Coronary Artery Calcification Measured by Multi-Detector Computed Tomography in Systemic Sclerosis

Mi Ra Cho; Young Eun Park; Seung Hoon Baek; Joung Wook Lee; Sung Il Kim; Geun Tae Kim; Jun Hee Lee; Ki Seok Choo; Yeon-Ju Jeong; Sun Hee Lee

doi:10.4078/jkra.2009.16.3.181

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Cho, Park, Baek, Lee, Kim, Kim, Lee, Choo, Jeong, and Lee: Coronary Artery Calcification Measured by Multi-Detector Computed Tomography in Systemic Sclerosis

Original Article

J Korean Rheum Assoc 2009;16(3):181-187.

Published online: 20 September 2009

DOI: https://doi.org/10.4078/jkra.2009.16.3.181

Coronary Artery Calcification Measured by Multi-Detector Computed Tomography in Systemic Sclerosis

Mi Ra Cho¹, Young Eun Park¹, Seung Hoon Baek¹, Joung Wook Lee², Sung Il Kim¹, Geun Tae Kim³, Jun Hee Lee⁴, Ki Seok Choo⁵, Yeon-Ju Jeong⁵, Sun Hee Lee¹

¹Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea

²St. Mary's Medical Center, Busan, Korea

³Kosin University, Busan, Korea

⁴Choonhae Hospital, Busan, Korea

⁵Department of Radiology, School of Medicine, Pusan National University, Busan, Korea

Received 16 April 2009 Revised 1 June 2009 Accepted 3 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

There is some controversy regarding the early onset or high incidence of coronary atherosclerosis in patients with systemic sclerosis (SSc). Measurements of the coronary calcification score (CCS) by multi-detector computed tomography (MDCT) is an accurate and non-invasive method for detecting coronary atherosclerosis, and a high level of CCS (≥160) can predict coronary events. This study examined the CCS using MDCT and evaluated the risk of coronary events in patients with SSc.

Methods

The clinical and laboratory characteristics of 35 patients with SSc were examined. The CCS was measured by MDCT, and the risk of coronary events were evaluated by CCS and the Framingham risk score (FRS).

Results

In 35 patients (2 males and 33 females, 20 with limited and 15 with diffuse type), the mean age was 52±12 years and the disease duration was 8±7 years. The mean CCS was 10.1±30.8, the CCS of 28 patients (80%) was 0, and all patients had a CCS＜160. The CCS had no significant correlation with the clinical and laboratory characteristics. The FRS was evaluated in 29 patients. Twenty eight patients were categorized into the low-risk group (FRS ＜10%) and only one was classified into the moderate-risk group (FRS=13%).

Conclusion

These results suggest that the risk of coronary events due to coronary atherosclerosis might not be high in patients with SSc.

Keywords: Systemic sclerosis, Coronary arteries, Pathologic calcification

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Fig. 1.

Prospective electrocardiography gated computed tomography image of the heart showing calcification in the left coronary artery.

Table 1.

Demographic, clinical and laboratory characteristics of the 35 patients with systemic sclerosis

Variable	Total (n=35)	Limited (n=20)	Diffuse (n=15)
Age, years	52±12	52±13	50±11
Female (n=33)	51±12
Male (n=2)	65±4
Duration, years	8±7	7±7	10±7
BMI, kg/m²	22±2	21±2	22±3
Smoking, pack year	4±11	5±13	2±8
Modified Rodnan skin score	12±7	7±4^∗	19±4^∗
Diabetes mellitus, n	0	0	0
Hypertension, n	0	0	0
Total steroid doses, mg	1,956±2,838	821±1,233^†	3,468±3,634^†
Six months steroid doses, mg/day	3±5	1±3	4±7
Fasting plasma glucose (mg/dl)	82±14	86±11	78±17
Total cholesterol, mg/dl	170±35	160±35	179±35
HDL, mg/dl	53±15	52±14	53±17
LDL, mg/dl	110±36	108±39	112±32
Triglyceride, mg/dl	139±55	142±62	134±45
CRP, mg/dl	0.4±0.5	0.2±0.3	0.5±0.6
ESR, mm/hr	36±26	31±23	40±29
ANA, n/total (%)	34/34 (100)	20/20 (100)	14/14 (100)
Anti-Scl70 Ab, n/total (%)	11/34 (32)	2/20 (10)^‡	9/14 (64)^‡
Anti-centromere Ab, n/total (%)	4/31 (13)	3/20 (15)	1/11 (9)
Anti-RNP Ab, n/total (%)	12/25 (48)	7/15 (47)	5/10 (50)
Pulmonary involvement, n/total (%)	28/35 (80)	16/20 (80)	12/15 (80)
Esophageal involvement, n/total (%)	30/35 (86)	18/20 (90)	12/15 (80)

BMI: Body mass index, CRP: C-reactive protein, ESR: Erythrocyte sedimentation rate, HDL: High density lipoprotein cholesterol, LDL: Low density lipoprotein cholesterol. ∗,†,‡ Statistics for Limited vs Diffuse

^∗ Mann-Whitney test, p ＜0.001,

^† Mann-Whitney test, p=0.025,

^‡ Fisher's Exact test, p=0.002

Table 2.

Individual characteristics, Framingham risk score and coronary calcification score of the 35 patients with systemic sclerosis

Patient no.	Age, years	Sex	Disease duration, years	Subtype	BMI	Smoking, pack year	Total chol, mg/dl	HDL, mg/dl	LDL, mg/dl	TG, mg/dl	FRS	CCS
1	46	F	8	diffuse	22.5	0	222	42	154	126	1%	0.0
2	54	F	7	limited	19.2	0	175	67	101	138	＜1%	7.3
3	41	F	5	diffuse	22.0	0	172	33	132	73	＜1%	0.0
4	55	F	4	limited	24.0	0	117	33	63	108	1%	0.0
5	52	F	10	limited	23.1	0	157	36	84	237	1%	0.0
6	47	F	7	limited	21.2	30	147	57	87	151	1%	1.7
7	53	F	8	limited	18.0	0	167	67	88	149	＜1%	105.9
8	52	F	6	diffuse	27.2	0	252	83	179	170	1%	0.0
9	63	F	33	limited	17.5	0	198	79	107	75	1%	0.0
10	46	F	6	limited	22.7	0	170	57	101	53	＜1%	0.0
11	48	F	15	diffuse	22.4	0	192	59	115	194	＜1%	0.0
12	30	F	12	limited	25.2	NA	122	NA	NA	NA	NA	0.0
13	37	F	4	limited	19.2	0	131	47	54	165	＜1%	0.0
14	23	F	3	limited	19.8	0	192	47	114	277	＜1%	0.0
15	53	F	2	limited	19.4	0	156	42	110	75	1%	0.0
16	48	F	3	limited	22.5	0	92	NA	NA	174	NA	0.0
17	47	F	30	diffuse	20.4	0	139	65	57	160	＜1%	0.0
18	67	M	2	limited	22.6	50	114	NA	NA	NA	NA	0.0
19	62	M	4	diffuse	25.9	30	161	36	118	162	13%	79.3
20	59	F	13	diffuse	22.6	0	194	NA	NA	NA	NA	0.0
21	36	F	5	diffuse	19.8	0	152	63	81	60	＜1%	0.0
22	53	F	10	diffuse	22.4	0	191	49	118	135	1%	10.0
23	54	F	10	limited	17.9	0	217	76	128	51	1%	0.0
24	52	F	2	diffuse	19.6	0	169	64	90	74	＜1%	0.0
25	68	F	5	limited	21.1	10	210	60	114	200	4%	0.0
26	67	F	6	diffuse	23.2	0	164	56	83	190	2%	0.0
27	33	F	2	diffuse	20.4	0	129	NA	NA	NA	NA	0.0
28	61	F	9	diffuse	25.1	0	151	27	94	145	2%	0.0
29	69	F	4	limited	23.2	0	166	38	119	120	3%	0.0
30	34	F	15	diffuse	17.7	0	170	38	110	95	＜1%	0.0
31	66	F	14	diffuse	22.5	0	234	76	128	160	2%	0.0
32	66	F	15	limited	24.2	0	149	44	75	103	2%	16.6
33	35	F	3	limited	NA	0	191	NA	NA	NA	NA	0.0
34	59	F	1	limited	NA	0	195	39	218	174	2%	0.0
35	67	F	6	limited	24.7	0	193	50	160	167	2%	133.5

BMI: Body mass index, FRS: Framingham risk score, CCS: Coronary calcification score, HDL: High density lipoprotein cholesterol, LDL: Low density lipoprotein cholesterol, NA: Not available, Total chol.: Total cholesterol, TG: Triglyceride

Table 3.

Statistics of the coronary calcification scores in the 35 patients with systemic sclerosis

Variables	CCS, Mean±SD	CCS＞0, no. (%)
Total (n=35)	10.1±30.8	7 (20)
Sex
Male (n=2)	39.7±39.7	1 (50)
Female (n=33)	8.3±5.1	6 (18)
Subtyp
Limited (n=20)	13.3±36.9	5 (25)
Diffuse (n=15)	6.0±20.5	2 (13)

CCSs: Coronary calcification score

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