Skip to main content

Electron Beam Tomography in the Prevention of Coronary Artery Disease

  • Chapter
Book cover Preventive Cardiology

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 134 Accesses

Abstract

As technology advances, the noninvasive imaging of preclinical and subclinical disease holds great promise for the early detection of the atherosclerotic process and for monitoring its progression after prevention strategies are instituted (1). Electron beam computed tomography (EBT) acquires images in 50–100 ms compared with 500 ms plus for conventional computed tomography (CT) scanners. Just as a camera with a fast shutter speed can stop action, the EBT acquires images of the beating heart without motion artifact. This allows detection and precise quantification of small deposits of coronary calcium.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Devereux RB, Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993; 88: 1444–1455.

    Article  PubMed  CAS  Google Scholar 

  2. McNamara JJ, Molot MA, Stremple IF, Cutting RT. Coronary artery disease in combat casualties in Vietnam. JAMA 1971; 216: 1185–1187. 21.

    Google Scholar 

  3. Strong JP. Coronary atherosclerosis in soldiers: a clue to the natural history of atherosclerosis in the young. JAMA 1986; 256: 2863–2866.

    Article  PubMed  CAS  Google Scholar 

  4. Enos WF, Holmes RH, Beyer J. Coronary disease among United States soldiers killed in action in Korea: preliminary report. JAMA 1953; 152: 1090–1093.

    Article  CAS  Google Scholar 

  5. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1690– 1692.

    Google Scholar 

  6. Roberts WC, Jones AA. Quantitation of coronary artery narrowing at necropsy in sudden coronary death: analysis of 31 patients and comparison with 25 control subjects. Am J Cardiol 1979; 44: 39–45.

    Article  PubMed  CAS  Google Scholar 

  7. Wames CA, Roberts WC. Comparison at necropsy by age group, of amount and distribution of narrowing by atherosclerotic plaque in 2995 5 mm long segments of 240 major coronary arteries in 60 men aged 31 to 70 years with sudden coronary death. Am Heart J 1994; 108: 431–435.

    Google Scholar 

  8. Cabin HS, Roberts WC. Quantitative comparison of extent of coronary narrowing and size of healed myocardial infarct in 33 necropsy patients with clinically recognized and in 28 with clinically unrecognized (silent) previous acute myocardial infarction. Am J Cardiol 1982; 50: 677–680.

    Article  PubMed  CAS  Google Scholar 

  9. Arnett EN, Isner JM, Redwood DR, et al. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350–356.

    PubMed  CAS  Google Scholar 

  10. Waller BF, The eccentric coronary atherosclerotic plaque: morphologic observations and clinical relevance. Clin Cardiol 1989; 12: 14–20.

    Article  PubMed  CAS  Google Scholar 

  11. Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316: 1371–1375.

    Article  PubMed  CAS  Google Scholar 

  12. Tobis JM, Mallery J, Mahon D, et al. Intravascular ultrasound imaging of human coronary arteries in vivo. Circulation 1991; 83: 913–926.

    Article  PubMed  CAS  Google Scholar 

  13. Rifkin RD, Parisi AF, Folland E. Coronary calcification in the diagnosis of coronary artery disease. Am J Cardiol 1979; 44: 141–146.

    Article  PubMed  CAS  Google Scholar 

  14. Blankenhorn DH. Coronary calcification: a review. Am J Med Sci 1961; 242: 1–9.

    Article  Google Scholar 

  15. Beakenkopf WG, Daoud AS, Love BM. Calcification in the coronary arteries and its relation to arteriosclerosis and myocardial infarction. Am J Radiol 1964; 92: 865–871.

    Google Scholar 

  16. Warburton RK, Tampas JP, Soule AB, et al. Coronary artery calcification: its relationship to coronary artery stenosis and myocardial infarction. Radiology 1968; 91: 109–115.

    PubMed  CAS  Google Scholar 

  17. Frink RJ, Achor RWP, Brown AL, et al. Significance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241–247.

    Article  PubMed  CAS  Google Scholar 

  18. McCarthy JH, Palmer FJ. Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499–506.

    Article  PubMed  CAS  Google Scholar 

  19. Eggen DA, Strong JP, McGill KC. Coronary calcification: relationship to clinically significant coronary lesions and race, sex and topographical distribution. Circulation 1965; 32: 948–955.

    Article  PubMed  CAS  Google Scholar 

  20. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (first of two parts). N Engl J Med 1992; 326: 242–250.

