Top

Published in:

01-09-2009 | Cardiac

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

Authors: Anselmo Alessandro Palumbo, Erica Maffei, Chiara Martini, Giuseppe Tarantini, Gian Luca Di Tanna, Elena Berti, Roberto Grilli, Giancarlo Casolo, Valerio Brambilla, Marcella Cerrato, Antonio Rotondo, Annick C. Weustink, Nico R. A. Mollet, Filippo Cademartiri

Published in: European Radiology | Issue 9/2009

Abstract

We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1–10, group 3: score 11–100, group 4: score 101–400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–32PubMedCrossRef

Raggi P (2001) Coronary calcium on electron beam tomography imaging as a surrogate marker of coronary artery disease. Am J Cardiol 87:27A–34APubMedCrossRef

Cademartiri F (2006) Is calcium the key for the assessment of progression/regression of coronary artery disease? Heart 92(9):1187–1188PubMedCrossRef

Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228:826–833PubMedCrossRef

Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. Jama 291:210–215PubMedCrossRef

Cademartiri F, Runza G, La Grutta L, Palumbo A, Mollet NR, Brambilla L, Gualerzi M, Luccichenti G, Marano R, Krestin GP, Coruzzi P, Midiri M (2005) Non-invasive evaluation of coronary calcium. Radiol Med (Torino) 110:506–522

Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054PubMedCrossRef

Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S (2003) Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 107:664–666PubMedCrossRef

Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, Serruys PW, Krestin GP, de Feyter PJ (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef

10.

Leschka S, Alkadhi H, Plass A, Desbiolles L, Grunenfelder J, Marincek B, Wildermuth S (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487PubMedCrossRef

11.

Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557PubMedCrossRef

12.

Ropers D, Rixe J, Anders K, Kuttner A, Baum U, Bautz W, Daniel WG, Achenbach S (2006) Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348PubMedCrossRef

13.

Schuijf JD, Pundziute G, Jukema JW, Lamb HJ, van der Hoeven BL, de Roos A, van der Wall EE, Bax JJ (2006) Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. Am J Cardiol 98:145–148PubMedCrossRef

14.

Kuettner A, Kopp AF, Schroeder S, Rieger T, Brunn J, Meisner C, Heuschmid M, Trabold T, Burgstahler C, Martensen J, Schoebel W, Selbmann HK, Claussen CD (2004) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43:831–839PubMedCrossRef

15.

Cademartiri F, Mollet NR, Lemos PA, Saia F, Runza G, Midiri M, Krestin GP, de Feyter PJ (2005) Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography. Am J Cardiol 95:1225–1227PubMedCrossRef

16.

Cademartiri F, Runza G, Mollet NR, Luccichenti G, Belgrano M, Bartolotta TV, Galia M, Midiri M, Pozzi Mucelli R, Krestin GP (2005) Impact of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in multislice computed tomography coronary angiography. Radiol Med (Torino) 110:42–51

17.

Kuettner A, Burgstahler C, Beck T, Drosch T, Kopp AF, Heuschmid M, Claussen CD, Schroeder S (2005) Coronary vessel visualization using true 16-row multi-slice computed tomography technology. Int J Cardiovasc Imaging 21:331–337PubMedCrossRef

18.

19.

Mollet NR, Cademartiri F, Nieman K, Saia F, Lemos PA, McFadden EP, Pattynama PM, Serruys PW, Krestin GP, de Feyter PJ (2004) Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 43:2265–2270PubMedCrossRef

20.

Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252PubMedCrossRef

21.

Cademartiri F, Runza G, Belgrano M, Luccichenti G, Mollet NR, Malagutti P, Silvestrini M, Midiri M, Cova M, Pozzi Mucelli R, Krestin GP (2005) Introduction to coronary imaging with 64-slice computed tomography. Radiol Med (Torino) 110:16–41

22.

Cademartiri F, Luccichenti G, Marano R, Runza G, Midiri M (2004) Use of saline chaser in the intravenous administration of contrast material in non-invasive coronary angiography with 16-row multislice computed tomography. Radiol Med (Torino) 107:497–505

23.

Cademartiri F, Luccichenti G, Marano R, Pavone P (2004) [Techniques for the optimisation of coronary artery opacification in non-invasive angiography with a 16-row multislice computed tomography]. Radiol Med (Torino) 107:24–34

24.

Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40PubMed

25.

Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ (2008) Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 52:357–65PubMedCrossRef

26.

Nasir K, Budoff MJ, Blumenthal R (2008) Coronary calcium and events in four ethnic groups. N Engl J Med 359:203 author reply 204PubMed

27.

