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Cardiac Scoring

What is cardiac scoring?
Why is getting a cardiac score important?
Who should have cardiac scoring?
How does cardiac scoring work?
What preparation is needed for a cardiac scoring examination?
What should I expect when I arrive for my cardiac scoring examination?
What does a cardiac score mean?
What score is typical for a person my age?
What do the images from cardiac scoring look like?
What are the limitations of cardiac scoring?
Is multislice CT scanning as good as EBCT for cardiac scoring?
Is cardiac scoring safe?
How much does cardiac scoring cost?
Where can I get a cardiac scoring examination?

 Click here to read an article on The Heart Truth For Women

 

What is cardiac scoring?
Cardiac scoring (or coronary artery calcium scoring) is a noninvasive, painless screening of the heart for calcium deposits in the coronary arteries, which are the blood vessels that bring oxygen and nutrients to the heart. As calcium deposits build up, the blood vessels narrow, allowing less blood and oxygen to the heart. Coronary calcium can develop as early as the second decade of life. Although it is more common in advanced age, coronary calcium is not an inevitable part of aging. Calcium deposits can be absent in normal vessel walls, regardless of age.

Cardiac scoring is performed in just 20 seconds on a multislice computed tomography (CT) scanner and is extremely accurate in detecting the presence, extent, and severity of hard plaque burden within the coronary arteries. Hard plaque is a known indicator of coronary artery disease (CAD). Prior to advancements in CT scanning, it was extremely difficult to detect the very small calcium deposits that form in the early stages of heart disease. However, with multislice CT scanning, even miniscule calcium deposits can be detected easily.
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Why is getting a cardiac score important?
Coronary artery disease (CAD) or atherosclerosis is the #1 cause of death of both men and women, claiming over 500,000 lives each year. Over 400 people under age 65 die each day from cardiac events (ie, death, myocardial infarction, congestive heart failure, and stroke) related to CAD, many without prior symptoms or warning. Typically, patients are diagnosed with CAD when they have already shown symptoms (eg, chest pain, fatigue), responded abnormally to stress testing, or undergone cardiac angiography. This means that the opportunity for prevention is lost and the patient may have already suffered irreversible consequences or a cardiac event.

Cardiac scoring can detect coronary calcium in its early stages. Early detection allows for positive lifestyle changes to be made that will help prevent or minimize further progression of CAD or cardiac events. Currently, preventive therapies for heart disease include blood pressure and lipid control, smoking cessation, diet, and regular exercise. The use of statins to reduce blood cholesterol has been shown to decrease the risk of heart attack by one third.
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Who should have cardiac scoring?
Cardiac scoring is recommended for generally healthy, asymptomatic males over age 45 and females over age 55 who are at risk for CAD. Individuals with a strong family history of heart disease may want to undergo cardiac scoring as early as age 35 or 45. The following are major risk factors for CAD:

Family history of coronary artery disease

  • High blood pressure
  • High cholesterol
  • History of smoking
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • High level of stress

Cardiac scoring is not recommended for persons with arrhythmias or with relative resting tachycardia (heart rate greater than 90 beats per minute). A high or irregular heart rate makes ECG gating of the heart difficult, resulting in poor image quality. However, these conditions can be treated, making a cardiac scoring examination possible.
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How does cardiac scoring work?
As with a loaf of bread that is cut into many slices, computed tomography can make pictures of "slices" of the body’s internal structures.
Figure 1: As with a loaf of bread that is cut into many slices, computed tomography can make pictures of "slices" of the body’s internal structures.

Cardiac scoring and all other virtual studies at Diagnostic Imaging Associates are performed on the multislice GE LightSpeed Plus CT scanner. CT stands for computed tomography, a process by which a digital picture is made by a computer after low-dose x-rays record a slice or cross section of the body. A CT scanner is a diagnostic tool which, for cardiac scoring, allows visualization of the heart and its internal structures. The word "slice" is often used to explain the images taken of patient anatomy because they are similar to a single slice of bread taken from a whole loaf (Figure 1).

