Positive Coronary Artery Calcium Score Research Articles

Different manifestations of coronary artery disease by stress SPECT myocardial perfusion imaging, coronary calcium scoring, and multislice CT coronary angiography in asymptomatic patients with type 2 diabetes mellitus

We sought to assess prospectively the evidence for silent coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes mellitus by stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging, coronary artery calcium (CAC) scoring, and multislice computed tomographic (MSCT) coronary angiography. One hundred asymptomatic patients (aged 30 to 72 years) with type 2 diabetes mellitus and one or more risk factors for CAD were prospectively recruited from an outpatient diabetes clinic. All patients underwent adenosine technetium-99m sestamibi SPECT imaging, CAC scoring, and 64-slice MSCT coronary angiography. Twenty-three patients (23%) had abnormal stress SPECT imaging, consistent with inducible myocardial ischemia, whereas 60 patients (60%) had positive CAC scoring (18 patients [18%] with significant CAC >401), and 70 patients (70%) had abnormal MSCT coronary angiography (24 patients [24%] with significant, >or=50% stenosis). Of 77 patients with normal SPECT, 44 had a positive CAC score (10 patients [13%] >401), and 54 showed CAD on MSCT angiography (16 patients [21%] with >or=50% stenosis). Of 23 patients with an abnormal SPECT, 16 patients had a positive CAC score (8 patients [35%] >401), and 16 patients had CAD on MSCT angiography (8 patients [35%] with >or=50% stenosis). Overall, 17 patients (17%) had more than 2 significantly abnormal diagnostic test results, and 5 patients had three tests with significantly abnormal results. In this cohort of asymptomatic patients with type 2 diabetes mellitus, different modalities visualized different aspects of silent coronary atherosclerosis. Anatomic evidence of coronary atherosclerosis (CAC and MSCT) occurred more frequently than functional evidence (stress SPECT). However, clinically significant manifestations of CAD were observed in about one-quarter to one-fifth of patients by each modality, either separately or combined. The relative prognostic value of each modality needs to be determined by a follow-up of this cohort.

Relation of Coronary Artery Calcium to Flow-Mediated Dilation and C-Reactive Protein Levels in Asymptomatic Patients With Heterozygous Familial Hypercholesterolemia

The extent of coronary artery calcium (CAC) is correlated with coronary artery disease prognosis. However, the relation of CAC to endothelial function and high-sensitivity C-reactive protein (hs-CRP) in patients with asymptomatic heterozygous familial hypercholesterolemia (FH) requires clarification. The study aim was to investigate the relations among CAC, endothelial function, and hs-CRP in patients with asymptomatic heterozygous FH. Thirty-two patients with asymptomatic heterozygous FH (mean age 42 years) and 34 healthy control subjects (mean age 36 years) were enrolled. We measured CAC by electron-beam computed tomography and endothelial function by flow-mediated dilation of the brachial artery. A higher percentage of patients with FH had a positive CAC score compared with the control group. Comparing the FH group with detectable CAC (CAC score >0) and undetectable CAC (CAC score of 0), we found higher hs-CRP levels (0.29 +/- 0.23 vs 0.07 +/- 0.08 mg/dl, p = 0.001) and reduced flow-mediated dilation (0.04 +/- 0.03 vs 0.08 +/- 0.03, p = 0.005) in the detectable CAC group. Multivariate analysis showed an independent correlation of hs-CRP with detectable CAC (relative risk 5.034, 95% confidence interval 1.525 to 16.613, p = 0.04). In conclusion, FH subjects with positive CAC scores have decreased flow-mediated dilation and increased hs-CRP levels. Furthermore, hs-CRP level is the only independent predictor of the presence of CAC.

Metabolic Syndrome and Subclinical Atherosclerosis in Patients Infected with HIV

The present study examines the association between carotid and coronary atherosclerosis and metabolic syndrome in human immunodeficiency virus (HIV)-infected adults. We measured the common and internal carotid intima-media thickness (c-IMT) using B-mode ultrasonography, and we measured coronary artery calcium (CAC) using high-resolution, electrocardiographic, synchronized, computed tomography, for 314 HIV-infected men and women. Metabolic syndrome was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. We compared the c-IMT measurements and CAC scores of patients with metabolic syndrome with the scores of those without metabolic syndrome using a Wilcoxon test for continuous variables and a chi2 test for categorical variables. To examine the association between surrogate markers and metabolic syndrome, we used logistic regression analysis. Participants with metabolic syndrome were more likely to have a common c-IMT measurement >0.8 mm than were those without metabolic syndrome (17% vs.7%; P=.009), but both groups were equally likely to have an internal c-IMT measurement >1.0 mm (20% vs. 13%; P=.15). Any positive CAC score was more likely to occur for participants with metabolic syndrome (80.3% vs. 46.7%; P<.0001). In a multivariate model adjusted for sex, age, ethnicity, and smoking status, participants with metabolic syndrome were more likely than those without metabolic syndrome to have an abnormal common c-IMT measurement (odds ratio [OR], 2.9; P=.020) and detectable CAC scores (OR, 4.9; P<.0001) but not a higher internal c-IMT measurement (OR, 1.6; P=.255). Our study demonstrates that HIV-infected individuals with metabolic syndrome may be at increased risk for subclinical atherosclerosis and supports screening for metabolic syndrome among HIV-infected patients at risk for cardiovascular disease.

