Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
JACC Cardiovasc Imaging. 2017 Aug;10(8):923-937. doi: 10.1016/j.jcmg.2017.05.007.
Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution). After discussing the potential implementation of an improved score in clinical practice, we follow with a discussion of the future of CAC scoring, asking the central question: do we really need a new CAC score?
冠状动脉钙化 (CAC) 的定量已被证明是可靠的、可重复的，并可预测心血管风险。1990 年引入了 CAC 评分，早期的评分算法因其简单性和优雅性而引人注目。然而，由于缺乏关于如何构建最佳评分的证据，并且没有指导评分开发的概念模型，这些评分在很大程度上是任意的。在这篇综述中，我们描述了 CAC 评分的传统方法，指出了它们的优点、缺点和局限性。然后，我们讨论了一种用于开发改进的 CAC 评分的概念模型，回顾了最有可能导致有意义的评分改善的方法的证据（例如，考虑 CAC 密度和区域分布）。在讨论了在临床实践中实施改进评分的潜在性之后，我们接着讨论了 CAC 评分的未来，提出了一个核心问题：我们真的需要一个新的 CAC 评分吗？
