Rumberg2
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Coronary artery calcium detected by electron beam tomography (EBT) establishes a diagnosis of coronary atherosclerosis, as there are no false positive calcium measurements. The amount of calcium seen on EBT correlates directly with the actual amount of coronary plaque measured by intravascular ultrasound and histopathology. Studies have also shown that a higher coronary artery calcium score on EBT is associated with greater risk of future myocardial infarction, sudden cardiac death, or ischemia over follow-up periods of 3-6 years.
![EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium
Coronary Artery CalciumCoronary Artery Calcium ISIS AtherosclerosisAtherosclerosis
There areThere are NONO false positive calcium measuresfalse positive calcium measures
by EBT [i.e. ALL calcium is plaque]by EBT [i.e. ALL calcium is plaque]
Establishes a diagnosis ofEstablishes a diagnosis of
coronary atherosclerosiscoronary atherosclerosis](https://image.slidesharecdn.com/acasbeaur0oointlcfk5-signature-185c9c8f74195a69485b096cbf5bfb73f6b3ed8b7754452e736ee4598185e9e3-poli-160919191611/85/Rumberg2-1-320.jpg)
Rumberg2
- 1. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium Coronary Artery CalciumCoronary Artery Calcium ISIS AtherosclerosisAtherosclerosis There areThere are NONO false positive calcium measuresfalse positive calcium measures by EBT [i.e. ALL calcium is plaque]by EBT [i.e. ALL calcium is plaque] Establishes a diagnosis ofEstablishes a diagnosis of coronary atherosclerosiscoronary atherosclerosis
- 2. Coronary Calcium Area by EBT andCoronary Calcium Area by EBT and Coronary Artery Plaque AreaCoronary Artery Plaque Area 0 2 4 6 8 10 12 14 16 0 2 4 6 8 Square Root Sum of Calcium Areas SquareRootSumof PlaqueAreas Rumberger, Circ 1995:92:2157-62 n = 38n = 38 r = 0.90r = 0.90 p < .001p < .001
- 3. No. of coronary segments/pt. with plaques (IVUS) 0 1 2 3 4 5 6 7 No. of calcified coronary segments/pt. (EBCT) 0 1 2 3 4 5 6 7 Y = -0.67 + (0.90 * X) r = 0.86 p < 0.0001 N = 40 patients total of 222 coronary segments examined Acute Coronary Syndrome and Non-Obstructive CADAcute Coronary Syndrome and Non-Obstructive CAD # of segments with EBT calcium vs. # of segments with any plaque# of segments with EBT calcium vs. # of segments with any plaque Schmermund et alSchmermund et al AJC 1998; 81:AJC 1998; 81: 141-146141-146
- 4. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium Define the extent of disease? YESDefine the extent of disease? YES The amount of calciumThe amount of calcium correlates DIRECTLYcorrelates DIRECTLY toto the amount of measurable coronary disease by:the amount of measurable coronary disease by: 1) direct histopathologic comparison1) direct histopathologic comparison 2) with intravascular ultrasound2) with intravascular ultrasound
- 5. Electron Beam TomographyElectron Beam Tomography Hn x-factor (Agatston Scoring) 130-199 1 200-299 2 300-399 3 >400 4 Area = 15 mmArea = 15 mm22 Volume = 12 mmVolume = 12 mm33 x10x10-3-3 Agatston (area) ScoreAgatston (area) Score vs. Volume Scorevs. Volume Score Area = 8 mmArea = 8 mm22 Volume = 6 mmVolume = 6 mm33 x10x10-3-3 Agatston (area) ScoreAgatston (area) Score vs. Volume Scorevs. Volume Score Total Score =Total Score = ΣΣ
- 6. ““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia: initially asymptomatic adultsinitially asymptomatic adults 2.7 6.9 14.3 19.7 20.2 0 5 10 15 20 25 30 '1-49 >50 >80 >160 >600 Arad: JACC 2000;36:1253-60 EBCT Calcium ScoreEBCT Calcium Score Agatston: Circ 1997 OddsRatioOddsRatio 3-6 yr. f/u3-6 yr. f/u n = 367n = 367 3.5 yr. f/u3.5 yr. f/u n = 1177n = 1177
- 7. ““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia: initially asymptomatic adultsinitially asymptomatic adults 2.7 6.9 14.3 19.7 20.2 0 5 10 15 20 25 30 '1-49 >50 >80 >160 >600 Arad: JACC 2000;36:1253-60 EBCT Calcium ScoreEBCT Calcium Score Agatston: Circ 1997 OddsRatioOddsRatio 3-6 yr. f/u3-6 yr. f/u n = 367n = 367 3.5 yr. f/u3.5 yr. f/u n = 1177n = 1177