Related Experiment Video
Updated: May 13, 2026
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Prognostic interplay of coronary artery calcification and underlying vascular dysfunction in patients with suspected
Masanao Naya1, Venkatesh L Murthy, Courtney R Foster
1Division of Cardiovascular Medicine, Department of Medicine, Non-Invasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Insights
Coronary vascular function, measured by coronary flow reserve (CFR), is a better predictor of major adverse cardiac events (MACE) than coronary artery calcium (CAC) burden in patients with normal myocardial perfusion imaging. CFR provides incremental risk stratification for cardiac outcomes.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- The combined impact of coronary atherosclerotic burden and coronary vascular dysfunction on cardiac events remains unclear.
- Evaluating the predictive value of coronary artery calcium (CAC) and coronary flow reserve (CFR) for clinical outcomes is crucial.
Purpose of the Study:
- To assess the interrelation between atherosclerotic burden (CAC score) and coronary vascular function (CFR) in predicting clinical outcomes.
- To determine if CFR or CAC provides superior risk stratification for major adverse cardiac events (MACE).
Main Methods:
- 901 patients with normal myocardial perfusion imaging (MPI) underwent CAC scans and (82)Rubidium PET imaging for CFR assessment.
- The primary endpoint was a composite of MACE, including cardiac death, myocardial infarction, late revascularization, and heart failure admission.
- Cox proportional hazards analysis was used to evaluate the predictive capabilities of CFR and CAC.
Main Results:
- CFR decreased with increasing CAC scores (p < 0.0001).
- Higher MACE rates were observed in patients with CFR < 2.0 (5.5%/year) compared to CFR ≥ 2.0 (1.9%/year, p = 0.0007).
- Impaired CFR independently predicted MACE, even in patients with CAC = 0 (p = 0.03), and improved risk reclassification over clinical risk scores, whereas CAC did not.
Conclusions:
- In symptomatic patients with normal MPI, global CFR is a significant independent predictor of MACE.
- CFR offers superior incremental risk stratification for MACE compared to CAC score when added to clinical risk assessment.
Objectives:
This study sought to evaluate the interrelation of atherosclerotic burden, as assessed by coronary artery calcium (CAC) score and coronary vascular function, as assessed by quantitative estimates of coronary flow reserve (CFR), with respect to prediction of clinical outcomes.
Background:
The contribution of coronary vascular dysfunction, atherosclerotic burden, and the 2 combined to cardiac events is unknown.
Method:
A total of 901 consecutive patients underwent (82)Rubidium myocardial perfusion imaging (MPI) positron emission tomography (PET) and CAC scan. All patients had normal MPI. The primary endpoint was a composite of major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, late revascularization, and admission for heart failure.
Results:
At baseline, CFR decreased (2.15 ± 0.72, 2.02 ± 0.65, and 1.88 ± 0.64, p < 0.0001) with increasing levels of CAC (0, 1 to 399, and ≥400). Over a median of 1.53 years (interquartile range: 0.77 to 2.44), there were 57 MACE. Annual risk-adjusted MACE rates were higher for patients with CFR <2.0 compared with ≥2.0 (1.9 vs. 5.5%/year, p = 0.0007) but were only borderline associated with CAC (3.1%, 3.4%, and 6.2%/year for CAC of 0, 1 to 399, and ≥400, respectively; p = 0.09). Annualized adjusted MACE was increased in the presence of impaired CFR even among patients with CAC = 0 (1.4% vs. 5.2%, p = 0.03). Cox proportional hazards analysis revealed that CFR improved model fit, risk discrimination, and risk reclassification over clinical risk, whereas CAC only modestly improved model fit without improving risk discrimination or reclassification.
Conclusions:
In symptomatic patients with normal MPI, global CFR but not CAC provides significant incremental risk stratification over clinical risk score for prediction of major adverse cardiac events.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies