The Association between Carotid Artery Calcium on Dental Panoramic Radiographs and Coronary Calcium Score in Chest Computerized Tomography - The 67th Annual Conference of the Israel Heart Society

Shemy Carasso ^1,3 Dalit Porat Ben-Ami ^2,3 Mariana Masrawi ^2,3 Fabio Kusniec ^1,3 Diab Ghanim ³ Chen Shmuel ^2,3 Imad Abu El Naaj ^2,3 Gabi Elbaz Greener ^1,3 Erez Kachel ^1,3 Offer Amir ^1,3

¹Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel
²Oral and Cranio-maxillofacial surgery Department, B Padeh Medical Center, Poriya, Lower Galilee, Israel
³The Azrieli Faculty of Medicine in the Galilee, Safed, Bar-Ilan University, Israel

Background

Coronary artery calcium (CAC) measured by computerized tomography (CT) predicts future coronary events. Similarly, carotid arteries calcium in dental panoramic radiographs (DPR) has been associated with cardiovascular risk. Pre-procedural assessment of candidates for valve replacement in our institution includes DPRs and chest CT. We aimed to correlate quantitative carotid calcium on DPR with CAC measured on chest CT.

Methods

Paired pre-procedural DPR and chest CT scans were done in 177 patients (age 69±12years, 53% males) between October 2016-October 2017. DPR carotid calcium was quantified using NIH’s ImageJ. CAC was quantified by the Agatston score using Philips Intellispace portal, V8.0.1.20640). Patients were divided into two groups based on CAC requiring interventions: no intervention advised (CAC=0-99); statin or coronary angiography advised (CAC 100-299, CAC≥300, respectively).

Results

Patients with CAC≥100 (n=120) were older; more were men, likely to have had a previous coronary intervention, hypertension, renal failure and ventricular hypertrophy compared to patients with CAC 0-99 (n=57) (table). Left ventricular systolic function was similar. Carotid calcium maximal intensity, area and perimeter were significantly higher among patients in high compared to low CAC. Non-zreo carotid calcium (Max>0) was found in half of patients with high CAC, doubling prevalence of low CAC. Multivariable logistic regression including risk factors and Max>0 revealed hypertension (HR=4.8, CI 2.02-11.26, p<0.0004) and Max>0 (HR=3.1, CI 1.28-7.37, p=0.0117) as significant associates of intervention level CAC.

Conclusion

Carotid calcium identified in DPR was associated with intervention-level CAC. Calcium recognized by dental surgeons in DPR may serve as a screening tool for coronary disease .