Cardiovascular diseases are the leading cause of death in men and women in the United States. Approximately 50% of produce the heart attack in people with no history of coronary artery disease. The sudden cardiac death is often the first sign of coronary heart disease. Coronary atherosclerosis is a slowly progressive disease that often goes unnoticed until you develop symptoms. When the symptoms begin to appear coronary artery disease is usually at a relatively late stage, both require percutaneous or surgical revascularization. The opportunity for the prevention of disease or modification of aggressive risk factors is forgotten. What is needed is a way to identify asymptomatic people with a high risk of cardiovascular at the beginning of the disease process events. Traditional cardiovascular risk factors are well established (levels high lipids, high blood pressure, smoking, obesity, lack of exercise, diabetes, family history of
heart disease) and useful to predict future cardiovascular disease. Many people suffer however cardiovascular events in the absence of these factors established coronary artery disease risk.
Myocardial infarctions usually occurs in patients who have a mild moderate that develops the plaque rupture and leads to an acute thrombosis coronary artery stenosis. These mild to moderate Coronary lesions may not cause symptoms and/or not cause ischemia enough to be picked up during a routine stress test.
During the early stages of coronary atherosclerosis calcium begins to accumulate on the Board. As the atherosclerosis process progresses increases the amount of calcification. During the late stages of atherosclerosis plenty of coronary calcification may be present.
Women have been reported as calcification of the coronary arteries less than men and the average prevalence of calcification in women more or less a decade later than in men, as well as the incidence of cardiovascular events. The prevalence of calcium in adults aged 30-39 is 21% for men and 11% for women, while the prevalence is 44% in men and 23% in women in adults between 40 to 49 years of age. A recent study found that scores of coronary calcium were similar in African-American and Caucasian women despite the fact that African American women were more risk factors. Diabetes mellitus and not exercise regularly is associated with an increase in coronary artery calcium in white women but not African-American women scores. The overall prevalence of calcium in women is about half of men until the age of sixty. Another study in asymptomatic women found smoking, high levels of total cholesterol and hypertension associated with better outcomes in all coronary artery calcium. Calcium deposits has also been found to increase with age regardless of sex. Patients with diabetes and stage renal disease requiring hemodialysis patients have a higher prevalence of calcium. Factors of cardiovascular risk that a person has greater prevalence of calcium.
Atherosclerosis is the disease process are known to cause calcium to deposit on the walls of the coronary arteries. The calcification is a degenerative disease, is not a part of the "normal" ageing process. Calcium is not in the normal coronary arteries.
Since calcium deposits begin to develop in the early stages of atherosclerosis and if we are able to identify the presence of calcium that are able to identify the preclinical asymptomatic during coronary artery disease. This may allow the application of the aggressive risk factor reduction principles.
The calcium from the heart of computerized detection score is a test non-invasive that detects calcium deposits in the walls of the coronary arteries. The test is performed with a scanner electron cat do (electron beam) allows scan at high speed. Images are enabled with the assistance of the ECG monitoring during the diastole and a second breath several hold to remove motion artifacts. Scanning takes only 30 seconds and computer programs then quantifies the calcium area, and density.
The electron beam detects the presence, location and extent of the calcium deposits in the coronary system. Separates calcium scores can be obtained by the main artery left, left anterior descending artery, the circumflex, and the right coronary artery, but the total calcium score is most important. The beam of electrons can detect tiny which is what usually occur with early disease coronary artery calcium deposits. The presence of coronary calcification represents the coronary artery disease. People with low scores in total calcium found in a reduced cardiovascular risk than the highest scores.
scores of calcium vary between zero (no Board) to several thousands (extensive Board) and is a unitless measure calculated for the entire coronary system. A score of calcium zero indicates the absence of calcium and a probability very obstructive coronary artery disease low. A score of more than 400 calcium means extensive calcification and a high probability of significant coronary disease. (See table of calcium score) These people must undergo further assessment with stress test or test nuclear effort with ischemia myocardial. The higher the score total major is the burden of the Board. asymptomatic people with a score of intermediate calcium require a comprehensive assessment of the risks and the modification of individual risk factors. The age of a person and gender also must be considered to evaluate the results score of calcium. A score of 175 calcium can be a 65-year-old male average but very abnormal for a 55-year-old woman.
