(Circulation. 1996;93:1951-1953.)
© 1996 American Heart Association, Inc.
Articles |
Predictive Value of Electron Beam Computed Tomography of the Coronary Arteries
19-Month Follow-up of 1173 Asymptomatic Subjects
From the Departments of Preventive Cardiology (Y.A., L.A.S., G.L., A.D.G.) and Radiology (K.G., A.L., S.S.), St Francis Hospital, Roslyn, NY.
Correspondence to Yadon Arad, MD, Preventive Cardiology, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY 11576.
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Background Coronary electron beam computed tomography (EBCT) detects atherosclerotic coronary artery disease by measuring calcium deposition in the walls of coronary arteries. EBCT-derived coronary artery calcium (CAC) scores correlate with the severity of underlying coronary artery disease.
Methods and Results We followed 1173 asymptomatic patients who underwent EBCT between September 1993 and March 1994. During average follow-up of 19 months, 18 subjects had 26 cardiovascular events: 1 death, 7 myocardial infarctions, 8 coronary artery bypass graft procedures, 9 coronary angioplasties, and 1 nonhemorrhagic stroke. For CAC score thresholds of 100, 160, and 680, EBCT had sensitivities of 89%, 89%, and 50% and specificities of 77%, 82%, and 95%, respectively. Odds ratios ranged from 20.0 to 35.4 (P<.00001 for all).
Conclusions Coronary EBCT predicts future atherosclerotic cardiovascular disease events in asymptomatic subjects.
Key Words: tomography • calcium • atherosclerosis • coronary disease • follow-up studies
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Atherosclerotic CVD is the leading cause of death in developed countries. In up to 50% of patients, atherosclerotic CVD presents initially as either an acute MI or sudden death.1 Approaches that use cholesterol,2 assessment of nonlipid risk factors, or stress testing3 lack precision for the detection of preclinical CAD in asymptomatic subjects.
CAC content correlated closely with the severity of underlying CAD at autopsy.4 5 6 7 Coronary EBCT can accurately measure CAC content,8 9 and EBCT-derived CAC scores correlate with angiographically documented CAD,10 11 12 13 suggesting that EBCT might allow for more accurate screening for CAD.
To assess the potential predictive value of coronary EBCT-derived CAC content for future CAD events, we followed 1173 asymptomatic men and women for a mean duration of 19 months.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Study Protocol
All 1238 EBCT patients scanned between September 1, 1993, and March 11, 1994, were asked to complete initial and follow-up questionnaires, including a medical history, occurrence of cardiovascular events, and the modified Rose Angina Questionnaire.14 Results were analyzed for 1173 of 1175 consenting, eligible subjects (99.8%) without documented or symptomatic atherosclerotic CVD. Mean follow-up was 19 months (range, 14 to 23 months). A positive response to the modified Rose Angina Questionnaire required the presence of exertional chest discomfort relieved by rest in
10 minutes. Events were verified by
telephone inquiries and reviews of medical records. Patients were
self-referred or referred by physicians in response to information
in newspapers, local and national networks, and active advertisements.
In all cases, coronary EBCT was described as potentially useful
for screening purposes only.
The diagnosis of MI required two of the following three criteria:
ischemic myocardial pain lasting at least 30 minutes, CK
elevation to more than twice the upper limit of normal with CK-MB
5%, and development of new Q waves 40 ms on the ECG. The diagnosis
of a stroke required the development of a new, persistent
neurological deficit confirmed with head CT.
Electron Beam CT
EBCT was performed with a Siemens Evolution scanner as
previously reported.15 Forty contiguous slices 3 mm thick
were obtained during a single breath-hold, beginning at the lower
edge of the carina. Scan time was 100 ms per slice, with synchronized
ECG triggering at 80% of the RR interval. CAC scores were calculated
according to Agatston et al.15
Analysis
The relationship between CAC scores and events was
analyzed with Student's t test. An ROC was
generated to determine the predictive power of EBCT-derived CAC scores
for hard cardiovascular events over the average
19-month follow-up period. Increased area under the ROC curve
indicates increased predictive value of a diagnostic test.
We used contingency tables and the 
2 function to
examine the relationship between risk factors and events. Only one
event was counted per patient.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Mean age (±SD) was 53±11 years. Seventy-one percent of the subjects were male. During the follow-up period, there were 1 cardiac death, 7 nonfatal MIs, 1 spontaneous thromboembolic stroke, 8 coronary artery bypass procedures, and 9 coronary angioplasties in 18 patients, for an event rate of 1.53% (counting only 1 event per patient). Indications for revascularization included MI in 7 patients. Revascularization procedures not preceded by an MI were performed because of new unstable angina (2 subjects), positive early stress tests (3 subjects), extensive reversible defects on thallium scan (3 subjects), or severe dyspnea on stress testing out of proportion to effort and age (1 subject). No subject went directly from EBCT to coronary angiography, and all stress tests were performed at the direction of the patient's primary physician after the development of symptoms consistent with myocardial ischemia (chest pain or exertional dyspnea). Forty-four patients developed angina pectoris.
