(Circulation. 2000;102:126.)
© 2000 American Heart Association, Inc.
ACC/AHA Expert Consensus Document |
American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease
Committee Members
Key Words: ACC/AHA Expert Consensus Document • tomography, electron-beam computed • coronary disease • diagnosis
Executive Summary
Coronary artery calcification is part of the development of atherosclerosis; it occurs exclusively in atherosclerotic arteries and is absent in the normal vessel wall. Electron-beam computed tomography (EBCT), the focus of this document, is a highly sensitive technique for detecting coronary artery calcium and is being used with increasing frequency for the screening of asymptomatic people to assess those at high risk for developing coronary heart disease (CHD) and cardiac events, as well as for the diagnosis of obstructive coronary artery disease (CAD) in symptomatic patients. The use of EBCT has the greatest potential for further determination of risk, particularly in elderly asymptomatic patients and others at intermediate risk. The calcium score has been advocated by some as a potential surrogate for age in risk-assessment models. EBCT has also been proposed as a useful technique for assessing the progression or regression of coronary artery stenosis in response to treatment of risk factors such as hypercholesterolemia.
EBCT uses an electron beam in stationary tungsten targets, which
permits very rapid scanning times. Serial transaxial images are
obtained in 100 ms with a thickness of 3 to 6 mm for purposes of
detecting coronary artery calcium. Thirty to 40 adjacent axial
scans are obtained during 1 to 2 breath-holding sequences. Current EBCT
software permits quantification of calcium area and density.
Histological studies support the association of tissue
densities of 130 Hounsfield units (HU) with calcified plaque. However,
a plaque vulnerable to fissure or erosion can be present in the
absence of calcium. Also,
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