Calcium exploration score is not able to identify the location of injury significant coronary artery, or identify the percentage of stenosis. The amount of calcium in the coronary arteries predicts the total mass of the atherosclerotic plaque and likely to develop future cardiovascular events. coronary calcium reported a predictor independent of angina pectoris stable, myocardial infarction, cardiovascular death, and the need for coronary revascularization. A study in asymptomatic adults 20-69 years of age found that in 18 months follow-up myocardial infarction and cardiovascular death rate was 6.6 per cent in the people who had this exploration to 0.9% calcium in people without any form of calcium. There is a direct link between calcium rising scores and the occurrence of adverse events. Asymptomatic people with very high calcium (> 1000) scores was found to have a 25% per year develop cardiovascular death myocardial infarction risk. A recent study of asymptomatic adults over age 45 years of age with at least a factor of cardiovascular risk found a fourfold increase in cardiovascular risk in patients with coronary arteries of more than 300 calcium scores. A study in symptomatic patients found that a score of more than 170 coronary artery calcium was associated with an increased risk of coronary arteries obstructive disease regardless of the number of risk factors present.
A recent meta-analysis reported a 92.3% sensitivity and specificity for the accuracy of the electron beam 51.2% to diagnose obstructive coronary artery disease. This causes the overall accuracy of prediction about 70%. An advantage of analysis is that there is no "false positive" explorations, calcium deposits are found only in the presence of plate. InterScan calcium scores reliability has been questioned and reported to vary more with lower score. One study reported a 28 per cent in women calcium score variability and 43% in men when scans were performed on repeating the same individual. This really needs to be evaluated and may be even more dependent on the installation, the medical team of the interpretation of results.
Not calcificadas soft boards will not be detected by electron beam. Younger patients who smoke, cannot have this calcium deposits, but are still in high risk cardiovascular and prone to spasm and the formation of thrombi. There has been some research that suggests that patients with unstable angina are likely to have less calcificadas plates that patients with stable angina. Younger patients may develop a significant stenosis in the absence of calcification. This can be falsely reassure people who are at high risk. There is insufficient data to support the use of coronary calcium explorations in symptomatic patients who we know is a high risk patients.
Coronary calcium (EBCT) is more useful in asymptomatic patients with intermediate risk to help determine the need for an aggressive risk factor. (See graph coronary artery calcium scan below)
The traditional evidence not invasive to evaluate coronary artery disease (test effort, nuclear study, stress echocardiography), only detect Coronary lesions that are serious enough to limit blood flow and cause ischemia myocardial. People with coronary artery disease or mild atherosclerosis early be unidentified. detection of coronary calcium is able to identify non obstructive Coronary lesions mild symptoms appear. asymptomatic people with calcium score are also more likely to be indicative of silent ischemia isotope stress tests alterations. In a study 46% of patients with coronary arteries of more than 400 calcium scores gave an abnormal result nuclear scanner while 0% of patients with less than 10 coronary artery calcium scores had an abnormal nuclear scanner.
EBCT proved to be more beneficial for the women of detection. Many times women occur with atypical symptoms and are more prone to false-positive results of effort and/or nuclear scans. Calcium scoring explorations reported having more predictive value for significant coronary heart disease in women and less false positives than men. The negative predictive value in a study of symptomatic patients was 96% in women, and 89% in men. Women with normal lipid levels are also more likely to experience angina pectoris myocardial infarction than men. The lipid profile standard not always properly reflect the cardiovascular risk of women. A study of asymptomatic women over 55 years of age with normal lipids found high score of calcium in the coronary arteries. This is an area that needs to be evaluated further, but suggests coronary artery calcium results can be very beneficial in the assessment of cardiovascular risk in women profiles.
Coronary artery calcium analyzes directions :
1. the family history of heart disease (heart disease, especially premature)
2. History of smoking
3. Hypertension
4. Obesity
5. High levels of lipids
6. Diabetes
7. The men older than 40 years of age or
8 postmenopausal women.
Young people with atypical symptoms the contraindications to coronary artery calcium analyzes :
1. known coronary artery disease.
2. The people over 70 years of age (little clinical benefit)
3. Pregnant women
4. Arrhythmias (chronic atrial fibrillation, rest tachycardia heart rate greater than 90 beats per minute) is compromising the quality of the image
