대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제83권1호
  • /
  • Pages.54-69
  • /
  • 2022
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

무증상 정상인 또는 환자의 관상동맥 질환 선별 검사로서 관상동맥 전산화단층촬영 혈관조영술의 유용성

Use of Coronary CT Angiography as a Screening Tool for Coronary Artery Disease in Asymptomatic Healthy Individuals or Patients

  • 진공용 (전북대학교 의과대학 전북대학교병원 임상의학연구소-의생명연구원 영상의학과)
  • Gong Yong Jin (Department of Radiology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital)
  • 투고 : 2021.10.04
  • 심사 : 2021.12.24
  • 발행 : 2022.01.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

심장 돌연사 환자들은 종종 흉통 또는 운동성 호흡곤란 등의 전조증상이 나타나지 않기 때문에 잠재적인 무증상 관상동맥 질환을 조기에 발견하는 것이 매우 중요하다. 관상동맥 전산화단층촬영 혈관조영술은 방사선 노출로 인한 위험성 때문에 무증상 환자에서 스크리닝 검사로 정당화되지 못했었지만 최근에 전산화단층촬영 기술의 비약적인 발전으로 방사선량을 1 mSv 미만으로 최소화함으로써 무증상 환자의 관상동맥 질환 선별 검사의 유용성에 대한 많은 연구가 진행되어 왔다. 그러나, 여전히 무증상 정상인 또는 환자의 관상동맥 질환 선별 검사에 대한 관상동맥 전산화단층촬영 혈관조영술의 유용성에 대해서는 다양한 의견들이 있다. 이 종설에서는 무증상 정상인 또는 환자들에게 관상동맥 질환 선별 검사로 관상동맥 칼슘 점수와 관상동맥 전산화단층촬영 혈관조영술 유용성에 대해서 다양한 문헌고찰을 통해서 알아보았다. 관상동맥 전산화단층촬영 혈관조영술상 무증상 정상인의 2.6%에서 70% 이상의 유의한 관상동맥 협착이 발견되었고, 선별 목적의 관상동맥 전산화단층촬영 혈관조영술이 무증상 건강한 사람의 미래의 심혈관 질환 발생을 예측할 수 있다. 그러나 현재 미국국립보건원에서 진행하고 있는 SCOT-HEART 2 연구가 끝나면 관상동맥 전산화단층촬영 혈관조영술이 무증상 성인의 심혈관 예방에 선별 검사로 적절한지 결정을 내릴 수 있을 것으로 생각된다.

Early detection of potential asymptomatic coronary artery disease is very important, as patients with sudden cardiac death often do not show symptoms such as chest pain or motor dyspnea. Coronary CT angiography (CCTA) has long been unjustified as a screening tool for asymptomatic patients because of the risks posed by radiation exposure. However, there are still various opinions regarding the usefulness of CCTA for screening for coronary artery disease (CAD) in asymptomatic healthy individuals or patients. This review investigated the usefulness of coronary artery calcium score and CCTA as screening tests for CAD in asymptomatic healthy individuals or patients through various literature reviews. With the development of CT technology, recent studies have been conducted in asymptomatic CAD patients with a reduced radiation dose of less than 1 mSv. A total of 2.6% of asymptomatic subjects on CCTA found significant CAD over 70%, and it was concluded that screening CCTA for CAD showed prognostic power in predicting the future occurrence of CAD in asymptomatic people. However, after the completion of the current NIH SCOT-HEART 2 study, it may be possible to determine whether CCTA is appropriate as a screening tool for CAD in asymptomatic healthy individuals.

