Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency

被引：13

作者：

McBride C.B. ^{[1
]}

Cheezum M.K. ^{[1
]}

Gore R.S. ^{[1
]}

Pathirana I.N. ^{[2
]}

Slim A.M. ^{[3
]}

Villines T.C. ^{[1
]}

机构：

[1] Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, 20850

[2] Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, 20850

[3] Cardiology Service, San Antonio Military Medical Center, San Antonio, TX, 78234

来源：

Current Cardiovascular Imaging Reports | 2013年 / 6卷 / 3期

关键词：

Cardiac computed tomography; Cardiovascular risk; Chest pain; Coronary artery calcification; Coronary artery disease; Coronary calcium; Coronary computed tomography angiography; Coronary heart disease; Guidelines; Stress testing;

D O I：

10.1007/s12410-013-9198-0

中图分类号：

学科分类号：

摘要：

The detection and quantification of coronary artery calcification (CAC) significantly improves cardiovascular risk prediction in asymptomatic patients. Many have advocated for expanded CAC testing in symptomatic patients based on data demonstrating that the absence of quantifiable CAC in patients with possible angina makes obstructive coronary artery disease (CAD) and subsequent adverse events highly unlikely. However, the widespread use of CAC testing in symptomatic patients may be limited by the high background prevalence of CAC and its low specificity for obstructive CAD, necessitating additional testing ('test layering') in a large percentage of eligible patients. Further, adequately powered prospective studies validating the comparative effectiveness of a 'CAC first' approach with regards to cost, safety, accuracy and clinical outcomes are lacking. Due to marked reductions in patient radiation exposure and higher comparative accuracy and prognostic value make coronary computed tomographic angiography the preferred CT-based test for appropriately selected symptomatic patients. © 2013 Springer Science+Business Media New York (outside the USA).

引用

页码：211 / 220

页数：9

共 67 条

[11]

Vorobiof G., Achenbach S., Narula J., Minimizing radiation dose for coronary CT angiography, Cardiol Clin, 30, pp. 9-17, (2012)

[12]

D'Ascenzo F., Cerrato E., Biondi-Zoccai G., Et al., Coronary Computed Tomographic Angiography for Detection of Coronary Artery Disease in Patients Presenting to the Emergency Department with Chest Pain: A Meta-Analysis of Randomized Clinical Trials, (2012)

[13]

Cheezum M.K., Hulten E.A., Fischer C., Smith R.M., Slim A.M., Villines T.C., Prognostic value of coronary CT angiography, Cardiol Clin, 30, pp. 77-91, (2012)

[14]

Hulten E.A., Carbonaro S., Petrillo S.P., Mitchell J.D., Villines T.C., Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis, J Am Coll Cardiol, 57, pp. 1237-1247, (2011)

[15]

Min J.K., Dunning A., Lin F.Y., Et al., Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease, J Am Coll Cardiol, 58, pp. 849-860, (2011)

[16]

Wright R.S., Anderson J.L., Adams C.D., Et al., 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angi, J Am Coll Cardiol, 57, (2011)

[17]

Sangiorgi G., Rumberger J.A., Severson A., Et al., Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology, J Am Coll Cardiol, 31, pp. 126-133, (1998)

[18]

Greenland P., Alpert J.S., Beller G.A., Et al., 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol, 56, (2010)

[19]

Blaha M.J., Budoff M.J., DeFilippis A.P., Et al., Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study, Lancet, 378, pp. 684-692, (2011)

[20]

Budoff M.J., Shaw L.J., Liu S.T., Et al., Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients, J Am Coll Cardiol, 49, pp. 1860-1870, (2007)

← 1 2 3 4 5 6 7 →