239 coronary artery calcium
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EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium
Coronary Artery Calcium Coronary Artery Calcium ISIS Atherosclerosis Atherosclerosis
There are There are NONO false positive calcium measures false positive calcium measures by EBT [i.e. ALL calcium is plaque]by EBT [i.e. ALL calcium is plaque]
Establishes a diagnosis ofEstablishes a diagnosis of
coronary atherosclerosiscoronary atherosclerosis
Coronary Calcium Area by EBT andCoronary Calcium Area by EBT andCoronary Artery Plaque AreaCoronary Artery Plaque Area
0
2
4
6
8
10
12
14
16
0 2 4 6 8Square Root Sum of Calcium Areas
Squa
re R
oot S
um o
f Pl
aque
Are
as
Rumberger, Circ 1995:92:2157-62
n = 38n = 38r = 0.90r = 0.90p < .001p < .001
No. of coronary segments/pt. with plaques (IVUS)0 1 2 3 4 5 6 7
No. of calcified coronary
segments/pt. (EBCT)
0
1
2
3
4
5
6
7Y = -0.67 + (0.90 * X)r = 0.86p < 0.0001 N = 40 patientstotal of 222 coronary segments examined
Acute Coronary Syndrome and Non-Obstructive CADAcute Coronary Syndrome and Non-Obstructive CAD# of segments with EBT calcium vs. # of segments with any plaque# of segments with EBT calcium vs. # of segments with any plaque
Schmermund et alSchmermund et alAJC 1998; 81:AJC 1998; 81:141-146141-146
EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium
Define the extent of disease? YESDefine the extent of disease? YES
The amount of calcium The amount of calcium correlates DIRECTLYcorrelates DIRECTLY to to
the amount of measurable coronary disease by:the amount of measurable coronary disease by:
1) direct histopathologic comparison1) direct histopathologic comparison
2) with intravascular ultrasound2) with intravascular ultrasound
Electron Beam TomographyElectron Beam Tomography
Hn x-factor(Agatston Scoring)
130-199 1
200-299 2
300-399 3
>400 4
Area = 15 mmArea = 15 mm22
Volume = 12 mmVolume = 12 mm33 x10 x10-3-3
Agatston (area) ScoreAgatston (area) Scorevs. Volume Scorevs. Volume Score
Area = 8 mmArea = 8 mm22
Volume = 6 mmVolume = 6 mm33 x10 x10-3-3
Agatston (area) ScoreAgatston (area) Scorevs. Volume Scorevs. Volume Score
Total Score = Total Score =
““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia:initially asymptomatic adultsinitially asymptomatic adults
2.7
6.9
14.3
19.7 20.2
0
5
10
15
20
25
30
'1-49 >50 >80 >160 >600
Arad: JACC 2000;36:1253-60
EBCT Calcium ScoreEBCT Calcium Score
Agatston: Circ 1997
Odd
s Rat
ioO
dds R
atio
3-6 yr. f/u3-6 yr. f/un = 367n = 367
3.5 yr. f/u3.5 yr. f/un = 1177n = 1177
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