Gender Distribution of Coronary Artery Calcium Score and Degree of Stenosis Assessed by Computed Tomography Angiography in Iraqi Patients with Chest Pain:

Shaymaa Abdulqader; Ghasaq Ma'an Bakr; Saja Ali Ahmed; Qays Ahmed Hassan; Mortadha Al-Kinani

doi:10.54133/ajms.v7i1.1032

Authors

Shaymaa Abdulqader al Kindy college of medicine https://orcid.org/0000-0001-7029-0451
Ghasaq Ma'an Bakr Department of Radiology, College of Medicine, Diyala University, Diyala, Iraq
Saja Ali Ahmed Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-5741-1992
Qays Ahmed Hassan Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0003-4112-1688
Mortadha Al-Kinani The University of Texas Southwestern Medical Center, Dallas, Texas, USA https://orcid.org/0000-0001-6580-3486

DOI:

https://doi.org/10.54133/ajms.v7i1.1032

Keywords:

Agatston score, Coronary artery calcium, Coronary artery disease, Sex difference

Abstract

Background: Sex variations in coronary artery disease (CAD) are well documented. However, sex differences in coronary artery calcium (CAC) and its role in the detection of coronary artery stenosis remain controversial. Objective: To assess the impact of sex variation on coronary artery calcification and its efficacy in predicting coronary artery stenosis. Methods: This is a cross-sectional observational study including 230 consecutive patients with suspected CAD (120 men and 110 women) referred for coronary computed tomography angiography (CCTA). The study analyzed sex-based differences in the sensitivity and specificity of coronary artery calcification (CAC) for detecting moderate to severe stenosis across various coronary arteries. Results: The calcification scores 1-100 and 101-<400 were slightly more frequent in men (25% and 10%, respectively) than women (20.91% and 7.27%, respectively); however, the differences were not significant. For the left anterior descending artery (LAD), men showed slightly higher sensitivity and specificity (69.23% and 81.48%, respectively) than women (61.9% and 79.78%, respectively). For the left circumflex artery (LCX), men showed relatively higher sensitivity (68.75%) and lower specificity (89.42%) than women (50% and 98.81%, respectively). For the right coronary artery (RCA), women showed relatively higher sensitivity and specificity (75% and 93.4%, respectively) than men (50% and 91.82%, respectively). Conclusions: While the CAC has a relatively high specificity and low sensitivity in the detection of coronary artery disease, there is no difference in the score between men and women. When comparing vessels, women exhibit greater RCA calcification sensitivity and specificity than men, whereas for LAD, the opposite is true.

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References

Kuneman JH, Bax JJ. Sex differences in coronary artery disease. Neth Heart J. 2021;29(10):486-489. doi: 10.1007/s12471-021-01619-x. DOI: https://doi.org/10.1007/s12471-021-01619-x

Senoner T, Plank F, Beyer C, Langer C, Birkl K, Steinkohl F, et al. Gender differences in the atherosclerosis profile by coronary CTA in coronary artery calcium score zero patients. J Clin Med. 2021;10(6):1220. doi: 10.3390/jcm10061220. DOI: https://doi.org/10.3390/jcm10061220

Park SM, Merz CN. Women and ischemic heart disease: recognition, diagnosis and management. Korean Circ J. 2016;46(4):433. doi: 10.4070/kcj.2016.46.4.433. DOI: https://doi.org/10.4070/kcj.2016.46.4.433

Makaryus AN, Sison C, Kohansieh M, Makaryus JN. Implications of gender difference in coronary calcification as assessed by CT coronary angiography. Clin Med Insight Cardiol. 2014;8:S18764. doi: 10.4137/CMC.S18764. DOI: https://doi.org/10.4137/CMC.S18764

Mangla A, Oliveros E, Williams Sr KA, Kalra DK. Cardiac imaging in the diagnosis of coronary artery disease. Curr Problems Cardiol. 2017;42(10):316-366. doi: 10.1016/j.cpcardiol.2017.04.005. DOI: https://doi.org/10.1016/j.cpcardiol.2017.04.005

