Skip to main content
SpringerLink
Log in

Coronary vascular age: An alternate means for predicting stress-induced myocardial ischemia in patients with suspected coronary artery disease

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year’s scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD).

Methods

A total of 717 subjects referred to CAC scoring and 82Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied. CAC score was measured according to the Agatston method and coronary vascular age by equating estimated CAD risk for chronological age and CAC using the formula 39.1 + 7.25 × ln(CAC + 1).

Results

Stress-induced ischemia was present in 105 (15%) patients. Mean chronological age, CAC score, and coronary vascular age were higher (all P < .001) in patients with ischemia compared to those without. At incremental analysis, the global Chi square increased from 41.26 to 68.77 (P < .001) when chronological age was added to clinical variables. Including vascular age in the model, the global Chi square further increased from 68.77 to 106.38 (P < .001). Adding chronological age to clinical data, continuous net reclassification improvement (cNRI) was 0.57, while adding vascular age to clinical data and chronological age cNRI was 0.62. At decision curve analysis, the model including vascular age was associated with the highest net benefit compared to the model including only clinical data, to the model including chronological age and clinical data, and to a strategy considering that all patients had ischemia. The model including vascular age also showed the largest reduction in false-positive rate without missing any ischemic patients.

Conclusions

In subjects with suspected CAD, coronary vascular age is strongly associated with stress-induced ischemia. The communication of a given vascular age would have a superior emotive impact improving observance of therapies and healthier lifestyles.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

Abbreviations

CAC:

Coronary artery calcium

CT:

Computed tomography

CIMT:

Carotid intima-media thickness

CAD:

Coronary artery disease

PET:

Positron emission tomography

ROC:

Receiver-operating characteristic

RPART:

Recursive partitioning and regression trees

cNRI:

Continuous net reclassification improvement

IDI:

Integrated discrimination improvement

CI:

Confidence interval

References

  1. Grundy SM. Coronary plaque as a replacement for age as a risk factor in global risk assessment. Am J Cardiol 2001;88:8E-11E.

    Article  CAS  PubMed  Google Scholar 

  2. Executive Summary of the Third Report of the. National cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). J Am Med Assoc 2001;285:2486-97.

    Article  Google Scholar 

  3. Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999;100:1481-92.

    Article  CAS  PubMed  Google Scholar 

  4. Stein JH, Fraizer MC, Aeschlimann SE, Nelson-Worel J, McBride PE, Douglas PS. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol 2004;27:388-92.

    Article  PubMed  Google Scholar 

  5. Cuocolo A, Klain M, Petretta M. Coronary vascular age comes of age. J Nucl Cardiol 2017;24(6):1835-6.

    Article  PubMed  Google Scholar 

  6. Pletcher MJ, Greenland P. Coronary calcium scoring and cardiovascular risk: the shape of things to come. Arch Intern Med 2008;168:1027-8.

    Article  PubMed  Google Scholar 

  7. Coll B, Feinstein SB. Carotid intima-media thickness measurements: techniques and clinical relevance. Curr Atheroscler Rep 2008;10:444-50.

    Article  PubMed  Google Scholar 

  8. Khalil Y, Mukete B, Durkin MJ, Coccia J, Matsumura ME. A comparison of assessment of coronary calcium vs carotid intima media thickness for determination of vascular age and adjustment of the Framingham Risk Score. Prev Cardiol 2010;13:117-21.

    PubMed  Google Scholar 

  9. Groenewegen KA, den Ruijter HM, Pasterkamp G, Polak JF, Bots ML, Peters SA. Vascular age to determine cardiovascular disease risk: a systematic review of its concepts, definitions, and clinical applications. Eur J Prev Cardiol 2016;23:264-74.

    Article  CAS  PubMed  Google Scholar 

  10. Rosendorff C, Black HR, Cannon CP, Gersh BJ, Gore J, Izzo JL Jr, et al. Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation 2007;115:2761-88.

    Article  PubMed  Google Scholar 

  11. Assante R, Zampella E, Arumugam P, Acampa W, Imbriaco M, Tout D, et al. Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease. J Nucl Cardiol 2017;24:494-501.

    Article  PubMed  Google Scholar 

  12. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. American heart association writing group on myocardial segmentation and registration for cardiac imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.

