Coronary artery calcium assessed with calibrated mass scoring in asymptomatic individuals: results from the Copenhagen General Population Study
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.
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.
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.
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.
• 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.
KeywordsMultidetector computed tomography Risk assessment Cardiac imaging techniques Coronary artery disease Cross-sectional studies
Body mass index
Coronary artery calcification
Copenhagen General Population Study
Calibrated mass score
The European Society of Cardiology
Region of interest
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
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.
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.
Compliance with ethical standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained from the Regional Ethics Committee of Copenhagen (H-KF-01-144/01).
• Cross-sectional study
• Performed at one institution
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