The role and diagnostic value of assessing the degree of coronary arteries calcification for predicting the severity of coronary heart disease
DOI:
https://doi.org/10.14739/2310-1237.2021.1.228855Keywords:
coronary artery, calcium score, coronary computed tomography angiography, SYNTAX score, coronary heart diseasAbstract
Coronary heart disease (CHD) is one of the leading mortality causes. According to the latest guidelines, coronary computed tomography angiography (CCTA) is one of the main non-invasive methods for diagnosis of CHD, which allows for quantification of stenosis severity and the characterization of stenotic lesions.
Aim of the study. It is to study the role, diagnostic value and dependence of coronary artery calcification on the degree of stenotic lesion of the coronary arteries and anthropometric parameters in patients with coronary artery disease examined by computed tomography.
Materials and methods. According to the purpose of the study, 46 patients were included: 32 (69.6 %) males and 14 (30.4 %) females. The average age of the patients was 59.0 ± 9.8 years, height – 172 ± 9 cm, weight – 85.6 ± 12.9 kg, body mass index (BMI) – 28.6 ± 4.13, body surface area (BSA) – 1.98 ± 0.17 m2. Demographic and clinical variables were analyzed using descriptive statistics. Independent t-tests were conducted between two groups of patients (Agatston index ≥400 and <400), using P < 0.05 as a significant value. Pearson correlation coefficient was employed to determine independent coronary calcium predictors using P < 0.05 as a significant value.
Results. According to the results of the age analysis, significant differences were found among both groups of patients (P = 0.02). Notable differences in the number of affected coronary arteries between Groups 1 and 2 with an Agatston index ≥400 and <400 (P < 0.01) were found. During the correlation analysis, a significant moderate positive correlation of the SYNTAX score level with Agatston index (r = 0.69, P < 0.01) was revealed.
Conclusions. The degree of coronary arteries calcification with Agatston score ≥400 is an independent predictor of severe coronary heart disease with multivessel lesion of the coronary arteries. The degree of calcification of coronary arteries with Agatston score ≥400 is more common in males. Height, weight, BMI and BSA do not influence the degree of coronary calcification arteries and Agatston score level.
References
Ministry of Health of Ukraine. (2016, September 23). Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy. Stabilna ishemichna khvoroba sertsia : Nakaz MOZ Ukrainy No. 152 [Unified clinical protocol of the primary, secondary (specialized) and tertiary (highly specialized). Medical care stable ischemic heart disease (No. 152)]. http://mtd.dec.gov.ua/images/dodatki/2016_152_IHS/2016_152_YKPMD_IHS.pdf
Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., Prescott, E., Storey, R. F., Deaton, C., Cuisset, T., Agewall, S., Dickstein, K., Edvardsen, T., Escaned, J., Gersh, B. J., Svitil, P., Gilard, M., Hasdai, D., Hatala, R., Mahfoud, F., … ESC Scientific Document Group (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European heart journal, 41(3), 407-477. https://doi.org/10.1093/eurheartj/ehz425
Ndrepepa, G., Tada, T., Fusaro, M., Cassese, S., King, L., Hadamitzky, M., Haase, H. U., Schömig, A., Kastrati, A., & Pache, J. (2012). Association of coronary atherosclerotic burden with clinical presentation and prognosis in patients with stable and unstable coronary artery disease. Clinical research in cardiology, 101(12), 1003-1011. https://doi.org/10.1007/s00392-012-0490-9
Farooq, V., Serruys, P. W., Bourantas, C., Vranckx, P., Diletti, R., Garcia Garcia, H. M., Holmes, D. R., Kappetein, A. P., Mack, M., Feldman, T., Morice, M. C., Colombo, A., Morel, M. A., de Vries, T., van Es, G. A., Steyerberg, E. W., Dawkins, K. D., Mohr, F. W., James, S., & Ståhle, E. (2012). Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial. European heart journal, 33(24), 3105-3113. https://doi.org/10.1093/eurheartj/ehs367
Zimmermann, G. S., Rüther, T., Ziegler, F. V., Greif, M., Becker, C., & Becker, A. (2019). Predictive value of coronary calcifications for future cardiac events in asymptomatic patients: underestimation of risk in asymptomatic smokers. The international journal of cardiovascular imaging, 35(7), 1387-1393. https://doi.org/10.1007/s10554-019-01571-3
Mehta, A., Pandey, A., Ayers, C. R., Khera, A., Sperling, L. S., Szklo, M. S., Gottesman, R. F., Budoff, M. J., Blaha, M. J., Blumenthal, R. S., Nasir, K., & Joshi, P. H. (2020). Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race: MESA and DHS. Circulation. Cardiovascular imaging, 13(8), e010153. https://doi.org/10.1161/CIRCIMAGING.119.010153
