Coronary Calcium Score Azza Farag, MD ... - HeartMirror.com

More documents

Recommendations

Info

Vol. 4, No. 2, 2010 Sep 2010: 157-169 Mini-Reviews 162 9. Dorros G, Jaff M, Mathiak L, et al. Multicenter Palmaz stent renal artery stenosis revascularization registry report: Four-year followup of 1,058 successful patients. Catheter Cardiovasc Interv 2002; 55(2):182-8. 10. Levy MS, Creager MA. Revascularization versus medical therapy for renal-artery stenosis. The ASTRAL investigators. The New England Journal of Medicine 2009; 361: 1953-1962. Vasc Med 2010; 15(4):343-5. 11. Collins R, Peto R, Gray R, et al. Large-scale randomized evidence: Trials and overviews. In: Weatherall DJ, Ledingham JGG, Warrell DA, editors. Oxford textbook of medicine. 3rd ed. Oxford, UK: Oxford University Press; 1996. p. 21-32. 12. Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. Stent placement for renal arterial stenosis: Where do we stand? A meta-analysis. Radiology 2000; 216(1):78-85. 13. Chrysochou C, Sinha S, Chalmers N, et al. Anuric acute renal failure and pulmonary oedema: A case for urgent action. Int J Cardiol 2009; 132(1):e31-3. 3. Coronary Calcium Score Azza Farag, MD Abbreviations and Acronyms EBCT : Electron Beam Computed Tomography MDCT : Multidetector Computed Tomography Coronary artery disease (CAD) is currently, and will remain for the foreseeable future, the leading cause of death and disability worldwide. Although effective plans and tools are available for treating and delaying CAD progression, treatments are underutilized because at risk individuals are not easily identified. To date, in excess of 300 risk factors for CAD have been identified; however, most of these are not independent of each other and the number of truly independent risk factors remains small (1). Coronary Calcium Score: It is generally accepted that the presence of coronary calcium correlates directly with coronary atherosclerotic plaque burden and its detection is an established technique for cardiovascular risk assessment (2). Its presence per se as detected by electron beam computed tomography (EBCT) or multidetector computed tomography (MDCT) is significantly associated with incident cardiovascular disease events independent of the traditional risk factors such as blood pressure, plasma glucose level and cholesterol levels (3, 4). But does the amount of this calcium could independently predict adverse cardiac events, is still yet not clear. Calcium accumulates in the coronary arteries in an age-related manner, and the accumulation appears to be exponential because calcium continuously deposited in pre-existing lesion; thus all scores must be adjusted for age as well as for sex. Modification of the Framingham Risk Chart variable (chronologic age) by a non-chronometric variable (biologic age) which is the degree of calcium in the coronary tree is a debatable issue. However, the concept allows for a re-definition of conceived risk and might serve for treatment decisions in primary prevention in subjects with intermediate risk. The more the calcium becomes apparent, the older is the coronary lesion in a given patients and the higher is his subsequent risk (5). It is important to report that coronary calcium scoring examination does not define the location or severity of any particular lesion and it is not substitute for the physiological stress testing or angiography. Individuals with calcium score over 10, have coronary heart disease and should receive treatment to reduce the LDL cholesterol to less than 100 mg% as specified in the ATP III guidelines (6). Repeat scans are suggested every one or two years to monitor treatment response. Patients with score over 400 should be considered for further evaluation to rule out an obstructive lesion with an exercise or pharmacologic stress test. These patients are at increased risk for the development of symptomatic cardiac disease (4.8% per year). Individuals with symptomatic angina and calcium score >400 have an extremely high (~15% per year) cardiac event rate (2). Extracoronary Calcification: It is well established that atherosclerotic vascular disease is a diffuse process, thus explaining the association between coronary and extra-coronary atherosclerosis (7). Recently, few studies involve extracoronary cardiac calcification mainly the aortic valve, mitral annulus and thoracic aorta in the risk profile of patients with suspected coronary artery disease (7-10). The presence of aortic valve calcium has been shown to be an independent predictor of advanced coronary artery disease (7) as well as carotid stenosis (11) reflecting the atherosclerotic burden rather than just a degenerative change (12). The prevalence of three-vessel obstructive coronary artery disease is approaching 50% in patients with mitral annular calcification (13). Although, presence and severity of calcification in the coronaries has been clearly established as an indicator for an adverse cardiovascular outcome, the prognostic value of extracoronary cardiac calcification remained not entirely clear. It is imperative that the independent prognostic value of these markers for future events of coronary as well as non-coronary vascular tree (stroke, peripheral vascular disease) needs to be asserted (14). Downloaded from www.heartmirror.com