CAC scores were 935±1070 for patients with events versus 144±446 for
patients without events (P<.0001). The distributions of CAC
scores for both groups are shown in Fig 1
. CAC scores
were 363±746 for all patients who developed angina versus 147±455 for
those who did not (P=.063). Men with angina had CAC scores
of 555±843 versus men without angina, 165±492 (P=.053).
Women with angina had CAC scores of 203±627 versus women without
angina, 98.9±337 (P=.427).
|
For CAC scores >100 (previously shown to correspond to a worst
stenosis in any major coronary arterial
segment of 20%, see Reference 1313 ), sensitivity, specificity, and odds
ratio for predicting future hard cardiovascular events
in this population were 89%, 77%, and 25.8, respectively (CI, 5.9 to
113). For CAC scores >160 (the value that maximized the sum of
sensitivity and specificity), sensitivity, specificity, and odds ratio
for hard cardiovascular events were 89%, 82%, and
35.4, respectively (CI, 8.1 to 155). For CAC scores >680 (previously
shown to correspond to a worst stenosis of 50%, Reference 1313 ),
sensitivity, specificity, and odds ratio were 50%, 95%, and 20.0,
respectively (CI, 7.6 to 52) (Table). Negative
predictive values were all >99%, and the positive predictive value
was 14% for patients with CAC scores >680. The area under the ROC was
0.91 (Fig 2) and was unaltered after correction for the
effect of age on CAC scores (by ANCOVA).
|
|
Of the reported incidence of coronary risk factors (age, high
cholesterol, low HDL cholesterol, hypertension,
smoking, diabetes, and family history of premature atherosclerotic
disease), only hypertension correlated with CAC scores
(2=14.3, P=.0012) at baseline, and
only age showed a positive correlation with subsequent atherosclerotic
cardiovascular events (2=6.2,
P=.035).
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Autopsy7 8 9 and angiographic10 11 12 13 data consistently indicate a correlation (r=.75 to .88) between CAC content and the severity of CAD. EBCT can quantify coronary calcifications, thus identifying subjects with preclinical CAD.
This is the first large, written report with a high degree of completeness of follow-up (99.8%) documenting the prospective short-term predictive value of EBCT of the coronary arteries in asymptomatic patients. The strong positive correlation of CAC scores with clinical events is consistent with a study that used cinefluoroscopy16 and with three preliminary follow-up reports of subjects who underwent EBCT.17 18 19
We do not believe that subjects with high CAC scores underwent bypass surgery or angioplasty preferentially, because EBCT has not been accepted by the local medical community, no subject went directly from EBCT to coronary angiography, all stress tests were done for clinical indications, and all revascularization procedures not preceded by an MI were performed for clinical indications.
Compared with an area under the ROC of 0.74 for NCEP II guidelines
found in a recent 12-year analysis of the Lipid Research Clinic
Prevention Follow-up Studies,20 the area under the ROC
of 0.91 (Fig 2
) suggests that EBCT is a better predictor of CVD events
in a much shorter time period. This is supported by the high negative
predictive values and a positive predictive value of 14% for CVD
events, in only 19 months, in initially asymptomatic
subjects with CAC scores >680.
Finally, the lack of correlation between most traditional CAD risk factors and baseline CAC scores or subsequent events must be interpreted with caution because of the use of reported rather than measured risk factors. However, measured values are subject, in turn, to the problem of prior behavior modification and medical intervention. In this mostly self-referred, middle-class population, most middle-aged adults are likely to be aware of the presence or absence of risk factors.
We conclude that EBCT-based screening for CAD shows great applicability
to the development of CVD events in a relatively short time period
(average, 
1.5 years) in an initially asymptomatic
middle-aged population (mostly men). These data support the routine
use of coronary EBCT to screen for occult CAD in
asymptomatic middle-aged men and women.
|
Selected Abbreviations and Acronyms |
|---|
|
|
Acknowledgments |
|---|
We thank Sean Callahan, Lania Bianco, Joan Scordo, Denise Brennan, Laura Cook, Stephen Boyd, Lawrence Balletti, Frederick Bernstein, Michael Kortbus, Lorraine Lindsay, Puja Mahindra, David Sacrestano, Usman Saleem, and Sameer Sayeed for their tireless efforts in collecting the follow-up data and Bill Schoepfer for his technical expertise.
Received February 14, 1996; revision received March 11, 1996; accepted March 13, 1996.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. American Heart Association. 1989 Heart Facts. Dallas, Tex: American Heart Association; 1988.
2. Wald NJ. Cholesterol and coronary heart disease: to screen or not to screen. In: Marmot M, Elliott P, eds. Coronary Heart Disease Epidemiology. Oxford, UK: Oxford University Press; 1992.
3. Subcommittee on Exercise Testing. Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures: guidelines for exercise testing. J Am Coll Cardiol. 1986;8:725-738. [Medline] [Order article via Infotrieve]
4. Blankenhorn DH, Stern D. Calcification of the coronary arteries. Am J Roentgenol. 1959;81:772-777.
5. Beadenkopf WG, Daoud AS, Love BM. Calcification of the coronary arteries and its relation to arteriosclerosis and myocardial infarction. Am J Roentgenol. 1964;92:865-871.
6.
Eggen DA, Strong JP, McGill HC.
Coronary calcification: relationship to clinically significant
coronary lesions and race, sex, and topographic
distribution. Circulation. 1965;32:948-955.
7.
Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF,
Schwartz RS. Coronary calcium area by electron beam CT
and coronary atherosclerosis plaque
area. Circulation. 1995;92:2157-2162.
8. Detrano R, Tang W, Kang X, Mahaisavariya P, McCrae M, Garner D, Peng SK, Measham C, Molloi S, Gutfinger D, Nickerson S, Brundage BH. Accurate coronary calcium phosphate mass measurements from electron beam computed tomograms. Am J Card Imaging. 1995;9:167-173. [Medline] [Order article via Infotrieve]
9.
Mautner GC, Mautner SL, Froehlich J, Feuerstein IM,
Proschan MA, Roberts WC, Doppman JL. Coronary artery
calcification: assessment with electron beam CT and histomorphometric
correlation. Radiology. 1994;192:619-623.
10.
Budoff M, Georgiou D, Brody A, Agatston AS, Kennedy J,
Wolfkiel C, Stanford W, Shields P, Lewis RJ, Janowitz WR, Rich S,
Brundage BH. Ultrafast computed tomography as a
diagnostic modality in the detection of coronary
artery disease: a multicenter study.
Circulation. 1996;93:898-904.
11. Kajinami K, Takekoshi N. Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results. J Am Coll Cardiol. 1995;26:1209-1221. [Abstract]
12. Kaufman RB, Peyser PA, Sheedy PF, Rumberger JA, Schwartz RS. Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary disease in younger patients. J Am Coll Cardiol. 1995;25:626-632. [Abstract]
13. Guerci AD, Spadaro LA, Popma JJ, Goodman KJ, Brundage BH, Lerner G, Vizza RF. Electron beam tomography of the coronary arteries: relationship of coronary calcium score to arteriographic findings in asymptomatic adults. Am J Card Imaging. 1995;9:5. Abstract.
14. Rose GA. Chest Pain Questionnaire. Milbank Mem Fund Q. 1965;43:32-39. [Medline] [Order article via Infotrieve]
15. Agatston AS, Janowitz WR, Hildner FJ, Zustmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827-832. [Abstract]
16. Detrano RC, Wong ND, Tang W, French WJ, Georgiou D, Young E, Brezden OS, Doherty TM, Narahara KA, Brundage BH. Prognostic significance of cardiac cinefluoroscopy for coronary calcific deposits in asymptomatic high risk subjects. J Am Coll Cardiol. 1994;24:354-358. [Abstract]
17. Wong N, Vu A, Abrahamson D, Eisenberg H, Tobis JM. Prediction of coronary events from noninvasive calcium screening by ultrafast CT. Circulation. 1993;88(suppl I):I-15. Abstract.
18. Puentes G, Detrano R, Tang W, Wong N, French W, Narahara K, Brundage B, Baksheshi H. Estimation of coronary calcium mass using electron beam computed tomography: a promising approach for predicting coronary events? Circulation. 1995;92(suppl I):I-313. Abstract.
19. Balogh T, Hoff J, Rich S, Wolfkiel J. Development of coronary artery disease in asymptomatic subjects undergoing coronary artery calcification screening by electron beam tomograph. Circulation. 1995;92(suppl I):I-650. Abstract.
20.
Grover SA, Coupal L, Hu X. Identifying adults at
increased risk of coronary disease. JAMA. 1995;274:801-806.
