Coronary Artery Disease: Stanford W

Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P, Anonymous00008, Anonymous00009. · Department of Radiology, Groningen University Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. · Eur Radiol. · Pubmed #18651153 No free full text.

Abstract: Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed.

Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P. · Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. · Int J Cardiovasc Imaging. · Pubmed #18504647 links to  free full text

Abstract: Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.

Weinreb JC, Larson PA, Woodard PK, Stanford W, Rubin GD, Stillman AE, Bluemke DA, Duerinckx AJ, Dunnick NR, Smith GG. · Yale University School of Medicine, New Haven, Connecticut, USA. <> · J Am Coll Radiol. · Pubmed #17411862 No free full text.

Abstract: Coronary artery disease and other acquired and congenital cardiac diseases are major medical and socio-economic problems. Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease. Advances in computed tomography (CT), with multidetector CT and electron beam CT technology, and magnetic resonance (MR) imaging, now make it possible to noninvasively image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and assess cardiac function, and CT and MR imaging are becoming increasingly important in the evaluation of cardiac disease. Radiologists, because of their extensive experience in CT and MR imaging, have an important role in imaging cardiac patients using these modalities. This clinical statement of the ACR discusses various technical and patient safety issues related to cardiac CT and MR imaging, and it suggests appropriate qualifications for radiologists until such time as ACR practice guidelines for the performance of cardiac CT and cardiac MR imaging are written and approved through the usual ACR process. It stresses that the interpreting physician is responsible for examining not only the cardiac structures of interest but also all the visualized noncardiac structures and must report any clinically relevant abnormalities of these adjacent structures.

Thompson BH, Stanford W. · University of Iowa, Roy J and Lucille A Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. · Expert Rev Cardiovasc Ther. · Pubmed #16076278 No free full text.

Abstract: The measurement of parameters relating to the assessment of cardiac function and morphology are critically important prognostic determinates in patients with known or suspected cardiac disease, such as coronary artery disease and myocardial infarction. Similarly, the measurement of indices, such as ejection fraction and myocardial mass, are key in assessing the efficacy of therapy in patients with valvular, coronary artery and intrinsic myocardial diseases. Electron-beam computed tomography has been proven to be a reliable and accurate modality for measuring a host of parameters relating to cardiac function. This article reviews the unique technologic design of the electron-beam computed tomography scanner and specifically addresses how this technology has enabled electron-beam computed tomography to become the gold standard for the quantification of cardiac function.

Thompson BH, Stanford W. · Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Health Care, Iowa City, USA. · Int J Cardiovasc Imaging. · Pubmed #15915939 No free full text.

Abstract: Coronary artery disease (CAD) is the number one killer of adults in the United States, claiming one-half million deaths annually. Early detection and prevention strategies clearly remain a top priority for health care providers in order to reduce the high mortality rate of heart disease. As an unequivocal reflection of arteriosclerosis, coronary arterial calcium (CAC) may provide a means to qualitatively assess the overall disease severity and likewise serve as a means to assess risk for CHD. It is known that patients with heavy calcium burdens have more advanced CAD, a concomitantly a higher likelihood of coronary stenoses, and a concomitant higher risk for acute cardiac events. Computed tomography has been shown to be an accurate, non-invasive method to quantify coronary calcification burden in patients. Evidence shows that calcium measurements by CT correlate well with histological plaque analyses, and that CAC measurements accurately reflect disease severity and can be useful to assess individual risk for CHD. The purpose of this article is to summarize the currently available evidence that has attempted to validate CAC screening as a screening exam and risk predictor for coronary heart disease.

Thompson BH, Stanford W. · Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52246, USA. · J Magn Reson Imaging. · Pubmed #15170779 No free full text.

Abstract: As an unequivocal biomarker for arteriosclerosis, the presence of coronary calcium serves as a qualitative reflection of the severity of coronary artery disease (CAD). Greater calcium burdens correlate with more advanced disease, a higher likelihood of coronary stenoses, and a higher risk for coronary heart disease (CHD). Empirically, the quantification of coronary calcium not only provides an accurate reflection of disease severity, but also has great potential as a screening tool for CHD. Computed tomography (CT) has been shown to be capable of providing accurate, noninvasive measurements of coronary calcification. Evidence shows that calcium measurements by CT correlate well with histological plaque analyses, and that calcium burdens accurately reflect disease severity and can be used to assess individual risk for CHD. The purpose of this review article is to examine the accumulated evidence that has attempted to validate CT as a diagnostic tool for CAD and as a screening exam for CHD.

Thompson BH, Stanford W. · Department of Radiology, College of Medicine, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA. · J Thorac Imaging. · Pubmed #11149695 No free full text.

Abstract: Coronary arterial calcification has unequivocally been shown to be a marker of atherosclerosis. To date, much research interest has been generated regarding the quantification of coronary calcification by electron beam computed tomography, and how best to use such measurements to identify and predict those at greatest risk for an adverse cardiac event. This article represents an attempt to provide an objective review of the literature regarding the potential role electron beam computed tomography (EBCT) has as an accurate and cost effective screening modality for coronary arterial disease, as well as a predictor for coronary heart disease.