Agatston, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, M., Jr, & Detrano, R. (1990). Quantification of coronary artery calcium using ultrafast computed tomography. Journal of the American College of Cardiology, 15(4), 827-832. https://doi.org/10.1016/0735-1097(90)90282-t
de Agustín, J. A., Gómez de Diego, J. J., Marcos-Alberca, P., Mahía, P., Rodrigo, J. L., Luaces, M., Núñez-Gil, I. J., Ferreiros, J., Bustos, A., Cabeza, B., García-Fernández, M. Á., Macaya, C., & Pérez de Isla, L. (2018). Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography. Revista espanola de cardiologia, 71(2), 105-109. https://doi.org/10.1016/j.rec.2017.04.012
Tay, S. Y., Chang, P. Y., Lao, W. T., Lin, Y. C., Chung, Y. H., & Chan, W. P. (2017). The proper use of coronary calcium score and coronary computed tomography angiography for screening asymptomatic patients with cardiovascular risk factors. Scientific reports, 7(1), 17653. https://doi.org/10.1038/s41598-017-17655-w
Rozanski, A., & Berman, D. S. (2017). Coronary artery calcium scanning in symptomatic patients: Ready for use as a gatekeeper for further testing?. Journal of nuclear cardiology, 24(3), 835-838. https://doi.org/10.1007/s12350-017-0794-2
Greenland, P., Blaha, M. J., Budoff, M. J., Erbel, R., & Watson, K. E. (2018). Coronary Calcium Score and Cardiovascular Risk. Journal of the American College of Cardiology, 72(4), 434-447. https://doi.org/10.1016/j.jacc.2018.05.027
Sandfort, V., & Bluemke, D. A. (2017). CT calcium scoring. History, current status and outlook. Diagnostic and interventional imaging, 98(1), 3-10. https://doi.org/10.1016/j.diii.2016.06.007
Malguria, N., Zimmerman, S., & Fishman, E. K. (2018). Coronary Artery Calcium Scoring: Current Status and Review of Literature. Journal of computer assisted tomography, 42(6), 887-897. https://doi.org/10.1097/RCT.0000000000000825
Makaryus, A. N., Sison, C., Kohansieh, M., & Makaryus, J. N. (2015). Implications of Gender Difference in Coronary Calcification as Assessed by CT Coronary Angiography. Clinical Medicine Insights. Cardiology, 8(Suppl 4), 51-55. https://doi.org/10.4137/CMC.S18764
Lee, S. J., Lee, I. K., & Jeon, J. H. (2020). Vascular Calcification-New Insights Into Its Mechanism. International journal of molecular sciences, 21(8), 2685. https://doi.org/10.3390/ijms21082685
Lee, D. H., Youn, H. J., Jung, H. O., Chang, K., Choi, Y. S., & Jung, J. I. (2017). Coronary artery calcium score plays an important role for cardiovascular risk stratification in the statin benefit groups of asymptomatic individuals. Lipids in health and disease, 16(1), 172. https://doi.org/10.1186/s12944-017-0560-0
Klüner, L. V., Oikonomou, E. K., & Antoniades, C. (2021). Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography. Radiology. Cardiothoracic imaging, 3(1), e200563. https://doi.org/10.1148/ryct.2021200563
Garg, P. K., Jorgensen, N. W., McClelland, R. L., Leigh, J. A., Greenland, P., Blaha, M. J., Yoon, A. J., Wong, N. D., Yeboah, J., & Budoff, M. J. (2018). Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population: The Multi-Ethnic Study of Atherosclerosis (MESA). Journal of cardiovascular computed tomography, 12(6), 493-499. https://doi.org/10.1016/j.jcct.2018.10.001
Venkataraman, P., Stanton, T., Liew, D., Huynh, Q., Nicholls, S. J., Mitchell, G. K., Watts, G. F., Tonkin, A. M., & Marwick, T. H. (2020). Coronary artery calcium scoring in cardiovascular risk assessment of people with family histories of early onset coronary artery disease. The Medical journal of Australia, 213(4), 170-177. https://doi.org/10.5694/mja2.50702
Choi, H. Y., Shin, S. J., Yoo, J., Lee, K., Song, D., Kim, Y. D., Nam, H. S., Lee, K. Y., Lee, H. S., Kim, D. J., & Heo, J. H. (2020). Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke. Frontiers in neurology, 11, 206. https://doi.org/10.3389/fneur.2020.00206
Stähli, B. E., Bonassin, F., Goetti, R., Küest, S. M., Frank, M., Altwegg, L. A., Gebhard, C., Levis, A., Wischnewsky, M. B., Lüscher, T. F., Alkadhi, H., Kaufmann, P. A., & Maier, W. (2012). Coronary computed tomography angiography indicates complexity of percutaneous coronary interventions. The Journal of invasive cardiology, 24(5), 196-201.
Schmermund, A., Denktas, A. E., Rumberger, J. A., Christian, T. F., Sheedy, P. F., 2nd, Bailey, K. R., & Schwartz, R. S. (1999). Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: comparison with cardiac risk factors and radionuclide perfusion imaging. Journal of the American College of Cardiology, 34(3), 777-786. https://doi.org/10.1016/s0735-1097(99)00265-x
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).