키워드

참고문헌

  1. Myerburg RJ, Interian A Jr, Mitrani RM, Kessler KM, Castellanos A. Frequency of sudden cardiac death and profiles of risk. Am J Cardiol 1997;80:10F-19F https://doi.org/10.1016/S0002-9149(97)00477-3
  2. Kim KJ, Choi SI, Lee MS, Kim JA, Chun EJ, Jeon CH. The prevalence and characteristics of coronary atherosclerosis in asymptomatic subjects classified as low risk based on traditional risk stratification algorithm: assessment with coronary CT angiography. Heart 2013;99:1113-1117 https://doi.org/10.1136/heartjnl-2013-303631
  3. Gotto AM; NCEP ATP III. NCEP ATP III guidelines incorporate global risk assessment. Am J Manag Care 2003;Suppl:1, 3
  4. Grewal J, Anand S, Islam S, Lonn E; SHARE and SHARE-AP Investigators. Prevalence and predictors of subclinical atherosclerosis among asymptomatic "low risk" individuals in a multiethnic population. Atherosclerosis 2008;197:435-442 https://doi.org/10.1016/j.atherosclerosis.2007.06.020
  5. Nucifora G, Schuijf JD, van Werkhoven JM, Jukema JW, Djaberi R, Scholte AJ, et al. Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography. J Nucl Cardiol 2009;16:368-375 https://doi.org/10.1007/s12350-009-9059-z
  6. Salem HT, Sabek EAS. Value of coronary calcium scoring in symptomatic and asymptomatic coronary artery disease patients. Curr Med Imaging 2021;17:517-523 https://doi.org/10.2174/1573405616666201023142030
  7. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210-215 https://doi.org/10.1001/jama.291.2.210
  8. Naghavi M, Falk E, Hecht HS, Shah PK; SHAPE Task Force. The first shape (screening for heart attack prevention and education) guideline. Crit Pathw Cardiol 2006;5:187-190 https://doi.org/10.1097/01.hpc.0000249784.29151.54
  9. Jin KN, Chun EJ, Lee CH, Kim JA, Lee MS, Choi SI. Subclinical coronary atherosclerosis in young adults: prevalence, characteristics, predictors with coronary computed tomography angiography. Int J Cardiovasc Imaging 2012;28 Suppl 2:93-100 https://doi.org/10.1007/s10554-012-0143-0
  10. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;228:826-833 https://doi.org/10.1148/radiol.2283021006
  11. Jeon GH, Kim SH, Yun SC, Chae HD, Kim CH, Kang BM. Association between serum estradiol level and coronary artery calcification in postmenopausal women. Menopause 2010;17:902-907 https://doi.org/10.1097/gme.0b013e3181d76768
  12. Manson JE, Allison MA, Rossouw JE, Carr JJ, Langer RD, Hsia J, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356:2591-2602 https://doi.org/10.1056/NEJMoa071513
  13. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 2001;87:1335-1339 https://doi.org/10.1016/S0002-9149(01)01548-X
  14. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832 https://doi.org/10.1016/0735-1097(90)90282-T
  15. Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2009;2:675-688 https://doi.org/10.1016/j.jcmg.2008.12.031
  16. Park HE, Kim MK, Choi SY, Lee W, Shin CS, Cho SH, et al. The prevalence and distribution of coronary artery calcium in asymptomatic Korean population. Int J Cardiovasc Imaging 2012;28:1227-1235 https://doi.org/10.1007/s10554-011-9922-2
  17. Yoo DH, Chun EJ, Choi SI, Kim JA, Jin KN, Yeon TJ, et al. Significance of noncalcified coronary plaque in asymptomatic subjects with low coronary artery calcium score: assessment with coronary computed tomography angiography. Int J Cardiovasc Imaging 2011;27 Suppl 1:27-35 https://doi.org/10.1007/s10554-011-9968-1
  18. Lee S, Choi EK, Chang HJ, Kim CH, Seo WW, Park JJ, et al. Subclinical coronary artery disease as detected by coronary computed tomography angiography in an asymptomatic population. Korean Circ J 2010;40:434-441 https://doi.org/10.4070/kcj.2010.40.9.434