During the cardiac scoring procedure, the patient is asked to lie on the table of the CT scanner. This tabletop moves the patient’s body through the CT scanner’s gantry (Figure 2) which houses an x-ray tube and detectors. The tube rotates around the patient as x-rays pass through the body to the detectors, where thousands of x-ray measurements are recorded. Next, the computer processes this information and displays the corresponding images on a computer screen. This imaging technique avoids any overlap of organs or tissues.

Our multislice GE scanner can capture these images of the heart during a single breath-holdOur multislice GE scanner can capture these images of the heart during a single breath-hold, which means less stress and discomfort for the patient and a faster examination time. The cardiac scoring procedure takes only 5 minutes because the LightSpeed Plus CT scanner can take eight thin slices of the heart per second. This high scanning speed allows for clearer, sharper images with fewer artifacts (false images due to blurring) caused by movement of the body.

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What preparation is needed for a cardiac scoring examination?
Only two things must be done before undergoing cardiac scoring: no caffeine and no smoking 4 hours before the examination. Drinking caffeine and smoking before the test increases your heart rate. In order to have an accurate study, your heart rate should be below 80 beats per minute (bpm). As the heart rate increases over 80 bpm, it is more difficult to take images of the heart in diastole (ie, period of relaxation) which decreases the accuracy of the test results. If the heart rate is too elevated (ie, over 90 bpm), it may be necessary to reschedule your test for another day. If you anticipate your heart rate being a problem during cardiac scoring, a beta-blocker can be prescribed to help lower your heart rate for the examination.

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What should I expect when I arrive for my cardiac scoring examination?
When you arrive at Diagnostic Imaging Associates for your cardiac scoring study, you will be greeted by our staff at the front desk and then taken to a private waiting room. At this time, our Virtual Screening Manager will conduct a personal interview with you that will include questions about your family medical history and risk factors you may have for specific diseases or cancers. If time allows, a 5-minute movie outlining the steps of the cardiac scoring examination will be shown.

Next, you will be taken to a dressing room and asked to change into an examination gown. You will then be led to the CT suite where a radiologic technologist will position you on the table of our multislice GE scanner. Four electrodes will be attached to the chest area—two high on the anterior chest and two low on the sides of the chest. These electrodes are connected to a special ECG monitor that signals the CT scanner to take pictures of the heart in diastole. This assures a clearer, more accurate image. A slower heart rate makes it easier for the CT scanner to take pictures of the heart in diastole. If your heartbeat is too fast, your cardiac scoring examination may have to be rescheduled.

Two scout views will be taken to locate your heart within your chest. During these scout views, the technologist will enter your patient information (ie, name, patient number, examination date) into the computer workstation. These two scout views will then be used to plot the slices of the heart that will be recorded by the CT scanner. The third scan will obtain the slices of the heart that will be used to detect and measure the calcium in your coronary arteries. You will be asked by the technologist to hold your breath for 20 to 30 seconds. Holding your breath is very important because it eliminates artifacts on the image that are due to motion of the chest during breathing. Approximately 180 to 200 images of your heart will be taken at this time. The data from the x-rays will appear immediately on the computer screen, completing your examination.

The results of your cardiac scoring examination will be mailed to you in three business days. Your report will include a summary of the radiologist’s findings and recommendations for further follow-up. Results will also be sent to your primary care physician upon request. Because of the volume of images that must be analyzed, immediate results from the radiologist are not possible. Three working days allows the radiologist to take the proper amount of time to review your study, to report accurate findings, and if necessary, to seek consultation with other physicians regarding any unusual findings.
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What does a cardiac score mean?
A cardiac score can range from zero to several thousand and is based on the amount of calcification detected in the coronary arteries. The more calcium that is seen in the coronary arteries, the greater the score. This score is an indicator of your level of hard plaque burden. A very low score means that there is virtually no obstructive disease in the coronary arteries, whereas a high score indicates that the level of hard plaque burden is extensive and the risk of a future cardiac event is significant. The following chart outlines what specific ranges of scores mean and the recommendations a physician is likely to make based on these scores.

