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Current Postings (3)
• Thanks a lot. EST is only 71% sensitive with high false positive. CTA is more sensitive at 88%. Negative predictive value is equally good for both. You mention the high calcium score could be false positive especially in my father who has no added risks. What could be the reason for the FP? Is it because CAC was done with EBCT and not with the 64 slice MDCT? Since the EST is less sensitive we might as well go straight for the CTA. Besides, EST has high false positive, so likely would lead to CTA anyway. EST can't tell if the high calcium score is a false positive, whereas a CT angiogram can. Your comment is appreciated. James Lee, Tan & Tan SMC, Singapore, November 2, 2011
• James in Singapore -- Some cardiologists have called for Calcium scoring to be incorporated into the Framingham risk score, to give a more complete picture. Others are concerned that more imaging tests only lead to more unnecessary interventions. Your father's Framingham risk score of 11% is at the low end of what is considered "intermediate" and these types of cases are always more difficult to assess. But the high Calcium score in the LAD of 418 is what your cardiologist is concerned about, assuming it is correct. A Cardiac CT Angiogram (more extensive than the EBCT) might reveal more about the situation, although sometimes extensive Calcium in the arteries prevents the CTA from accurately showing if there are blockages. CTA is considered very accurate, especially in its "negative predictability": if the CTA shows no disease, you can be confident there is none. But given the Calcium, a stress test might be the next best test. Both CTA and stress tests, by the way, are non-invasive. If the stress test is a nuclear perfusion type, it has the ability to show ischemia -- parts of the heart that are not receiving sufficient oxygen due most likely to a narrowing. If the test is negative (no ischemia) your cardiologist would probably stop there. If not, he/she may recommend invasive angiography. Your father's relatively good clinical picture and lack of symptoms, of course, would make one wonder if the Calcium score is a false positive. You can read more about these tests in Angioplasty.Org's Imaging and Diagnosis Center. The American College of Cardiology has an extensive article on Calcium scoring at CardioSmart, their patient web site. We urge you to discuss these options with your doctor. If an invasive angiogram is ultimately decided on, we also urge you to read over our articles on fractional flow reserve, the most recent one is titled "Fractional Flow Reserve (FFR) Guides Stent Treatment for So-Called 'Widow Maker' Artery" and discusses how to decide on stenting vs. medical therapy in the LAD. Angioplasty.Org Staff,Angioplasty.Org, October 30, 2011
•My father is 72 years old, thin, no diabetes, no high blood pressure, nonsmoker and normal cholesterol. No symptom, but he went for a screening EBCT Calcium score and was told to have 418 Calcium score in his LAD and 75 in RCA. Dr. offer us a CT angiogram. The Framingham Risk calculated was 11%, largely from his age alone. We are not keen on invasive procedures, if CT Angio showed no clear cut negative, would require catheter angiogram. We are planning to just do a stress test and if it is OK, we plan to just stop at that. Would appreciate your expert views on this. Thanks a lot. James L., Singapore, October 30, 2011
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