Author + information
- Received January 15, 2004
- Revision received June 14, 2004
- Accepted June 15, 2004
- Published online August 18, 2004.
- Daniel S. Berman, MD, FACC*,†,* (, )
- Nathan D. Wong, PhD, FACC‡,
- Heidi Gransar, MS*,†,
- Romalisa Miranda-Peats, MPH*,†,
- John Dahlbeck, BS*,†,
- Sean W. Hayes, MD*,†,
- John D. Friedman, MD, FACC*,†,
- Xingping Kang, MD*,†,
- Donna Polk, MD, MPH*,†,
- Rory Hachamovitch, MD, FACC§,
- Leslee Shaw, PhD*,† and
- Alan Rozanski, MD, FACC*,†
- ↵*Reprint requests and correspondence:
Dr. Daniel S. Berman, Director of Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Building, Room 1258, Los Angeles, California 90048
Objectives We assessed the relationship between stress-induced myocardial ischemia on myocardial perfusion single-photon emission computed tomography (MPS) and magnitude of coronary artery calcification (CAC) by X-ray tomography in patients undergoing both tests.
Background There has been little evaluation regarding the relationship between CAC and inducible ischemia or parameters that might modify this relationship.
Methods A total of 1,195 patients without known coronary disease, 51% asymptomatic, underwent stress MPS and CAC tomography within 7.2 ± 44.8 days. The frequency of ischemia by MPS was compared to the magnitude of CAC abnormality.
Results Among 76 patients with ischemic MPS, the CAC scores were >0 in 95%, ≥100 in 88%, and ≥400 in 68%. Of 1,119 normal MPS patients, CAC scores were >0, ≥100, and ≥400 in 78%, 56%, and 31%, respectively. The frequency of ischemic MPS was <2% with CAC scores <100 and increased progressively with CAC ≥100 (p for trend <0.0001). Patients with symptoms with CAC scores ≥400 had increased likelihood of MPS ischemia versus those without symptoms (p = 0.025). Absolute rather than percentile CAC score was the most potent predictor of MPS ischemia by multivariable analysis. Importantly, 56% of patients with normal MPS had CAC scores ≥100.
Conclusions Ischemic MPS is associated with a high likelihood of subclinical atherosclerosis by CAC, but is rarely seen for CAC scores <100. In most patients, low CAC scores appear to obviate the need for subsequent noninvasive testing. Normal MPS patients, however, frequently have extensive atherosclerosis by CAC criteria. These findings imply a potential role for applying CAC screening afterMPS among patients manifesting normal MPS.
This study was supported by a grant from the Eisner Foundation, Los Angeles, California. Dr. John J. Mahamarian acted as Guest Editor for this paper.
- Received January 15, 2004.
- Revision received June 14, 2004.
- Accepted June 15, 2004.
- American College of Cardiology Foundation