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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
The Relationship Between Absence Coronary Artery Calcification and Myocardial Perfusion Single Photon Emission
Muhannad Alanazi1, Alaa AlDuraibi1, Mohamamed M Shoukri2
1Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, Riyadh, Saudi Arabia.
Insights
A zero Coronary Artery Calcification Score (CACS) in symptomatic patients with low to intermediate risk suggests a very low likelihood of obstructive coronary artery disease (CAD). Further testing may not be beneficial if myocardial perfusion imaging (MPS) is normal.
Area of Science:
- Cardiology
- Radiology
- Nuclear Medicine
Background:
- Coronary Artery Calcification Score (CACS) is a validated prognostic tool for Coronary Artery Disease (CAD).
- Limited data exists on myocardial ischemia prevalence in symptomatic patients with zero CACS and low-to-intermediate risk.
- The diagnostic utility of zero CACS in excluding myocardial ischemia needs further evaluation.
Purpose of the Study:
- To assess the capability of a zero CACS to exclude myocardial ischemia on Myocardial Perfusion Single Photon Emission Computed Tomography (MPS).
- To evaluate the prevalence of myocardial ischemia in symptomatic patients with zero CACS.
Main Methods:
- 157 patients with suspected CAD and low-to-intermediate pretest likelihood underwent CACS.
- All patients with zero CACS subsequently underwent MPS.
- Patients with abnormal MPS were further evaluated with Coronary Computed Tomography Angiography (CCTA).
Main Results:
- Out of 157 patients with zero CACS, 122 (78%) had normal MPS, while 35 (22%) had abnormal MPS.
- Abnormal MPS findings included fixed defects (13%), equivocal (6%), and reversible defects (3%).
- CCTA in patients with abnormal MPS revealed normal coronaries in 85%, with minor findings in the remainder.
Conclusions:
- Zero CACS in low-to-intermediate risk patients indicates a <1% likelihood of obstructive CAD.
- Normal MPS in zero CACS patients suggests further testing may not be beneficial.
- Abnormal MPS in zero CACS patients warrants further CCTA for coronary and cardiac morphology assessment.
Background:
Coronary artery calcification score (CACS) is well validated prognostic tool in coronary artery disease (CAD). The data on the prevalence of myocardial ischemia on myocardial perfusion single photon emission computed tomography (MPS) in symptomatic patients with zero CACS and low to intermediate risk probability is lacking and controversial. The aim of our study was to evaluate the capability of zero CACS to exclude myocardial ischemia on MPS.
Methods:
A total of 157 patients ((mean age 53 ± 10 years), 88 (56%) female patients, 69 (44%) male patients) who were suspected to have CAD and having low to intermediate pretest likelihood for CAD underwent CACS on dedicated computed tomography (CT) scanners. CACS was reported as zero in all patients, subsequently all patients underwent MPS. Patients with abnormal MPS underwent additional imaging with coronary computed tomography angiography (CCTA).
Results:
All patients had zero CACS, of which 122 (78%) had normal MPS, and 35 (22%) had abnormal MPS. Abnormal MPS included fixed defect in 22 (13%), equivocal in 10 (6%), and reversible defect in four (3%) patients. All patients with abnormal MPS had further imaging with CTCA. CTCA was normal in 30 (85%) patients, one patient had coronary artery stenosis more than 50%, one patient had coronary artery stenosis less than 50%, one patient had anomalous origin coronary artery, and two patients had myocardial bridging. Patients with abnormal MPS and normal coronary artery had dilated cardiomyopathy in 14 (40%), asymmetrical septal hypotrophy in one (3%), and mitral valve disease in three (9%).
Conclusions:
Zero CACS in stable patients with low or intermediate risk indicated very low likelihood of obstructive CAD, less than 1%. Patients with zero CACS and normal MPS most likely will not benefit from further testing; however, patients with abnormal MPS will need further imaging with CCTA. CCTA is helpful in this group of patients for evaluation of coronary artery and cardiac morphology.
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