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    Coronary Calcium Scoring

    Facts about heart disease: (Source: American Heart Association)

    • 58 million Americans have one or more forms of cardiovascular disease.
    • Coronary heart disease is the number one killer of men and women in the United States.
    • More Americans die of heart disease, than all types of cancer combined.
    • At least 250,000 people a year die of a heart attack within one hour of the onset of symptoms and before they reach a hospital.
    • 12 million people alive today have a history of heart attack, chest pain or both.

    What are the risk factors for heart disease?

      The risk factors for heart disease include the following:
      • Age (men 45 or older, women 55 or older)
      • Family history of heart disease
      • High cholesterol
      • History of smoking
      • High blood pressure
      • High stress levels,
      • Sedentary lifestyle
      • Diabetes

    What causes heart disease?

      The primary cause of heart disease is the build-up of plaque (atherosclerosis) in the arteries of the heart. This build-up can cause the arteries to narrow. Plaque can also break away from the artery walls and cause a blockage. In both instances the heart muscle does not receive enough blood flow and oxygen-thus a heart attack can occur.s

    What is cardiac scoring?

      Cardiac scoring is a revolutionary, pain-free, non-invasive and inexpensive procedure requiring less than 10 minutes. Using CT imaging with sub-second scanning capability, the equipment takes 70-90 images of your coronary arteries without any injections, needles or removal of your clothing. The amount of calcium or plaque detected in your coronary arteries is used to establish your cardiac score.

      CT scan reveals moderate calcification (plaque build-up) in the left coronary artery.

    What does the procedure involve?

      First, you complete a brief risk factor questionnaire. Next, you lie down on the imaging table while a CT technologist places a few EKG leads on you. You are then asked to hold your breath while the images are taken. That's it. You can return to your regular routine.

      A board certified radiologist, using high tech software, calculates your cardiac score based on the images taken.

      Reconstructed 3-dimensional image of the heart obtained from CT scanning

    Is cardiac scoring safe?

      The radiation exposure during cardiac scoring is very minimal (comparable to the radiation received during a chest x-ray). No intravenous injections or needles are required.

      Not only is it safe, but it is also simple. In most cases (unless there are certain types of buttons or bra metal involved), patients may keep their shirt or blouse on during the procedure.

    What can my cardiac score tell me and my doctor?

      Subtle early warning signs of heart disease can be detected. Cardiac scoring is the latest diagnostic tool to detect plaque in the coronary arteries. With this information, your doctor can recommend the appropriate treatment, including diet and lifestyle changes, medication and/or further testing.

    Is coronary artery disease treatable?

      Yes, the plaque build-up process can be slowed, stabilized and reversed, in some cases, through aggressive lifestyle modification and/or through medication therapies under the guidance of your physician.

    What are the general recommendations for interpretation of calcium scores?

      0 No identifiable atherosclerotic plaque.

      Very low cardiovascular disease (CVD) risk

      Healthy Diet (low in saturated fat and cholesterol)
      Stop Smoking
      Maintain Recommended Weight
      1-10 Minimal plaque burden

      Low CVD risk

      All recommendations above PLUS
      Tight control of Diabetes and Hypertension
      Consider use of Statins in cases of High Cholesterol
      11-100 Mild plaque burden

      Moderate CVD risk

      All recommendations above PLUS
      Estrogen for Post-Menopausal Women
      Aspirin Use
      Use of Statins in cases of High Cholesterol
      101-400 Moderate plaque burden

      High CVD risk

      All recommendations above PLUS
      Exercise program
      Use of Statins in cases of high and borderline cholesterol levels
      Consider use of Folic Acid, Vitam E, Fish Oils
      > 400 Extensive plaque burden

      Very high CVD risk

      All recommendations above PLUS
      Exercise Test to rule out obstructive disease
      Consider angiogram for symptomatic patients or those in high risk occupations
      Learn more about National Cholesterol Education Program (NCEP)

    How does my score compare with others in my age group?

      Coronary Artery Calcium Scores
      (percentile rankings in over 19,000 patients)
      % AGE
      40-45 46-50 51-55 56-60 61-65 66-70 70+
      10% 0 0 0 1 1 3 3
      25% 0.5 1 2 5 12 30 65
      50% 2 3 15 54 117 166 350
      75% 11 36 110 229 386 538 844
      90% 69 151 346 588 933 1151 1650
      10% 0 0 0 0 0 0 0
      25% 0.1 0.1 0.1 0.2 0.5 1 4
      50% 0.1 0.1 1 1 3 25 51
      75% 1 2 6 22 68 148 231
      90% 3 21 61 127 208 327 698

    Conventional Methods for Detecting Coronary Artery Disease

      Test Advantages Disadvantages
      Stress Test
    • Ideal for patients who are symptomatic
    • Used to determine extent of ishemia
    • Does not produce an image of coronary arteries
    • Significant blockage must be present to detect ischemia (i.e. does not detect preclinical disease)
    • Angiography
    • "Gold standard"
    • Shows narrowing of lumen
    • Shows number of diseased vessels
    • Generally used only with demonstrable ischemia
    • Invasive
    • Expensive
    • No information regarding type of plaque (soft or hard)
    • Intravascular Ultrasound
    • Direct visualization of vessel wall and lumen size; useful for angioplasty and stent placement
    • Can detect calcification
    • Generally used only with demonstrable ischemia
    • Invasive
    • Expensive
    • Helical/EBCT Cardiac Score
    • Noninvasive
    • Detects and quantifies coronary calcification
    • May be used in asymptomatic patients
    • May be used to estimate total atherosclerotic plaque burden and risk of future events
    • Does not identify stenotic lesions
    • Conflicting evidence regarding correlation of CAC score to risk of events
    • No universally defined treatment plans for those with positive test results

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