Comments on: Determinants of Coronary Calcium Conversion Among Patients With a Normal Coronary Calcium Scan: What Is the “Warranty Period” for Remaining Normal? http://www.thepreparedminds.com/archives/1383 In the field of observation, chance favors the prepared minds. Sat, 04 Feb 2012 14:45:45 +0000 hourly 1 http://wordpress.org/?v=3.3 By: Eric M. Dandes http://www.thepreparedminds.com/archives/1383/comment-page-1#comment-1295 Eric M. Dandes Tue, 16 Mar 2010 00:30:44 +0000 http://www.thepreparedminds.com/?p=1383#comment-1295 I think the issue of coronary calcium is complex! On one hand I think it's a great screening test, but we really don't know enough about the prognostic value of serial testing given various scenarios – i.e. whether a patient is treated with drugs (and what type/how long) or just followed-up clinically. From a screening viewpoint for someone with an intermediate Framingham risk score, a coronary calcium test is better than a stress test, largely because the latter only picks up obstructive disease, which is less likely to be present in an asymptomatic screened patient. Although, if a patient is just followed clinically without treatment, a rise in calcium score more than likely predicts an unfavorable prognosis. However, that argument isn’t as strong in a treatment setting because, increased calcification may signify a conversion of other previously undetected /detected "vulnerable" non-calcified plaque to more "stable" calcified plaque. What are some other opinions? I think the issue of coronary calcium is complex! On one hand I think it’s a great screening test, but we really don’t know enough about the prognostic value of serial testing given various scenarios – i.e. whether a patient is treated with drugs (and what type/how long) or just followed-up clinically.

From a screening viewpoint for someone with an intermediate Framingham risk score, a coronary calcium test is better than a stress test, largely because the latter only picks up obstructive disease, which is less likely to be present in an asymptomatic screened patient.

Although, if a patient is just followed clinically without treatment, a rise in calcium score more than likely predicts an unfavorable prognosis. However, that argument isn’t as strong in a treatment setting because, increased calcification may signify a conversion of other previously undetected /detected “vulnerable” non-calcified plaque to more “stable” calcified plaque.

What are some other opinions?

]]> By: Jacobo Kirsch, MD http://www.thepreparedminds.com/archives/1383/comment-page-1#comment-1293 Jacobo Kirsch, MD Mon, 15 Mar 2010 21:57:22 +0000 http://www.thepreparedminds.com/?p=1383#comment-1293 Very interesting prospective data that definitely adds to our knowledge of the natural history of plaque. Having said that, I do have concerns regarding a recommendation made in this paper: For the most part, it is believed that the major benefit of calcium scoring is achieved in patients with an intermediate Framingham risk score. The data in this paper suggests that more than a single calcium score should be obtained in view of the propensity of this measurement to change over time, especially in patients with higher initial scores. But, is this really going to have an impact on how these patients are treated? Or will it only initiate a domino effect of more testing? Very interesting prospective data that definitely adds to our knowledge of the natural history of plaque. Having said that, I do have concerns regarding a recommendation made in this paper:

For the most part, it is believed that the major benefit of calcium scoring is achieved in patients with an intermediate Framingham risk score. The data in this paper suggests that more than a single calcium score should be obtained in view of the propensity of this measurement to change over time, especially in patients with higher initial scores. But, is this really going to have an impact on how these patients are treated? Or will it only initiate a domino effect of more testing?

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