Puntuación de calcio coronario y grosor de íntima media carotídea en pacientes con sospecha de cardiopatía isquémica / Coronary calcium score and thickness of carotid middle intima in patients with suspicion of ischemic heart disease

INTRODUCCIÓN: El score de calcio coronario y la cuantificación del grosor de íntima media son métodos en desarrollo que se utilizan en el diagnóstico de aterosclerosis. OBJETIVO: Evaluar la relación del puntaje de calcio coronario con los factores de riesgo cardiovasculares clásicos y el grosor de la íntima media carotídea. MÉTODOS: Se tomaron 70 pacientes con sospecha de cardiopatía isquémica. A todos se les cuantificó el calcio coronario por tomografía de 64 cortes y el grosor de íntima media en carótidas por ultrasonido. Usando la variable dependiente (score de calcio coronario) de forma continua, fue realizada una regresión lineal simple para obtener los coeficientes de regresión (ß). El nivel de significación estadística (a) con que se trabajó fue del 95 por ciento (valor p < 0,05 como estadísticamente significativo). RESULTADOS: El puntaje de calcio fue superior en individuos del sexo masculino y se incrementó de manera lineal con el decursar de las décadas de edad, por cada año que se incrementa la edad, aumenta en 11,4 UA el score de calcio. El coeficiente de correlación entre el score de calcio y la edad fue de 0,36 estadísticamente significativo (p= 0,002). El 88,9 por ciento de los pacientes con grosor íntima media mayor de 1 mm tenían algún grado de calcificación coronaria, fue 2 veces mayor que los que presentaron un grosor de íntima media menor que 1 mm. El valor de la correlación (r) con el grosor de la íntima media carotídea fue de 0,24 (p= 0,04). CONCLUSIONES: La edad, el sexo masculino y el aumento del grosor íntima media carotídea se relacionan de manera significativa con la presencia y cuantía de la calcificación coronaria(AU)

INTRODUCTION: The coronary calcium's score and the quantification of media intima thickness are developing methods used in atherosclerosis diagnosis. OBJECTIVE: To assess the coronary calcium score relation to classic cardiovascular risk factors and the carotid media intima thickness. METHODS: Sample included 70 patients with suspicion of ischemic heart disease. In all of them the coronary calcium was quantified by 64 scans tomography and the media intima thickness by medias of ultrasound (US). Using continuously the dependent variable (coronary calcium score) we made a simple linear regression to obtain the regression coefficients (ß). The statistic significance level (a) used was of 95 percent (value p < 0,05 as statistically significant). RESULTS: Calcium score was higher in male sex subjects increasing linearly and annually with age in 11.4 UA. The correlation coefficient between calcium score and age was of 0.36 statistically significant (p = 0,002). The 88,9 percent of patients with a media intima thickness greater than 1mm had some degree of coronary calcification, was twice greater than those with a media intima thickness less than 1mm. Correlation value (r) with carotid media intima thickness was of 0.24 (p = 0.04). CONCLUSIONS: Age, male sex and increase of carotid media intima thickness, is significantly related to presence and quantity of coronary calcification(AU)

[Accuracy of the 64 multislice computed tomography in the diagnosis of coronary stent restenosis]. / Precisión de la tomografía de 64 cortes en el diagnóstico de reestenosis de stent coronario.

OBJECTIVE: To determine the accuracy of coronary angiography through 64-slice computed tomography in detecting in-stent restenosis. METHOD: Fifty-two patients with 76 coronary stents and suspicion of restenosis were examined. Initially, they underwent coronary angiography through 64-slice computed tomography, and subsequently invasive coronary angiography as gold standard. Diagnostic efficiency indexes were calculated. RESULTS: In the stents of 3 mm or more of diameter, tomography sensitivity, specificity, positive and negative predictive value were 95, 98, 95 and 98% respectively, with positive likelihood ratio of 42 (CI95%, 6 to 290) and negative of 0.05 (CI95%, .01 to .35), validity of 97% and Kappa of 0.93 (CI95%, .83 to 1), (p ? 0.00001). In the stents smaller than 3 mm, the indexes of diagnostic efficiency and Kappa considerably decreased, loosing the statistical significance (p >0.05). CONCLUSIONS: Coronary angiography through 64-slice computed tomography is an accurate, non-invasive clinical technique for the detection of in-stent restenosis, especially with stents of 3 mm or more of diameter, and reliable allows identification of patients who need to undergo or not control invasive coronary angiography.

