Cardiac calcium score on 2D echo: correlations with cardiac and coronary calcium at multi-detector computed tomography

Abstract

BackgroundTo test the hypothesis that a semi-quantitative echocardiographic calcium score (eCS) significantly correlates with cardiac calcium measured by coronary computed tomography angiography (CCTA) and, secondarily, severe coronary artery calcifications and stenosis.MethodsThis is a retrospective, observational study, conducted in a tertiary centre. eCS was compared with CCTA scores of non-coronary cardiac calcium (nCACS), coronary cardiac calcium (CACS) and number of diseased coronary vessels, in 141 subjects without known coronary artery disease (CAD), who underwent both echocardiography and CCTA for clinical reasons.ResultsAge, prevalence of hypertension and all measures of calcium (eCS, nCACS and CACS) differed significantly between the no-CAD and CAD subgroups. eCS was positively correlated with nCACS (Spearman rho = 0.64, p < 0.0001), CACS (rho = 0.46, p < 0.01) and weakly with the number of diseased coronary vessels (rho = 0.28, p < 0.05). eCS and nCACS had similar area under the curve (AUC) for the prediction of severe CACS (≥400) (0.77, 95% CI 0.68-0.86 and 0.79, 95% CI 0.72-0.88) or obstructive CAD (0.63, 95% CI 0.54-0.72 and 0.63, 95% CI 0.55-0.73).ConclusionseCS, a calcium score easily obtainable during standard echocardiography, is moderately to strongly correlated with nCACS by CCTA. The full eCS score correlates with nCACS better than its single components. It correlates with CACS and predicts severe coronary calcification (CACS > 400), a known predictor of cardiovascular morbidity and mortality. The eCS also predicts obstructive CAD, incrementally to age and clinical variables, although for this purpose CACS remains the most accurate score.

Stress echocardiography: Need to optimize its appropriate use in suspected angina and a review of available additional tools for its clinical application in 2018: First do no harm! second do it at the highest possible accuracy

“…Cardiac calcium is more robustly proven as a parameter acquired outside of this stress echocardiography setting, during standard rest echocardiography, when it has an incredible long-standing “career” since the first 1999 NEJM outcome paper in which, specifically for the aortic valve,[ 17 ] the association between cardiac calcium and mortality became first widely known, and this association in general for cardiac calcium also assessed in the mitral valve or other sites remained valid both for diagnostic and prognostic purposes in primary prevention prospective studies. [ 18 19 20 21 22 23 ] Several types of scores have also been built and tested assessing the grade of sclerosis-calcification of the aortic valve, mitral valve, ascending aorta, and sometimes papillary muscles, but, in general, some structured assessment of echogenicity and thickening of at least aortic and mitral valves is enough, and the presence of zero cardiac calcium versus moderate-severe calcium does help to stratify the absence or presence of obstructive CAD or future cardiovascular events. Importantly, this variable or score adds incrementally to wall motion behavior assessed during stress echocardiography, which makes ultrasound cardiac calcium scoring another good candidate as an additional parameter in this context.…”

Correlation Between Cardiac Calcium Index and Coronary Artery Disease

“…5 Coronary angiotomography is known to predict individual risk of coronary events, evaluating the calcium score of the coronary arteries and the semiquantitative scores of valvular calcium. 5 A study by Gaibazzi et al 6 has established a cardiac calcification index by TTE and predicted the presence of important coronary calcification, with results comparable to those of coronary angiotomography. 6 In patients with coronary artery disease (CAD), mitral annular calcification and aortic valve sclerosis on TTE are independent risk factors for cardiovascular events.…”

“…5 A study by Gaibazzi et al 6 has established a cardiac calcification index by TTE and predicted the presence of important coronary calcification, with results comparable to those of coronary angiotomography. 6 In patients with coronary artery disease (CAD), mitral annular calcification and aortic valve sclerosis on TTE are independent risk factors for cardiovascular events. 7 Some studies have shown that calcium deposition in the aortic leaflets and fibrous skeleton at the base of the heart is related to aging.…”

Cardiac calcification as a marker of subclinical atherosclerosis and predictor of cardiovascular events: A review of the evidence

“…Of interest, conventional echocardiographic examination may offer a semi-quantitative assessment of cardiac calcifications at different sites: the mitral apparatus (annulus, leaflets and papillary muscles), aortic valve and ascending aorta 16 (Figures 1 and 2). Calcification of intracardiac structures on echocardiography corresponds to valve calcium detected by CT, and is also related to CAC (Figure 3).…”