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239 coronary artery calcium

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239 coronary artery calcium

  1. 1. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium  Coronary Artery CalciumCoronary Artery Calcium ISIS AtherosclerosisAtherosclerosis  There areThere are NONO false positive calcium measuresfalse positive calcium measures by EBT [i.e. ALL calcium is plaque]by EBT [i.e. ALL calcium is plaque]  Establishes a diagnosis ofEstablishes a diagnosis of coronary atherosclerosiscoronary atherosclerosis
  2. 2. Coronary Calcium Area by EBT andCoronary Calcium Area by EBT and Coronary Artery Plaque AreaCoronary Artery Plaque Area 0 2 4 6 8 10 12 14 16 0 2 4 6 8 Square Root Sum of Calcium Areas SquareRootSumof PlaqueAreas Rumberger, Circ 1995:92:2157-62 n = 38n = 38 r = 0.90r = 0.90 p < .001p < .001
  3. 3. No. of coronary segments/pt. with plaques (IVUS) 0 1 2 3 4 5 6 7 No. of calcified coronary segments/pt. (EBCT) 0 1 2 3 4 5 6 7 Y = -0.67 + (0.90 * X) r = 0.86 p < 0.0001 N = 40 patients total of 222 coronary segments examined Acute Coronary Syndrome and Non-Obstructive CADAcute Coronary Syndrome and Non-Obstructive CAD # of segments with EBT calcium vs. # of segments with any plaque# of segments with EBT calcium vs. # of segments with any plaque Schmermund et alSchmermund et al AJC 1998; 81:AJC 1998; 81: 141-146141-146
  4. 4. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium  Define the extent of disease? YESDefine the extent of disease? YES  The amount of calciumThe amount of calcium correlates DIRECTLYcorrelates DIRECTLY toto the amount of measurable coronary disease by:the amount of measurable coronary disease by: 1) direct histopathologic comparison1) direct histopathologic comparison 2) with intravascular ultrasound2) with intravascular ultrasound
  5. 5. Electron Beam TomographyElectron Beam Tomography Hn x-factor (Agatston Scoring) 130-199 1 200-299 2 300-399 3 >400 4 Area = 15 mmArea = 15 mm22 Volume = 12 mmVolume = 12 mm33 x10x10-3-3 Agatston (area) ScoreAgatston (area) Score vs. Volume Scorevs. Volume Score Area = 8 mmArea = 8 mm22 Volume = 6 mmVolume = 6 mm33 x10x10-3-3 Agatston (area) ScoreAgatston (area) Score vs. Volume Scorevs. Volume Score Total Score =Total Score = ΣΣ
  6. 6. ““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia: initially asymptomatic adultsinitially asymptomatic adults 2.7 6.9 14.3 19.7 20.2 0 5 10 15 20 25 30 '1-49 >50 >80 >160 >600 Arad: JACC 2000;36:1253-60 EBCT Calcium ScoreEBCT Calcium Score Agatston: Circ 1997 OddsRatioOddsRatio 3-6 yr. f/u3-6 yr. f/u n = 367n = 367 3.5 yr. f/u3.5 yr. f/u n = 1177n = 1177
  7. 7. ““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia: initially asymptomatic adultsinitially asymptomatic adults 2.7 6.9 14.3 19.7 20.2 0 5 10 15 20 25 30 '1-49 >50 >80 >160 >600 Arad: JACC 2000;36:1253-60 EBCT Calcium ScoreEBCT Calcium Score Agatston: Circ 1997 OddsRatioOddsRatio 3-6 yr. f/u3-6 yr. f/u n = 367n = 367 3.5 yr. f/u3.5 yr. f/u n = 1177n = 1177

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