SHAPE Society

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. 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. 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. 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. 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. ““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. ““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