DETECTION AND QUANTITATION OF CALCIFIC ATHEROSCLEROSIS BY ULTRAFAST COMPUTED-TOMOGRAPHY IN CHILDREN AND YOUNG-ADULTS WITH HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA

Ultrafast computed tomography (CT) is a new method for detecting calci fic lesions in the coronary arteries. The ability of CT to detect and quantify coronary artery atherosclerosis in children and young adults at risk for malignant atherogenesis was evaluated. A total of 11 conse cutive familial hypercholesterolemic (FH) homozygotes (3 to 37 years o ld) participated. Untreated total cholesterol concentrations were 488 to 1277 mg/dL (12.7 to 33.2 mmol/L). Angiography detected significant lesions in 7 of 11 patients. CT detected calcific atherosclerosis in a ll 9 of the patients older than 12 years of age, including all those w ith angina. CT was more sensitive in detecting aortic root and coronar y ostial lesions, where atherosclerosis first appears in homozygous FH . The volume of calcification (in cubic millimeters) correlated with t he severity and duration of the hypercholesterolemia (r=.62, P<.05) as well as with the presence of angina (P<.05). All patients with angina (7 of 7) had >150 mm(3) of calcified volume, whereas only 1 of 4 asym ptomatic patients had a volume score >150 mm(3). We conclude that (1) coronary and aortic calcium phosphate deposits are common in young FH homozygotes; (2) these deposits are associated with the presence of an giographic stenoses, as has been seen in adults with coronary atherosc lerosis; and (3) aortic calcific deposits are more common than calcifi c coronary lesions.