    Article  PubMed  CAS  Google Scholar 

  21. Kragel AH, Reddy SG, Wittes JT, et al. Morphomeuic analysis of the composition of atherosclerotic plaques in the four major epicardial coronary arteries in acute myocardial infarction and in sudden coronary death. Circulation 1989; 80: 1747–1756.

    Article  PubMed  CAS  Google Scholar 

  22. Mintz GS, Pichard AD, Popma JJ, et al. Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study. J Am Coll Cardiol 1997; 29: 268–274.

    Article  PubMed  CAS  Google Scholar 

  23. Schmermund A, Baumgart G, Görge G, et al. Coronary artery calcium in acute coronary syndromes: a comparative study of electron beam CT, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation 1997; 96: 1461–1469.

    Article  PubMed  CAS  Google Scholar 

  24. Fitzpatrick LA, Severson A, Edwards WD, Ingram RT. Diffuse calcification in human coronary arteries: association of osteopontin with atherosclerosis. J Clin Invest 1994; 1597–1604.

    Google Scholar 

  25. Mautner SL, Mautner GC, Froehlich J, et al. Coronary artery disease: prediction with in vitro electron beam CT. Radiology 1994; 192: 625–630.

    PubMed  CAS  Google Scholar 

  26. Simons DB, Schwartz RS, Edwards WD, et al. Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study. J Am Coll Cardiol 1992; 20: 1118–1126.

    Article  PubMed  CAS  Google Scholar 

  27. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using non-decalcifying methodology. J Am Cardiol 1998; 31: 126–133.

    CAS  Google Scholar 

  28. Uretsky BF, Rifkin RD, Sharma SC, et al. Value of fluoroscopy in the detection of coronary stenosis: influence of age, sex and number of vessels calcified on diagnostic efficacy. Am Heart J 1988; 115: 323–333.

    Article  PubMed  CAS  Google Scholar 

  29. Detrano R, Markovic D, Simpfendorfer C, et al. Digital subtraction fluoroscopy: a new method of detecting coronary calcifications with improved sensitivity for the prediction of coronary disease. Circulation 1985; 71: 725–732.

    Article  PubMed  CAS  Google Scholar 

  30. Margolis JR, Chen M, Kong Y, et al. The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology 1980; 137: 609–616.

    PubMed  CAS  Google Scholar 

  31. Witteman JCM, Kannel WB, Wolf PA, et al. Aortic calcified plaques and cardiovascular disease: The Framingham Study. Am J Cardiol 1990; 66: 1060–1064.

    Article  PubMed  CAS  Google Scholar 

  32. Witteman JCM, Kok FJ, Saase Van JLCM, et al. Aortic calcification as a predictor of cardiovascular mortality. Lancet 1986; 2: 1120–1122.

    Article  PubMed  CAS  Google Scholar 

  33. Gould RG. Principles of ultrafast computed tomography: historical aspects, mechanism of action and scanner characteristics. In: Stanford W, Rumberger JA, eds. Ultrafast Computed Tomography in Cardiac Imaging: Principles and Practice. Futura Publishing, Mount Kisco, NY, 1992, pp. 1–16.

    Google Scholar 

  34. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.

    Article  PubMed  CAS  Google Scholar 

  35. Kaufmann RB, Sheedy PF II, Breen JF, et al. Detection of heart calcification with electron beam CT: interobserver and intraobserver reliability for scoring quantification. Radiology 1994; 190: 347–352.

    PubMed  CAS  Google Scholar 

  36. Bielak LF, Kaufmann RB, Moll PP, et al. Small lesions in the heart identified at electron beam CT: calcification or nose? Radiology 1994; 192: 631–636.

    PubMed  CAS  Google Scholar 

  37. Devries S, Wolfkiel C, Shah V, et al. Reproducibility of the measurement of coronary calcium with ultrafast computed tomography. Am J Cardiol 1995; 75: 973–977.

    Article  PubMed  CAS  Google Scholar 

  38. McColloough CH, Kaufmann RB, Cameron BM, et al. Electron beam CT: use of a calibration phantom to reduce variability in calcium quantification. Radiology 1995; 196: 159–165.

    Google Scholar 

  39. Kemp HG, Kronmal RA, Vlietstra RE, Frye RL. Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol 1986; 7: 479–483.

    Article  PubMed  CAS  Google Scholar 

  40. Nakagomi A, Celermajer DS, Lumley T, Freedman SB. Angiographic severity of coronary narrowing is a surrogate marker for the extent of coronary artherosclerosis. Am J Cardiol 1996; 78: 516–519.