This article has been cited by other articles:
 |
|
 |
|
  C. S. White and D. Kuo Chest Pain in the Emergency Department: Role of Multidetector CT Radiology, December 1, 2007; 245(3): 672 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rutten, I. Isgum, and M. Prokop Coronary Calcification: Effect of Small Variation of Scan Starting Position on Agatston, Volume, and Mass Scores Radiology, December 1, 2007; 246(1): 90 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. T. Wilson, P. Gopalakrishnan, and T. Tak Noninvasive Cardiac Imaging with Computed Tomography Clin. Med. Res., October 1, 2007; 5(3): 165 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-D. Lee, D. R Jacobs Jr, P. J Schreiner, C. Iribarren, and A. Hankinson Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study Am. J. Clinical Nutrition, July 1, 2007; 86(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Loria, K. Liu, C. E. Lewis, S. B. Hulley, S. Sidney, P. J. Schreiner, O. D. Williams, D. E. Bild, and R. Detrano Early Adult Risk Factor Levels and Subsequent Coronary Artery Calcification: The CARDIA Study J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2013 - 2020. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sabour, A. Franx, A. Rutten, D. E. Grobbee, M. Prokop, M.-L. Bartelink, Y. T. van der Schouw, and M. L. Bots High Blood Pressure in Pregnancy and Coronary Calcification Hypertension, April 1, 2007; 49(4): 813 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ramakrishna, J. F. Breen, S. L. Mulvagh, R. B. McCully, and P. A. Pellikka Relationship Between Coronary Artery Calcification Detected by Electron-Beam Computed Tomography and Abnormal Stress Echocardiography: Association and Prognostic Implications J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2125 - 2131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. K Mittal, M. Barbir, and M. Rubens Role of computed tomography in risk assessment for coronary heart disease. Postgrad. Med. J., October 1, 2006; 82(972): 664 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Tomiyama, A. Higa, M. A. Dalboni, M. Cendoroglo, S. A. Draibe, L. Cuppari, A. B. Carvalho, E. M. Neto, and M. E. F. Canziani The impact of traditional and non-traditional risk factors on coronary calcification in pre-dialysis patients Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2464 - 2471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Yoshimura, E. Suzuki, K. Egawa, Y. Nishio, H. Maegawa, S. Morikawa, T. Inubushi, A. Hisatomi, K. Fujimoto, and A. Kashiwagi Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes Diabetes Care, August 1, 2006; 29(8): 1884 - 1890. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Vasan Biomarkers of Cardiovascular Disease: Molecular Basis and Practical Considerations Circulation, May 16, 2006; 113(19): 2335 - 2362. [Full Text] [PDF]
|
|
|
|
|
|
K. A. Matthews, S. Zhu, D. C. Tucker, and M. A. Whooley Blood Pressure Reactivity to Psychological Stress and Coronary Calcification in the Coronary Artery Risk Development in Young Adults Study Hypertension, March 1, 2006; 47(3): 391 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Clouse, J. Chen, H. M. Krumholz, M. E. Clouse, J. Chen, and H. M. Krumholz Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful Circulation, January 3, 2006; 113(1): 125 - 146. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Mozaffarian Electron-Beam Computed Tomography for Coronary Calcium: A Useful Test to Screen for Coronary Heart Disease? JAMA, December 14, 2005; 294(22): 2897 - 2901. [Full Text] [PDF]
|
|
|
|
|
|
K. Nasir, E. D. Michos, R. S. Blumenthal, and P. Raggi Detection of High-Risk Young Adults and Women by Coronary Calcium and National Cholesterol Education Program Panel III Guidelines J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1931 - 1936. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Raggi, A. Taylor, Z. Fayad, D. O'Leary, S. Nissen, D. Rader, and L. J. Shaw Atherosclerotic Plaque Imaging: Contemporary Role in Preventive Cardiology Arch Intern Med, November 14, 2005; 165(20): 2345 - 2353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. LaMonte, S. J. FitzGerald, T. S. Church, C. E. Barlow, N. B. Radford, B. D. Levine, J. J. Pippin, L. W. Gibbons, S. N. Blair, and M. Z. Nichaman Coronary Artery Calcium Score and Coronary Heart Disease Events in a Large Cohort of Asymptomatic Men and Women Am. J. Epidemiol., September 1, 2005; 162(5): 421 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Adams and J. Pepping Vitamin K in the treatment and prevention of osteoporosis and arterial calcification Am. J. Health Syst. Pharm., August 1, 2005; 62(15): 1574 - 1581. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-H. Huang, L.-C. Chen, H.-B. Leu, P. Y.-A. Ding, J.-W. Chen, T.-C. Wu, and S.