Effect of Electrocardiogram Triggering on Reproducibility of Coronary Artery Calcium Scoring

Mao, Songshou; Bakhsheshi, Hamid; Lü, Bin; Liu, Steve C. K.; Oudiz, Ronald J.; Budoff, Matthew J.

doi:10.1148/radiol.2203001129

Cited by 95 publications

(35 citation statements)

References 22 publications

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“…[25][26][27][28] Our study has several limitations. Even though recent studies have shown that ECG triggering at 80% of the R-R interval may result in higher interscan variability than triggering at an earlier cardiac phase, 29 we used 80% triggering throughout our study, because that was the standard when we performed our initial EBT scans and we could not change acquisition parameters during the course of the investigation. Also, on request, most patients were informed about their calcification scores, and it is conceivable that patients modified their lifestyle after being aware of an increase in coronary calcium during the untreated period.…”

Section: Discussionmentioning

confidence: 99%

Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

et al. 2002

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Background-Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. Methods and Results-In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol Ͼ130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164Ϯ30 to 107Ϯ21 mg/dL. The median calcified volume was 155 mm 3 (range, 15 to 1849) at baseline, 201 mm 3 (19 to 2486) after 14 months without treatment, and 203 mm 3 (15 to 2569) after 12 months of cerivastatin treatment. The median annualized absolute increase in coronary calcium was 25 mm 3 during the untreated versus 11 mm 3 during the treatment period (Pϭ0.01). The median annual relative increase in coronary calcium was 25% during the untreated versus 8.8% during the treatment period (PϽ0.0001). In 32 patients with an LDL cholesterol level Ͻ100 mg/dL under treatment, the median relative change was 27% during the untreated versus Ϫ3.4% during the treatment period (Pϭ0.0001). Conclusions-Treatment with the cholesterol synthesis enzyme inhibitor cerivastatin significantly reduces coronary calcium progression in patients with LDL cholesterol Ͼ130 mg/dL.

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Section: Discussionmentioning

confidence: 99%

Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

et al. 2002

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“…With EBCT, the mean interscan variability, with improved methodology (early diastolic or end-systolic triggering) and hardware improvements available since 1997, has been shown to be approximately 15%, with interreader variability approximately 3% and intrareader variability Ͻ1%. 39,[53][54][55][56][57][58] Achenbach demonstrated the median variability to be 5.7% using EBCT. 59 The interscan variability in several early studies using noncardiac gated MDCT (dual slice) scanners was 32% to 43%.…”

Section: Reproducibility and Validity Of Calcium Scoringmentioning

confidence: 99%

Assessment of Coronary Artery Disease by Cardiac Computed Tomography

Budoff¹,

Achenbach²,

Blumenthal³

et al. 2006

Circulation

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“…With respect to interscan variability, recent studies [3,25,27] conducted with ECG-gated MDCT have shown interscan variability ranging from 12% to 32%, and studies [5,8,[28][29][30][31][32] of electron-beam CT conducted in the late 1990s showed variability ranging from 13% to 51% for both Agatston and calcium volume score algorithms. We have found interscan variability of 60-70%.…”

Section: Calcium Scoring and Ct For Lung Cancermentioning

confidence: 99%

Coronary Artery Calcification Scoring in Low-Dose Ungated CT Screening for Lung Cancer: Interscan Agreement

Jacobs

Išgum

Gondrie

et al. 2010

American Journal of Roentgenology

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C a r d io p u lm o n a r y I m ag i ng • O r ig i n a l R e s e a rc h AJR 2010; 194:1244-1249 0361-803X/10/1945-1244 © American Roentgen Ray Society B ecause prolonged and heavy smoking is a strong etiologic factor in the development of lung cancer and cardiovascular disease (CVD), simultaneous screening for both diseases in a high-risk population of heavy smokers and former smokers is an attractive strategy for maximizing the beneficial effects on survival in lung cancer screening programs and minimizing the radiation dose for individuals in the screening population. The presence and extent of coronary artery calcification (CAC) detected with electronbeam CT and ECG-gated MDCT have been found to be independent predictors of CVD events OBJECTIVE. In previous studies detection of coronary artery calcification (CAC) with low-dose ungated MDCT performed for lung cancer screening has been compared with detection with cardiac CT. We evaluated the interscan agreement of CAC scores from two consecutive low-dose ungated MDCT examinations. SUBJECTS AND METHODS.The subjects were 584 participants in the screening segment of a lung cancer screening trial who underwent two low-dose ungated MDCT examinations within 4 months (mean, 3.1 ± 0.6 months) of a baseline CT examination. Agatston score, volume score, and calcium mass score were measured by two observers. Interscan agreement of stratification of participants into four Agatston score risk categories (0, 1-100, 101-400, > 400) was assessed with kappa values. Interscan variability and 95% repeatability limits were calculated for all three calcium measures and compared by repeated measures analysis of variance.RESULTS. An Agatston score > 0 was detected in 443 baseline CT examinations (75.8%). Interscan agreement of the four risk categories was good (κ = 0.67). The Agatston scores were in the same risk category in both examinations in 440 cases (75.3%); 578 participants (99.0%) had scores differing a maximum of one category. Furthermore, mean interscan variability ranged from 61% for calcium volume score to 71% for Agatston score (p < 0.01). A limitation of this study was that no comparison of CAC scores between low-dose ungated CT and the reference standard ECG-gated CT was performed.CONCLUSION. Cardiovascular disease risk stratification with low-dose ungated MDCT is feasible and has good interscan agreement of stratification of participants into Agatston score risk categories. High mean interscan variability precludes the use of this technique for monitoring CAC scores for individual patients.Jacobs et al.

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Effect of Electrocardiogram Triggering on Reproducibility of Coronary Artery Calcium Scoring

Abstract: Study results strongly support the use of an ECG trigger of 40% rather than 80% of the R-R interval in electron-beam CT calcium studies.

Cited by 95 publications

References 22 publications

Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

Assessment of Coronary Artery Disease by Cardiac Computed Tomography

Coronary Artery Calcification Scoring in Low-Dose Ungated CT Screening for Lung Cancer: Interscan Agreement

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