Concomitant Atherosclerotic Disease Detected by Whole-Body MR Angiography in Relation to Coronary Artery Calcification in Patients with Coronary Artery Disease

Zusammenfassung

Ziel: Patienten mit einer koronaren Herzerkrankung (KHK) weisen häufig begleitende arteriosklerotische Gefäßwandveränderungen des peripheren Gefäßsystems (pAVK) auf. Eine pAVK scheint ein zusätzlicher Risikofaktor für das Auftreten kardialer Ereignisse zu sein. In unserer Untersuchung korrelierten wir das Auftreten von Gefäßwandveränderungen, die mittels Ganzkörper-MR-Angiografie detektiert wurden, mit dem Maß an Koronargefäßverkalkungen, die mittels EBCT oder MSCT gefunden wurden. Material and Methoden: 228 Patienten (161 Männer; 67 Frauen) mit Verdacht auf eine KHK bzw. mit einer bekannten KHK wurden mittels kontrastverstärkter Ganzkörper-MR-Angiografie und EBCT/MSCT untersucht. Für jeden Patienten wurde ein Arterioskleroseindex berechnet:

Index = ∑⁴⁰ _n=1w_i

(w_i Grad der Stenose in i^ten der 40 Gefäßsegmente [Grad: 0 – kein Plaque; 1 – Plaque – ≤ 50 % Stenose; 2 – > 50 % Stenose – ≤ 90 % Stenose; 3 – > 90 % Stenose – < 100 % Stenose; 4 – Gefäßverschluss]). Ergebnisse: Die Ganzkörper-MR-Angiografie und die koronare Koronarkalkbelastung korrelieren mäßig. Für einen Arterioskleroseindex 8 liegt der positiv prädiktive Wert für eine Koronarkalkbelastung 100 bei 63,3 %. Schlussfolgerung: Der hier benutzte Arterioskleroseindex korreliert nicht im vollen Umfang mit dem Ausmaß der KHK, so wie es mittels Koronarangiografie oder EBCT/MSCT detektiert werden kann, jedoch spiegelt er theoretisch das erhöhte Risiko für Patienten mit einer pAVK für eine KHK wider. Dieser Index könnte daher ein weiteres vielsprechendes Hilfsmittel für die Vorhersage von kardialen Ereignissen sein. Jedoch müssen weitere Studien dieses zeigen.

Abstract

Purpose: Patients with coronary artery disease (CAD) show a high prevalence for concomitant atherosclerotic peripheral arterial disease (PAD). On the other hand, PAD seems to be an additional risk factor for cardiac events. We evaluated the correlation between arterial pathologies as found in whole-body MR angiography and coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) and multislice CT (MSCT). Materials and Methods: Two hundred and twenty-eight patients (161 men; 67 women) with suspicion for CAD/known CAD underwent whole-body contrast-enhanced MR angiography (wb-ce-MRA) and EBCT/MSCT. An atherosclerosis index was calculated for each patient

Index = ∑⁴⁰ _n=1w_i

with w_i being the grading of the stenosis of the i^ten of 40 arteria segments (grade: 0 – no plaque; 1 – plaque – ≤ 50 % stenosis; 2 – > 50 % stenosis – ≤ 90 % stenosis; 3 – > 90 % stenosis – < 100 % stenosis; 4 – occlusion). Correlations between CAC and atherosclerosis index were performed. Results: Wb-ce MRA and CAC correlate only moderately in this population. An atherosclerosis index 8 renders a positive predictive value for a CAC 100 of 63.3 %. Conclusion: An atherosclerosis index as defined in this study does not fully correlate with the extent of CAD as revealed by catheter angiography or EBCT/MSCT, but it might theoretically mirror the increased risk by PAD. It thus might be a promising complementary parameter for the prediction of cardiac events. Future studies need to show its possible additional predictive impact.

