The Added Value of Cardiac Computed Tomography in Early Detection of Coronary Artery Disease: A single-centre Retrospective Analysis of Asymptomatic Individuals with low-to-medium pre-test probability

Irene S. Mastorakou, Markos Marios L. Kaklamanis, Dionissios Kyriakopoulos, Emmanouil Michail Arvanitis, Sofia Georgantzi, Panagiotis Kalomitsinis

Abstract


Purpose: To evaluate the contribution of Cardiac Computed Tomography (CCT) in the early detection of coronary atheromatosis in asymptomatic individuals with or without risk factors for Coronary Artery Disease (CAD).

Materials and Methods: This is a retrospective, single centre study of 373 asymptomatic individuals with low-to-medium pre-test probability for CAD who performed CCT to exclude CAD, between September 2020 and November 2021. All individuals had a Coronary Artery Calcium (CAC) test, followed by a Coronary Computed Tomography Angiography (CCTA), unless CAC scoring (CACS) was above 1000 with the Agatston scoring system. CAC was estimated with the Agatston scoring system and the CAD-RADs system was used to assess the presence and extent of CAD.

Results: 58.4% of the participants were detected with coronary atheromatosis (CACS>0) when the CAC test was considered, with 16% of those having CAC>400 with a high likelihood of at least one coronary stenosis. When assessed with CCTA, 68% of the participants were detected with coronary atheromatosis and any degree of CAD, 11.6% with significant stenosis and 7.8% with severe stenosis. Nine (9) participants without risk factors were detected with minimal atheromatosis and one with moderate atheromatosis. Fifteen participants were under 40y with three (3) of them detected with minimal and two (2) with mild atheromatosis.

Conclusions: CCTA has the potential of becoming the established method for the early diagnosis of coronary atheromatosis and CAD. CCTA is superior to CAC for the early diagnosis of coronary atheromatosis and CAD. Individuals who may benefit from CCTA are diabetics, young males with multiple risk factors for CAD and middle-aged males with no risk factors for CAD.


Keywords


asymptomatic patients;Coronary Artery Disease; Cardiac Computed Tomography; Coronary Computed Tomography Angiography; Coronary Artery Calcium

Full Text:

PDF

References


Khan M, Hashim MJ, Mustafa H. et al. Global Epidemiology of Ischaemic Heart Disease: Results from the Global Burden of Disease Cureus 2020 Jul 23;12(7): e9349. doi: 10.7759/cureus.9349.

Shah N, Soon K, Wong C, et al. Screening for asymptomatic coronary heart disease in the young “at risk” population: Who and how? Int J Cardiol Heart Vasc. 2015;6:60-65.

Thompson BH, Stanford W. Update on using coronary calcium screening by computed tomography to measure risk for coronary heart disease. Int J Cardiovasc Imaging 2005; 21:39–53. doi: 10.1007/s10554-004-5343-9

Maurovich-Horvat P, Ferencik M, Voros S, et al. Comprehensive plaque assessment by coronary CT angiography Nat Rev Cardiol. 2014; 11:390–402. doi: 10.1038/nrcardio.2014.60

Winther S, Schmidt SE, Mayrhofer T, et al. Incorporating coronary calcification into pre-test assessment of the likelihood of coronary artery disease J Am Coll Cardiol. 2020; 76:2421–2432. doi: 10.1016/j.jacc.2020.09.585

Erbel R, Möhlenkamp S, Moebus S, et al. Heinz Nixdorf Recall Study Investigative Group: Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study J Am Coll Cardiol. 2010; 56:1397–1406. doi: 10.1016/j.jacc.2010.06.030

Al-Mallah MH, Qureshi W, Lin FY, et al. Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry Eur Heart J Cardiovasc Imaging 2014; 15:267–274. doi: 10.1093/ehjci/jet148

National Institute for Health and Clinical Excellence. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin (update). CG95. London: National Institute for Health and Clinical Excellence; 2016

Moss AJ, Williams MC, Newby J, et al. The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease Curr Cardiovasc Imaging Rep. 2017; 10(5): 15.

Han D, O’Hartaigh B, Gransar H, et al. Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. European Heart Journal - Cardiovascular Imaging 2018;19(6): 675–683.

Shah N, Soon K, Wong C, et al. Screening for asymptomatic coronary heart disease in the young ‘at risk’ population: Who and how? Int J Cardiol Heart Vasc. 2015;1(6): 60–65.

Hatzidakis A, Savva E, Perisinakis K et al. CT coronary angiography in asymptomatic male patients with high atherosclerosis risk: Is it justified? Hellenic Journal of Cardiology 2021;62:129-134

Bergstrom G, Persson M, Adiels M. et al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population Circulation 2021;144:916–929

Williams B, Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) European Heart Journal 2018; 39 (33): 3021–3104

Mach F, Baignet C, Catapano A. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) European Heart Journal 2020; 41 (1):111–188

Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2002;106:1883–92.

Kwan AC, Gransar H, Tzolos E., et al. The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiography Journal of Cardiovascular Computed Tomography 2021;15: 412–418

Cury RC, Abbara S, Achenbach S, et al. CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardio- vascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology J Cardiovasc Comput Tomogr 2016;10(4):269–281.

Adabag AS, Luepker RV, Roger VL, et al. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol 2010;7:216–25.

Cohn JN. Identifying the risk and preventing the consequences of cardiovascular disease Heart Lung Circ 2013; 22: 512-516

Gibbons LW, Mitchell TL, Wei M et al. Maximal exercise test as a predictor of risk for mortality from coronary heart disease in asymptomatic men Am J Cardiol 2000; 86:53-58

Fleischmann KE, Hunink MG, Kuntz MK, et al. Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance JAMA 1998; 280:913-920

Marwick T, D’Hondt AM, Baudhuin T, et al. Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both? J Am Coll Cardiol 1993;22:159-167

Philip D. Adamson, Michelle C. Williams, Marc R. Dweck et al. Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients with Stable Chest Pain 2019 JACC;74 (16):374

Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52(21):1724–1732.

Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359(22):2324–2336.

Rajiah P, Abbara S. CT coronary imaging-a fast evolving world. QJM 2018;111(9):595–604.

Cheong BYC, Wilson JM, Spann SJ et al. Coronary artery calcium scoring: an evidence-based guide for primary care physicians JIM 2021;289(3):309-324




DOI: http://dx.doi.org/10.36162/hjr.v7i1.473

Refbacks

  • There are currently no refbacks.