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Coronary artery calcium score: has anything changed?

Coronary artery calcium score: è cambiato qualcosa?

  • Cardiac Radiology Cardioradiologia
  • Published:
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Abstract

Calcium deposition along the coronary artery walls is a surrogate biomarker for atherosclerosis, and its presence in the coronary arteries could reflect the severity of coronary artery disease (CAD) High coronary artery calcium score (CACS) correlates with advanced disease and a higher likelihood of coronary stenoses. Many studies have supported the role of CACS as a screening tool for CAD. Historically, CACS was introduced with electron beam computed tomography (EBCT), but in the last 30 years, many changes have occurred in CT, where the development of multidetector spiral technology has made reliable the noninvasive study of the heart and coronary arteries. Correlation studies with intravascular ultrasound (IVUS) and histology have demonstrated the capability of multidetector CT (MDCT) to provide information useful for characterising atherosclerotic plaque in a noninvasive manner. This has shifted the interest from heavily calcified deposits to plaque with a low-density core and small, superficial calcified nodules, features more frequently present in atherosclerotic plaque prone to rupture and responsible for acute coronary events (culprit lesions). The purpose of this review article is to summarise the recent evolution and revolution in the field of CT, strengthen the importance of a coronary CT study not limited to CACS evaluation and CAD grading but also used to obtain information about plaque composition, and to improve stratification of the patient at risk for acute coronary events.

Riassunto

La deposizione di calcio lungo le pareti delle arterie coronarie è un indicatore biologico della malattia aterosclerotica e la sua quantità potrebbe riflettere la severità della malattia coronarica (CAD). Un elevato score del calcio coronarico si correla, infatti, con stadi avanzati della malattia aterosclerotica e maggiore risulta la probabilità di presenza di stenosi coronariche. In molti lavori della letteratura è stato riconosciuto al Coronary Artery Calcium Score (CACS) un ruolo di strumento di screening della malattia coronarica; storicamente esso è stato introdotto con la Electron Beam-CT (EBCT), ma negli ultimi anni la tumultuosa evoluzione/rivoluzione tecnologica in ambito della tomografia computerizzata (TC), con lo sviluppo di scanner spirali multidetettore, ha reso possibile lo studio non invasivo del cuore e delle coronarie anche con questa metodica. Studi di correlazione con l’ecografia endovascolare (IVUS) e l’istologia hanno recentemente documentato la possibilità di ottenere mediante TCMD ed in maniera non invasiva informazioni utili ai fini della caratterizzazione della placca aterosclerotica, spostando l’attenzione dai marcati depositi di calcio alle placche coronariche con core a bassa densità e piccoli noduli calcifici superficiali, reperti più frequentemente presenti nelle lesioni ateromasiche a rischio di rottura e responsabili, pertanto, di eventi coronarici acuti (culprit lesion). Lo scopo di questa review è di riassumere l’evoluzione verificatasi recentemente nel campo della tomografia computerizzata, sottolineando l’importanza di uno studio angio grafico non invasivo delle coronarie con TCMD non limitato solamente alla semplice valutazione del CACS ed al grading delle lesioni, ma utile anche al fine di ottenere informazioni relative alla composizione della placca e migliorare, quindi, la stratificazione del paziente a rischio di evento coronarico acuto.

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Authors and Affiliations

  1. Department of Clinical Sciences and Bioimaging, Section of Radiology, “G. d’Annunzio” University, “SS. Annunziata” Hospital, Via dei Vestini, I-66013, Chieti, Italy

    R. Marano

  2. Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital, Catholic University, Rome, Italy

    L. Bonomo

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Correspondence to R. Marano.

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Marano, R., Bonomo, L. Coronary artery calcium score: has anything changed?. Radiol med 112, 949–958 (2007). https://doi.org/10.1007/s11547-007-0195-8

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  • DOI: https://doi.org/10.1007/s11547-007-0195-8

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