Key words

vascular - MR angiography - CT electron beam

References

• 1 Myerburg R J, Kessler K M, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment.  Ann Intern Med. 1993;  119 1187-1197
• 2 Shepherd J, Cobbe S M, Ford I. et al . Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group.  N Engl J Med. 1995;  333 1301-1307
• 3 Wilson P W, D’Agostino R B, Levy D. et al . Prediction of coronary heart disease using risk factor categories.  Circulation. 1998;  97 1837-1847
• 4 Assmann G, Schulte H. The Prospective Cardiovascular Munster Study: prevalence and prognostic significance of hyperlipidemia in men with systemic hypertension.  Am J Cardiol. 1987;  59 9G-17G
• 5 Schmermund A, Stang A, Mohlenkamp S. et al . Prognostic value of electron-beam computed tomography-derived coronary calcium scores compared with clinical parameters in patients evaluated for coronary artery disease. Prognostic value of EBCT in symptomatic patients.  Z Kardiol. 2004;  93 696-705
• 6 Shaw L J, Raggi P, Schisterman E. et al . Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality.  Radiology. 2003;  228 826-833
• 7 Erbel R, Mohlenkamp S, Kerkhoff G. et al . Non-invasive screening for coronary artery disease: calcium scoring.  Heart. 2007;  93 1620-1629
• 8 Knez A, Becker C, Becker A. et al . Determination of coronary calcium with multi-slice spiral computed tomography: a comparative study with electron-beam CT.  Int J Cardiovasc Imaging. 2002;  18 295-303
• 9 Dormandy J, Heeck L, Vig S. Lower-extremity arteriosclerosis as a reflection of a systemic process: implications for concomitant coronary and carotid disease.  Semin Vasc Surg. 1999;  12 118-122
• 10 Cohen M G, Pascua J A, Garcia-Ben M. et al . A simple prediction rule for significant renal artery stenosis in patients undergoing cardiac catheterization.  Am Heart J. 2005;  150 1204-1211
• 11 Rockman C B, Jacobowitz G R, Gagne P J. et al . Focused screening for occult carotid artery disease: patients with known heart disease are at high risk.  J Vasc Surg. 2004;  39 44-51
• 12 Diehm C, Kareem S, Lawall H. Epidemiology of peripheral arterial disease.  Vasa. 2004;  33 183-189
• 13 Januzzi J L, Buros Jr J, Cannon C P. Peripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial.  Clin Cardiol. 2005;  28 238-242
• 14 Naghavi M. Preventive Cardiology: the SHAPE of the future. A Synopsis from the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.  Herz. 2007;  32 356-361
• 15 Meaney J F, Ridgway J P, Chakraverty S. et al . Stepping-table gadolinium-enhanced digital subtraction MR angiography of the aorta and lower extremity arteries: preliminary experience.  Radiology. 1999;  211 59-67
• 16 Ruehm S G, Goyen M, Barkhausen J. et al . Rapid magnetic resonance angiography for detection of atherosclerosis.  Lancet. 2001;  357 1086-1091
• 17 Goyen M, Herborn C U, Kroger K. et al . Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography – initial experience.  Radiology. 2003;  227 277-282
• 18 Zenge M O, Vogt F M, Brauck K. et al . High-resolution continuously acquired peripheral MR angiography featuring partial parallel imaging GRAPPA.  Magn Reson Med. 2006;  56 859-865
• 19 Berg F, Gossmann A, Bangard C. et al . Pelvic and lower leg arteries: Diagnostic accuracy of contrast-enhanced MR-Angiography at 3.0 Tesla in hybrid techniques.  Röntgenstr Fortschr. 2008;  180 169
• 20 Hadizadeh D, Gieseke J, Kukuk G. et al . Highly accelerated 4D MRA with keyhole (4D TRAK) and additional view-sharing at 3.0 T.  Röntgenstr Fortschr. 2008;  180 170
• 21 Seeger A, Fenchel M, Doring J. et al . Whole-body MR angiography using two-dimensional parallel immagin (iPAT2) at 3 T.  Röntgenstr Fortschr. 2009;  181 85-86
