Tanner Imaging Services - Calcium Scoring

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.

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?

A non-invasive CT scan that quantitatively assesses extent of coronary artery calcium deposits
Comprehensive scoring tools including
- Automatic image selection algorithm that picks one image from each heart cycle
- Highlighted and scored calcified regions
- Customized patient reports
- 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.

How reliable is the test?

CAC scoring can identify atherosclerosis in approximately 93% of at risk patients

The presence, location and extent of calcified plaque is clearly identified by the CAC scoring procedure

Through the screening of calcified plaque, the total plaque burden can be inferred

Who is a candidate for a SmartScore screening?

Asymptomatic Individuals
- Between 35-70
- With Risk factors including
  - Hypercholesterolemia
  - Family history (1^st degree male 45 or younger or 1^st degree female 55 or older)
  - Obesity
  - Women who have undergone menopause
  - Tobacco Abuse
  - Peripheral Vascular Disease
Symptomatic Individuals
- With chest pain of undetermined cause with or without risk factors and with negative cardiac evaluation

Who is NOT a candidate for a SmartScore screening?

Known coronary artery disease
- History of bypass surgery
- History of myocardial infarction
- History of percutaneous coronary interventions
- Non obstructive coronary disease
Individuals younger than 35 (unless with significant risk factors)
Individuals older than 70

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.

How much does it Cost?

Tanner Medical Center/Carrollton and Tanner Medical Center/Villa Rica are now offering non-invasive CT scans to people who may be at risk of coronary artery disease for $99. Screenings usually cost up to $600 and are not covered by most insurance. All screenings must be ordered by a physician.

Candidates include individual with or without symptoms and those between 35 and 70 with risk factors.

What are the general recommendations for interpretation of calcium scores?

0	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, Vitamin 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?

Coronary Artery Calcium Scores
(percentile rankings in over 19,000 patients)

	AGE
	40-45	46-50	51-55	56-60	61-65	66-70	70 +
PERCENTILE
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

Source: cardiacplus.com

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