-J. Lin Enhanced Coronary Calcification Determined by Electron Beam CT Is Strongly Related to Endothelial Dysfunction in Patients With Suspected Coronary Artery Disease Chest, August 1, 2005; 128(2): 810 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Arad, L. A. Spadaro, M. Roth, D. Newstein, and A. D. Guerci Treatment of Asymptomatic Adults With Elevated Coronary Calcium Scores With Atorvastatin, Vitamin C, and Vitamin E: The St. Francis Heart Study Randomized Clinical Trial J. Am. Coll. Cardiol., July 5, 2005; 46(1): 166 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Gianaros, K. Salomon, F. Zhou, J. F. Owens, D. Edmundowicz, L. H. Kuller, and K. A. Matthews A Greater Reduction in High-Frequency Heart Rate Variability to a Psychological Stressor is Associated With Subclinical Coronary and Aortic Calcification in Postmenopausal Women Psychosom Med, July 1, 2005; 67(4): 553 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. I. Freedman, C. D. Langefeld, K. K. Lohman, D. W. Bowden, J. J. Carr, S. S. Rich, and L. E. Wagenknecht Relationship between Albuminuria and Cardiovascular Disease in Type 2 Diabetes J. Am. Soc. Nephrol., July 1, 2005; 16(7): 2156 - 2161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Agatisa, K. A. Matthews, J. T. Bromberger, D. Edmundowicz, Y.-F. Chang, and K. Sutton-Tyrrell Coronary and Aortic Calcification in Women With a History of Major Depression Arch Intern Med, June 13, 2005; 165(11): 1229 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Kop, D. S. Berman, H. Gransar, N. D. Wong, R. Miranda-Peats, M. D. White, M. Shin, M. Bruce, D. S. Krantz, and A. Rozanski Social Network and Coronary Artery Calcification in Asymptomatic Individuals Psychosom Med, May 1, 2005; 67(3): 343 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kramer, R. Toto, R. Peshock, R. Cooper, and R. Victor Association between Chronic Kidney Disease and Coronary Artery Calcification: The Dallas Heart Study J. Am. Soc. Nephrol., February 1, 2005; 16(2): 507 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.E. Norman and J.T. Powell Vitamin D, Shedding Light on the Development of Disease in Peripheral Arteries Arterioscler Thromb Vasc Biol, January 1, 2005; 25(1): 39 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. G. Araneta and E. Barrett-Connor Subclinical Coronary Atherosclerosis in Asymptomatic Filipino and White Women Circulation, November 2, 2004; 110(18): 2817 - 2823. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. O. Talbott, J. V. Zborowski, J. R. Rager, M. Y. Boudreaux, D. A. Edmundowicz, and D. S. Guzick Evidence for an Association between Metabolic Cardiovascular Syndrome and Coronary and Aortic Calcification among Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5454 - 5461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hong, T. K. Pilgram, F. Zhu, and K. T. Bae Coronary Artery Calcification: Effect of Size of Field of View on Multi-Detector Row CT Measurements Radiology, October 1, 2004; 233(1): 281 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Berman, N. D. Wong, H. Gransar, R. Miranda-Peats, J. Dahlbeck, S. W. Hayes, J. D. Friedman, X. Kang, D. Polk, R. Hachamovitch, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography J. Am. Coll. Cardiol., August 18, 2004; 44(4): 923 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. J. Schoepf, C. R. Becker, B. M. Ohnesorge, and E. K. Yucel CT of Coronary Artery Disease Radiology, July 1, 2004; 232(1): 18 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Horiguchi, H. Yamamoto, Y. Akiyama, K. Marukawa, N. Hirai, and K. Ito Coronary Artery Calcium Scoring Using 16-MDCT and a Retrospective ECG-Gating Reconstruction Algorithm Am. J. Roentgenol., July 1, 2004; 183(1): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Golledge, M. McCann, S. Mangan, A. Lam, and M. Karan Osteoprotegerin and Osteopontin Are Expressed at High Concentrations Within Symptomatic Carotid Atherosclerosis Stroke, July 1, 2004; 35(7): 1636 - 1641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Pletcher, J. A. Tice, M. Pignone, and W. S. Browner Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events: A Systematic Review and Meta-analysis Arch Intern Med, June 28, 2004; 164(12): 1285 - 1292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Reaven and J. Sacks Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes Diabetes Care, May 1, 2004; 27(5): 1115 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Akhrass, A. T. Evans, Y. Wang, S. Rich, C. R. Kannan, L. Fogelfeld, and T. Mazzone Hormone Replacement Therapy Is Associated with Less Coronary Atherosclerosis in Postmenopausal Women J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5611 - 5614. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Dabelea, G. Kinney, J. K. Snell-Bergeon, J. E. Hokanson, R. H. Eckel, J. Ehrlich, S. Garg, R. F. Hamman, and M. Rewers Effect of Type 1 Diabetes on the Gender Difference in Coronary Artery Calcification: a Role for Insulin Resistance?: The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study Diabetes, November 1, 2003; 52(11): 2833 - 2839. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Snell-Bergeon, J. E. Hokanson, L. Jensen, T. MacKenzie, G. Kinney, D. Dabelea, R. H. Eckel, J. Ehrlich, S. Garg, and M. Rewers Progression of Coronary Artery Calcification in Type 1 Diabetes: The importance of glycemic control Diabetes Care, October 1, 2003; 26(10): 2923 - 2928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Rumberger and L. Kaufman A Rosetta Stone for Coronary Calcium Risk Stratification: Agatston, Volume, and Mass Scores in 11,490 Individuals Am. J. Roentgenol., September 1, 2003; 181(3): 743 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, P. Raggi, E. Schisterman, D. S. Berman, and T. Q. Callister Prognostic Value of Cardiac Risk Factors and Coronary Artery Calcium Screening for All-Cause Mortality Radiology, September 1, 2003; 228(3): 826 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Chertow Slowing the Progression of Vascular Calcification in Hemodialysis J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S310 - 314. [Abstract] [Full Text]
|
|
|
|
|
|
T. Sano, A. Tanaka, M. Namba, Y. Nishibori, Y. Nishida, T. Kawarabayashi, D. Fukuda, K. Shimada, and J. Yoshikawa C-Reactive Protein and Lesion Morphology in Patients With Acute Myocardial Infarction Circulation, July 22, 2003; 108(3): 282 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Watanabe, T. Hiroki, and N. Koga Relation of Thoracic Aorta Calcification on Computed Tomography and Coronary Risk Factors to Obstructive Coronary Artery Disease on Angiography Angiology, July 1, 2003; 54(4): 433 - 441. [Abstract] [PDF]
|
|
|
|
|
|
C. Hong, K. T. Bae, T. K. Pilgram, and F. Zhu Coronary Artery Calcium Quantification at Multi-Detector Row CT: Influence of Heart Rate and Measurement Methods on Interacquisition Variability—Initial Experience Radiology, July 1, 2003; 228(1): 95 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Takahashi and K. T. Bae Quantification of Coronary Artery Calcium with Multi-Detector row CT: Assessing Interscan Variability with Different Tube Currents—Pilot Study Radiology, July 1, 2003; 228(1): 101 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Christian, D. A. Dumesic, T. Behrenbeck, A. L. Oberg, P. F. Sheedy II, and L. A. Fitzpatrick Prevalence and Predictors of Coronary Artery Calcification in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2562 - 2568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Pohle, D Ropers, R Maffert, P Geitner, W Moshage, M Regenfus, M Kusus, W G Daniel, and S Achenbach Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography Heart, June 1, 2003; 89(6): 625 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hong, K. T. Bae, T. K. Pilgram, J. Suh, and D. Bradley Coronary Artery Calcium Measurement with Multi-Detector Row CT: In Vitro Assessment of Effect of Radiation Dose Radiology, December 1, 2002; 225(3): 901 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Treede, C. Becker, H. Reichenspurner, A. Knez, C. Detter, M. Reiser, and B. Reichart Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease Ann. Thorac. Surg., October 1, 2002; 74(4): S1398 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-C. Yoon, A. M. Emerick, J. A. Hill, D. W. Gjertson, and J. G. Goldin Calcium Begets Calcium: Progression of Coronary Artery Calcification in Asymptomatic Subjects Radiology, July 1, 2002; 224(1): 236 - 241. [Abstract] [Full Text]
|
|
|
|
|
|
F. A. Jaffer, C. J. O'Donnell, M. G. Larson, S. K. Chan, K. V. Kissinger, M. J. Kupka, C. Salton, R. M. Botnar, D. Levy, and W. J. Manning Age and Sex Distribution of Subclinical Aortic Atherosclerosis: A Magnetic Resonance Imaging Examination of the Framingham Heart Study Arterioscler Thromb Vasc Biol, May 1, 2002; 22(5): 849 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Bodenheimer, P. C. Keelan, K. Ashai, J. A. Rumberger, A. E. Denktas, P. F. Sheedy II, L. F. Bielak, L. S. Jamjoum, P. P. Peyser, and R. S. Schwartz Long-Term Prognostic Value of Coronary Calcification Detected by Electron Beam Computed Tomography in Patients Undergoing Coronary Arteriography * Response Circulation, April 30, 2002; 105 (17): e127 - e127. [Full Text] [PDF]
|
|
|
|
|
|
M. Hosoi, T. Sato, K. Yamagami, T. Hasegawa, T. Yamakita, M. Miyamoto, K. Yoshioka, T. Yamamoto, T. Ishii, S. Tanaka, et al. Impact of Diabetes on Coronary Stenosis and Coronary Artery Calcification Detected by Electron-Beam Computed Tomography in Symptomatic Patients Diabetes Care, April 1, 2002; 25(4): 696 - 701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Christian, S. Harrington, W. D. Edwards, A. L. Oberg, and L. A. Fitzpatrick Estrogen Status Correlates with the Calcium Content of Coronary Atherosclerotic Plaques in Women J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 1062 - 1067. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Pearson New Tools for Coronary Risk Assessment: What Are Their Advantages and Limitations? Circulation, February 19, 2002; 105(7): 886 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff, T. P. Yang, R. M. Shavelle, D. H. Lamont, and B. H. Brundage Ethnic differences in coronary atherosclerosis J. Am. Coll. Cardiol., February 6, 2002; 39(3): 408 - 412. