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Breast Arterial Calcifications on Mammography Do Not Predict Myocardial Ischemia on Myocardial Perfusion
Ahmed Fathala1, Salma Salem1, Fahad Alanazi1
1Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia.
Insights
Breast arterial calcification (BAC) on mammography does not predict myocardial ischemia (MI) on stress myocardial perfusion imaging. Further cardiac workup based on BAC presence is not warranted, as BAC is common but not a reliable indicator of MI.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Breast arterial calcification (BAC) is incidentally observed on mammography.
- The link between BAC and myocardial ischemia (MI) on stress myocardial perfusion imaging (MPS) is not well-established.
- This study investigates BAC as a predictor of MI.
Purpose of the Study:
- To determine if breast arterial calcification (BAC) on mammography predicts myocardial ischemia (MI) on stress myocardial perfusion single-photon emission computed tomography (MPS).
Main Methods:
- 435 women underwent mammography and stress MPS within one year.
- BAC was quantitatively evaluated; patients with known coronary artery disease were excluded.
- Risk factors for coronary artery disease were collected via chart review.
Main Results:
- BAC was present in 59% of women and associated with older age, hypertension, CKD, and diabetes.
- No significant associations were found between total BAC score or BAC categories and MPS results.
- BAC did not predict MI on stress MPS.
Conclusions:
- BAC on mammography does not predict MI on stress MPS.
- Further cardiac workup based solely on the presence of BAC is not recommended.
- BAC is common and linked to cardiovascular risk factors but not a direct predictor of MI on MPS.
Background:
The aim of this study was to determine if breast arterial calcification (BAC) on mammography predicts myocardial ischemia (MI) on stress myocardial perfusion single-photon emission computed tomography (MPS). BAC is a type of medial artery calcification that can be seen incidentally on mammography, but the relationship between coronary artery calcification and MI on MPS is yet unknown.
Methods:
A total of 435 consecutive women underwent mammography and stress MPS within 1 year of each other. BAC was quantitatively evaluated (0 - 13). Patients with known coronary artery diseases (CADs) such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), MI, positive coronary angiogram or positive MPS were excluded from the study. Risk factors for CAD were obtained from a chart review.
Results:
The mean age was 58 ± 8 years. BAC was found in 258 (59%) of the study population. BAC-positive patients were significantly older than BAC-negative patients (P < 0.0001), there were strong associations between BAC and hypertension (P = 0.0309), chronic kidney disease (CKD) (P = 0.0001), and diabetes (P = 0.0309), but there were significant associations between BACV and hyperlipidemia, family history of CAD, and smoking (P = 0.6856, P = 0.9642, and P = 0.087, respectively). The mean score of BAC was 5 ± 5 in patients with normal MPS and was 6 ± 6 in patients with abnormal MPS. There were no associations between total BAC and MPS results (P = 0.2095), and between BAC categories and MPS result (P = 0.3069).
Conclusions:
Based on our study, the presence and severity of BAC on screening or diagnostic mammography do not predict MI on stress MPS, and further cardiac workup based on the presence of BAC is not warranted. BAC is very common in mammography up to 59% and associated with age, diabetes, CKD, and hypertension. In contrast, the prevalence of MI is only 13% in women with BAC and associated with age, diabetes, CKD, hyperlipidemia, and impaired left ventricular function.
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