8-OR: Coronary Calcium Scoring to Select Asymptomatic Diabetic Patients with Coronary Artery Stenoses Suitable for Revascularization

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 8-OR
Author(s):  
NARIMANE BERKANE ◽  
EMMANUEL COSSON ◽  
SARA PINTO ◽  
TIT-LIVIU CIUNGANU ◽  
PAUL VALENSI
Keyword(s):  
Coronary Artery ◽  
Coronary Calcium ◽  
Diabetic Patients ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring ◽  
Coronary Artery Stenoses

Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Hala T. Salem ◽  
Eman A.S. Sabek
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
High Sensitivity ◽  
Coronary Calcium ◽  
Risk Estimate ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring ◽  
Framingham Risk ◽  
Artery Disease

Aim and Objective: To estimate the relationship between Coronary Calcium Scoring (CCS)and presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. Background: Coronary Calcium Scoring (CCS) is a test uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep “patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information”. Methods: Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, measures to keep it as low as possible were presented, CCS and Framingham risk estimate were compared to the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. Results: CCS is a strong discriminator for obstructive CAD and can with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate which has high sensitivity and low specificity. Conclusion: CCS helps reducing the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions was unlikely, and as a test does not use contrast material, harmful effect on the kidney will be avoided as most of coronary atherosclerotic patients have renal problems.

Contrast Enhanced Cardiac CT Detects Coronary Artery Disease In 44% Of Asymptomatic Long-Term Adult Allogeneic Stem Cell Transplant Survivors

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2080-2080
Author(s):  
Natasha A Jain ◽  
Marcus Y Chen ◽  
Sujata Shanbhag ◽  
Kit Lu ◽  
Priyanka A Pophali ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Calcium Score ◽  
Low Risk ◽  
Coronary Calcium ◽  
Coronary Calcium Score ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring ◽  
Coronary Ct ◽  
Ct Angiogram ◽  
Artery Disease

Abstract Long term allogeneic stem cell transplantation (allo-SCT) survivors face a 2.3 fold increase risk of premature cardiovascular (CV) related death compared to the general population. A reliable screening strategy to identify allo-SCT survivors at risk for CV-related disease is therefore warranted to minimize future events. Cardiac CT is an emerging non-invasive imaging technology with high sensitivity for detecting coronary artery disease (CAD) and high negative predictive value to exclude the presence of CAD. We conducted the first prospective non-randomized single institution study to evaluate Agatston coronary calcium scoring by CT with concomitant coronary CT angiograms as a tool to identify the survivors at risk for CV disease. Sixteen asymptomatic post allo-SCT survivors (11 males; 5 females) with median age of 45 years (range 22-66) at transplant underwent coronary calcium scoring and contrast enhanced coronary CT angiograms at a median follow up of 5 years post transplant. 10-year Framingham cardiovascular risk scores (incorporating age, sex, total cholesterol, HDL cholesterol, systolic BP, HTN, smoking status) were also calculated at time of screening. Two were classified as high risk, 1 intermediate and 13 as low risk. Iodinated IV contrast was administered for coronary artery visualization and IV hydration given to patients with decreased creatinine clearance. Non-obstructive CAD was detected in seven (44%) patients. Additionally, four (25%) of these subjects had aortic root calcification. Lesion distributions by arterial territory were: left main 5.8%, left anterior descending 35.3%, left circumflex 29.4% and right coronary artery 29.4%. Characteristics of coronary plaques were: 47% calcified, 47% mixed calcified / non-calcified, and 6% non-calcified. In those with CAD, the median coronary calcium score was 55 (range: 0-992) (p<0.001), corresponding to the 75th percentile (range: 33rd to 97th percentile) (p < 0.001) adjusted for age, gender, and ethnicity. In comparison, those without any CAD had a median coronary calcium score of 0, < 1 percentile. There was one patient with <1% Framingham cardiovascular risk score who had a zero coronary calcium score with non-obstructive CAD on the CT angiogram. The radiation exposure during the procedure was acceptable, at a median of 0.60 mSv (range 0.18 to 3.12 mSv) for the coronary calcium score and 0.85 mSv (range 0.34 to 8.01) for the coronary CT angiogram. There were no complications related to the procedure. Current (2010 AHA/ACC) guidelines suggest a role for coronary calcium scoring for screening asymptomatic non-transplant individuals with intermediate Framingham risk. However, we detected CAD in 4 of 13 (30.8%) low risk transplant survivors. Coronary calcium scoring alone (sensitivity of 85.7% and specificity of 100%) may be adequate for screening and avoids the use of IV contrast. In conclusion, coronary calcium score with or without CT angiogram is a safe, feasible, highly sensitive study in transplant survivors; even asymptomatic, low-risk survivors may benefit from screening.Table 1Coronary Calcium Scoring in Subjects With and Without CAD by AngiographyPresent CAD by CT angiographyAbsent CAD by CT angiographyp-valueAgatston coronary calcium scoreMedian 55 (range 0 to 992)0 (range 0 to 0)< 0.001Coronary Calcium score percentileMedian 75th % ile (range 0 to 97)< 1st % ile (range 0 to 0 )<0.001 Disclosures: No relevant conflicts of interest to declare.

Implementation study of CT calcium score in patients with atypical angina pectoris and non-specific thoracic complaints in primary care: rationale, objectives, and design of the CONCRETE study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.Y Koopman ◽  
S.M.P Martens ◽  
R.T.A Willemsen ◽  
R Van Bruggen ◽  
G.J Dinant ◽  
...  
Keyword(s):  
Primary Care ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Standard Of Care ◽  
Coronary Calcium ◽  
Direct Access ◽  
Funding Source ◽  
Implementation Study ◽  
Calcium Scoring ◽  
Coronary Calcium Scoring

Abstract Background Identifying and excluding coronary artery diseases (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). It is unclear what the best diagnostic and prognostic strategy is for these patients in primary care. Computed Tomography coronary calcium scoring (CT CCS) has a high sensitivity for early diagnosis and exclusion of CAD. However, CT CCS has not been tested in a primary care setting. In the CONCRETE study, the impact of direct access of GPs to CT CCS on management and diagnosis will be investigated. CONCRETE is the abbreviation for “COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain.” Currently, we present the rationale, objectives and design of this study. Purpose The purpose of CONCRETE is to study the implementation of CT CCS in primary care, and determine the effects on GP office level. The primary objective is to determine the increase in detection/treatment rate of CAD in GP offices with CT CCS, compared to GP offices with standard of care. Methods CONCRETE is an implementation study with a cluster randomized design, in which direct access to CT CCS in a group of 40 GP offices is compared to the standard of care in a control group of 40 GP offices. In both arms, inclusion of 800 patients with atypical angina pectoris and non-specific thoracic complaints is intended. Results Recruitment of GP offices and participants started in January 2019. First results will be presented. Conclusion CONCRETE will determine whether access to CT CCS will lead to earlier and more effective detection or exclusion of CAD in GP patients with atypical angina pectoris and non-specific thoracic complaints, in comparison to the standard of care. Implementation of the study findings could initiate a change in the (Dutch) GP healthcare policy, for these patients in primary care. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

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