Reporting incidental coronary, aortic valve & cardiac calcification on non-gated thoracic computed tomography

Dr Anna Reid, Consultant Cardiologist, Manchester University Hospitals, comments on findings published by the British Institute of Radiology.

The finding of coronary calcification represents an important marker of prognosis, with even small increases in a coronary artery calcium score connoting worse outcomes, both in terms of cardiac events and all-cause mortality, in comparison to their counterparts with a zero calcium score. The finding of coronary artery calcification, or formal coronary artery calcium scoring enhances a clinicians ability to personalise an individual’s risk, over and above traditional population-based approaches to risk-stratification. The occurrence of coronary heart disease events are rare in the absence of coronary calcification, and recently published data from the Multi-Ethnic Study of Atherosclerosis highlights the ‘Power of Zero’, indicating ‘warranty periods’ of a zero calcium score across differing traditional risk factor profiles.

The finding of coronary artery calcification is, of course, common with advancing age. However, concerted effort is required to drive away from the concept of a ‘common finding’ equating a ‘normal finding’, to identify those patient who may benefit from preventative intervention, or those with undisclosed symptoms who may require downstream testing. The consensus statement from the BSCI / BSCCT and BSTI regarding the incidental finding of cardiac calcification on non-gated thoracic CT stresses this point, clearly identifying a pathway for the downstream investigation and management of such patients. Importantly, the paper formalises the recommendations regarding the finding of valvular calcification, hopefully identifying those with silent, but important valvular heart disease requiring surveillance. This approach, of course, requires the collaborative efforts of not only the reporter to highlight the finding of cardiac calcification, but also the referrer to respond, and we as cardiologists will be required to lead in the disseminate of this information and support downstream patient care.