CT Coronary Calcium Score Test For The Heart in Hyderabad: A Cardiologist Perspective

CT Coronary Calcium Score Test For The Heart: Introduction

 

The CT coronary calcium score test measures the amount of calcium that’s present in your arteries. A low coronary calcium score on a CT scan can significantly decrease your risk of heart attack or death, according to a study by the American Heart Association.

A high calcium score indicates that there is a lot of calcified plaque in your coronary arteries, while a low score means that there is a much-calcified plaque there at all, making you less likely to have cardiac arrest down the road. Sounds simple enough, right?. Let’s take a closer look at what the calcium score test for the heart involves and how the results are interpreted by your cardiologist in Hyderabad

The calcium score test for the heart may be used to determine whether or not you have developed coronary artery disease (CAD). This test is also used to determine if you are at risk of developing this condition, or if it has already occurred, so it can be treated accordingly. Let’s take a closer look at what the calcium score test for the heart involves and how the results are interpreted by your doctor

What Is A CT Calcium Score?

 

A CT calcium score test is a quick and painless way to evaluate your heart health. It measures how much calcium is in your coronary arteries, which can indicate whether you have plaque buildup that might cause blockages or heart attacks. The calcium score test for the heart may be used to determine whether or not you have the risk of developing coronary artery disease (CAD).

How Does A Cardiac CT Scan Work?

 

A cardiac CT scan, or CT calcium score test, uses an x-ray and a specialized computer to measure how much calcium has build-up in your coronaries. At its core, a cardiac CT calcium scan ( CT CAC scan) is a medical imaging technique that allows radiologists to get an in-depth view of your heart. They can detect tiny amounts of calcium build-up around your coronary arteries. This is important because any plaque build-up that goes unnoticed could potentially cause a blockage or rupture at some point down the road, which can lead to a heart attack or stroke.

 

What is a normal CT calcium score?

 

The normal CT calcium score is zero. Anything above zero indicated subclinical CAD.

What is the average calcium score of a 40-year-old?

 

It should always be zero.

 

Why Get a Cardiac CT Scan?

 

For people who are at high risk of having a heart attack, knowing whether or not you have built-up calcium in your coronary arteries can help determine if you need to make certain lifestyle changes or even get certain preventative treatments. This test can help your cardiologist decide if you have a high risk of coronary artery disease (CAD). Cardiac CT Scan is often used in addition to ECG (electrocardiogram),2d echo test, and exercise stress test (tmt test).

The presence of calcium in the coronary arteries in a patient without symptoms of heart disease is a well-validated risk marker for future cardiac events such as heart attack, sudden death, and brain strokes. The presence of calcium tells you the extent of subclinical coronary artery disease. The presence of calcium above 100 will prompt your cardiologist consideration of lifestyle modification and medicines for you.

 

What To Expect After Getting CT coronary calcium scan?

 

CT coronary calcium scoring does not need any major preparation, unlike CT coronary angiogram. Even fasting is not required. There is no need for drugs like beta-blockers and nitroglycerin before or during the test. You will not be given any dye or iodinated contrast. So, it is even suitable for patients with dye allergies. But you should ideally be able to follow instructions given to you by ct technician. You should hold your breath for three to five seconds when the technician says so. You should lie still during scan acquisition. You should not move. You should not take coffee or smoke a cigarette 4 hours prior

Why caffeine and smokings are to be stopped before a CT coronary calcium scan?

 

Caffeine and smoking both increase the heart rate. High heart rate during the test gives low-quality images. To get accurate values, you should refrain from them at least 4 hours prior.

Which novel risk factors are better for predicting future cardiac events?

 

Other Novel risk markers for coronary artery disease are

•   Carotid intima-medial thickness (CIMT)
•   Carotid plaque
•   Low ankle brachial index ( <0.9)
•   B-type natriuretic peptide (BNP)
•   Albuminuria
•   Elevated HsCRP (>2.0 mg/L)
•   Raised Lipoprotein A (Lp/(a)> 50 mg/Dl)

CT coronary calcium test fares better than other novel markers in all aspects of the prediction of cardiac risk. Zero calcium score is the strongest “negative risk factor” as compared to normal or negative values of other novel and traditional risk markers.

