Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography

BackgroundExtracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD).Methods and ResultsA total of 1741 patients at all stages of pre‐dialysis CKD from the prospective observational cohort of CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center‐High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water‐to‐total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R 2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis.Conclusions ECF status is independently associated with a high risk of CAC in patients with CKD.Study Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02003781.

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“…Agatston calcium scores were calculated to quantify the extent of CAC. A total CACS of ≥400 was defined as CAC 14, 15…”

Section: Methodsmentioning

confidence: 99%

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Park

Jhee

Yun

et al. 2018

JAHA

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“…32 The same team of investigators had shown earlier that reducing the tube voltage to 100 kV gives equivalent results to standard 120 kV at reduced radiation exposure. 33 It must be noted, however, for lower tube voltages that the corresponding calcium thresholds for calcium scoring need to be manually calibrated for the …”

Section: Clinical Reports Of Dose Reduction For Coronary Calcium Scoringmentioning

confidence: 99%

Achieving Very-Low-Dose Radiation Exposure in Cardiac Computed Tomography, Single-Photon Emission Computed Tomography, and Positron Emission Tomography

Dey

Slomka

Berman

2014

Circ: Cardiovascular Imaging

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“…Coronary artery calcium can be assessed by performing low-dose calcium scoring prior to MDCTA (110 kV, 100 mA); this has little effect on the estimated Agatston score [54]. There is no consensus on what levels of calcium will prohibit CTA; however, high calcium levels undoubtedly reduced the positive predictive value of CTA.…”

Section: Patient Considerationsmentioning

confidence: 99%

The role of non-invasive imaging in patients with suspected acute coronary syndrome

Roobottom

Mitchell²,

Iyengar³

2011

BJR

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Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography

Cited by 96 publications

References 30 publications

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Achieving Very-Low-Dose Radiation Exposure in Cardiac Computed Tomography, Single-Photon Emission Computed Tomography, and Positron Emission Tomography

The role of non-invasive imaging in patients with suspected acute coronary syndrome

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