McCollough CH, Ulzheimer S, Halliburton SS, Shanneik K, White RD, Kalender WA. Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT. Radiology. 2007;243(2):527-538. doi: 10.1148/radiol.2432050808. DOI: https://doi.org/10.1148/radiol.2432050808

Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. J Am Coll Cardiol. 2018;72(4):434-447. doi: 10.1016/j.jacc.2018.05.027. DOI: https://doi.org/10.1016/j.jacc.2018.05.027

Al-Mallah MH, Qureshi W, Lin FY, Achenbach S, Berman DS, Budoff MJ, et al. Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry. Eur Heart J Cardiovasc Imag. 2014;15(3):267-274. doi: 10.1093/ehjci/jet148. DOI: https://doi.org/10.1093/ehjci/jet148

Chow BJ, Yam Y, Small G, Wells GA, Crean AM, Ruddy TD, et al. Prognostic durability of coronary computed tomography angiography. Eur Heart J Cardiovasc Imag. 2021;22(3):331-338. doi: 10.1093/ehjci/jeaa196. DOI: https://doi.org/10.1093/ehjci/jeaa196

Kai N, Oda S, Utsunomiya D, Nakaura T, Funama Y, Kidoh M, et al. Dual-region-of-interest bolus-tracking technique for coronary computed tomographic angiography on a 320-row scanner: reduction in the interpatient variability of arterial contrast enhancement. Br J Radiol. 2018;91(1081):20170541. doi: 10.1259/bjr.20170541. DOI: https://doi.org/10.1259/bjr.20170541

Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. In: Seminars in Ultrasound, CT and MRI, WB Saunders, 2022. pp. 184-193. doi: 10.1053/j.sult.2022.01.005. DOI: https://doi.org/10.1053/j.sult.2022.01.005

Sun Z, Ng CK, Xu L, Fan Z, Lei J. Coronary CT angiography in heavily calcified coronary arteries: Improvement of coronary lumen visualization and coronary stenosis assessment with image postprocessing methods. Medicine. 2015;94(48):e2148. doi: 10.1097/MD.0000000000002148. DOI: https://doi.org/10.1097/MD.0000000000002148

Mohammad AM, Rashad HH, Habeeb QS, Rashad BH, Saeed SY. Demographic, clinical and angiographic profile of coronary artery disease in Kurdistan region of Iraq. Am J Cardiovasc Dis. 2021;11(1):39. PMID: 33815918.

Mohamed M, Bosserdt M, Wieske V, Dubourg B, Alkadhi H, Garcia MJ, et al. Combination of computed tomography angiography with coronary artery calcium score for improved diagnosis of coronary artery disease: a collaborative meta-analysis of stable chest pain patients referred for invasive coronary angiography. Eur Radiol. 2024;34(4):2426-2436. doi: 10.1007/s00330-023-10223-z. DOI: https://doi.org/10.1007/s00330-023-10223-z

Arbab-Zadeh A, Miller JM, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification: the CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol. 2012;59(4):379-387. DOI: 10.1016/j.jacc.2011.06.079. DOI: https://doi.org/10.1016/j.jacc.2011.06.079

Czaja-Ziółkowska M, Wasilewski J, Gąsior M, Głowacki J. An update on the coronary calcium score: a review for clinicians. Adv Intervent Cardiol. 2022;18(3):201-205. doi: 10.5114/aic.2022.121035. DOI: https://doi.org/10.5114/aic.2022.121035

Celeng C, Leiner T, Maurovich-Horvat P, Merkely B, de Jong P, Dankbaar JW, van Es HW, Ghoshhajra BB, Hoffmann U, Takx RA. Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis. JACC Cardiovas Imag. 2019;12(7 Part 2):1316-1325. doi: 10.1016/j.jcmg.2018.07.022. DOI: https://doi.org/10.1016/j.jcmg.2018.07.022