Traditional risk factors

•    High blood pressure or Hypertension
•    Diabetes mellitus or DM
•    Cigarette Smoking
•    High cholesterol or hyperlipidemia
•    Obesity
•    Premature family history of heart attacks

 

Definition of coronary artery disease based on CT coronary calcium score

 

• 0 score– No disease
• 1 to 99 score – Mild disease
• 100 to 399 score – Moderate disease
• ≥400 score – Severe disease

 

Categories of 10-year ASCVD risk:

 

• Low risk – below 5 percent
• Borderline elevated risk – 5 to 7.4 percent
• Intermediate risk – 7.5 to 19.9 percent
• High risk –20 percent or above

 

What is the Radiation dose with CT coronary calcium scan?

 

The radiation dose is very minimal. It is no more than 1 mSv. However, Radiation the dose should not prompt or defer your CT coronary calcium test

 

What are the 2019 ACC/AHA Guidelines for coronary calcium score?

 

2019 ACC/AHA Guidelines recommend coronary calcium score only in asymptomatic patients.

1. Coronary calcium scoring is indicated only in intermediate-risk (7.5 percent to <20 percent). They have advised coronary calcium scoring only in select adults with borderline increased risk (5 percent to <7.5 percent).

2.   Routine CT coronary calcium scan should not be performed in patients at low risk or high risk.

3. CT coronary calcium scan has no role as a stand-alone test in patients with symptoms of heart disease.

 

What is the ideal age for CT coronary calcium testing

 

• Adults aged over 40 years of age who are at intermediate risk of heart diseases are the ideal candidates for CT coronary calcium testing. Testing can be done earlier if you have multiple traditional risk factors.

 

• CT coronary calcium testing can be suggested if chest CT scans are needed for other clinical indications like chest pathology irrespective of age and risk.

 

When is the CT calcium score not indicated?

 

Routine CT coronary calcium tests should not be performed in patients at low risk or high risk.

Routine CT coronary calcium testing should not be advised for patients with symptoms of heart diseases. For them, either a stress test or coronary angiogram is better. However, in symptomatic patients who are undergoing CT coronary angiography (CCTA), CT coronary calcium scoring may be concurrently performed

 

 Treatment based on CT coronary calcium score

 

• If you have a coronary calcium score of 0, and your 10 years estimated risk is under 7.5%, a healthy lifestyle is just what you need

 

• You will need medicines to prevent heart diseases along with lifestyle modifications if the coronary calcium score is above 100 or 75 percentile for age and sex

 

• If your calcium score is between 1 to 99 or <75 th percentile, your cardiologist decides whether you need medical therapy also.

 

• Lifestyle changes such as a heart-healthy diet, quitting smoking, daily exercise, etc for everyone irrespective of calcium score. Similarly, controlling blood pressure, blood sugars, and blood cholesterol to recommended levels are mandatory irrespective of calcium score.

 

• aspirin is not started for you unless you have CT coronary calcium score ≥100 and you are aged between40 to 75 years. The Aspirin role is not that much strong unlike statin therapy for asymptomatic patients.

What are the uses of the CT coronary calcium test?

 

CT coronary calcium test is a non-invasive, fast, and easy way to know the future risk. CT coronary calcium scoring guides your cardiologist on the necessity to start lipid-lowering drugs and blood thinners.

It helps your heart specialist to

1. Guide lipid-lowering therapy
2. Decide on the use of aspirin
3. Motivates you to consideration of lifestyle changes if your score is above zero
4. It assures you if the score is zero.

My CT coronary calcium score falls between 101 to 300. What should I do?

 

Compared with patients with a coronary calcium score of 0, Your risk of a cardiac event( heart attack, brain stroke, or sudden death) is higher. You should start a healthy lifestyle and take statins. Statins are the drugs that decrease your cholesterol levels significantly.

My CT coronary calcium score is between 400 to 999. What is my life expectancy?

If you have three or more traditional risk factors for coronary artery disease with an initial CT coronary calcium score ≥400, Your chances of getting a heart attack or sudden death are twofold higher. So you need preventive medicines for the rest of your life. By this, your risk can be brought down.

If you have no traditional risk factors but an initial CT coronary calcium score ≥400, You still will have higher mortality compared with patients with three or more risk factors and a CT coronary calcium score of 0. You again need medicine for the rest of your life. your risk can be reduced with statin +/- aspirin therapy.

 

I have CT coronary calcium score ≥1000. What should I do?

 

About 4.3 percent of adults will have an initial CT coronary calcium score ≥1000. Your risk is 1.7 times higher than others with a score between 400 to 999.