Calcification in coronary artery disease can be reversed by EDTA–tetracycline long-term chemotherapy

Atherosclerosis is a complex process with multiple mechanisms and factors contributing to its initiation and progression. Detection and quantification of coronary artery calcium (CAC) scores with electron beam tomography has been shown to correlate with obstructive and nonobstructive coronary artery disease (CAD). Pathogen-triggered calcification could play a role in CAD. Recent reports suggest that infectious blood nanobacteria (NB) emerge to be such a trigger. So far, minimal or no reversal of atherosclerosis has been claimed by therapies with iv ethylenediaminetetraacetic acid disodium salt (EDTA), antibiotics, or other regimens, and therapies for atherosclerosis remain non-curative. We have now combined EDTA with antibiotic tetracycline (comET), an in vitro proven nanobacteriocidal treatment, and tested comET therapy in patients with documented CAD. Three hypotheses were probed: (1) Are NB present in patients with CAD?; (2) Does treatment with comET affect blood NB antigen and serology?; (3) Does a comET decrease CAC scores? One hundred patients with stable CAD and positive CAC scores were enrolled into a 4 month study of comET therapy. ComET therapy is composed of (1) Nutraceutical Powder (Vitamin C, Vitamin B6, Niacin, Folic Acid, Selenium, EDTA, l-Arginine, l-Lysine, l-Ornithine, Bromelain, Trypsin, CoQ10, Grapeseed Extract, Hawthorn Berry, Papain) 5 cm 3 taken orally every evening; (2) Tetracycline HCl 500 mg taken orally every evening; (3) EDTA 1500 mg taken in a rectal suppository base every evening. CAC scoring was repeated at 4 months and serum samples were analyzed for NB antigen and serology at baseline, 2 and 4 months. Complete blood count, metabolic panel, liver function, C-reactive protein (hs-CRP) and lipids were analyzed at baseline and 4 months. Seventy-seven patients completed the study and all patients were positive for NB serology, antigen or both. Responders ( n = 44; 57%) had significant decreases in total CAC scores ( P = 0.001), the average decrease being 14%. Non-responders ( n = 33; 44%) had no change or had increases in CAC scores. Angina was decreased or ablated in 16 of 19 patients (84%). Lipid profiles improved to non-atherogenic direction significantly ( P = 0.001), a remarkable finding in a patient group where 86% were on continuous statin medication already before the trial. No adverse physiologic effects were seen in renal, hepatic, or hematopoetic systems. In conclusion, CAC scores decreased during ComET therapy trial in most CAD patients inferring regression of calcified coronary artery plaque volume. The patients tolerated the therapy well and their angina and lipid profiles improved. Further treatment trials for long term therapy with matched controls are warranted.

Electron-beam CT: The effect of using a correction function on coronary artery calcium quantitation

The purpose of the study was to determine if use of a correction function derived from a phantom with known calcium density reduces variation in coronary artery calcium scores measured with electron-beam computed tomography (CT) and to evaluate the influence of body girth, as measured by body mass index (BMI), on coronary artery calcium-score variability in a clinical screening cohort. Two hundred fifty consecutive patients underwent two electron-beam CT examinations with a standardized phantom. Region-of-interest (ROI) measurements of the phantom were correlated with the patient BMI. In a subset of 28 patients with low but positive coronary artery calcium scores, ROI values of the phantom were used as a correction for signal attenuation. Patient BMI was not significantly correlated to signal attenuation. Application of a correction function resulted in a small but insignificant decrease in interscan coronary artery calcium-score variation. The interscan coronary artery calcium score variation was 24.5% +/- 23.9; it decreased to 24.3% +/- 21.6 with use of the 75 mg/cm3 portion of the phantom and to 22.2% +/- 21.4 with use of the 150 mg/cm3 portion of the phantom. The use of a coronary artery calcium phantom does not reduce interscan variation sufficiently to warrant regular clinical usage. Interscan variation in the coronary artery calcium score is not significantly influenced by patient BMI.

Relation between hormone replacement therapy in women and coronary artery disease estimated by electron beam tomography

Many studies have suggested that hormone replacement therapy reduces the risk of coronary heart disease. Electron beam tomography is a highly sensitive noninvasive method by which to detect coronary artery disease. Our objective was to investigate whether hormone replacement therapy had an effect on coronary artery disease as determined by electron beam tomography in postmenopausal women. Nine hundred fourteen self-referred postmenopausal women older than 50 years underwent electron beam tomography. Each woman completed a questionnaire regarding age, risk factors, menopausal status, and hormone replacement therapy. Women taking hormone replacement therapy were slightly younger (57.8 years) than those not (60.7 years). A significantly higher incidence of a family history of myocardial infarction and smoking history was found in the group taking hormone replacement therapy, whereas more diabetics were in the group not taking hormone replacement therapy. The mean total coronary artery scores for women receiving hormone replacement therapy and not receiving hormone replacement therapy were 54.2 and 86.2, respectively ( p = 0.02). Independent predictive variables of a positive coronary artery calcium score with multiple logistic regression analysis were age, hypercholesterolemia, diabetes, and estrogen use. These results suggest that hormone replacement therapy is associated with less coronary artery disease in postmenopausal women as determined by electron beam tomography. (Am Heart J 1997;134:1115-9.)