• 22 Vahl A C, Geselschap J, Montauban van Swijndregt A D. et al . Contrast enhanced magnetic resonance angiography versus intra-arterial digital subtraction angiography for treatment planning in patients with peripheral arterial disease: a randomised controlled diagnostic trial.  Eur J Vasc Endovasc Surg. 2008;  35 514-521, discussion 522 – 513
• 23 Vogt F M, Herborn C U, Parsons E C. et al . Diagnostische Wertigkeit der kontrastverstärkten Magnetresonanzangiografie der Beckenstrombahn mit dem intravaskulären Kontrastmittel Vasovist®: Erste klinische Erfahrungen im Vergleich zur i. a. DSA.  Röntgenstr Fortschr. 2007;  179 412-420
• 24 Brauck K, Breuckmann F, Barkhausen J. et al .Concomitant atherosclerotic changes in whole-body MR-Angiography and coronary calcium deposit in patients with catheter-staged coronary artery disease. Proc. ISMRM abstract no 1965. Seattle, USA; 2006
• 25 Hansen T, Ahlstrom H, Wikstrom J. et al . A total atherosclerotic score for whole-body MRA and its relation to traditional cardiovascular risk factors.  Eur Radiol. 2008;  18 1174-1180
• 26 Goyen M, Quick H H, Debatin J F. et al . Whole-body three-dimensional MR angiography with a rolling table platform: initial clinical experience.  Radiology. 2002;  224 270-277
• 27 Vogt F M, Zenge M O, Ladd M E. et al . Peripheral vascular disease: comparison of continuous MR angiography and conventional MR angiography – pilot study.  Radiology. 2007;  243 229-238
• 28 Hunold P, Vogt F M, Schmermund A. et al . Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT.  Radiology. 2003;  226 145-152
• 29 Schlosser T, Hunold P, Schmermund A. et al . Coronary artery calcium score: influence of reconstruction interval at 16-detector row CT with retrospective electrocardiographic gating.  Radiology. 2004;  233 586-589
• 30 Agatston A S, Janowitz W R, Hildner F J. et al . Quantification of coronary artery calcium using ultrafast computed tomography.  J Am Coll Cardiol. 1990;  15 827-832
• 31 Schmermund A, Lehmann N, Bielak L F. et al . Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America.  Atherosclerosis. 2007;  195 e207-e216
• 32 Haberl R, Becker A, Lang C. et al . Ausschluss von Koronarkalk mit Elektronenstrahltomographie: Geeignet als Filter vor invasiver Diagnostik bei symptomatischen Patienten?.  Z Kardiol. 2001;  90 21-27
• 33 Guerci A D, Spadaro L A, Goodman K J. et al . Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease.  J Am Coll Cardiol. 1998;  32 673-679
• 34 Kajinami K, Seki H, Takekoshi N. et al . Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results.  J Am Coll Cardiol. 1995;  26 1209-1221
• 35 Kennedy J, Shavelle R, Wang S. et al . Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography.  Am Heart J. 1998;  135 696-702
• 36 Ruehm S G, Goehde S C, Goyen M. Whole body MR angiography screening.  Int J Cardiovasc Imaging. 2004;  20 587-591
• 37 Herborn C U, Vogt F M, Goyen M. et al . Kardiovaskulare Ganzkörper-MRT: Möglichkeiten und Grenzen in der Früherkennung.  Radiologe. 2004;  44 826-834
• 38 Naghavi M, Libby P, Falk E. et al . From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.  Circulation. 2003;  108 1664-1672
• 39 Stanford W, Thompson B H, Burns T L. et al . Coronary artery calcium quantification at multi-detector row helical CT versus electron-beam CT.  Radiology. 2004;  230 397-402
• 40 Schmermund A, Mohlenkamp S, Stang A. et al . Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle.  Am Heart J. 2002;  144 212-218
• 41 Ladd S C, Debatin J F, Stang A. et al . Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients.  Eur Radiol. 2007;  17 1035-1045