    Article  PubMed  Google Scholar 

  13. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-32.

    Article  CAS  PubMed  Google Scholar 

  14. McClelland RL, Nasir K, Budoff M, Blumenthal RS, Kronmal RA. Arterial age as a function of coronary artery calcium (from the multi-ethnic study of atherosclerosis [MESA]). Am J Cardiol 2009;103:59-63.

    Article  CAS  PubMed  Google Scholar 

  15. Assante R, Acampa W, Zampella E, Arumugam P, Nappi C, Gaudieri V, et al. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease. Eur J Nucl Med Mol Imaging. 2017. https://doi.org/10.1007/s00259-017-3800-7.

    Article  PubMed  Google Scholar 

  16. Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 2008;27:157-72.

    Article  PubMed  Google Scholar 

  17. Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Mak 2006;26:565-74.

    Article  Google Scholar 

  18. Chang SM, Nabi F, Xu J, Peterson LE, Achari A, Pratt CM, et al. The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol 2009;54:1872-82.

    Article  Google Scholar 

  19. Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronary artery calcification and all-cause mortality. JACC Cardiovasc Imaging 2009;2:692-700.

    Article  PubMed  Google Scholar 

  20. Nappi C, Nicolai E, Daniele S, Acampa W, Gaudieri V, Assante R, et al. Long-term prognostic value of coronary artery calcium scanning, coronary computed tomographic angiography and stress myocardial perfusion imaging in patients with suspected coronary artery disease. J Nucl Cardiol. 2016. https://doi.org/10.1007/s12350-016-0657-2.

    Article  PubMed  Google Scholar 

  21. Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol 2009;53:345-52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Samani NJ, van der Harst P. Biological ageing and cardiovascular disease. Heart 2008;94:537-9.

    Article  CAS  PubMed  Google Scholar 

  23. De Meyer T, Rietzschel ER, De Buyzere ML, Van Criekinge W, Bekaert S. Telomere length and cardiovascular aging: the means to the ends? Ageing Res Rev 2011;10:297-303.

    Article  CAS  PubMed  Google Scholar 

  24. Lopez-Gonzalez AA, Aguilo A, Frontera M, Bennasar-Veny M, Campos I, Vicente-Herrero T, et al. Effectiveness of the heart age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial. Eur J Prev Cardiol 2015;22:389-96.

    Article  PubMed  Google Scholar 

  25. Spiegelhalter D. How old are you, really? Communicating chronic risk through ‘effective age’ of your body and organs. BMC Med Inf Decis Mak. 2016;16:104.

    Article  Google Scholar 

Download references

Disclosure

Carmela Nappi, Valeria Gaudieri, Wanda Acampa, Parthiban Arumugam, Roberta Assante, Emilia Zampella, Teresa Mannarino, Ciro Gabriele Mainolfi, Massimo Imbriaco, Mario Petretta, and Alberto Cuocolo declare that they have no conflict of interest.

Author information

Author notes

  1. Carmela Nappi and Valeria Gaudieri have contributed equally to this work.

Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

    Carmela Nappi MD, Wanda Acampa MD, PhD, Roberta Assante MD, Emilia Zampella MD, Teresa Mannarino MD, Ciro Gabriele Mainolfi MD, Massimo Imbriaco MD & Alberto Cuocolo MD

  2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

    Valeria Gaudieri MD & Wanda Acampa MD, PhD

  3. Department of Nuclear Medicine, Central Manchester University Hospitals, Manchester, UK

    Parthiban Arumugam MD

  4. Department of Translational Medical Sciences, University Federico II, Naples, Italy

    Mario Petretta MD

Authors
  1. Carmela Nappi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valeria Gaudieri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wanda Acampa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Parthiban Arumugam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberta Assante MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emilia Zampella MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Teresa Mannarino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ciro Gabriele Mainolfi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Massimo Imbriaco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mario Petretta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alberto Cuocolo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Cuocolo MD.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 602 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nappi, C., Gaudieri, V., Acampa, W. et al. Coronary vascular age: An alternate means for predicting stress-induced myocardial ischemia in patients with suspected coronary artery disease. J. Nucl. Cardiol. 26, 1348–1355 (2019). https://doi.org/10.1007/s12350-018-1191-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-018-1191-1

Keywords

Search

Navigation