Raggi P, Shaw LJ, Berman DS, Callister TQ. Gender-based differences in the prognostic value of coronary calcification. J Women's Health. 2004;13(3):273-83. doi: 10.1089/154099904323016437. DOI: https://doi.org/10.1089/154099904323016437

Lessmann N, de Jong PA, Celeng C, Takx RA, Viergever MA, van Ginneken B, et al. Sex differences in coronary artery and thoracic aorta calcification and their association with cardiovascular mortality in heavy smokers. JACC Cardiovasc Imag. 2019;12(9):1808-1817. doi: 10.1016/j.jcmg.2018.10.026. DOI: https://doi.org/10.1016/j.jcmg.2018.10.026

McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113(1):30-37. doi: 10.1161/CIRCULATIONAHA.105.580696. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.580696

Shaw LJ, Min JK, Nasir K, Xie JX, Berman DS, Miedema MD, et al. Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC consortium. Eur Heart J. 2018;39(41):3727-3735. doi: 10.1093/eurheartj/ehy534. DOI: https://doi.org/10.1093/eurheartj/ehy534

Nakao YM, Miyamoto Y, Higashi M, Noguchi T, Ohishi M, Kubota I, et al. Sex differences in impact of coronary artery calcification to predict coronary artery disease. Heart. 2018;104(13):1118-1124. doi: 10.1136/heartjnl-2017-312151. DOI: https://doi.org/10.1136/heartjnl-2017-312151

El Mahdiui M, Smit JM, van Rosendael AR, Neglia D, Knuuti J, Saraste A, et al. Sex differences in coronary plaque changes assessed by serial computed tomography angiography. Int J Cardiovas Imag. 2021;37:2311-2321. doi: 10.1007/s10554-021-02204-4. DOI: https://doi.org/10.1007/s10554-021-02204-4

Chiha J, Mitchell P, Gopinath B, Burlutsky G, Plant A, Kovoor P, et al. Prediction of coronary artery disease extent and severity using pulse wave velocity. PLoS One. 2016;11(12):e0168598. doi: 10.1371/journal.pone.0168598. DOI: https://doi.org/10.1371/journal.pone.0168598

Lin C, McCarthy CP, Mohebi R, Liu Y, Blankstein R, Murphy SP, et al. Sex differences in coronary artery disease characteristics among patients with type 2 myocardial infarction. JACC Adv. 2024;3(2):100795. doi: 10.1016/j.jacadv.2023.100795. DOI: https://doi.org/10.1016/j.jacadv.2023.100795

Meyer MR, Barton M. Estrogens and coronary artery disease: new clinical perspectives. Adv Pharmacol. 2016;77:307-360. doi: 10.1016/bs.apha.2016.05.003. DOI: https://doi.org/10.1016/bs.apha.2016.05.003

Yamamoto H, Kitagawa T, Kihara Y. Clinical implications of the coronary artery calcium score in Japanese patients. J Atheroscler Thromb. 2014;21(11):1101-1108. doi: 10.5551/jat.26427. DOI: https://doi.org/10.5551/jat.26427

Motevalli M, Ghanaati H, Firouznia K, Kargar J, Ghasabeh MA, Shahriari M, et al. Diagnostic efficacy of vessel specific coronary calcium score in detection of coronary artery stenosis. Iran Red Cresc Med J. 2014;16(12). doi: 10.5812/ircmj.26010. DOI: https://doi.org/10.5812/ircmj.26010

Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001;37(2):451-457. doi: 10.1016/s0735-1097(00)01119-0. DOI: https://doi.org/10.1016/S0735-1097(00)01119-0

Budoff MJ, Diamond GA, Raggi P, Arad Y, Guerci AD, Callister TQ, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation. 2002;105(15):1791-1796. doi: 10.1161/01.cir.0000014483.43921.8c. DOI: https://doi.org/10.1161/01.CIR.0000014483.43921.8C