CORRESPONDENCE: LETTER TO THE EDITOR
Coronary Calcium Scoring: Calcium Location Needs to Be Integrated!
Zhi-Yong Li, PhD*,
Umar Sadat, MRCS and
Jonathan H. Gillard, MD
* University Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ, United Kingdom (Email: ZYL22{at}cam.ac.uk).
Coronary calcium scoring (CCS) has been a topic of great interest lately. In a large population-based study comprising 6,722 patients, Detrano et al. (1) have effectively shown that CCS can be a strong predictor of incident coronary heart disease among different racial groups. Henneman et al. (2) have, however, reported that CCS does not reliably exclude the presence of (significant) atherosclerosis. This topic is quite controversial as there is significant evidence from Detrano's work that higher CCS is associated with an increased risk of acute coronary events.
We think that the location of calcium within the coronary arteries should also be considered. Li et al. (3,4) have shown that the position of the calcium in the plaque is a better determinant of plaque vulnerability than the total calcium load. Using a biomechanical model, predicted maximum stress was found to increase by 47.5% when calcium deposits were located in the thin fibrous cap. The presence of calcium deposits in the lipid core or remote from the fibrous cap resulted in no increase in maximum stress. It was also noted that the presence of calcification within the lipid core may even stabilize the plaque.
Integration of calcium location in CCS will, therefore, enable better assessment of severity of atherosclerosis and prediction of future cardiovascular events.
 |
References
|
|---|
1. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups N Engl J Med 2008;358:1336-1345.[Abstract/Free Full Text]2. Henneman MM, Schuijf JD, Pundziute G, et al. 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 2008;52:216-222.[Abstract/Free Full Text] 3. Li ZY, Howarth S, Tang T, Graves M, U-King-Im J, Gillard JH. Does calcium deposition play a role in the stability of atheroma?. Location may be the key. Cerebrovasc Dis 2007;24:452-459.[CrossRef][Web of Science][Medline] 4. Li ZY, U-King-Im J, Tang TY, Soh E, See TC, Gillard JH. Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm J Vasc Surg 2008;47:928-935.[CrossRef][Web of Science][Medline]
Related Article
-
Reply
- Joanne D. Schuijf, Maureen M. Henneman, and Jeroen J. Bax
J. Am. Coll. Cardiol. 2009 54: 745-746.
[Full Text]
[PDF]
|
Top
References