Skip to main content
SpringerLink
Log in

Screening, Risikostratifizierung und CT-Bildgebung zur Abklärung der koronaren Herzkrankheit

Screening, risk stratification and CT imaging for assessment of coronary artery disease

  • Leitthema
  • Published:
Die Radiologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die frühzeitige Behandlung kardiovaskulärer Risikofaktoren sowie die genaue Charakterisierung von Koronarplaques ist essenziell, um die koronare Herzkrankheit (KHK) prognostisch abschätzen zu können und kardiovaskulären Ereignissen vorzubeugen.

Fragestellung

Diskussion der wichtigsten Risikofaktoren, der grundlegenden Diagnostik sowie der Prävention und Prognoseabschätzung der KHK mit Fokus auf die kardiale Computertomographie (CT).

Material und Methoden

Prävalenz/prognostische Bedeutung der Risikofaktoren der KHK, Beschreibung der gezielten Erfassung des Risikoprofils, Abschätzung der Vortestwahrscheinlichkeit, konventionelle Prävention der KHK, Prognoseabschätzung mittels Kalzium-Scoring und kardialer CT-Angiographie.

Ergebnisse

Die Erstellung eines Risikoprofils und Einschätzung der Vortestwahrscheinlichkeit für eine obstruktive Koronarstenose bedingt eine gezielte Anamnese und Labordiagnostik. Die Zusammensetzung und das Ausmaß kalzifizierter und nichtkalzifizierter Plaques in der CT gemäß den Kriterien des „Coronary Artery Disease—Reporting and Data System“ liefern wichtige prognostische Informationen über die Wahrscheinlichkeit kardiovaskulärer Ereignisse, die je nach Ausprägung der Plaques steigt bzw. sinkt. Die initiale Bildgebung mittels CT bei V.a. KHK führt nachfolgend zu einer Verringerung an invasiven Koronarangiographien und katheterassoziierten Komplikationen.

Diskussion

Neben der Erfassung kardiovaskulärer Risikofaktoren kann die ergänzende Abklärung der Plaqueausprägung und signifikanter Stenosen in der CT darüber hinaus weitere prognostische Informationen liefern. Ein organisiertes Screening mittels Kalzium-Scoring gibt es jedoch derzeit aufgrund unzureichender Studienlage nicht, obwohl es potenziell das Risiko von Patienten mit ausgeprägten Risikofaktoren frühzeitig stratifizieren könnte.

Abstract

Background

Early treatment of cardiovascular risk factors and characterization of coronary plaques is essential to collect prognostic information about coronary artery disease (CAD) and prevent cardiovascular events.

Objectives

Discussion of the most important risk factors of CAD, basic diagnostic of CAD, prevention, and prognostic factors of CAD with focus on cardiac computed tomography (CT).

Materials and methods

Prevalence and prognostic impact of CAD risk factors; description of specific assessment of risk profiles; estimation of pretest probability; conventional prevention of CAD; prognostic assessment of CAD using the Calcium Scoring and coronary CT angiography.

Results

Assessment of risk profiles and estimation of pretest probability for obstructive coronary stenosis necessitates a thorough evaluation of medical history and laboratory values. The composition and extent of calcified and noncalcified plaques in CT exams based on the criteria of the Coronary Artery Disease—Reporting and Data System give important prognostic information about the risk of cardiovascular events, which increases with high plaque burden and vice versa. Initial imaging with CT for evaluation of CAD leads to a reduction of invasive coronary angiographies and catheter-associated complications.

Conclusions

Besides early detection of cardiovascular risk factors, the additional assessment of plaque burden and significant stenosis in CT gives further prognostic information to facilitate effective therapies to prevent cardiovascular events and in the case of low plaque burden avoid invasive coronary angiography. However, systmatic screening using Calcium Scoring is not established yet due to insufficient data, although it could potentially be used for an early risk stratification in patients with multiple risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Abbreviations

CAD-RADS :

Coronary Artery Disease-Reporting and Data System

CAS :

Kalzium-Scoring

CT :

Computertomographie

CTA :

CT-Angiographie

KHK :

Koronare Herzkrankheit

Literatur

  1. Brown JC, Gerhardt TE, Kwon E (2023) Risk Factors for Coronary Artery Disease. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK554410/

  2. Budoff MJ, Mayrhofer T, Ferencik M et al (2017) Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 136(21):1993–2005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Cheng VY, Berman DS, Rozanski A et al (2011) Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: results from the multinational coronary CT angiography evaluation for clinical outcomes: an international multicenter registry (CONFIRM). Circulation 124(22):2423–2432 (1–8)

    Article  PubMed  PubMed Central  Google Scholar 

  4. Curry SJ, Krist AH, Owens DK et al (2018) Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA 320(3):272–280

    Article  PubMed  Google Scholar 

  5. Cury RC, Leipsic J, Abbara S et al (2022) CAD-RADS™ 2.0—2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 16(6):536–557

