Background: The 2007 expert consensus document endorsed by the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) recommends the use of zero coronary calcium score (CCS) in ruling out significant coronary artery disease and consequently the need for coronary angiography among symptomatic patients.(1) This was further supported by the results of systematic reviews that showed that zero CCS is associated with a very low future risk of cardiovascular morbidity and mortality.(2, 3) Interestingly, the review finding showed that the negative predictive value...

Retrospective cross-sectional study for cardiac patients who were referred to computed tomography for standard indications at the Prince Sultan Cardiac Centre (Riyadh,Saudi Arabia) between July 2007 and November 2011. Those who had pre-test documented coronary artery disease (CAD), defined as coronary artery bypass graft (CABG, N=93) or percutaneous coronary intervention (PCI, N=39) were excluded from the study. Those with scan artifacts were also excluded (N=37). Patients’ demographic and clinical characteristics were abstracted from the patient charts. All patients underwent 64 multidetector spiral computed tomography. A...

A total of 1405 patients were included in the current study. (Figure 1) The majority of patients were males (65%) and the average age was 50.8±11.6. The average body mass index (BMI) was 29.7±13.4 with overweight and obese represent 78% (39% each). (Table 1) Zero CCS was observed in 956 (68.0%) patients while positive CCS was observed in 449 (32.0%) patients. Zero CCS was associated with younger age, female gender, normal BMI, certain pre-test conditions (such as unstable angina, arrhythmia, palpitation, shortness of breath, abnormal...

Considerable variability of negative predictive value (which indicates the predictivity of zero CCS) was observed by patients’ symptoms and cardiovascular risk factors. While zero CCS is a perfect non-invasive tool to rule out CAD among asymptomatic patients, it should be interpreted with caution among patients with chest pain and multiple traditional cardiovascular risk factors.

1. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am...

Name : Al Helali , Sumaya Marshoud Mohamed Position : consultant cardiologist adult cardiology imagind department Prince Sultan cardiac center Saudi Arabia , Riyadh 0099611530787548 Sumaya [email protected] MBBS on 1995 ,King Saud unversity , Riyadh , Saudi Arabia Board certified of internal medicine (2002)and adult cardiology(2008 ) , Saudi Arabia Clinical fellowship of cardiac MRI and CT , university of Toronto , Canada (2006-2008 ) National board of Echocardiography ( July 2011 ) 3 month training at Duke university hospital in December 2012 During my...