Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der TU München, Lazarettstrasse 36, Munich, Germany.
Eur Heart J Cardiovasc Imaging. 2012 Jun;13(6):468-75. doi: 10.1093/ejechocard/jer261. Epub 2011 Dec 13.
The extent of coronary artery calcification (CAC) has been shown to be a strong and independent predictor for cardiovascular events. Usually, CAC scoring is performed in non-contrast-enhanced computed tomography (CT) examinations. The ability and accuracy of cardiovascular risk classification according to the degree of CAC determined in contrast-enhanced coronary CT angiography (CCTA) has not been investigated so far. The aim of this analysis was to develop and validate a method for CAC risk classification in CCTA.
In a test series of 100 patients who underwent both non-enhanced CAC scoring and CCTA, we developed a method to assess the extent of coronary calcification and the associated cardiovascular risk category in CCTA. The accuracy of the developed approach of CAC assessment in CCTA was determined in 500 consecutive patients in comparison to CAC scoring in the non-enhanced scan. CAC scoring results in the non-enhanced scan and CCTA scan showed a high correlation (r = 0.954; P < 0.001). CAC quantification in CCTA correctly identified 98% of patients without CAC as shown in the non-enhanced scan (184 of 188 patients). When compared with non-enhanced CAC scoring, CAC scoring in CCTA grouped more than 95% of high-risk patients correctly into the same risk category according to the 75th age- and gender-specific percentiles or the absolute calcium scores.
Assessing cardiovascular risk associated with CAC is feasible and accurate in contrast-enhanced CCTA. This new technique may allow for reducing the radiation exposure of coronary CT studies while maintaining an accurate cardiovascular risk assessment, because the addition of non-enhanced scans to CCTA becomes unnecessary for comprehensive coronary CT studies.
冠状动脉钙化（CAC）的程度已被证明是心血管事件的一个强有力且独立的预测因素。通常，CAC 评分是在非增强计算机断层扫描（CT）检查中进行的。到目前为止，还没有研究过根据对比增强冠状动脉 CT 血管造影（CCTA）中确定的 CAC 程度进行心血管风险分类的能力和准确性。本分析的目的是开发和验证 CCTA 中 CAC 风险分类的方法。
在对 100 例同时进行非增强 CAC 评分和 CCTA 的患者的测试系列中，我们开发了一种方法来评估 CCTA 中冠状动脉钙化的程度和相关的心血管风险类别。在与非增强扫描相比，在 500 例连续患者中确定了 CCTA 中 CAC 评估方法的准确性。非增强扫描和 CCTA 扫描中的 CAC 评分结果高度相关（r=0.954；P<0.001）。CCTA 中的 CAC 定量正确识别了 98%的非增强扫描中无 CAC 的患者（184 例患者中的 188 例）。与非增强 CAC 评分相比，根据第 75 个年龄和性别特定百分位数或绝对钙评分，CCTA 中的 CAC 评分将超过 95%的高危患者正确分组到相同的风险类别中。
在对比增强 CCTA 中评估与 CAC 相关的心血管风险是可行且准确的。这种新技术可能允许减少冠状动脉 CT 研究的辐射暴露，同时保持准确的心血管风险评估，因为不需要将非增强扫描添加到 CCTA 中以进行全面的冠状动脉 CT 研究。