Pollin IS, Kral BG, Shattuck T, Sadler MD, Boyle JR, McKillop L, Campbell C, Ashen MD, Nasir K, Redberg RF, Brintzenhofeszoc K, Blumenthal RS, Michos ED (2008) High prevalence of cardiometabolic risk factors in women considered low risk by traditional risk assessment. J Womens Health (Larchmt) 17:947–953CrossRef

28.

Greenland P, Gaziano JM (2003) Clinical practice. Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing. N Engl J Med 349:465–473PubMedCrossRef

29.

Greenland P, Smith SC Jr, Grundy SM (2001) Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation 104:1863–1867PubMedCrossRef

30.

Raggi P (2002) [Electron beam computed tomography as a method to study coronary atherosclerosis]. Ital Heart J Suppl 3:1177–1187PubMed

31.

Hendel RC, Patel MR, Kramer CM, Poon M, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Douglas PS, Peterson ED, Wolk MJ, Allen JM (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48:1475–1497PubMedCrossRef

32.

Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, De Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Osterspey A, Tamargo J, Zamorano JL (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27:1341–1381PubMedCrossRef

33.

Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Mohlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P (2008) Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 18(12):2785–2807PubMedCrossRef

34.

Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK (2008) Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Circulation 118:586–606PubMedCrossRef

35.

Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Suss C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak AN, Kuttner A, Achenbach S, Becker C, Kopp A, Ohnesorge BM (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268PubMedCrossRef

36.

Cademartiri F, Maffei E, Mollet NR (2008) Is dual-source CT coronary angiography ready for the real world? Eur Heart J 29:701–703PubMedCrossRef

37.

Weustink AC, Mollet NR, Pugliese F, Meijboom WB, Nieman K, Heijenbrok-Kal MH, Flohr TG, Neefjes LA, Cademartiri F, de Feyter PJ, Krestin GP (2008) Optimal electrocardiographic pulsing windows and heart rate: effect on image quality and radiation exposure at dual-source coronary CT angiography. Radiology 248:792–798PubMedCrossRef

38.

Weustink AC, Meijboom WB, Mollet NR, Otsuka M, Pugliese F, van Mieghem C, Malago R, van Pelt N, Dijkshoorn ML, Cademartiri F, Krestin GP, de Feyter PJ (2007) Reliable high-speed coronary computed tomography in symptomatic patients. J Am Coll Cardiol 50:786–794PubMedCrossRef

39.

Achenbach S, Ropers D, Kuettner A, Flohr T, Ohnesorge B, Bruder H, Theessen H, Karakaya M, Daniel WG, Bautz W, Kalender WA, Anders K (2006) Contrast-enhanced coronary artery visualization by dual-source computed tomography-initial experience. Eur J Radiol 57:331–335PubMedCrossRef

40.

Ropers U, Ropers D, Pflederer T, Anders K, Kuettner A, Stilianakis NI, Komatsu S, Kalender W, Bautz W, Daniel WG, Achenbach S (2007) Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol 50:2393–2398PubMedCrossRef

41.

Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, Claussen CD, Kopp AF, Schroeder S (2005) Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. J Am Coll Cardiol 45:123–127PubMedCrossRef

42.

Mollet NR, Cademartiri F, Krestin GP, McFadden EP, Arampatzis CA, Serruys PW, de Feyter PJ (2005) Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. J Am Coll Cardiol 45:128–132PubMedCrossRef

43.

Pohle K, Otte M, Maffert R, Ropers D, Schmid M, Daniel WG, Achenbach S (2004) Association of cardiovascular risk factors to aortic valve calcification as quantified by electron beam computed tomography. Mayo Clin Proc 79:1242–1246PubMedCrossRef

44.

Shaw LJ, Raggi P, Berman DS, Callister TQ (2006) Coronary artery calcium as a measure of biologic age. Atherosclerosis 188:112–119PubMedCrossRef

Title: Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis
Authors: Anselmo Alessandro Palumbo
Erica Maffei
Chiara Martini
Giuseppe Tarantini
Gian Luca Di Tanna
Elena Berti
Roberto Grilli
Giancarlo Casolo
Valerio Brambilla
Marcella Cerrato
Antonio Rotondo
Annick C. Weustink
Nico R. A. Mollet
Filippo Cademartiri
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 9/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-009-1398-2

At a glance: The STEP trials

Springer Medicine

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2009

Penumbra Stroke System as an “add-on” for the treatment of large vessel occlusive disease following thrombolysis: first results

Ultrasound-guided percutaneous release of the annular pulley in trigger digit

CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

Direct magnetic resonance arthrography of the knee: utility of axial traction

A case of intermittent lumbar pain radiating to the right shoulder in a 76-year-old woman (2009: 6b)

Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques