Coronary Calcium as an Indicator of Coronary Artery Disease

  • Axel Schmermund
  • John A. Rumberger
Part of the Medical Radiology book series (MEDRAD)

Abstract

Due to biological factors (mainly arterial remodeling) and the methodological limitations of a contour method, coronary angiography may underestimate both the extent and the severity of atherosclerosis (TopoL and Nissen 1995). But, angiography remains the clinical standard method for defining coronary anatomy in patients. Angiography and electron beam computed tomography (EBCT) evaluate two facets of atherosclerotic plaque disease, that is, luminal narrowing and calcified plaque itself. This was emphasized by a recent study in 49 patients with normal or near-normal angiograms, of whom 28 (57%) had quantifiable coronary calcium (Schmermund et al. 1998b). Coronary calcium in these patients was usually observed in the form of “spotty” calcium as defined by Kajinami et al. (1997). Some coronary segments with spotty calcium showed an increased lumen caliber, probably due to exaggerated compensatory remodeling. Accordingly, atherosclerotic plaque formation in these patients did not entail luminal narrowing, but rather even resulted in a seemingly paradoxical increased lumen in some cases. While other noninvasive tests focus on the physiological consequences of coronary obstruction, EBCT represents anatomic disease itself (Fig. 4.5.1) (ERBEL 1996). Indeed, early stages of atherosclerotic plaque formation that may oftentimes go undetected by angiography are reliably visualized by EBCT (Schmermund et al. 1998b; Baumgart et al. 1997).

Keywords

Shrinkage Radionuclide Luminal Eter Cardiol 

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References

  1. Agatston AS, Janowitz WR, Kaplan G, Gasso J, Hildner F, Viamonte M Jr. (1994) Ultrafast computed tomography-detected coronary calcium reflects the angiographic extent of coronary arterial atherosclerosis. Am J Cardiol 74: 1272–1274PubMedCrossRefGoogle Scholar
  2. Baumgart D, Schmermund A, Görge G, Haude M, Ge J,Adamzik M, Schnert C, Altmaier K, Groenemeyer D, Seibel R, Erbel R (1997) Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for the detection of coronary atherosclerosis. J Am Coll Cardiol 30: 57–64Google Scholar
  3. Bielak LF, Rumberger JA, Sheedy PF 2nd, Schwartz RS, Peyser PA (2000) Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. Circulation 102: 380–385PubMedCrossRefGoogle Scholar
  4. Budoff, MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, Stanford W, Shields P, Lewis RJ, Janowitz WR, Rich S, Brundage BH (1996) Ultrafast computed tomographyGoogle Scholar
  5. as a diagnostic modality in the detection of coronary artery disease. A multicenter study. Circulation 93: 898–904Google Scholar
  6. Emond M, Mock MB, Davis KB, Fisher LD, Holmes DR Jr, Chaitman BR, Kaiser GC, Alderman E, Killip T 3rd (1994) Long-term survival of medically treated patients in the Coronary Artery Surgery Study ( CASS) Registry. Circulation 90: 2645–2657Google Scholar
  7. Erbel R (1996) The dawn of a new era–non-invasive coronary imaging. Herz 21: 75–77PubMedGoogle Scholar
  8. Gerber TC, Erbel R, Görge G, Ge J, Rupprecht H-J, Meyer J (1994) Extent of atherosclerosis and remodeling of the left main coronary artery determined by intravasular ultrasound. Am J Cardiol 73: 666–671PubMedCrossRefGoogle Scholar
  9. Haberl R, Becker A, Lang C, Becker C, Knez A, Leber A, Bruning R, Reiser M, Steinbeck G (2001)Exclusion of coronary calcium with electron-beam computed tomography: an effective filter before diagnostic heart catheterization in symptomatic patients? Z Kardiol 90: 21–27Google Scholar
  10. Hangartner JR, Charleston AJ, Davies MJ, Thomas AC (1986) Morphological characteristics of clinically significant coronary artery stenosis in stable angina. Br Heart J 56: 501508Google Scholar
  11. Kajinami K, Seki H, Takekoshi N, Mabuchi H (1995) 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 26: 1209–1221PubMedCrossRefGoogle Scholar
  12. Kajinami K, Seki H, Takekoshi N, Mabuchi H (1997) Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. J Am Coll Cardiol 29: 1549–1556PubMedCrossRefGoogle Scholar
  13. Proudfit WL, Bruschke VG, Sones FM Jr (1980) Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation 62: 712–717PubMedCrossRefGoogle Scholar
  14. Rumberger JA, Sheedy PF 2nd, Breen JF, Schwartz RS (1995a) Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram: effect of patient’s sex on diagnosis. Circulation 91: 13631367Google Scholar
  15. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995b) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92: 2157–2162Google Scholar
  16. Rumberger JA, Sheedy PF, Breen JF, Schwartz RS (1997) Electron beam computed tomographic calcium score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 29: 1542–1548PubMedCrossRefGoogle Scholar
  17. Schmermund A, Baumgart D, Adamzik M, Ge J, Gronemeyer D, Seibel R, Sehnert C, Gorge G, Haude M, Erbel R (1998a) Comparison of electron-beam computed tomography and intracoronary ultrasound in detecting calcified and non-calcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease. Am J Cardiol 81: 141–146PubMedCrossRefGoogle Scholar
  18. Schmermund A, Rumberger JA, Colter J, Sheedy PF 2nd, Schwartz RS (1998b) 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 82: 508–511PubMedCrossRefGoogle Scholar
  19. Schmermund A, Bailey KR, Rumberger JA, Reed JE, Sheedy PF II, Schwartz RS (1999a) An algorithm for non-invasive 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 torno-graphic calcium scores. J Am Coll Cardiol 33: 444–452PubMedCrossRefGoogle Scholar
  20. Schmermund A, Denktas AE, Rumberger JA, Christian TF, Sheedy PF 2nd, Bailey KR, Schwartz RS (1999b) 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. J Am Coll Cardiol 34: 777–786PubMedCrossRefGoogle Scholar
  21. Schmermund A, Baumgart D, Sack S, Mohlenkamp S, Gronemeyer D, Seibel R, Erbel R (2000) Assessment of coronaryGoogle Scholar
  22. calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal, or equivocal exercise stress test. Eur Heart J 21:1674–1682Google Scholar
  23. Shavelle DM, Budoff MJ, LaMont DH, Shavelle RM, Kennedy JM, Brundage BH (2000) Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol 36: 32–38PubMedCrossRefGoogle Scholar
  24. Topol EJ, Nissen SE (1995) Our preoccupation with coronary luminology. Circulation 92: 2333–2342PubMedCrossRefGoogle Scholar
  25. Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Standford W, White R, Taubert K (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Circulation 94: 1175–1192Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • Axel Schmermund
    • 1
  • John A. Rumberger
    • 2
  1. 1.Department of CardiologyUniversity Clinic EssenEssenGermany
  2. 2.Preventive Imaging c/o Ohio HeartColumbusUSA

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