Prevention, Screening and Health Maintenance
Family Medicine Clerkship
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Coronary Artery Disease
Coronary artery disease
What is the role of ultra fast heart CT in early
diagnosis of coronary artery disease?
Ultra fast heart CT is an imaging modality that can
identify locations of calcification within the coronary
- It is also referred to as electron beam computed
tomography, or EBCT.
- This imaging modality is a rapid, non-invasive method
to view the heart and coronary vessels.
- Besides detection of coronary calcification, it can be
used to assess perfusion of the myocardium, and to observe
the functioning status of coronary artery bypass grafts.
- Calcification of coronary arteries, even in small
amounts, can be detected via EBCT.
What is the significance of calcification in coronary
- The coronary vessels are frequently diseased by
- Atheromas form within the intima of blood vessels,
have a lipid-rich core and are surrounded by fibrous caps.
- An advanced stage of plaque formation involves
sporadic or diffuse calcification of these atheromas, thus
the term “hardening of the arteries.”
- The calcification of the blood vessels changes
normally flexible, pliable vessels into solid, brittle,
and narrow vessels that are insufficient for perfusion and
at high risk for plaque rupture.
What is the sensitivity and specificity of electron beam
computed tomography in early diagnosis of coronary artery
- A meta-analysis of 1,662 subjects performed by the
American College of Cardiology and the American Heart
Association Expert Consensus group found EBCT to have high
sensitivity (92 percent), lower specificity (51 percent),
and predictive accuracy of nearly 70 percent in a patient
population typical for having coronary artery disease.
- It was not found to be more efficient, sensitive or
specific than current alternative non-invasive methods for
- It is important to remember that not all coronary
plaques are calcified, and thus not all coronary artery
disease can be identified via EBCT.
- Females are much less likely to have calcified plaques
than their same age counterparts until the age of 60
What is the current recommendation for ultra fast heart
CT in early diagnosis of coronary artery disease?
- Ultra fast CT, or EBCT, is currently the subject of
much testing and investigation to assess its proper
- As of yet, data has not supported it as an adequate
screening tool for CAD.
- The current recommendation of the American College of
Cardiology and the American Heart Association Expert
Consensus group remains the same as it has been since the
AHA's statement in 1996.
- Their conclusion statement is “there was no role for
the use of EBCT for screening populations of young,
healthy individuals with no risk factors and that the
importance of calcification in such individuals was