    Article  PubMed  Google Scholar 

  6. DISCHARGE Trial Group, Maurovich-Horvat P, Bosserdt M et al (2022) CT or Invasive Coronary Angiography in Stable Chest Pain. N Engl J Med 386(17):1591–1602

    Article  Google Scholar 

  7. Douglas PS, Hoffmann U, Patel MR et al (2015) PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 372(14):1291–1300

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fan L, Fan K (2018) Lung cancer screening CT-based coronary artery calcification in predicting cardiovascular events: A systematic review and meta-analysis. Medicine 97(20):e10461

    Article  PubMed  PubMed Central  Google Scholar 

  9. Genders TS, Steyerberg EW, Hunink MG et al (2012) Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ 344:e3485

    Article  PubMed  PubMed Central  Google Scholar 

  10. Giugliano D, Chiodini P, Maiorino MI et al (2019) Cardiovascular outcome trials and major cardiovascular events: does glucose matter? A systematic review with meta-analysis. J Endocrinol Invest 42(10):1165–1169

    Article  CAS  PubMed  Google Scholar 

  11. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankheitskosten/_inhalt.html#250402. Zugegriffen: 12. Okt. 2023

  12. https://www.leitlinien.de/themen/khk/version-6. Zugegriffen: 12. Okt. 2023

  13. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Zugegriffen: 12. Okt. 2023

  14. Knuuti J, Wijns W, Saraste A, ESC Scientific Document Group et al (2019) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477

    Article  Google Scholar 

  15. Merai R, Siegel C, Rakotz M et al (2016) CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. Mmwr Morb Mortal Wkly Rep 65(45):1261–1264

    Article  PubMed  Google Scholar 

  16. Nam K, Hur J, Han K et al (2019) Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. Atherosclerosis 287:1–7

    Article  CAS  PubMed  Google Scholar 

  17. Ndumele CE, Matsushita K, Lazo M et al (2016) Obesity and Subtypes of Incident Cardiovascular Disease. J Am Heart Assoc 5(8):e3921

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pencina MJ, Navar AM, Wojdyla D et al (2019) Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation 139(13):1603–1611

    Article  PubMed  Google Scholar 

  19. Puchner SB, Liu T, Mayrhofer T et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64(7):684–692

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sarwar A, Shaw LJ, Shapiro MD et al (2010) Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 3(10):1089

    Google Scholar 

  21. SCORE2 working group and ESC Cardiovascular risk collaboration (2021) SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 42(25):2439–2454

    Article  Google Scholar 

  22. SCOT-HEART investigators (2015) CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet 385(9985):2383–2391

    Article  Google Scholar 

  23. Siu AL, U.S. Preventive Services Task Force (2015) Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 163(11):861–868

    Article  PubMed  Google Scholar 

  24. Siu AL, U.S. Preventive Services Task Force (2015) Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 163(10):778–786

    Article  PubMed  Google Scholar 

  25. Thomopoulos C, Parati G, Zanchetti A (2016) Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels—updated overview and meta-analyses of randomized trials. J Hypertens 34(4):613–622

    Article  CAS  PubMed  Google Scholar 

  26. Tsao CW, Aday AW, Almarzooq ZI et al (2023) Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 147(8):e93–e621

    Article  PubMed  Google Scholar 

  27. van der Aalst CM, Denissen SJAM, Vonder M et al (2020) Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium scoring: the ROBINSCA trial. Eur Heart J Cardiovasc Imaging 21(11):1216–1224

    Article  PubMed  Google Scholar 

  28. Williams MC, Moss AJ, Dweck M et al (2019) Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study. J Am Coll Cardiol 73(3):291–301

    Article  PubMed  PubMed Central  Google Scholar 

  29. Williams MC, Moss A, Dweck M et al (2020) Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain. J Cardiovasc Comput Tomogr 14(1):3–11

    Article  PubMed  Google Scholar 

  30. Xie JX, Cury RC, Leipsic J et al (2018) The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting. JACC Cardiovasc Imaging 11(1):78–89

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland

    Leon M. Bischoff & Julian A. Luetkens

  2. Quantitative Imaging Lab Bonn (QILaB), Universitätsklinikum Bonn, Bonn, Deutschland

    Leon M. Bischoff & Julian A. Luetkens

Authors
  1. Leon M. Bischoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julian A. Luetkens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leon M. Bischoff.

Ethics declarations

Interessenkonflikt

J.A. Luetkens ist als Referent für die Firmen Novartis, Philips Healthcare und Siemens Healthineers tätig und erhält Beraterhonorare von der Firma Bayer Healthcare. L.M. Bischoff gibt an, dass kein Interessenskonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bischoff, L.M., Luetkens, J.A. Screening, Risikostratifizierung und CT-Bildgebung zur Abklärung der koronaren Herzkrankheit. Radiologie (2024). https://doi.org/10.1007/s00117-024-01287-z

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00117-024-01287-z

Schlüsselwörter

Keywords

Search

Navigation