Stanford W. · Department of Radiology, University of Iowa Hospitals and Clinics and University of Iowa College of Medicine, Iowa City 52242, USA. · Radiographics. · Pubmed #10555665 links to  free full text

This publication has no abstract.

Stanford W, Thompson BH. · Department of Radiology, University of Iowa College of Medicine, Iowa City, USA. · Radiol Clin North Am. · Pubmed #10198644 No free full text.

Abstract: Coronary artery calcification is a marker for atherosclerotic disease. The calcifications frequently occur early in the disease process and often before the development of luminal narrowing or cardiac events. Electron beam CT has a high accuracy in detecting calcifications, and thus has prognostic value in predicting luminal narrowing and future cardiac events.

Stanford W, Thompson BH, Burns TL, Heery SD, Burr MC. · Department of Radiology, College of Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA. · Radiology. · Pubmed #14752183 links to  free full text

Abstract: PURPOSE: To compare coronary artery calcium scores from a multi-detector row helical computed tomographic (CT) scanner with those from an electron-beam CT scanner, with emphasis on subjects with calcium scores less than 400. MATERIALS AND METHODS: Seventy-eight asymptomatic subjects (37 women, 41 men; age range, 39-78 years; mean age, 54.2 years) underwent multi-detector row CT and electron-beam CT. Volume and Agatston scores were calculated with a workstation. Statistical analyses included assessment of association between calcium scores from two scanners, calculation of percent absolute difference to assess score variability between scanners, equivalence analysis, construction of Bland-Altman plots to assess agreement between scores, and assessment of changes in score grouping and risk criteria based on score differences between scanners. RESULTS: Electron-beam CT calcium scores were higher than multi-detector row CT scores. Linear association between calcium scores obtained from paired scans was significant (r = 0.96-0.99, P <.001). Mean percent absolute differences were 67.9% and 65.0% for volume and Agatston scores, respectively (48.6% and 46.3% for corresponding natural log-transformed scores). In subjects with a score of 11 or greater, mean percent absolute differences between electron-beam CT and multi-detector row CT scores ranged from 15% to 30% (<10% for natural log-transformed calcium scores). With a 20% equivalence limit, calcium scores from the two scanners were statistically equivalent (P <.05). Score grouping would have been subject to change in 12 (11 increased and one decreased; six with scores of 11 or greater), and possible risk management decisions would have been subject to change in eight (16%) of 51 subjects who underwent electron-beam CT versus multi-detector row CT scanning. CONCLUSION: Multi-detector row CT appears to be comparable to electron-beam CT for coronary calcification screening, except in subjects with a calcium score less than 11.

Palen B, Stanford W, Fagan T, Hill JA. · Department of Internal Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA. · Am J Cardiol. · Pubmed #12842267 No free full text.

This publication has no abstract.

Stanford W. · Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52246-1077, USA. · Int J Cardiovasc Imaging. · Pubmed #12365550 No free full text.

Abstract: HCT and EBT imaging of soft plaque and the use of these modalities in CT angiographic applications are important in the non-calcified plaque assessment of coronary artery disease and in the follow-up of treatment.

Stanford W. · Department of Radiology, University of Iowa Hospitalsand Clinics, Iowa City 52246-1077, USA. · Int J Cardiovasc Imaging. · Pubmed #12365549 No free full text.

This publication has no abstract.

Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, Lauer RM. · Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA. · Am J Cardiol. · Pubmed #11524059 No free full text.

Abstract: The value of a coronary artery disease prediction algorithm, the Framingham risk score (score), for detecting coronary artery calcium (CAC) was examined in 385 men and 472 women, aged 29 to 43 years. Scores were compared in subjects with and without CAC and were also used to predict presence of CAC. Receiver-operating characteristic curves were computed to compare different prediction models. The score model was compared with age only, natural logarithm of body mass index (lnBMI) only, and score plus lnBMI models. CAC was detected in 30% of men and 16% of women. The mean score was significantly higher in men and women with CAC. For every 2-point increase in the score, the odds of CAC increased by 30% in women and 20% in men. Significant associations between CAC status and risk factors were observed for age in women, and high- density lipoprotein cholesterol and blood pressure in men and women. The area under the receiver-operating characteristic curve for the score was 0.67 and 0.57 for women and men, respectively. When lnBMI was added to the score model, the area increased to 0.76 in women (lnBMI p <0.0001, score p <0.005). For men, the area increased from 0.57 to 0.67, and the score was no longer significant (p >0.60) in the model with lnBMI (p <0.0001). Score predicts CAC in asymptomatic young adults. Inclusion of lnBMI in the score model adds significantly to the prediction of CAC in women and men. The lnBMI model has a greater predictive value than the score in this young population.

Stanford W. · No affiliation provided · Radiology. · Pubmed #10189486 links to  free full text

This publication has no abstract.