    Article  PubMed  CAS  Google Scholar 

  41. Little WC, Constantiescu M, Applegate RI, et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 1988; 78: 1157–1166.

    Article  PubMed  CAS  Google Scholar 

  42. Ambrose JA, Tannenbaum MA, Alexopoulos D, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 1988; 12: 56–62.

    Article  PubMed  CAS  Google Scholar 

  43. Fallavollita JA, Kumar K, Brody AS, et al. Detection of coronary artery calcium to differentiate patient with early coronary atherosclerosis from luminally normal arteries. Am J Cardiol 1996; 78: 1281–1283.

    Article  PubMed  CAS  Google Scholar 

  44. Schmermund A, Rumberger JA, Colter JF, et al. Angiographic correlates of “spotty” coronary artery calcium detected by electron-beam computed tomography in patients with normal or near-normal coronary angiograms. Am J Cardiol 1998; 82: 508–511.

    Article  PubMed  CAS  Google Scholar 

  45. Agatston AS, Janowitz WR, Kaplan G, et al. Ultrafast computed tomography-detected coronary calcium reflects the angiographic extent of coronary arterial atherosclerosis. Am J Cardiol 1994; 74: 1272–1274.

    Article  PubMed  CAS  Google Scholar 

  46. Mahoney LT, Burns TL, Stanford W, et al. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. Am Coll Cardiol 1996; 27: 277–284.

    Article  CAS  Google Scholar 

  47. Schmidt HH, Hill S, Makariou EV, et al. Relation of cholesterol-year score to severity of calcific atherosclerosis and tissue deposition in homozygous familial hypercholesterolemia. Am J Cardiol 1996; 77: 575–580.

    Article  PubMed  CAS  Google Scholar 

  48. Gidding SS, Bookstein LC, Chomka EV. Usefulness of electron beam tomography in adolescents and young adults with heterozygous familial hypercholesteromia. Circulation 1998; 98: 2580–2583.

    Article  PubMed  CAS  Google Scholar 

  49. Kaufmann RB, Peyser PA, Sheedy PF, et al. Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary artery disease in younger patients. J Am Coll Cardiol 1995; 25: 626–632.

    Article  PubMed  CAS  Google Scholar 

  50. Guerci AD, Spadaro LA, Popma JJ, et al. Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and Budoff symptomatic adults. Am J Cardiol 1997; 79: 128–133.

    Article  PubMed  CAS  Google Scholar 

  51. Schmermund A, Bailey KR, Rumberger JA, et al. An algorithm for noninvasive identification of angiographic three-vessel and/or left main coronary artery disease in symptomatic patients on the basis of cardiac risk and electron-beam computed tomograpic calcium scores. J Am Coll Cardiol 1999; 33: 444–452.

    Article  PubMed  CAS  Google Scholar 

  52. Budoff MJ, Georgiou D, Brody A, Agatston AS, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circultation 1996; 93: 898–904.

    Article  CAS  Google Scholar 

  53. Guerci AD, Spadaro LA, Goodman KJ, et al. Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease. J Am Coll Cardiol 1998; 32: 673–679.

    Article  PubMed  CAS  Google Scholar 

  54. Kennedy J, Shavelle R, Wang S, et al. Coronary calcium and standard risk factors in symptomatic patient referred for coronary angiography. Am Heart J 1998; 135: 696–702.

    Article  PubMed  CAS  Google Scholar 

  55. Strong JP, Richard ML. Cigarette smoking and atherosclerosis in autopsied men. Atherosclerosis 1976; 23: 451–476.

    Article  PubMed  CAS  Google Scholar 

  56. Fuster V, Chesebro JH, Frye RL, Elveback LR. Platelet survival and the development of coronary artery disease in the young adult: effects of cigarette smoking, strong family history and medical therapy. Circulation 1981; 63: 546–550.

    Article  PubMed  CAS  Google Scholar 

  57. Hung J, Lam JYT, Lacoste L, Letchacovski G. Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. Circulation 1995; 92: 2432–2436.

    Article  PubMed  CAS  Google Scholar 

  58. Kennedy J, Shavelle R, Wang S, et al. Coronary calcium and standard risk factors in symptomatic patient referred for coronary angiography. Am Heart J 1998; 135: 696–702.

    Article  PubMed  CAS  Google Scholar 

  59. Ozner M, Ahn YS, Meyerberg RJ. Chronic platelet activation and acute coronary syndromes in 13 middle aged patients. J Clin Appl Thromb 1997; 3: 46–53.