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Raggi Effects of excess calcium load on the cardiovascular system measured with electron beam tomography in end-stage renal disease Nephrol. Dial. Transplant., February 1, 2002; 17(2): 332 - 335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Vliegenthart, M. Hollander, M. M.B. Breteler, D. A.M. van der Kuip, A. Hofman, M. Oudkerk, and J. C.M. Witteman Stroke Is Associated With Coronary Calcification as Detected by Electron-Beam CT: The Rotterdam Coronary Calcification Study Stroke, February 1, 2002; 33(2): 462 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wayhs, A. Zelinger, and P. Raggi High coronary artery calcium scores pose an extremely elevated risk for hard events J. Am. Coll. Cardiol., January 16, 2002; 39(2): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S Elkeles, M. Flather, M. D Feher, I. Godsland, W. Richmond, S. E Humphries, M. B Rubens, and S R. Underwood Prospective evaluation of diabetic ischaemic heart disease by computed tomography: the PREDICT study The British Journal of Diabetes & Vascular Disease, January 1, 2002; 2(1): 69 - 72a. [Abstract] [PDF]
|
|
|
|
|
|
L.-C. Chen, J.-W. Chen, M.-H. Wu, J.-C. Liu, G.-Y. Lan, P. Y.-A. Ding, and M.-S. Chang Differential Coronary Calcification on Electron-Beam CT Between Syndrome X and Coronary Artery Disease in Patients With Chronic Stable Angina Pectoris Chest, November 1, 2001; 120(5): 1525 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Beckman, J. Ganz, M. A. Creager, P. Ganz, and S. Kinlay Relationship of Clinical Presentation and Calcification of Culprit Coronary Artery Stenoses Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1618 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Goldin, H.-C. Yoon, L. E. Greaser III, S. B. Heinze, M. M. McNitt-Gray, M. S. Brown, J. W. Sayre, A. M. Emerick, and D. R. Aberle Spiral versus Electron-Beam CT for Coronary Artery Calcium Scoring Radiology, October 1, 2001; 221(1): 213 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hong, C. R. Becker, A. Huber, U. J. Schoepf, B. Ohnesorge, A. Knez, R. Bruning, and M. F. Reiser ECG-gated Reconstructed Multi-Detector Row CT Coronary Angiography: Effect of Varying Trigger Delay on Image Quality Radiology, September 1, 2001; 220(3): 712 - 717. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy Coronary calcium as a risk factor: role in global risk assessment J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1512 - 1515. [Full Text] [PDF]
|
|
|
|
|
|
D. E. Bild, A. R. Folsom, L. P. Lowe, S. Sidney, C. Kiefe, A. O. Westfall, Z.-J. Zheng, and J. Rumberger Prevalence and Correlates of Coronary Calcification in Black and White Young Adults : The Coronary Artery Risk Development in Young Adults (CARDIA) Study Arterioscler Thromb Vasc Biol, May 1, 2001; 21(5): 852 - 857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Hunt, G. W. Evans, A. R. Folsom, A. R. Sharrett, L. E. Chambless, C. H. Tegeler, and G. Heiss Acoustic Shadowing on B-Mode Ultrasound of the Carotid Artery Predicts Ischemic Stroke : The Atherosclerosis Risk in Communities (ARIC) Study Stroke, May 1, 2001; 32(5): 1120 - 1126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. E. Wagenknecht, D. W. Bowden, J. J. Carr, C. D. Langefeld, B. I. Freedman, and S. S. Rich Familial Aggregation of Coronary Artery Calcium in Families With Type 2 Diabetes Diabetes, April 1, 2001; 50(4): 861 - 866. [Abstract] [Full Text]
|
|
|
|
|
|
B. K. Nallamothu, S. Saint, L. F. Bielak, S. S. Sonnad, P. A. Peyser, M. Rubenfire, and A. M. Fendrick Electron-Beam Computed Tomography in the Diagnosis of Coronary Artery Disease: A Meta-analysis Arch Intern Med, March 26, 2001; 161(6): 833 - 838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. F. Wilson, L. I. Kauppila, C. J. O'Donnell, D. P. Kiel, M. Hannan, J. M. Polak, and L. A. Cupples Abdominal Aortic Calcific Deposits Are an Important Predictor of Vascular Morbidity and Mortality Circulation, March 20, 2001; 103(11): 1529 - 1534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff C-reactive protein and electron beam computed tomography: a perfect match? J. Am. Coll. Cardiol., March 1, 2001; 37(3): 971 - 972. [Full Text] [PDF]
|
|
|
|
|
|
R. Redberg and P. Ridker C-reactive protein and electron beam computed tomography: a perfect match?: reply J. Am. Coll. Cardiol., March 1, 2001; 37(3): 972 - 972. [Full Text] [PDF]
|
|
|
|
|
|
H. M. Colhoun, L. M. Scheek, M. B. Rubens, T. Van Gent, S. R. Underwood, J. H. Fuller, and A. Van Tol Lipid Transfer Protein Activities in Type 1 Diabetic Patients Without Renal Failure and Nondiabetic Control Subjects and Their Association With Coronary Artery Calcification Diabetes, March 1, 2001; 50(3): 652 - 659. [Abstract] [Full Text]
|
|
|
|
|
|
R. Haberl, A. Becker, A. Leber, A. Knez, C. Becker, C. Lang, R. Bruning, M. Reiser, and G. Steinbeck Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients J. Am. Coll. Cardiol., February 1, 2001; 37(2): 451 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Moshage, S. Achenbach, and W. G. Daniel Novel approaches to the non-invasive diagnosis of coronary-artery disease Nephrol. Dial. Transplant., January 1, 2001; 16(1): 21 - 28. [Full Text] [PDF]