 

Is there any Role of CT coronary calcium when I fall in the Low-risk category?

Though the presence of any CT coronary calcium puts you at a higher risk for heart diseases, CT coronary calcium is not recommended in low-risk patients

 

Coronary calcium score in Females

 

Ladies tend to have less coronary calcium scores as compared to gents of similar age, ethnicity, and risk factors

coronary calcium score by Age, Ethnicity, and gender

 

CT coronary calcium scores were higher in males compared with females and increased progressively with age. Ethnicity also affects the likelihood of having coronary calcium.

For males, CT coronary calcium scores will be higher in White and Hispanic Americans when compared to African Americans and Chinese.

For females, higher CAC scores are reported in White Americans when compared to Hispanic American and Chinese American females.

 

 

What is the role of CT coronary calcium score in patients with symptoms of coronary artery disease?

 

There is no role of CT coronary calcium scoring as a stand-alone test in patients with symptoms suggestive of coronary artery disease. However, testing for CT coronary calcium can be performed along with coronary CTA. Then, it provides a measure of the overall plaque burden.

Can I have a heart attack with a CT coronary calcium of zero?

 

Yes. The risk of a heart attack does not depend just on calcium score. Various other factors like traditional risk factors and novel risk factors also influence it.

How can I have a heart attack with a CT coronary calcium of zero?

 

A lot of people with coronary artery disease have blockages in the coronary arteries without calcium. Especially, younger patients can have zero calcium with more than 90% blockage. So, CT coronary calcium has decreased specificity for predicting significant coronary artery disease. This is the reason why CT coronary calcium scoring is not used for symptomatic patients.

 

When do I need to repeat CT coronary calcium scanning?

 

A. If your initial CT coronary calcium is above zero (>0)

 

We recommend against serial CAC scoring in patients with established CT coronary calcium (>0), particularly those with CT coronary calcium >100. Repeated measurement will rarely alter the management plan in such patients. Serial CT coronary calcium scoring to assess the efficacy of medicines is also not recommended.

 

B. If your initial CT coronary calcium is zero (=0)

 

The time for conversion to CT coronary calcium score >0 from zero depends on

1. 1. 1.   Baseline ASCVD risk

1. 1. 2.   Presence of risk factors like diabetes

A. In patients at low 10-year  risk, repeat CT coronary calcium scanning in five to seven years is preferred

B. Repeat CT coronary calcium scanning is to be done in three to five years in those at intermediate 10-year risk.

C. Three years gap is ideal for patients with diabetes.

 

What Preventive therapies are recommended if my CT coronary calcium score is high?

 

The treatment for a high calcium score is statins +/- aspirin along with a healthy lifestyle.

 

Patients with a CT coronary calcium score ≥100 will benefit from long-term use of drugs that can decrease cholesterol levels such as statins.

Aspirin is useful to prevent heart attacks in adults under 70 years old with a CT coronary calcium score ≥100 regardless of 10-year ASCVD risk.

As bleeding risk with aspirin increases with age, net clinical benefits after the age of 70 years are controversial, and hence aspirin is not indicated.

Statin therapy in patients with calcium scores above 100 has shown multiple benefits in preventing heart attacks, death, and brain stroke. However, statin therapy does not decrease CT coronary calcium score. Hence repeat coronary calcium scan is not recommended at any time if the baseline score is above zero.

 

How Much Does A Cardiac CTA Cost in Hyderabad, India?

 

A cardiac CT calcium score (or CTA) is one of the most advanced diagnostic tools for evaluating and screening patients with cardiovascular diseases. A cardiac CTA can identify calcium in your heart and blood vessels in great detail, helping your doctor diagnose and treat potential cardiovascular conditions such as coronary artery disease.

Although prices vary based on location, a cardiac CTA typically costs around ₹ 3,000 to ₹ 4,500 without any insurance coverage.

If you take A computerized tomography (CT) coronary angiogram along with CT coronary calcium score test, the cost increases to ₹ 12000 – ₹ 15000.

Who is the best cardiologist to consult in Hyderabad if my calcium score is above zero?

 

Dr. Malleswara Rao is a senior interventional cardiologist in Hyderabad with vast experience in preventive cardiology.  You can consult him at Asian vascular hospitals, Banjara hills.

 

Conclusion: To Get a Healthy Heart, Take a Calcium Score Test