Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology?

JACC: Cardiovascular Imaging

Volumn 10, Issue 8, 2017, Pages 923-937

  Blaha, Michael J ^a   Mortensen, Martin Bødtker ^a,b   Kianoush, Sina ^a   Tota Maharaj, Rajesh ^a,c   Cainzos Achirica, Miguel ^a,d,e  

^a JOHNS HOPKINS UNIVERSITY   (United States)

^b AARHUS UNIVERSITY HOSPITAL   (Denmark)

^c Florida Heart and Vascular   (United States)

^d BELLVITGE BIOMEDICAL RESEARCH INSTITUTE IDIBELL   (Spain)

^e RTI HEALTH SOLUTIONS   (United States)

Author keywords

cardiac CT; cardiovascular disease; coronary artery calcium; prediction; risk; score

Indexed keywords

BIOLOGICAL MARKER; CALCIUM;

AGATSTON SCORE; CLINICAL PRACTICE; CONCEPTUAL FRAMEWORK; CORONARY ARTERY CALCIFICATION; CORONARY ARTERY CALCIUM SCORE; EVIDENCE BASED MEDICINE; HUMAN; MASS SCORE; PRIORITY JOURNAL; REVIEW; SCORING SYSTEM; VOLUME SCORE; ALGORITHM; BLOOD VESSEL CALCIFICATION; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; CORONARY BLOOD VESSEL; DECISION SUPPORT SYSTEM; DIAGNOSTIC IMAGING; MULTIDETECTOR COMPUTED TOMOGRAPHY; PREDICTIVE VALUE; PROCEDURES; PROGNOSIS; REPRODUCIBILITY; SEVERITY OF ILLNESS INDEX;

ALGORITHMS; COMPUTED TOMOGRAPHY ANGIOGRAPHY; CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; CORONARY VESSELS; DECISION SUPPORT TECHNIQUES; HUMANS; MULTIDETECTOR COMPUTED TOMOGRAPHY; PREDICTIVE VALUE OF TESTS; PROGNOSIS; REPRODUCIBILITY OF RESULTS; SEVERITY OF ILLNESS INDEX; VASCULAR CALCIFICATION;

EID: 85026859106     PISSN: 1936878X     EISSN: 18767591     Source Type: Journal    
DOI: 10.1016/j.jcmg.2017.05.007     Document Type: Review

References (58)

