Utilité du score calcique coronariens et des marqueurs biologiques de calcification dans l'évaluation du risque cardiovasculaire individuel

Abstract

AbstractQuantification of coronary calcification using a CT-scanner without contrast, makes it possible to calculate a calcification score (CAC). CAC improves individual cardiovascular risk (CVR) prediction compared to population models alone (Framingham, SCORE,.). A CAC of 0 excludes the risk of a CV event at ten years, whereas a CAC > 100, especially in an asymptomatic patient, allows to re-allocate the patient in a high-risk category requiring a medical follow up. The CAC is simple to implement, using low irradiation levels and intended to better predict the CVR risk at ten years of asymptomatic patients at intermediate risk. Besides CAC, several circulating biological markers such as Fetuine A, Matrix Gla Protein (MGP), Tissue-Non specific Alkaline Phosphatase (TNAP) or serum T50 which measures the propensity of the serum to calcify in-vitro, have been proposed to assess the risk of cardiovascular calcification. The values of these calcification markers are weakly associated with CAC but their clinical use for determining CVR has yet to be demonstrated. However, some of them, such as T50, are associated with cardiovascular mortality especially in patients with renal insufficiency and could therefore constitute a new independent and modifiable risk factor for cardiovascular risk.