 40 to 49 years; 83 versus 462, age 50 to 59 years; and 187 versus 786, age 60 to 69 years. Sensitivity, specificity and predictive values for clinical coronary artery disease were calculated for several total calcium scores in each decade. For age groups 40 to 49 and 50 to 59 years, a total score of 50 resulted in a sensitivity of 71% and 74% and a specificity of 91% and 70%, respectively. For age group 60 to 69 years, a total score of 300 gave a sensitivity of 74% and a specificity of 81%. The negative predictive value of a 0 score was 98%, 94% and 100% for age groups 40 to 49, 50 to 59 and 60 to 69 years, respectively. Ultrafast computed tomography is an excellent tool for detecting and quantifying coronary artery calcium.

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				R. C. Shroff, V. Shah, M. P. Hiorns, M. Schoppet, L. C. Hofbauer, G. Hawa, L. J. Schurgers, A. Singhal, I. Merryweather, P. Brogan, et al. The circulating calcification inhibitors, fetuin-A and osteoprotegerin, but not Matrix Gla protein, are associated with vascular stiffness and calcification in children on dialysis Nephrol. Dial. Transplant., October 1, 2008; 23(10): 3263 - 3271. [Abstract] [Full Text] [PDF]

				A. Sarwar, J. Rieber, E. A. Q. Mooyaart, S. K. Seneviratne, S. L. Houser, F. Bamberg, O. C. Raffel, R. Gupta, M. K. Kalra, H. Pien, et al. Calcified Plaque: Measurement of Area at Thin-Section Flat-Panel CT and 64-Section Multidetector CT and Comparison with Histopathologic Findings Radiology, October 1, 2008; 249(1): 301 - 306. [Abstract] [Full Text] [PDF]

				A. Eisen, A. Tenenbaum, N. Koren-Morag, D. Tanne, J. Shemesh, M. Imazio, E. Z. Fisman, M. Motro, E. Schwammenthal, and Y. Adler Calcification of the Thoracic Aorta as Detected by Spiral Computed Tomography Among Stable Angina Pectoris Patients: Association With Cardiovascular Events and Death Circulation, September 23, 2008; 118(13): 1328 - 1334. [Abstract] [Full Text] [PDF]

				R. C. Thurston, K. Sutton-Tyrrell, S. A. Everson-Rose, R. Hess, and K. A. Matthews Hot Flashes and Subclinical Cardiovascular Disease: Findings From the Study of Women's Health Across the Nation Heart Study Circulation, September 16, 2008; 118(12): 1234 - 1240. [Abstract] [Full Text] [PDF]

				R. S. Elkeles, I. F. Godsland, M. D. Feher, M. B. Rubens, M. Roughton, F. Nugara, S. E. Humphries, W. Richmond, M. D. Flather, and for the PREDICT Study Group Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study Eur. Heart J., September 2, 2008; 29(18): 2244 - 2251. [Abstract] [Full Text] [PDF]

				J. Ding, S. B Kritchevsky, F.-C. Hsu, T. B Harris, G. L Burke, R. C Detrano, M. Szklo, M. H Criqui, M. Allison, P. Ouyang, et al. Association between non-subcutaneous adiposity and calcified coronary plaque: a substudy of the Multi-Ethnic Study of Atherosclerosis Am. J. Clinical Nutrition, September 1, 2008; 88(3): 645 - 650. [Abstract] [Full Text] [PDF]

				S. Kobayashi, M. Oka, K. Maesato, R. Ikee, T. Mano, M. Hidekazu, and T. Ohtake Coronary Artery Calcification, ADMA, and Insulin Resistance in CKD Patients Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1289 - 1295. [Abstract] [Full Text] [PDF]

				S Leschka, H Scheffel, L Desbiolles, A Plass, O Gaemperli, P Stolzmann, M Genoni, T Luescher, B Marincek, P Kaufmann, et al. Combining dual-source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease Heart, September 1, 2008; 94(9): 1154 - 1161. [Abstract] [Full Text] [PDF]

				M. Jayachandran, R. D. Litwiller, W. G. Owen, J. A. Heit, T. Behrenbeck, S. L. Mulvagh, P. A. Araoz, M. J. Budoff, S. M. Harman, and V. M. Miller Characterization of blood borne microparticles as markers of premature coronary calcification in newly menopausal women Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H931 - H938. [Abstract] [Full Text] [PDF]

				A. Sekikawa, J. D. Curb, H. Ueshima, A. El-Saed, T. Kadowaki, R. D. Abbott, R. W. Evans, B. L. Rodriguez, T. Okamura, K. Sutton-Tyrrell, et al. Marine-Derived n-3 Fatty Acids and Atherosclerosis in Japanese, Japanese-American, and White Men: A Cross-Sectional Study J. Am. Coll. Cardiol., August 5, 2008; 52(6): 417 - 424. [Abstract] [Full Text] [PDF]

				M. M. Henneman, J. D. Schuijf, J. M. van Werkhoven, G. Pundziute, E. E. van der Wall, J. W. Jukema, and J. J. Bax Multi-slice computed tomography coronary angiography for ruling out suspected coronary artery disease: what is the prevalence of a normal study in a general clinical population? Eur. Heart J., August 2, 2008; 29(16): 2006 - 2013. [Abstract] [Full Text] [PDF]

				J. S. Saczynski, M. K. Jonsdottir, S. Sigurdsson, G. Eiriksdottir, P. V. Jonsson, M. E. Garcia, O. Kjartansson, M. A. van Buchem, V. Gudnason, and L. J. Launer White Matter Lesions and Cognitive Performance: The Role of Cognitively Complex Leisure Activity J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2008; 63(8): 848 - 854. [Abstract] [Full Text] [PDF]

				M. Shuvy, S. Abedat, R. Beeri, H. D. Danenberg, D. Planer, I. Z. Ben-Dov, K. Meir, J. Sosna, and C. Lotan Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats Cardiovasc Res, August 1, 2008; 79(3): 492 - 499. [Abstract] [Full Text] [PDF]

				E.-K. Choi, S. I. Choi, J. J. Rivera, K. Nasir, S.-A. Chang, E. J. Chun, H.-K. Kim, D.-J. Choi, R. S. Blumenthal, and H.-J. Chang Coronary Computed Tomography Angiography as a Screening Tool for the Detection of Occult Coronary Artery Disease in Asymptomatic Individuals J. Am. Coll. Cardiol., July 29, 2008; 52(5): 357 - 365. [Abstract] [Full Text] [PDF]

				M. M. Henneman, J. D. Schuijf, G. Pundziute, J. M. van Werkhoven, E. E. van der Wall, J. W. Jukema, and J. J. Bax Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome plaque morphology on multislice computed tomography versus coronary calcium score. J. Am. Coll. Cardiol., July 15, 2008; 52(3): 216 - 222. [Abstract] [Full Text] [PDF]