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To the Editor: Dr Greenland and colleagues¹ stated that "absence of CACS did not preclude the risk of a CHD [coronary heart disease] event as has been reported in some other studies." However, in explaining why individuals without detectable CAC might experience coronary events, the authors did not consider that their scanning methodology used a 6-mm scan thickness, twice the scan thickness used in other prognostic studies. For instance, Callister et al² evaluated patients with both 3-mm and 6-mm scans and concluded that "[a] 6-mm slicing protocol is significantly less sensitive than a 3-mm protocol for the detection and quantification of CAC. Since one-third of coronary events occur in patients with low CACS, a 6-mm protocol might be unreliable for risk assessment because of substantial loss of information."

Greenland et al reported that "CACS (was) calculated by the Agatston method." However, the authors used a minimal volume of 8.16 mm³ . . . [Full Text of this Article]

Matthew J. Budoff, MD
Budoff@Flash.net
Harbor-UCLA Research and Education Insitute
Harbor-UCLA Medical Center
Torrance, Calif

James Ehrlich, MD
Department of Medicine
George Washington University School of Medicine
Washington, DC

Harvey S. Hecht, MD
Beth Israel Medical Center and the Continuum Heart Institute
New York, NY

John A. Rumberger, PhD, MD
Division of Cardiology
The Ohio State University
Columbus

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