Agatston score

The Agatston score, also occasionally referred to as the "Agastone score", is a standardized measure utilized in diagnostic cardiology to evaluate the amount of calcium deposits present in coronary arteries. Conceived by Dr. Arthur Agatston, this measure serves as an important metric in the results obtained from a CT Test for Coronary Calcification.

Historical Background

The foundations of the Agatston score can be traced back to the 1980s, stemming from the collaborative efforts of Drs. Arthur Agatston and Janowitz, affiliated with the University of Miami School of Medicine. The pioneering work that laid the groundwork for this scoring system was reliant on electron beam computed tomography (EBCT), which is frequently referred to as ultrafast CT.

Calculation Principles

The methodology for determining the Agatston score is rooted in assessing the density of coronary artery calcification. This is gauged in terms of Hounsfield units (HU), with a set of predefined weighted values assigned as follows:

• Score of 1: 130–199 HU
• Score of 2: 200–299 HU
• Score of 3: 300–399 HU
• Score of 4: 400 HU or more

Subsequent to determining the density, the weighted score is multiplicated with the area (quantified in square millimeters) of the coronary calcification. For instance, if one identifies a "speck" of coronary calcification in the left anterior descending artery with an area of 4 square millimeters and a peak density of 270 HU, the resulting score would be 8, calculated as (4 square millimeters × weighted score of 2).

A typical CT scan encompasses tomographic slices of the heart that are approximately 3 millimeters in thickness, resulting in an average of 50–60 slices spanning from the coronary artery ostia to the inferior wall of the heart. By aggregating the calcium score of every discernible calcification across these slices for each coronary artery, one obtains the total coronary artery calcium score, often abbreviated as the CAC score.

Advancements and Refinements

The domain of calcium scoring has witnessed significant evolution, with innovative approaches devised to extract nuanced details pertaining to coronary plaque. One such method, the lesion-specific calcium-scoring technique, has emerged as a potentially more precise alternative, demonstrating superior efficacy in certain studies when juxtaposed against the traditional Agatston score.

Clinical Implications

The Agatston score serves as an instrumental tool in the clinician's repertoire, enabling:

• Risk stratification for coronary events
• Personalized therapeutic and interventional strategies
• Monitoring the trajectory of disease progression or the impact of interventions

While the score offers a plethora of insights, it's paramount for medical professionals to interpret it within the larger context of a comprehensive cardiac assessment.

See Also

• Coronary artery disease
• Atherosclerosis
• Computed tomography
• Hounsfield units