 
SCORE
 
LEVEL OF
HARD PLAQUE BURDEN
 
LEVEL OF SIGNIFICANT RISK OF CAD
 
RECOMMENDATIONS
 
  0   None   Extremely low   Patient should maintain a healthy diet that is low in saturated fat and cholesterol, refrain from smoking, maintain ideal body weight, and exercise regularly  
  1-10   Minimal   Very unlikely   All of the above PLUS close control of diabetes and high blood pressure, and possibly the use of statins for high cholesterol.  
  11-100   Mild   Mild to moderate   All of the above PLUS daily aspirin, statins for high cholesterol, and estrogen for postmenopausal women.  
  101-399   Moderate   Moderate to high   All of the above PLUS use of folic acid, and possibly stress testing for further risk assessment.  
  400 or greater   Extensive   High to very high   All of the above PLUS stress testing to assess extent of obstructive disease, and possibly cardiac angiography.  

The odds ratios for developing symptomatic CAD based on cardiac scoring are as follow: 7:1 for scores greater than 50, 20:1 for scores greater than 100, and 35:1 for scores above 160. This means that a person with a calcium score greater than 50 is 7 times more likely to experience symptoms of CAD compared with a completely healthy individual. The ability of calcium scores to predict the risk of developing symptomatic CAD is particularly striking when compared with the predictive powers of traditional risk factors. For example, the likelihood of experiencing symptoms of CAD is 3.6 times greater for an individual with a smoking history and 1.8 times greater for a person with high cholesterol, compared with a healthy individual.

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What score is typical for a person my age?

 
PERCENTILE
 

40-45

46-50

51-55

56-60

61-65

66-70

71+

 
  MEN  







 
  10%  
0
0
0
1
1
3
3
 
  25%  
0.5
1
2
5
12
30
65
 
  50%  
2
3
15
54
117
166
350
 
  75%  
11
36
110
229
386
538
844
 
  90%  
69
151
346
588
933
1151
1650
 
     







 
  WOMEN  







 
  10%  
0
0
0
0
0
0
0
 
  25%  
0.1
0.1
0.1
0.2
0.5
1
4
 
  50%  
0.1
0.1
1
1
3
25
51
 
  75%  
1
2
6
22
68
148
231
 
  90%  
3
21
61
127
208
327
698
 

Percentile rank is calculated by adjusting calcium scores for age and sex. The following example illustrates how to read the above table: a 57-year-old man with a calcium score of 54 would be in the 50th percentile. This means that, in his age- and sex-matched group, 50% of men have calcium scores greater than his and 50% have scores less than his score. A 46-year-old woman with a calcium score of 2 would be in the 75th percentile. This means that compared with her age- and sex-matched peers, 75% have calcium scores less than hers and 25% have scores above her score of 2.
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What do the images from cardiac scoring look like?

calcium in arterycoronary artery3d reformation

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What are the limitations of cardiac scoring?
One of the limitations of cardiac scoring is that even though calcium deposition occurs early in the process of atherosclerosis, plaque material in its earliest stage is not yet calcified. Thus, despite cardiac scoring being a more powerful tool for detecting atherosclerosis at an earlier stage than other x-ray techniques, soft plaque material cannot be detected.
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Is multislice CT scanning as good as EBCT for cardiac scoring?
Several studies published in the past year have concluded that multislice CT (MSCT) and electron beam computed tomography (EBCT) are equal in their ability to accurately detect hard plaque deposits in the coronary arteries. Some studies have shown that MSCT has a better contrast-to-noise ratio and superior spatial resolution— two key elements in producing clear, accurate images. Due to these results and because MSCT is less expensive and more widely available, this technique is gaining in popularity.
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Is cardiac scoring safe?
A concern with any study that exposes the patient to x-rays is radiation exposure. It is estimate that the amount of radiation received from a cardiac scoring examination is equal to the background radiation received from a standard chest x-ray.
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How much does cardiac scoring cost?
Please call Central Scheduling at (302) 369-4342. At this time insurance plans do not cover the cost of this screening test. Diagnostic Imaging Associates accepts cash, check, and Visa and MasterCard. Payment is required at the time of your screening examination.
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Where can I get a cardiac scoring examination?
Diagnostic Imaging Associates is the first radiology provider in Delaware to offer Virtual Check-Up™ and requires no referral from a doctor or insurance plan. All virtual screening studies can be performed at three of our seven convenient locations – Omega Imaging & MRI, Brandywine, Pike Creek, and Glasgow.
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