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CT-calciumscore: geschikte test voor uitsluiting coronairlijden

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Scherptong RWC, Sieders AJ. CT-calciumscore: geschikte test voor uitsluiting coronairlijden. Huisarts Wet 2014;57(6):314-7.

Pijn op de borst is een veelvoorkomende klacht. Het kan lastig zijn om symptomatisch coronairlijden uit te sluiten. In veel situaties is fietsergometrie niet conclusief. CT-calciumscore is een relatief recente techniek die de aanwezigheid van coronairsclerose kan uitsluiten. Deze techniek kan calcificaties in de vaatwand aantonen, die ontstaan als gevolg van atherosclerose. Bij patiënten met thoracale pijnklachten hangt een lage calciumscore, in het bijzonder een calciumscore van 0, samen met een uitstekende prognose. Ook bij asymptomatische patiënten kan de calciumscore van waarde zijn. Hierbij geldt eveneens dat een score van 0 coronairlijden uitsluit. Het is wel van belang om na te gaan of er risicofactoren zijn, vooral omdat het absolute risico op cardiovasculaire sterfte bij jongere patiënten (< 45 jaar) in het algemeen laag is, ongeacht de calciumscore. Omdat atherosclerose met de leeftijd toeneemt, wordt de kans op een lage calciumscore steeds kleiner. Daarom is de CT-calciumscore in algemene zin niet aan te raden bij patiënten ouder dan 65 jaar. In deze groep is het beter om functioneel onderzoek te verrichten.

Abstract

Scherptong RWC, Sieders AJ. CT calcium score: a suitable test for excluding coronary artery disease. Huisarts Wet 2014;57(6):314-7.

Chest pain is a common symptom. It can be difficult to exclude symptomatic coronary artery disease, and in many cases the results of exercise stress testing are not conclusive. The detection of calcium in the coronary arteries, by computed tomography (CT) scanning (the so-called coronary artery calcium score), is a relatively new method to establish the presence and severity of coronary artery disease, because vessel wall calcification is associated with atherosclerosis. In patients with chest pain, a low calcium score, and especially a score of zero, is associated with an excellent prognosis. The calcium score can also be useful for patients without symptoms, with a score of zero again excluding coronary artery disease. However, it is important to establish whether the patient has risk factors, especially because the absolute risk of coronary artery disease is generally low in young (< 45 years) patients, regardless of the calcium score. Because atherosclerosis increases with age, the likelihood a person has a low calcium score decreases with advancing age. For this reason, determination of the calcium score in patients older than 65 years is generally not recommended – instead functional investigations should be carried out.

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Authors and Affiliations

  1. afdeling Cardiologie, Rijnland ziekenhuis, 4220, 2350, CC, Leiderdorp, The Netherlands

    Roderick Scherptong & Allard Sieders

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  1. Roderick Scherptong
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  2. Allard Sieders
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Rijnland ziekenhuis, afdeling Cardiologie, Postbus 4220, 2350 CC Leiderdorp: dr. R.W.C. Scherptong, aios cardiologie; A.J. Sieders, cardioloog Correspondentie: a.sieders@rijnland.nl Mogelijke belangenverstrengeling: niets aangegeven.

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Scherptong, R., Sieders, A. CT-calciumscore: geschikte test voor uitsluiting coronairlijden. HUISARTS WETENSCHAP 57, 314–317 (2014). https://doi.org/10.1007/s12445-014-0155-1

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