    Google Scholar 

  60. Kajinami K, Seki H, Takekoshi N, Mabuchi H. Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results. J Am Coll Cardiol 1995; 26: 1209–1221.

    Article  PubMed  CAS  Google Scholar 

  61. He ZX, Hedrick TD, Pratt CM, et al. Severity of coronary artery calcification by eltectron beam tomography predicts silent myocardial ischemia. Circulation 2000; 101: 244–251.

    Article  PubMed  CAS  Google Scholar 

  62. Janowitz WR, Agatston AS, Kaplan G, Viamonte M Jr. Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. Am J Cardiol 1993; 72 (3): 247–254.

    Article  PubMed  CAS  Google Scholar 

  63. Detrano RC, Wong ND, Tang W, et al. Prognostic significance of cardiac cinefluoroscopy for coronary calcific deposits in asymptomatic high risk subjects. J Am Coll Cardiol 1994; 24: 354–358.

    Article  PubMed  CAS  Google Scholar 

  64. Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol 1996; 27: 285–290.

    Article  PubMed  CAS  Google Scholar 

  65. Agatston AS, Janowitz WR, Kaplan G, et al. Electron beam CT coronary calcium predicts future coronary events. Circulation 1996; 94: I–360A.

    Google Scholar 

  66. Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries. 19 month follow-up of 1173 asymptomatic subjects. Circulation 1996; 93 (11): 1951–1953.

    Article  PubMed  CAS  Google Scholar 

  67. Detrano RC, Wong ND, Doherty TM, et al. Coronary calcium does not accurately predict near-term future coronary events in high-risk adults. Circulation 1999; 99: 2633–2638.

    Article  PubMed  CAS  Google Scholar 

  68. Waters D, Craven CE, Lesperance J. Prognostic significance of progression of coronary atherosclerosis. Circulation 1993; 87: 1067–1075.

    Article  PubMed  CAS  Google Scholar 

  69. Janowitz WR, Agatston AS, Viamonte M. Comparison of serial quantitative evaluation of calcified coronary artery plaque by ultrafast computed tomography in persons with and without obstructive coronary artery disease. Am J Cardiol 1991; 681: 1–6.

    Article  Google Scholar 

  70. Callister TQ, Raggi P, Cooil B, et al. Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med 1998; 339 (27): 1972–1978.

    Article  PubMed  CAS  Google Scholar 

  71. Hennekens CH, Buring JE. Statistical association and cause-effect relationships. In: Mayrent SL, ed. Epidemiology in Medicine. Little, Brown and Co., Boston/Toronto, 1987, pp. 30–53.

    Google Scholar 

  72. Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 1999; 74: 243–252.

    Article  PubMed  CAS  Google Scholar 

  73. Grundy SM. Age as a risk factor: you are as old as your arteries. Am J Cardiol 1999; 83 (10): 1455–1457.

    Article  PubMed  CAS  Google Scholar 

  74. Grundy SM. Primary prevention of heart disease-integrating risk assessment with intervention. Circulation 1999; 100: 988–998.

    Article  PubMed  CAS  Google Scholar 

  75. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in men and women with essential hypertension. Ann Intern Med. 1991; 114: 345–352.

    PubMed  CAS  Google Scholar 

  76. O’Leary DH, Polak JF, Kronmal RA, et al. Carotid atherosclerosis as quantified by measuring the intimal-medial thickness is a superior predictor of myocardial infarction and stroke compared to the conventional risk factors. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340 (1): 14–22.

    Article  PubMed  Google Scholar 

  77. Superko HR. Beyond LDL-C reduction. Circulation 1996; 94: 2351–2354.

    Article  PubMed  CAS  Google Scholar 

  78. Corr LA, Oliver MF. The low fat/low cholesterol diet is ineffective. Eur Heart J 1997; 18: 18–22.

    Article  PubMed  CAS  Google Scholar 

  79. Superko HR. The new thinking on lipids and coronary artery disease. Curr Opin Cardiol 1997; 12: 180–187.

    Article  PubMed  CAS  Google Scholar 

  80. Wong ND, Detrano RC, Diamond G, et al. Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviors? Am J Cardiol 1996; 78: 1220–1223.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Agatston, A. (2001). Electron Beam Tomography in the Prevention of Coronary Artery Disease. In: Foody, J.M. (eds) Preventive Cardiology. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-001-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-001-8_16

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-6241-9

  • Online ISBN: 978-1-59259-001-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics