Profile picture
Dr Andrew D. Choi @AChoiHeart
, 14 tweets, 21 min read Read on Twitter
Intro to #CAC Tweetorial!

@heart_scct #YesCCT #AHA18 #SCCT2019 #Cardiotwitter 😀😀

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

#AHA2018 #YesCCT #CAC #ACCImaging

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
.@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)
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”
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

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

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
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Dr Andrew D. Choi
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member and get exclusive features!

Premium member ($30.00/year)

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!