Related Experiment Video
Updated: Jun 17, 2025
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Refining Cardiovascular Calcification in the Appraisal of Ischemic Heart
Vinh Nguyen1, Jerry Fan1, Imran Hafeez2
1Cardiology, Baylor Scott and White Medical Center - Temple, Temple, USA.
Insights
The complete absence of cardiovascular calcification strongly predicts no significant myocardial perfusion defects. Patients with suspected ischemia but no calcifications can be safely managed medically without further nuclear stress testing.
Area of Science:
- Cardiology
- Radiology
- Nuclear Medicine
Background:
- Cardiovascular calcification, including coronary arteries and valves, is linked to myocardial ischemia.
- Absence of calcification is a strong negative predictor of cardiovascular events and ischemia.
- Chest CT imaging can identify cardiovascular calcification to guide ischemia diagnosis.
Purpose of the Study:
- To evaluate the negative predictive value of absent cardiovascular calcification for myocardial perfusion defects.
- To determine if patients with suspected ischemia and no calcifications can avoid further diagnostic imaging.
Main Methods:
- Retrospective review of 132 patients undergoing non-contrast CT for SPECT/PET attenuation correction.
- Cardiologist and radiologist blinded assessment for cardiovascular calcification (coronary, valvular, thoracic aorta).
- Analysis of medical records for demographics and history.
Main Results:
- None of the 132 patients without calcifications had significant myocardial perfusion defects on SPECT/PET.
- Seven patients had minor defects, but none were significant; six were managed medically.
- Follow-up angiography/CTA in two patients showed no significant coronary artery disease.
Conclusions:
- Complete absence of cardiovascular calcification has 100% negative predictive value for significant perfusion defects.
- Patients with suspected ischemia and absent cardiovascular calcification can be safely managed medically.
- Further nuclear stress testing may be unnecessary in this patient group.
Background:
Even in asymptomatic patients, there is a high association of ischemia on myocardial perfusion scans in those with coronary artery calcification or valvular calcifications. Patients without coronary artery calcifications have exceeding-low rates of cardiovascular events. The absence of cardiovascular calcification, including coronary artery, valvular, and thoracic aorta is a strong negative predictor of myocardial ischemia. In individuals with suspected ischemia who had chest computed tomography imaging, evaluation for cardiovascular calcification (coronary artery, valves, and thoracic aorta) is an invaluable tool to guide management for further diagnostic imaging. We hypothesize that the complete absence of cardiovascular calcification has a high negative predictive value for defects in myocardial perfusion imaging such as single-photon emission computed tomography (SPECT) or positron emission tomography (PET).
Methods:
Non-contrast computed tomography performed for SPECT/PET CT attenuation correction from March 1, 2017, to September 30, 2017, were retrospectively reviewed for the absence of cardiovascular calcification by a cardiologist and radiologist who were blinded to patients' medical history. Medical records were reviewed to include patient demographics and medical history. A total of 132 patients were analyzed.
Results:
Of the 132 patients without calcifications, seven patients had small myocardial perfusion defects suggestive of ischemia or infarct, but none were considered significant defects. Of these seven patients, six were managed medically and one was from an outside institution with no follow-up data. Two of the seven patients had follow-up invasive angiography or coronary CTA that did not show significant atherosclerotic coronary artery disease.
Conclusion:
A complete absence of cardiovascular calcification indicates a 100% negative predictive value for a significant perfusion defect on same-day confirmatory nuclear stress testing. Patients with suspected ischemia but absent cardiovascular calcifications can be safely managed medically without further testing for ischemia.
More Related Videos
08:43Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
08:02Author Spotlight: Enhanced Quantification of Cardiovascular Calcification Progression for Longitudinal Micro PET/CT Studies in Small Research Animals
Published on: November 15, 2024
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...