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Updated: Jul 18, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relationship between coronary artery calcification detected by electron-beam computed tomography and abnormal stress
Gautam Ramakrishna1, Jerome F Breen, Sharon L Mulvagh
1Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Electron-beam computed tomography (EBCT) coronary artery calcium scores (CACS) predict abnormal exercise echocardiography wall motion score index (WMSI), but most patients with high CACS have normal WMSI. Age and WMSI best predict cardiac events.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Elevated coronary artery calcium scores (CACS) on electron-beam computed tomography (EBCT) may lead to exercise echocardiography referrals.
- The relationship between EBCT CACS and exercise echocardiography's wall motion score index (WMSI) is not well-established.
Purpose of the Study:
- To compare the diagnostic results and prognostic value of EBCT and exercise echocardiography.
- To investigate the association between EBCT-derived CACS and exercise-induced WMSI.
Main Methods:
- Identified 556 patients without known coronary artery disease who underwent both EBCT and exercise echocardiography within 3 months.
- Calculated EBCT CACS using the Agatston scoring system and exercise WMSI using a 16-segment model.
- Followed patients for the combined endpoint of death and myocardial infarction.
Main Results:
- A statistically significant, though limited, correlation was found between EBCT CACS and exercise WMSI (r = 0.17, p < 0.0001).
- Abnormal exercise WMSI increased with CACS severity, but 66% of patients with CACS > 400 had normal WMSI.
- Age, CACS, and chest pain independently predicted abnormal exercise WMSI; age and WMSI predicted cardiac events.
Conclusions:
- EBCT CACS predicts abnormal exercise WMSI, but most patients with elevated CACS show normal WMSI.
- Wall motion score index and age are the strongest predictors of cardiac events.
- Further prospective studies are needed to define the roles of EBCT and exercise echocardiography in risk stratification.
Objectives:
The purpose of this study was to compare the results and prognostic value of electron-beam computed tomography (EBCT) and exercise echocardiography.
Background:
Although patients with elevated coronary artery calcium scores (CACS) might be referred for exercise echocardiography, the association of EBCT CACS with wall motion score index (WMSI) is not known.
Methods:
Patients without known coronary artery disease who underwent both clinically indicated EBCT and exercise echocardiography within a 3-month period were identified. Exercise WMSI was based on a 16-segment model (normal = 1; abnormal >1). The EBCT CACS was derived with the Agatston scoring system. Follow-up was obtained for the combined end point of death and myocardial infarction.
Results:
The study population included 556 patients (age 54 +/- 10 years; 65% male). Correlation between EBCT CACS and exercise WMSI was limited (r = 0.17, p < 0.0001) but statistically significant. The proportion of patients with abnormal exercise WMSI increased with increasing CACS severity (chi-square = 19.1, p < 0.001). However, even in those with CACS >400, 66% had normal exercise WMSI. Age, CACS, and chest pain were independently associated with abnormal exercise WMSI. Events occurred in 12 (2%) patients. Wall motion score index (risk ratio [RR] 3.7, p = 0.023) and age (RR 1.9, p = 0.019) were associated with events.
Conclusions:
Electron-beam computed tomography CACS was predictive of abnormal exercise WMSI, but the majority of patients with elevated CACS had normal WMSI. Wall motion score index and age were the best predictors of events. Prospective studies are indicated to establish the relative roles of these tests in risk stratification.
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