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Coronary artery calcium assessed with calibrated mass scoring in asymptomatic individuals: results from the Copenhagen General Population Study

  • Cardiac
  • Published:
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Abstract

Background

Coronary artery calcification (CAC) is commonly assessed with Agatston score (AS). A higher sensitivity and precision for the detection of CAC has been demonstrated with calibrated mass score (cMS). We hypothesized that cMS would detect low-level CAC not detectable with AS in a large asymptomatic background population.

Methods

Participants (N = 2985) from the Copenhagen General Population Study were evaluated for CAC using both conventional AS and cMS. The population was grouped according to number of traditional risk factors and heart score was used to assess the risk of event for those with no CAC, those with only cMS > 0 and those with both AS and cMS > 0.

Results

In participants with an AS = 0, 11% had cMS > 0. The risk profile of this cMS-only group was between that of the CAC-negative participants and those with AS > 0 and cMS > 0. Overall, 6% of the population belonged to the cMS-only group independent of the number of risk factors.

Conclusion

In individuals with AS = 0, a fraction was found to have cMS > 0. Based on traditional risk factors, this group has a higher 10-year risk than individuals with both AS = 0 and cMS = 0; cMS might offer very early cardiovascular risk assessment in asymptomatic individuals.

Key Points

• In individuals with AS=0, a fraction has CAC with highly sensitive cMS.

• This fraction has a higher 10-year risk of cardiovascular disease.

• Regardless of risk factors, 6% has CAC detectable only with cMS.

• cMS might offer very early cardiovascular risk assessment in asymptomatic individuals.

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Abbreviations

AS:

Agatston score

BMI:

Body mass index

CAC:

Coronary artery calcification

CGPS:

Copenhagen General Population Study

cMS:

Calibrated mass score

CT:

Computed tomography

ESC:

The European Society of Cardiology

ROI:

Region of interest

SCORE :

Systematic coronary risk evaluation

CAC-negative group:

cMS = 0 and AS = 0

cMS-only group:

cMS > 0 and AS = 0

AS-only group:

AS > 0 and cMS = 0

(cMS+AS) group:

both AS > 0 and cMS > 0

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Acknowledgements

The authors wish to thank chief radiographer Kim Madsen, Department of Radiology, and his staff of radiographers and nurses working at the scanner for their enthusiastic technical and logistical support.

Funding

This study has received funding by The John and Birthe Meyer Foundation; A.P. Møller og Hustru Chastine Mc-Kinney Møllers Fond Til Almene Formaal; Pfizer Inc; The Research Fund at Rigshospitalet.

Author information

Authors and Affiliations

  1. Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100-Cph, Copenhagen, Denmark

    Andreas D. Knudsen, Andreas Fuchs, J. Tobias Kühl, Lars V. Køber & Klaus F. Kofoed

  2. Image Analysis, 1380 Burkesville Road, Columbia, KY, USA

    Ben A. Arnold

  3. Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

    Børge G. Nordestgaard

  4. Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Klaus F. Kofoed

Authors
  1. Andreas D. Knudsen
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  2. Andreas Fuchs
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  3. J. Tobias Kühl
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  4. Ben A. Arnold
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  5. Børge G. Nordestgaard
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  6. Lars V. Køber
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  7. Klaus F. Kofoed
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Corresponding author

Correspondence to Andreas D. Knudsen.

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Guarantor

The scientific guarantor of this publication is Professor Klaus F. Kofoed, MD, DMSc.

Conflict of interest

Ben Arnold is the president and owner of Image Analysis Inc. and owns the Nvivo software used to measure cMS. He was not involved with study protocol, data acquisition or analysis.

All other authors have no conflict of interest to declare.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained from the Regional Ethics Committee of Copenhagen (H-KF-01-144/01).

Methodology

• Cross-sectional study

• Performed at one institution

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Knudsen, A.D., Fuchs, A., Kühl, J.T. et al. Coronary artery calcium assessed with calibrated mass scoring in asymptomatic individuals: results from the Copenhagen General Population Study. Eur Radiol 28, 4607–4614 (2018). https://doi.org/10.1007/s00330-018-5446-7

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  • DOI: https://doi.org/10.1007/s00330-018-5446-7

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