1. Eggen, D.A., Strong, J.P., Mcgill, H.C., Coronary calcification. Circulation 32 (1965), 948–955.
2. Bolick, L.E., Blankenhorn, D.H., A quantitative study of coronary arterial calcification. Am J Pathol, 39, 1961, 511.
3. Bartel, A.G., Chen, J.T., Peter, R.H., Behar, V.S., Kong, Y., Lester, R.G., The significance of coronary calcification detected by fluoroscopy. Circulation 49 (1974), 1247–1253.
4. Margolis, J., Chen, J., Kong, Y., Peter, R., Behar, V., Kisslo, J., The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology 137 (1980), 609–616.
5. Budoff, M.J., Georgiou, D., Brody, A., et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 93 (1996), 898–904.
6. Schmermund, A., Baumgart, D., Möhlenkamp, S., et al. Natural history and topographic pattern of progression of coronary calcification in symptomatic patients. Arterioscler Thromb Vasc Biol 21 (2001), 421–426.
7. Greenland, P., Alpert, J.S., Beller, G.A., et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56 (2010), e50–e103.
8. Hecht, H., Blaha, M.J., Berman, D.S., et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 11 (2017), 157–168.
9. Alluri, K., Joshi, P.H., Henry, T.S., Blumenthal, R.S., Nasir, K., Blaha, M.J., Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 239 (2015), 109–117.
10. Agatston, A.S., Janowitz, W.R., Hildner, F.J., Zusmer, N.R., Viamonte, M., Detrano, R., Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15 (1990), 827–832.
11. Detrano, R.C., Anderson, M., Nelson, J., et al. Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility—MESA study 1. Radiology 236 (2005), 477–484.
12. Callister, T.Q., Cooil, B., Raya, S.P., Lippolis, N.J., Russo, D.J., Raggi, P., Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology 208 (1998), 807–814.
13. Hong, C., Bae, K.T., Pilgram, T.K., Coronary artery calcium: accuracy and reproducibility of measurements with multi–detector row CT—assessment of effects of different thresholds and quantification methods. Radiology 227 (2003), 795–801.
14. Arbab-Zadeh, A., Nakano, M., Virmani, R., Fuster, V., Acute coronary events. Circulation 125 (2012), 1147–1156.
15. Arbab-Zadeh, A., Fuster, V., The myth of the “vulnerable plaque”: transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment. J Am Coll Cardiol 65 (2015), 846–855.
16. Hecht, H.S., Cronin, P., Blaha, M.J., et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: a report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr 11 (2017), 74–84.
17. Shemesh, J., Apter, S., Itzchak, Y., Motro, M., Coronary calcification compared in patients with acute versus in those with chronic coronary events by using dual-sector spiral CT. Radiology 226 (2003), 483–488.
18. Hou, Z.-h., Lu, B., Gao, Y., et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. J Am Coll Cardiol Img 5 (2012), 990–999.
19. Motoyama, S., Kondo, T., Sarai, M., et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50 (2007), 319–326.
20. Criqui, M.H., Denenberg, J.O., Ix, J.H., et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA 311 (2014), 271–278.
21. Blaha, M.J., Martin, S.S., How do statins work? Changing paradigms with implications for statin allocation. J Am Coll Cardiol 62 (2013), 2392–2394.
22. Inoue, K., Motoyama, S., Sarai, M., et al. Serial coronary CT angiography–verified changes in plaque characteristics as an end point. J Am Coll Cardiol Img 3 (2010), 691–698.
23. Detrano, R., Guerci, A.D., Carr, J.J., et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358 (2008), 1336–1345.
24. Forbang, N.I., McClelland, R.L., Remigio-Baker, R.A., et al. Associations of cardiovascular disease risk factors with abdominal aortic calcium volume and density: the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 255 (2016), 54–58.
25. Leber, A.W., Knez, A., White, C.W., et al. Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 91 (2003), 714–718.
26. Saremi, A., Bahn, G., Reaven, P.D., for the VADT Investigators. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care 35 (2012), 2390–2392.
27. Puri, R., Nicholls, S.J., Ellis, S.G., Tuzcu, E.M., Kapadia, S.R., High-risk coronary atheroma: the interplay between ischemia, plaque burden, and disease progression. J Am Coll Cardiol 63 (2014), 1134–1140.
28. Bittencourt, M.S., Hulten, E., Ghoshhajra, B., et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging 7 (2014), 282–291.
29. Brown, E.R., Kronmal, R.A., Bluemke, D.A., et al. Coronary calcium coverage score: determination, correlates, and predictive accuracy in the Multi-Ethnic Study of Atherosclerosis. Radiology 247 (2008), 669–675.
30. Tota-Maharaj, R., Al-Mallah, M.H., Nasir, K., Qureshi, W.T., Blumenthal, R.S., Blaha, M.J., Improving the relationship between coronary artery calcium score and coronary plaque burden: addition of regional measures of coronary artery calcium distribution. Atherosclerosis 238 (2015), 126–131.
31. Tota-Maharaj, R., Joshi, P.H., Budoff, M.J., et al. Usefulness of regional distribution of coronary artery calcium to improve the prediction of all-cause mortality. Am J Cardiol 115 (2015), 1229–1234.
