ReviewIn the search of coronary calcium
Introduction
Coronary artery calcium (CAC) is a constituent of atherosclerosis detected almost exclusively in atherosclerotic arteries [1]. CAC pathophysiology and association with cardiovascular risk have been an area of intense investigation for several years. Specifically, the association between CAC and plaque vulnerability—which is the most important pathophysiological entity leading to acute coronary syndromes—has not been yet fully elucidated. It has been proposed that CAC might serve as a stimulus for plaque disruption [2], whereas other researchers describe the coronary calcification as a ‘healing’ process providing plaque stability after subclinical plaque rupture events [3]. Several studies, though, have shown that CAC amount is predictive of an increased risk for future coronary events [4] and, thus, CAC detection has become an established method for cardiovascular risk assessment, particularly useful in asymptomatic intermediate risk individuals [5].
Various diagnostic techniques, both non-invasive and invasive, providing anatomic information for the presence of atherosclerosis have been used for CAC imaging [Table 1]. The focus of this review is to present CAC detection methods and describe their current position in our armamentarium for accurate detection and more comprehensive assessment of the coronary atherosclerotic plaques.
Section snippets
Chest radiography
The possibility of detecting calcified coronary arteries on plain chest films was described decades ago. However, it was early recognised that chest radiographs are insensitive for CAC detection [6]. In a recent study, plane chest radiography had an at most moderate accuracy for CAC detection when compared with multislice computed tomography (MSCT) suggestive of the limited ability to differentiate between the presence and absence of CAC from conventional chest radiographs [7]. Dual-energy
Coronary angiography
CAC can be seen during routine coronary angiography (CA) even before contrast injection in the vicinity of the coronary arteries and relates to atheroma presence and vessel remodelling [Fig. 1B, Video-2]. Moreover, CAC detection during CA has potential implications in percutaneous coronary intervention (PCI) outcome of calcific lesions, including higher rates of procedural failure, stent under-deployment, lower post-procedural minimal luminal diameter and acute gain, and elevated risk of
Future perspectives—conclusion
During the last 3 decades—through intense research and controversies—significant advancements were made regarding the pathophysiology, clinical significance and imaging methods of CAC.
Since the early reports of CAC detection on plain chest films the evolution of cardiac imaging was enormous and offered more sensitive tools of CAC detection and quantification. Fluoroscopy and digital fluoroscopy initially deemed promising but were soon abandoned. The advent of EBCT and—one decade later—MDCT,
Conflict of interest
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Acknowledgment
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
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