163 Mini-Reviews Vol. 4, No. 2, 2010 Sep 2010: 157-169 Corresponding Author Azza Farag, MD Cardiology Department, Cairo University, Egypt E-mail: azzzabdelmoniem@yahoo.com REFERENCES 1. http://newportbodyscan.com/TheHeartScan.shtm 2. O'Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol 2000; 36(1):326-40. 3. Kondos GT, Hoff JA, Sevrukov A, et al. Electron-beam tomography coronary artery calcium and cardiac events: A 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation 2003; 107(20):2571-6. 4. Raggi P, Shaw LJ, Berman DS, et al. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol 2004; 43(9):1663-9. 5. Grundy SM. Coronary plaque as a replacement for age as a risk factor in global risk assessment. Am J Cardiol 2001; 88(2A): 8E-11E. 6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285(19):2486-97. 7. Yamamoto H, Shavelle D, Takasu J, et al. Valvular and thoracic aortic calcium as a marker of the extent and severity of angiographic coronary artery disease. Am Heart J 2003; 146(1):153-9. 8. Allison MA, Cheung P, Criqui MH, et al. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006; 113(6):861-6. 9. Adler Y, Fisman EZ, Shemesh J, et al. Spiral computed tomography evidence of close correlation between coronary and thoracic aorta calcifications. Atherosclerosis 2004; 176(1):133-8. 10. Wong ND, Sciammarella M, Arad Y, et al. Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment. Am J Cardiol 2003; 92(8):951-5. 11. Adler Y, Levinger U, Koren A, et al. Relation of nonobstructive aortic valve calcium to carotid arterial atherosclerosis. Am J Cardiol 2000; 86(10):1102-5. 12. Watanabe K, Hiroki T, Koga N. Relation of thoracic aorta calcification on computed tomography and coronary risk factors to obstructive coronary artery disease on angiography. Angiology 2003; 54(4):433-41. 13. Adler Y, Herz I, Vaturi M, et al. Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol 1998; 82(10):1183-6. 14. Nasir K, Katz R, Takasu J, et al. Ethnic differences between extracoronary measures on cardiac computed tomography: Multi- Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2008; 198(1):104-14. 4. The Burden of Atrial Fibrillation Aly Zaki, MD, MRCP Abbreviations and Acronyms ACE-I : Angiotensin converting enzyme inhibitors. AF: Atrial fibrillation. ATHENA: Effect of dronaderone on cardiovascular outcomes in high risk patients with atrial fibrillation or atrial flutter study. COCAF : Cost of Care Distribution in Atrial Fibrillation patients study. CRT : Cardiac resynchronization therapy. CV : Cardiovascular ICD : Internal cardiovertor defibrillator. NYHA : New York Heart Association PCI : Percutaneous coronary intervention. QOL : Quality of life RFA : Radiofrequency ablation TE : Thromboembolism/thromboembolic TRENDS: The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk study. Despite a plethora of medications and procedures used in the treatment and prevention of atrial fibrillation (AF), morbidity and mortality related to the arrhythmia remain substantial. AF poses a significant burden on the quality of life of patients as well on the resources of communities and healthcare providers. From the patients’ perspective, the symptomatic burden of the arrhythmia often significantly impacts the quality of life. The economic burden of treating and caring for patients with AF, including treatment of related complications is both costly and complex, often requiring specialist medical care, hospitalization and interventional procedures. This article briefly reviews the epidemiologic, temporal and symptomatic burden of AF and the consequent economic burden imposed by this prevalent arrhythmia. Epidemiologic, Morbidity and Mortality Burden: Atrial fibrillation is the commonest sustained arrhythmia with an overall prevalence reported between 1 and 6% in the general population (1-3). Prevalence rises to approximately 10% in those older than 80 years and 15% for those over 90 years old, and data from the Framingham Heart study estimate that 1 in 4 people above the age of 40 will have AF at some point in their lives (1). Furthermore, the reported prevalence of AF may actually be underestimated seeing as sustained silent AF is likely more common than previously thought. Indeed, modern implantable devices such as pacemakers and ICDs show that up to 50-60% of people older than 65 years have silent Downloaded from www.heartmirror.com
Page 1: Coronary Calcium Score Azza Farag,

Coronary Calcium Score Azza Farag, MD ... - HeartMirror.com

Create successful ePaper yourself

Delete template?

Save as template?