|
|
|
|
|
|
A Farzaneh-Far, D Proudfoot, C Shanahan, and P L Weissberg Vascular and valvar calcification: recent advances Heart, January 1, 2001; 85(1): 13 - 17. [Full Text]
|
|
|
|
|
|
L. F. Bielak, P. F. Sheedy II, and P. A. Peyser Coronary Artery Calcification Measured at Electron-Beam CT: Agreement in Dual Scan Runs and Change over Time Radiology, January 1, 2001; 218(1): 224 - 229. [Abstract] [Full Text]
|
|
|
|
|
|
H. M. Colhoun, M. B. Rubens, S. R. Underwood, and J. H. Fuller The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2160 - 2167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Callister, W. Janowitz, and P. Raggi Sensitivity of Two Electron Beam Tomography Protocols for the Detection and Quantification of Coronary Artery Calcium Am. J. Roentgenol., December 1, 2000; 175(6): 1743 - 1746. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Lu, R. Dai, H. Bai, S. He, B. Jing, N. Zhuang, R. Gao, Y. Yang, J. Chen, and M. J. Budoff Evaluation of Electron Beam Tomographic Coronary Arteriography with Three-Dimensional Reconstruction in Healthy Subjects Angiology, November 1, 2000; 51(11): 895 - 904. [Abstract] [PDF]
|
|
|
|
|
|
Y. Arad, L. A. Spadaro, K. Goodman, D. Newstein, and A. D. Guerci Prediction of coronary events with electron beam computed tomography J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1253 - 1260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. N. H. Enzweiler, D. E. Kivelitz, T. H. Wiese, M. Taupitz, S. Höhn, A. C. Borges, L. Pietsch, P. Dohmen, G. Baumann, and B. Hamm Coronary Artery Bypass Grafts: Improved Electron-Beam Tomography by Prolonging Breath Holds with Preoxygenation Radiology, October 1, 2000; 217(1): 278 - 283. [Abstract] [Full Text]
|
|
|
|
|
|
L. F. Bielak, G. G. Klee, P. F. Sheedy II, S. T. Turner, R. S. Schwartz, and P. A. Peyser Association of Fibrinogen With Quantity of Coronary Artery Calcification Measured by Electron Beam Computed Tomography Arterioscler Thromb Vasc Biol, September 1, 2000; 20(9): 2167 - 2171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. F. Bielak, J. A. Rumberger, P. F. Sheedy II, R. S. Schwartz, and P. A. Peyser Probabilistic Model for Prediction of Angiographically Defined Obstructive Coronary Artery Disease Using Electron Beam Computed Tomography Calcium Score Strata Circulation, July 25, 2000; 102(4): 380 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. R. Janowitz, R. C. Detrano, N. D. Wong, T. M. Doherty, R. M. Shavelle, W. Tang, L. E. Ginzton, M. J. Budoff, and K. A. Narahara Coronary Calcium Does Not Accurately Predict Near-Term Future Coronary Events in High-Risk Adults Response Circulation, July 11, 2000; 102 (2): e20 - e21. [Full Text] [PDF]
|
|
|
|
|
|
R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease : Committee Members Circulation, July 4, 2000; 102(1): 126 - 140. [Full Text] [PDF]
|
|
|
|
|
|
R. F. Redberg, N. Rifai, L. Gee, and P. M. Ridker Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening J. Am. Coll. Cardiol., July 1, 2000; 36(1): 39 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease J. Am. Coll. Cardiol., July 1, 2000; 36(1): 326 - 340. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Rogers, J. W. Prichard, Y.-L. Hu, P. R. Olson, D. H. Benckart, C. M. Kramer, D. A. Vido, and N. Reichek Characterization of Signal Properties in Atherosclerotic Plaque Components by Intravascular MRI Arterioscler Thromb Vasc Biol, July 1, 2000; 20(7): 1824 - 1830. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Iribarren, S. Sidney, B. Sternfeld, and W. S. Browner Calcification of the Aortic Arch: Risk Factors and Association With Coronary Heart Disease, Stroke, and Peripheral Vascular Disease JAMA, June 7, 2000; 283(21): 2810 - 2815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. D. Knollmann, W. Bocksch, S. Spiegelsberger, R. Hetzer, R. Felix, and M. Hummel Electron-Beam Computed Tomography in the Assessment of Coronary Artery Disease After Heart Transplantation Circulation, May 2, 2000; 101(17): 2078 - 2082. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Erbel, A Schmermund, S Mohlenkamp, S Sack, and D Baumgart Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis Eur. Heart J., May 1, 2000; 21(9): 720 - 732. [PDF]
|
|
|
|
|
|
J. J. Carr, J. R. Crouse III, D. C. Goff Jr., R. B. D'Agostino Jr., N. P. Peterson, and G. L. Burke Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT Am. J. Roentgenol., April 1, 2000; 174(4): 915 - 921. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Taylor, A. P. Burke, P. G. O’Malley, A. Farb, G. T. Malcom, J. Smialek, and R. Virmani A Comparison of the Framingham Risk Index, Coronary Artery Calcification, and Culprit Plaque Morphology in Sudden Cardiac Death Circulation, March 21, 2000; 101(11): 1243 - 1248. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||