(Circulation. 2000;101:244.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia
Presented in part at the 46th Annual Scientific Session, American College of Cardiology, Anaheim, Calif, March 19, 1997.
From the Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College, Beijing, China (Z.-X.H.); Baylor College of Medicine, Houston, Tex (T.D.H., C.M.P., M.S.V., R.R., J.J.M.); and North Houston Heart Center, Houston, Tex (V.A.).
Background—Detection of subclinical coronary artery disease (CAD) before the development of life-threatening cardiac complications has great potential clinical relevance. Electron beam computed tomography (EBCT) is currently the only noninvasive test that can detect CAD in all stages of its development and thus has the potential to be an excellent screening technique for identifying asymptomatic subjects with underlying myocardial ischemia.
Methods and Results—Over 2.5 years, we prospectively studied 3895
generally asymptomatic subjects with EBCT, 411 of whom had
stress myocardial perfusion tomography (SPECT) within a close (median,
17 days) time period. SPECT and exercise treadmill results were
compared with the coronary artery calcium score (CACS) as
assessed by EBCT. The total CACS identified a population at high risk
for having myocardial ischemia by SPECT although only a
minority of subjects (22%) with an abnormal EBCT had an abnormal
SPECT. No subject with CACS <10 had an abnormal SPECT compared with
2.6% of those with scores from 11 to 100, 11.3% of those with scores
from 101 to 399, and 46% of those with scores 
400
(P<0.0001). CACS predicted an abnormal SPECT regardless
of subject age or sex.
Conclusions—CACS identifies a high-risk group of asymptomatic subjects who have clinically important silent myocardial ischemia. Our results support the role of EBCT as the initial screening tool for identifying individuals at various stages of CAD development for whom therapeutic decision making may differ considerably.
Key Words: tomography • calcium • ischemia
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|
|
|
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|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
 |
|
 G. M. London Cardiovascular Calcifications in Uremic Patients: Clinical Impact on Cardiovascular Function J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S305 - 309. [Abstract] [Full Text]
|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
 EBCT Predicts Silent Ischemia Journal Watch Cardiology, March 3, 2000; 2000(303): 5 - 5. [Full Text]
|
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