Non-invasive measurement of coronary heart disease using electron beam computed tomography.
OBJECTIVE
Electron beam computed tomography is a non-invasive investigation that can quantify calcification within the walls of coronary arteries. Coronary arteries remodel to maintain luminal integrity, so that significant plaque may be present before the development of luminal stenoses. This has led to interest in techniques that assess the coronary artery wall, rather than the lumen. This review examines the power of coronary calcification detected by electron beam computed tomography to predict coronary heart disease events, and outlines recent studies in which it has been used as a surrogate marker for coronary heart disease.


RESULTS
The predictive power of coronary calcification has been shown to exceed that of traditional coronary heart disease risk factors and possibly also coronary angiography. This may justify the use of coronary calcification as a surrogate marker for coronary heart disease, and studies have thus examined cross-sectional associations between coronary calcification and potential risk factors in healthy individuals and patients with diabetes, end-stage renal failure and familial hypercholesterolaemia. Intervention studies can use the rate of change of coronary calcification detected by serial electron beam computed tomography imaging as an end-point, rather than relying on coronary heart disease events. As every participant reaches an end-point, sufficient power can be attained with smaller numbers at substantially less cost.


CONCLUSIONS
Coronary calcification detected by electron beam computed tomography may prove an invaluable tool in the selection of at-risk individuals suitable for primary prevention, and a useful surrogate marker for coronary heart disease in clinical trials.
Valabhji
Jonathan
J
Imperial College Faculty of Medicine, St Mary's Hospital, London, UK. j.valabhji@ic.ac.uk
Elkeles
Robert S
RS
D000792:Angiography; D001161:Arteriosclerosis / Q000175:diagnosis; D003327:Coronary Disease / Q000175:diagnosis* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000175:diagnosis; D018450:Disease Progression; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis; D051437:Renal Insufficiency / Q000175:diagnosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*