Cardiac Imaging Services at

Boca Raton Regional Hospital
RAYUS Radiology, Florida Southeast

Cardiac Scoring

What's Your Cardiac Score?

A revolutionary advance in detecting heart disease.

Facts about heart disease:

* 58 million Americans have one or more forms of cardiovascular disease.

* Coronary heart disease is the number one killer of men and women in the United States.

* More Americans die of heart disease, than all types of cancer combined.

* At least 250,000 people a year die of a heart attack within one hour of the onset of symptoms and before they reach a hospital.

* 12 million people alive today have a history of heart attack, chest pain or both.

Source: American Heart Association

What are the risk factors for heart disease?

The risk factors for heart disease include the following:

* Age (men 45 or older, women 55 or older)

* Family history of heart disease

* High cholesterol

* History of smoking

* High blood pressure

* High stress levels,

* Sedentary lifestyle

* Diabetes

What causes heart disease?

The primary cause of heart disease is the build-up of plaque (atherosclerosis) in the arteries of the heart. This build-up can cause the arteries to narrow. Plaque can also break away from the artery walls and cause a blockage. In both instances the heart muscle does not receive enough blood flow and oxygen-thus a heart attack can occur.

What is cardiac scoring?

Cardiac scoring is a revolutionary, pain-free, non-invasive and inexpensive procedure requiring less than 10 minutes. Using CT imaging with sub-second scanning capability, the equipment takes 70-90 images of your coronary arteries without any injections, needles or removal of your clothing. The amount of calcium or plaque detected in your coronary arteries is used to establish your cardiac score.

CT scan reveals moderate calcification (plaque build-up) in the left coronary artery.

What does the procedure involve?

First, you complete a brief risk factor questionnaire. Next, you lie down on the imaging table while a CT technologist places a few EKG leads on you. You are then asked to hold your breath while the images are taken. That's it. You can return to your regular routine.

A board certified radiologist, using high tech software, calculates your cardiac score based on the images taken.

Reconstructed 3-dimensional image of the heart obtained from CT scanning.

Is cardiac scoring safe?

The radiation exposure during cardiac scoring is very minimal (comparable to the radiation received during a chest x-ray). No intravenous injections or needles are required.

Not only is it safe, but it is also simple. In most cases (unless there are certain types of buttons or bra metal involved),, patients may keep their shirt or blouse on during the procedure.

What can my cardiac score tell me and my doctor?

Subtle early warning signs of heart disease can be detected. Cardiac scoring is the latest diagnostic tool to detect plaque in the coronary arteries. With this information, your doctor can recommend the appropriate treatment, including diet and lifestyle changes, medication and/or further testing.

Is coronary artery disease treatable?

Yes, the plaque build-up process can be slowed, stabilized and reversed, in some cases, through aggressive lifestyle modification and/or through medication therapies under the guidance of your physician.

What are the general recommendations for interpretation of calcium scores?

No identifiable atherosclerotic plaque.

Very low cardiovascular disease (CVD) risk

Healthy Diet (low in saturated fat and cholesterol)
Stop Smoking
Maintain Recommended Weight

1-10

Minimal plaque burden

Low CVD risk

All recommendations above PLUS
Tight control of Diabetes and Hypertension
Consider use of Statins in cases of High Cholesterol

11-100

Mild plaque burden

Moderate CVD risk

All recommendations above PLUS
Estrogen for Post-Menopausal Women
Aspirin Use
Use of Statins in cases of High Cholesterol

101-400

Moderate plaque burden

High CVD risk

All recommendations above PLUS
Exercise program
Use of Statins in cases of high and borderline cholesterol levels
Consider use of Folic Acid, Vitam E, Fish Oils

>400

Extensive plaque burden

Very high CVD risk

All recommendations above PLUS
Exercise Test to rule out obstructive disease
Consider angiogram for symptomatic patients or those in high risk occupations

Learn more about National Cholesterol Education Program (NCEP)

How does my score compare with others in my age group?

MESA
* Coronary Artery Calcium (CAC) Score Reference Values web tool *

McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113(1):30-37.

Conventional Methods for Detecting Coronary Artery Disease

Test	Advantages	Disadvantages
Stress Test	°Ideal for patients who are symptomatic °Used to determine extent of ishemia	° Does not produce an image of coronary arteries ° Significant blockage must be present to detect ischemia (i.e. does not detect preclinical disease)
Angiography	° "Gold standard" ° Shows narrowing of lumen ° Shows number of diseased vessels	° Generally used only with demonstrable ischemia ° Invasive ° Expensive ° No information regarding type of plaque (soft or hard)
Intravascular Ultrasound	° Direct visualization of vessel wall and lumen size; useful for angioplasty and stent placement ° Can detect calcification	° Generally used only with demonstrable ischemia ° Invasive ° Expensive
Helical/EBCT Cardiac Score	° Noninvasive ° Detects and quantifies coronary calcification ° May be used in asymptomatic patients ° May be used to estimate total atherosclerotic plaque burden and risk of future events	° Does not identify stenotic lesions ° Conflicting evidence regarding correlation of CAC score to risk of events ° No universally defined treatment plans for those with positive test results

Schedule your appointment to learn your cardiac score

Boca Raton Regional Hospital

(561) 955-4700

RAYUS Radiology, Florida Southeast

(561) 496-6935

Where Can I Learn More About Cardiac Scoring?

For the most current, comprehensive discussion of this state-of-the-art test and its implications, click on one of the links below:

Coronary Calcium Screening Seen Useful Beginning Between Age 40 and 50. J Am Coll Cardiol. 2005;46:807-814

Coronary Artery Calcium Measurement: Agreement of Multirow Detector and Electron Beam CT. C. R. Becker, T. Kleffel, A. Crispin, A. Knez, J. Young, U. J. Schoepf, R. Haberl, and M. F. Reiser
Am. J. Roentgenol., May 1, 2001; 176(5): 1295 - 1298.

Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT. J. Jeffrey Carr, et al. Am. J. Roentgenol 2000; 174:915-921.

Coronary Artery Calcification as an Indicator of Preclinical Coronary Artery Disease, by William Stanford, MD
Radiographics. 1999;19:1409-1419.

Where Can I Learn More About Controlling my Cholesterol?

The National Heart, Lung, and Blood Institute (NHLBI) launched the National Cholesterol Education Program (NCEP) in November 1985. The goal of the NCEP is to contribute to reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol.


Cardiac Imaging Background	Cardiac CT & Coronary CTA	Cardiac MRI	Cardiac Scoring

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