32. Blaha, M.J., Budoff, M.J., Tota-Maharaj, R., et al. Improving the CAC score by addition of regional measures of calcium distribution: Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol Img 9 (2016), 1407–1416.
33. Silverman, M.G., Harkness, J.R., Blankstein, R., et al. Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol Img 7 (2014), 476–486.
34. Abedin, M., Tintut, Y., Demer, L.L., Vascular calcification. Arterioscler Thromb Vasc Biol 24 (2004), 1161–1170.
35. Bentzon, J.F., Otsuka, F., Virmani, R., Falk, E., Mechanisms of plaque formation and rupture. Circ Res 114 (2014), 1852–1866.
36. Williams, M., Shaw, L.J., Raggi, P., et al. Prognostic value of number and site of calcified coronary lesions compared with the total score. J Am Coll Cardiol Img 1 (2008), 61–69.
37. Qian, Z., Anderson, H., Marvasty, I., et al. Lesion-and vessel-specific coronary artery calcium scores are superior to whole-heart Agatston and volume scores in the diagnosis of obstructive coronary artery disease. J Cardiovasc Comput Tomogr 4 (2010), 391–399.
38. Qian, Z., Marvasty, I., Rinehart, S., Voros, S., A lesion-specific coronary artery calcium quantification framework for the prediction of cardiac events. IEEE Trans Inf Technol Biomed 15 (2011), 673–680.
39. Beckman, J.A., Ganz, J., Creager, M.A., Ganz, P., Kinlay, S., Relationship of clinical presentation and calcification of culprit coronary artery stenoses. Arterioscler Thromb Vasc Biol 21 (2001), 1618–1622.
40. Urabe, Y., Yamamoto, H., Kitagawa, T., et al. Identifying small coronary calcification in non-contrast 0.5-mm slice reconstruction to diagnose coronary artery disease in patients with a conventional zero coronary artery calcium score. J Atheroscler Thromb 23 (2016), 1324–1333.
41. Al Rifai, M., Cainzos-Achirica, M., Blaha, M.J., Establishing the warranty of a coronary artery calcium score of zero. Atherosclerosis 238 (2015), 1–3.
42. Groen, J.M., Kofoed, K.F., Zacho, M., Vliegenthart, R., Willems, T., Greuter, M., Calcium score of small coronary calcifications on. Eur J Radiol 82 (2013), e58–e63.
43. Baron, K.B., Choi, A.D., Chen, M.Y., Low radiation dose calcium scoring: evidence and techniques. Curr Cardiovasc Imaging Rep 9 (2016), 1–8.
44. Deprez, F.C., Vlassenbroek, A., Ghaye, B., Raaijmakers, R., Coche, E., Controversies about effects of low-kilovoltage MDCT acquisition on Agatston calcium scoring. J Cardiovasc Comput Tomogr 7 (2013), 58–61.
45. Marwan, M., Mettin, C., Pflederer, T., et al. Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: comparison between 120-kV and 100-kV tube voltage protocols. J Cardiovasc Comput Tomogr 7 (2013), 32–38.
46. Vonder, M., Pelgrim, G.J., Huijsse, S.E., et al. Feasibility of spectral shaping for detection and quantification of coronary calcifications in ultra-low dose CT. Eur Radiol, 2016, 1–8.
47. den Harder, A.M., Wolterink, J.M., Willemink, M.J., et al. Submillisievert coronary calcium quantification using model-based iterative reconstruction: a within-patient analysis. Eur J Radiol 85 (2016), 2152–2159.
48. Willemink, M.J., Takx, R.A., de Jong, P.A., et al. The impact of CT radiation dose reduction and iterative reconstruction algorithms from four different vendors on coronary calcium scoring. Eur Radiol 24 (2014), 2201–2212.
49. Hutt, A., Duhamel, A., Deken, V., et al. Coronary calcium screening with dual-source CT: reliability of ungated, high-pitch chest CT in comparison with dedicated calcium-scoring CT. Eur Radiol 26 (2016), 1521–1528.
50. Iribarren, C., Sidney, S., Sternfeld, B., Browner, W.S., Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 283 (2000), 2810–2815.
51. Blaha, M.J., Budoff, M.J., Rivera, J.J., et al. Relation of aortic valve calcium detected by cardiac computed tomography to all-cause mortality. Am J Cardiol 106 (2010), 1787–1791.
52. Eisen, A., Tenenbaum, A., Koren-Morag, N., et al. Calcification of the thoracic aorta as detected by spiral computed tomography among stable angina pectoris patients. Circulation 118 (2008), 1328–1334.
53. Bos, D., Leening, M.J., Kavousi, M., et al. Comparison of atherosclerotic calcification in major vessel beds on the risk of all-cause and cause-specific mortality: the Rotterdam study. Circ Cardiovasc Imaging, 8, 2015, e003843.
54. Tison, G.H., Guo, M., Blaha, M.J., et al. Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr 9 (2015), 406–414.
55. Blaha, M.J., Blumenthal, R.S., Budoff, M.J., Nasir, K., Understanding the utility of zero coronary calcium as a prognostic test. Circ Cardiovasc Qual Outcomes 4 (2011), 253–256.
56. Nasir, K., Bittencourt, M.S., Blaha, M.J., et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). Journal of the American College of Cardiology 66 (2015), 1657–1668.
57. Blaha, M.J., Cainzos-Achirica, M., Greenland, P., et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 133 (2016), 849–858.
58. Mortensen, M.B., Fuster, V., Muntendam, P., et al. A simple disease-guided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage Study. J Am Coll Cardiol 68 (2016), 881–891.