Thread by @AChoiHeart

Intro to #CAC Tweetorial!

For #ACCFIT, @FiRSTSCCT @ACRRFS #ACCImaging,
@heart_scct #YesCCT #AHA18 #SCCT2019 #Cardiotwitter 😀😀

*⃣Case
*⃣Basics on CAC
*⃣CAC & prognosis
*⃣ACC/AHA 2018 vs SCCT 2017 guidelines
*⃣Case follow-up
(1/n)

Here’s a case – similar to patients we see everyday in the primary care and cardiology offices. (2/n)

72 year-old asymptomatic healthy 💃
BP 117/74, BMI 22
Lipids: TC 270, TG 100 HDL 90 LDL 155
ACC/AHA ASCVD Risk: 10%

#AHA2018 #YesCCT #CAC #ACCImaging

POLL:

Based on the clinical information, would you (3/n):

#AHA2018 #YesCCT #CAC #SCCT2019 #ACCImaging #Cardiotwitter

What is coronary artery calcification?

Atherosclerosis starts as a fatty streak w/i the coronary intima, but importantly does *not* correlate with angiographic luminal stenosis and usually represents pre-clinical athero. **(Severe CAC ≠ severe stenosis!!!)**
(4/n) #AHA18

CAC quantification inc. coronary plaques at > 130 Hounsfeld Units (HU) on CT multiplied by the area of plaque. (0 HU = Water)
Taking all plaques in the coronary tree = Agatston Score.
Dr. Agatston (he of South Beach Diet) wrote seminal paper JACC in 1990. (5/n) #AHA18

#CAC has important prognostication – in multiple ethnic groups and women. The multi-ethnic society of atherosclerosis (MESA) of 6,814 ethnically diverse adults showed the prognostic value of CAC score. (6/n) #AHA18 #YesCCT

#CAC is a also better predictor of long-term outcomes in women vs risk score as cited from MESA in a just published in @journalCCT - expert consensus on #YesCCT in women

@QuynhTruongMD , @lesleejshaw & @Heart_SCCT Women's Committee (7/n)
#AHA18 #YesCCT

ow.ly/KWyg50jC2ri

.@khurramn1 @MBittencourtMD @MichaelJBlaha @RonBlankstein @lesleejshaw @hmkyale & others others among thought leaders articulating value of #CAC for decision-making

Recent seminal 2015 @JACCJournals paper- MESA data risk in pts w 0 CAC or > 0 CAC . #AHA18 #YesCCT (8/n)

In reviewing new 2018 ACC/AHA guidelines in @JACCJournals @CircAHA & 2017 @Heart_SCCT guidelines in @journalCCT on #CAC they draw conceptually from @khurramn1 2015 paper & shows close alignment to each other in recommendations.
#AHA18 # (9/n)

ow.ly/lKcx50jC1Z5

Both guidelines suggest this approach:
1) Eval ASCVD risk. 2) If intermediate range, discuss risk w pt 3) If uncertainty, perform CAC to refine. 4) If CAC > 0, add statin. Consider no 💊if CAC=0. #ThePowerofZero (10/n)
ACC/AHA – adds use of “risk enhancers”
#AHA18

The @heart_scct 2017 consensus document in @journalCCT also offers additional recommendations on non-gated CT, high risk asymptomatic patients, and use of CAC in SPECT and PET imaging. (11/n)
#AHA18 #YesCCT #SCCT2019 #ACCImaging #Cardiotwitter

https://twitter.com/journalCCT/status/1060185188150530048

In our patient, 72F with ASCVD risk of 10% -- joint discussion with the patient (now supported by ACC/AHA 2018 guideline) as she was reluctant to start on statins. Her CAC was zero! (12/n)

#AHA18 #YesCCT #SCCT2019

This allowed through SDM -> ❤️lifestyle and no new 💊💊! Yes!!

3 years later, patient remains in excellent health. (12/n)

Congratulations and THANK YOU to @khuramnasir @MichaelJBLaha @RonBlankstein @LesleeJShaw and global team for yrs of work refining this approach

#AHA18

Postscript - (14/14) @heart_SCCT
For a deeper dive into #CAC & all aspects of cardiovascular CT/#YesCCT -- please mark your calendars and join us for #SCCT2019 in Baltimore, MD, July 2019!

@RonBlankstein @MBittencourtMD @ghoshhajra @SuhnyAbbara @lesleejshaw @FiRSTSCCT