  19. Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, et al. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 2008;52:357-365 https://doi.org/10.1016/j.jacc.2008.02.086
  20. Ehara M, Surmely JF, Kawai M, Katoh O, Matsubara T, Terashima M, et al. Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circ J 2006;70:564-571 https://doi.org/10.1253/circj.70.564
  21. Park HE, Chun EJ, Choi SI, Lee SP, Yoon CH, Kim HK, et al. Clinical and imaging parameters to predict cardiovascular outcome in asymptomatic subjects. Int J Cardiovasc Imaging 2013;29:1595-1602 https://doi.org/10.1007/s10554-013-0235-5
  22. Achenbach S, Raggi P. Imaging of coronary atherosclerosis by computed tomography. Eur Heart J 2010;31:1442-1448 https://doi.org/10.1093/eurheartj/ehq150
  23. Hamon M, Biondi-Zoccai GG, Malagutti P, Agostoni P, Morello R, Valgimigli M, et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol 2006;48:1896-1910 https://doi.org/10.1016/j.jacc.2006.08.028
  24. Cho I, Chang HJ, Sung JM, Pencina MJ, Lin FY, Dunning AM, et al. Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry). Circulation 2012;126:304-313 https://doi.org/10.1161/CIRCULATIONAHA.111.081380
  25. Jalowiec DA, Hill JA. Myocardial infarction in the young and in women. Cardiovasc Clin 1989;20:197-206
  26. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001;103:2705-2710 https://doi.org/10.1161/01.CIR.103.22.2705
  27. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. Circulation 1998;97:2099-2100 https://doi.org/10.1161/01.CIR.97.21.2099
  28. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-234 https://doi.org/10.1056/NEJM199807233390404
  29. Park GM, Lee SW, Cho YR, Kim CJ, Cho JS, Park MW, et al. Coronary computed tomographic angiographic findings in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol 2014;113:765-771 https://doi.org/10.1016/j.amjcard.2013.11.028
  30. Jin GY, Jeong SK, Lee SR, Kwon KS, Han YM, Cho YI. Screening strategies for the diagnosis of coronary artery stenosis in patients with cerebral infarction using dual-source spiral CT. J Neurol Sci 2009;284:129-134 https://doi.org/10.1016/j.jns.2009.04.036
  31. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010;303:235-241 https://doi.org/10.1001/jama.2009.2014
  32. Ingelsson E, Sullivan LM, Fox CS, Murabito JM, Benjamin EJ, Polak JF, et al. Burden and prognostic importance of subclinical cardiovascular disease in overweight and obese individuals. Circulation 2007;116:375-384 https://doi.org/10.1161/CIRCULATIONAHA.107.688788
  33. Lubanski MS, Vanhecke TE, Chinnaiyan KM, Franklin BA, McCullough PA. Subclinical coronary atherosclerosis identified by coronary computed tomographic angiography in asymptomatic morbidly obese patients. Heart Int 2010;5:e15
  34. Ulimoen GR, Ofstad AP, Endresen K, Gullestad L, Johansen OE, Borthne A. Low-dose CT coronary angiography for assessment of coronary artery disease in patients with type 2 diabetes--a cross-sectional study. BMC Cardiovasc Disord 2015;15:147
  35. Shimabukuro M, Saito T, Higa T, Nakamura K, Masuzaki H, Sata M; Fukuoka diabetologists group. Risk stratification of coronary artery disease in asymptomatic diabetic subjects using multidetector computed tomography. Circ J 2015;79:2422-2429 https://doi.org/10.1253/circj.CJ-15-0325
  36. Yoon SH, Kim E, Jeon Y, Yi SY, Bae HJ, Jang IK, et al. Prognostic value of coronary CT angiography for predicting poor cardiac outcome in stroke patients without known cardiac disease or chest pain: the assessment of coronary artery disease in stroke patients study. Korean J Radiol 2020;21:1055-1064 https://doi.org/10.3348/kjr.2020.0103
  37. Gongora-Rivera F, Labreuche J, Jaramillo A, Steg PG, Hauw JJ, Amarenco P. Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Stroke 2007;38:1203-1210 https://doi.org/10.1161/01.STR.0000260091.13729.96
  38. Calvet D, Touze E, Varenne O, Sablayrolles JL, Weber S, Mas JL. Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study. Circulation 2010;121:1623-1629 https://doi.org/10.1161/CIRCULATIONAHA.109.906958
  39. Assanelli D, Ermolao A, Carre F, Deligiannis A, Mellwig K, Mellwig K, et al. Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study. Intern Emerg Med 2014;9:427-434 https://doi.org/10.1007/s11739-013-0955-5
  40. Wagner G, Lim T, Gettes L, Gorgels A, Josephson M, Wellens H, et al. Consideration of pitfalls in and omissions from the current ECG standards for diagnosis of myocardial ischemia/infarction in patients who have acute coronary syndromes. Cardiol Clin 2006;24:331-342, vii https://doi.org/10.1016/j.ccl.2006.04.012
  41. Desai MY, Crugnale S, Mondeau J, Helin K, Mannting F. Slow upsloping ST-segment depression during exercise: does it really signify a positive stress test? Am Heart J 2002;143:482-487 https://doi.org/10.1067/mhj.2002.120771
  42. Lee SE, Cho I, Hong GR, Chang HJ, Sung JM, Cho IJ, et al. Differential prognostic value of coronary computed tomography angiography in relation to exercise electrocardiography in asymptomatic subjects. J Cardiovasc Ultrasound 2015;23:244-252 https://doi.org/10.4250/jcu.2015.23.4.244
  43. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010;56:e50-e103 https://doi.org/10.1016/j.jacc.2010.09.001
  44. Giusca S, Schutz M, Kronbach F, Wolf D, Nunninger P, Korosoglou G. Coronary computer tomography angiography in 2021-acquisition protocols, tips and tricks and heading beyond the possible. Diagnostics (Basel) 2021;11:1072
  45. Lee MS, Chun EJ, Kim KJ, Kim JA, Yoo JY, Choi SI. Asymptomatic subjects with zero coronary calcium score: coronary CT angiographic features of plaques in event-prone patients. Int J Cardiovasc Imaging 2013;29 Suppl 1:29-36 https://doi.org/10.1007/s10554-013-0257-z
  46. Huang YL, Lin HS, Wu CC, Wu FZ, Yeh C, Chiou KR, et al. CT attenuation features of individual calcified coronary plaque: differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups. PLoS One 2015;10:e0131254
  47. Rodriguez K, Kwan AC, Lai S, Lima JA, Vigneault D, Sandfort V, et al. Coronary plaque burden at coronary CT angiography in asymptomatic men and women. Radiology 2015;277:73-80 https://doi.org/10.1148/radiol.2015142551
  48. Cho I, Al'Aref SJ, Berger A, O Hartaigh B, Gransar H, Valenti V, et al. Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study. Eur Heart J 2018;39:934-941 https://doi.org/10.1093/eurheartj/ehx774
  49. Schneer S, Bachar GN, Atar E, Koronowski R, Dicker D. Evaluation of framingham and systematic coronary risk evaluation scores by coronary computed tomographic angiography in asymptomatic adults. Am J Cardiol 2013;111:700-704 https://doi.org/10.1016/j.amjcard.2012.11.023
  50. Espinoza A, Malone K, Balyakina E, Fulda KG, Cardarelli R. Incidental computer tomography radiologic findings through research participation in the North Texas Healthy Heart Study. J Am Board Fam Med 2014;27:314-320 https://doi.org/10.3122/jabfm.2014.03.130250
  51. Chung SL, Yang CC, Chen CC, Hsu YC, Lei MH. Coronary artery calcium score compared with cardio-ankle vascular index in the prediction of cardiovascular events in asymptomatic patients with type 2 diabetes. J Atheroscler Thromb 2015;22:1255-1265 https://doi.org/10.5551/jat.29926
  52. Nezarat N, Budoff MJ, Luo Y, Darabian S, Nakanishi R, Li D, et al. Presence, characteristics, and volumes of coronary plaque determined by computed tomography angiography in young type 2 diabetes mellitus. Am J Cardiol 2017;119:1566-1571 https://doi.org/10.1016/j.amjcard.2017.02.023