TY - JOUR
T1 - Evolving Role of Calcium Density in Coronary Artery Calcium Scoring and Atherosclerotic Cardiovascular Disease Risk
AU - Razavi, Alexander C.
AU - Agatston, Arthur S.
AU - Shaw, Leslee J.
AU - De Cecco, Carlo N.
AU - van Assen, Marly
AU - Sperling, Laurence S.
AU - Bittencourt, Marcio S.
AU - Daubert, Melissa A.
AU - Nasir, Khurram
AU - Blumenthal, Roger S.
AU - Mortensen, Martin Bødtker
AU - Whelton, Seamus P.
AU - Blaha, Michael J.
AU - Dzaye, Omar
N1 - Funding Information:
Dr Blaha has received grants from the National Institutes of Health, U.S. Food and Drug Administration, AHA, Amgen, Novo Nordisk, and Bayer; and is on the advisory boards for Amgen, Sanofi, Regeneron, Novartis, Novo Nordisk, Bayer, 89Bio, Kaleido, Roche, Inozyme, emocha, VoxelCloud, and Kowa. Dr Dzaye has received support from National Institutes of Health grant T32 HL007227. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/9
Y1 - 2022/9
N2 - Coronary artery calcium (CAC) is a specific marker of coronary atherosclerosis that can be used to measure calcified subclinical atherosclerotic burden. The Agatston method is the most widely used scoring algorithm for quantifying CAC and is expressed as the product of total calcium area and a quantized peak calcium density weighting factor defined by the calcification attenuation in HU on noncontrast computed tomography. Calcium density has emerged as an important area of inquiry because the Agatston score is upweighted based on the assumption that peak calcium density and atherosclerotic cardiovascular disease (ASCVD) risk are positively correlated. However, recent evidence demonstrates that calcium density is inversely associated with lesion vulnerability and ASCVD risk in population-based cohorts when accounting for age and plaque area. Here, we review calcium density by focusing on 3 main areas: 1) CAC scan acquisition parameters; 2) pathophysiology of calcified plaques; and 3) epidemiologic evidence relating calcium density to ASCVD outcomes. Through this process, we hope to provide further insight into the evolution of CAC scoring on noncontrast computed tomography.
AB - Coronary artery calcium (CAC) is a specific marker of coronary atherosclerosis that can be used to measure calcified subclinical atherosclerotic burden. The Agatston method is the most widely used scoring algorithm for quantifying CAC and is expressed as the product of total calcium area and a quantized peak calcium density weighting factor defined by the calcification attenuation in HU on noncontrast computed tomography. Calcium density has emerged as an important area of inquiry because the Agatston score is upweighted based on the assumption that peak calcium density and atherosclerotic cardiovascular disease (ASCVD) risk are positively correlated. However, recent evidence demonstrates that calcium density is inversely associated with lesion vulnerability and ASCVD risk in population-based cohorts when accounting for age and plaque area. Here, we review calcium density by focusing on 3 main areas: 1) CAC scan acquisition parameters; 2) pathophysiology of calcified plaques; and 3) epidemiologic evidence relating calcium density to ASCVD outcomes. Through this process, we hope to provide further insight into the evolution of CAC scoring on noncontrast computed tomography.
KW - atherosclerosis
KW - calcium density
KW - coronary artery calcium
KW - noncontrast computed tomography
KW - Predictive Value of Tests
KW - Calcium
KW - Cardiovascular Diseases/complications
KW - Risk Assessment
KW - Vascular Calcification/complications
KW - Humans
KW - Risk Factors
KW - Plaque, Atherosclerotic
KW - Coronary Artery Disease/complications
KW - Atherosclerosis
KW - Coronary Vessels/diagnostic imaging
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U2 - 10.1016/j.jcmg.2022.02.026
DO - 10.1016/j.jcmg.2022.02.026
M3 - Review article
C2 - 35861969
AN - SCOPUS:85136535755
SN - 1936-878X
VL - 15
SP - 1648
EP - 1662
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -