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Updated: Jul 1, 2025

Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
06:57

Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection

Published on: September 22, 2023

983

The Zero Calcium Score Paradox

Rachad Ghazal1, Danish Bawa1, Adnan Ahmed1

  • 1Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA.

JACC. Case Reports
|March 11, 2024
PubMed

Insights

A zero calcium score did not rule out severe coronary artery disease in this angina patient. Noncalcified plaque can cause significant stenosis, limiting the coronary calcium score

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) is a leading cause of mortality.
  • Coronary calcium score (CCS) is a widely used tool for cardiovascular risk assessment.
  • Noncalcified plaque represents a significant, yet often underestimated, component of atherosclerosis.

Purpose of the Study:

  • To present a case of angina with severe coronary stenosis despite a zero calcium score.
  • To highlight the limitations of the coronary calcium score in symptomatic patients.
  • To emphasize the prognostic importance of noncalcified plaque.

Main Methods:

  • Case report of a patient presenting with angina.
  • Coronary computed tomography angiography (CCTA) to assess coronary anatomy and plaque burden.
  • Evaluation of coronary calcium score in conjunction with plaque characterization.

Main Results:

  • The patient exhibited severe coronary stenosis.
  • The coronary calcium score was zero, indicating no calcified plaque.
  • Noncalcified plaque was identified as the cause of the significant stenosis.

Conclusions:

  • A zero coronary calcium score does not exclude severe coronary artery disease.
  • Noncalcified plaque can lead to significant coronary stenosis and symptoms.
  • The coronary calcium score should not be used as a sole predictive tool in symptomatic individuals.

Keywords:
CTA coronary angiographyarterial plaquecoronary artery calcium scorecoronary artery diseasecoronary atherosclerosiscoronary calcification

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