Precisión de la tomografía de 64 cortes en el diagnóstico de reestenosis de stent coronario / Accuracy of the 64 multislice computed tomography in the diagnosis of coronary stent restenosis

Objetivo: Determinar la precisión de la coronariografía por tomografía de 64 cortes para la detección de la reestenosis de los stents. Método: Se examinaron 52 pacientes portadores de 76 stents coronarios con sospecha de reestenosis. Inicialmente se les realizó coronariografía mediante tomógrafo de 64 cortes y posteriormente coronariografía invasiva como patrón de referencia. Se calcularon los índices de eficiencia diagnóstica. Resultados: En los stents valorables de 3 mm o más de diámetro, la sensibilidad, especificidad, valor predictivo positivo y negativo de la tomografía fueron de 95, 98, 95 y 98% respectivamente, con razón de verosimilitud positiva de 42 (IC95%, 6 a 290) y negativa de 0.05 (IC95%, 0.01 a 0.35), validez de 97% y Kappa de 0.93 (IC95%, 0.83 a 1), (p ≤ 0.00001). En los stents valorables menores que 3 mm, disminuyeron apreciablemente los índices de eficiencia diagnóstica y de Kappa, perdiendo la significancia estadística (p > 0.05). Conclusión: La coronariografía por tomografía de 64 cortes es una técnica clínica no invasiva precisa, en la detección de la reestenosis de los stents, sobre todo en los stents de 3 mm o más, y segura, ya que permite identificar a los pacientes que necesitan o no la realización de una coronariografía invasiva de control.

Objective: To determine the accuracy of coronary angiography through 64-slice computed tomography in detecting in-stent restenosis. Method: Fifty-two patients with 76 coronary stents and suspicion of restenosis were examined. Initially, they underwent coronary angiography through 64-slice computed tomography, and subsequently invasive coronary angiography as gold standard. Diagnostic efficiency indexes were calculated. Results: In the stents of 3 mm or more of diameter, tomography sensitivity, specificity, positive and negative predictive value were 95, 98, 95 and 98% respectively, with positive likelihood ratio of 42 (CI95%, 6 to 290) and negative of 0.05 (CI95%, .01 to .35), validity of 97% and Kappa of 0.93 (CI95%, .83 to 1), (p ≤ 0.00001). In the stents smaller than 3 mm, the indexes of diagnostic efficiency and Kappa considerably decreased, loosing the statistical significance (p >0.05). Conclusions: Coronary angiography through 64-slice computed tomography is an accurate, non-invasive clinical technique for the detection of in-stent restenosis, especially with stents of 3 mm or more of diameter, and reliable allows identification of patients who need to undergo or not control invasive coronary angiography.

[Volume of coronary calcified plaques by computed tomography and presence of significant stenosis by coronary angiography]. / Volumen de placas coronarias calcificadas por tomografía computarizada y presencia de estenosis significativa por angiografía coronaria.

BACKGROUND: Coronary artery calcium is almost pathognomonic of atherosclerosis. In 1990, Agatston designed a method to measure the coronary calcium score by computed tomography. Our aim was to establish the association between coronary calcified plaque volumes calculated by 64 slice computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography. METHOD: 150 consecutive patients, 66.6% male, scheduled for invasive coronary angiography were studied. Coronary calcium score was measured per patient and per artery by computed tomography previous to invasive coronary angiography. 128 calcified plaques were enrolled and volume was determined by Callister method introduced in 1998. According to the volume, the plaques were classified in two groups: small if volume ≤ 10 mm3 and big if > 10 mm3. RESULTS: In 79% of plaques with a volume > 10 mm3, significant coronary stenosis was detected by invasive coronary angiography versus 17% with small volume (p < 0.0001). More than 75% of plaques with volume > 10 mm3 in circumflex artery, anterior descending artery and right coronary artery were associated with significant coronary stenosis (p < 0.0001). Spearman correlation was 0.8. The sensitivity and specificity of significant coronary stenosis were 98.7% and 71.7% respectively for a cut off value of 6,5 mm3, area under the curve of 0,88 ± 0,32 (CI 95%, 0.815 to 0.940). CONCLUSIONS: Association between coronary calcified plaque volume diagnosed by computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography was observed.

Volumen de placas coronarias calcificadas por tomografía computarizada y presencia de estenosis significativa por angiografía coronaria / Volume of coronary calcified plaques by computed tomography and presence of significant stenosis by coronary angiography

Introducción: La presencia de calcio en las arterias coronarias es prácticamente patognomónica de aterosclerosis. En 1990, Agatston diseñó un método para cuantificar el puntaje de calcio coronario a través de la tomografía computarizada. Nuestro objetivo fue determinar la asociación entre el volumen de las placas calcificadas en las arterias coronarias determinado por tomografía de 64 cortes y la presencia de estenosis coronaria significativa diagnosticada por coronariografía invasiva. Método: Se estudiaron consecutivamente 150 pacientes, 66.6% varones, programados para coronariografía invasiva. Previo a este procedimiento, se les cuantificó el puntaje de calcio por arteria y por paciente a través de la tomografía. Se incluyeron 128 placas calcificadas, a las que se les determinó el volumen a través del método de Callister introducido en el año 1998. Las placas se consideraron pequeñas si el volumen era ≤ 10 mm³ y grandes si >10 mm³. Resultados: Se asociaron a estenosis coronaria significativa 79% de las placas con volumen mayor a 10 mm³, contra 17% con volumen pequeño (p < 0.0001). Más de 75% de las placas con volumen mayores de 10 mm³ en las arterias circunfleja, descendente anterior y coronaria derecha, se asociaron a estenosis coronaria significativa en el segmento de la placa (p < 0.0001). Correlación de Spearman 0.8. La sensibilidad y especificidad diagnóstica de estenosis coronaria significativa fueron 98.7% y 71.7 % respectivamente para un valor de corte 6.5 mm³ con un área bajo la curva de 0.88 ± 0.32 (IC 95%, 0.815 a 0.940). Conclusiones: Se observó asociación entre el volumen de las placas calcificadas circunscritas en las arterias coronarias diagnosticada por tomografía computada y la presencia de estenosis coronaria significativa diagnosticada por coronariografía invasiva.

Background: Coronary artery calcium is almost patognomonic of atherosclerosis. In 1990, Agatston designed a method to measure the coronary calcium score by computed tomography. Our aim was to establish the association between coronary calcified plaque volumes calculated by 64 slice computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography. Method: 150 consecutive patients, 66.6% male, scheduled for invasive coronary angiography were studied. Coronary calcium score was measured per patient and per artery by computed tomography previous to invasive coronary angiography. 128 calcified plaques were enrrolled and volume was determined by Callister method introduced in 1998. According to the volume, the plaques were classified in two groups: small if volume ≤ 10 mm³ and big if > 10 mm³. Results: In 79% of plaques with a volume > 10 mm³, significant coronary stenosis was detected by invasive coronary angiography versus 17% with small volume (p < 0.0001). More than 75% of plaques with volume > 10 mm³ in circumflex artery, anterior descending artery and right coronary artery were associated with significant coronary stenosis (p < 0.0001). Spearman correlation was 0.8. The sensitivity and specificity of significant coronary stenosis were 98.7% and 71.7% respectively for a cut off value of 6,5 mm³, area under the curve of 0,88 ± 0,32 (CI 95%, 0.815 to 0.940). Conclusions: Association between coronary calcified plaque volume diagnosed by computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography was observed.