Journal of Nuclear Cardiology

, Volume 24, Issue 2, pp 494–501 | Cite as

Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease

  • Roberta Assante
  • Emilia Zampella
  • Parthiban Arumugam
  • Wanda Acampa
  • Massimo Imbriaco
  • Deborah Tout
  • Mario Petretta
  • Christine Tonge
  • Alberto Cuocolo
Original Article



We assessed the relationship between coronary artery calcium (CAC) score, myocardial blood flow (MBF) and coronary flow reserve (CFR) in patients undergoing hybrid 82Rb positron emission tomography (PET)/computed tomography (CT) imaging for suspected CAD. We also evaluated if CAC score is able to predict a reduced CFR independently from conventional coronary risk factors.


A total of 637 (mean age 58 ± 13 years) consecutive patients were studied. CAC score was measured according to the Agatston method and patients were categorized into 4 groups (0, 0.01-99.9, 100-399.9, and ≥400). Baseline and hyperemic MBF were automatically quantified. CFR was calculated as the ratio of hyperemic to baseline MBF and it was considered reduced when <2.


Global CAC score showed a significant inverse correlation with hyperemic MBF and CFR (both P < .001), while no correlation between CAC score and baseline MBF was found. At multivariable logistic regression analysis age, diabetes and CAC score were independently associated with reduced CFR (all P < .001). The addition of CAC score to clinical data increased the global chi-square value for predicting reduced CFR from 81.01 to 91.13 (P < .01). Continuous net reclassification improvement, obtained by adding CAC score to clinical data, was 0.36.


CAC score provides incremental information about coronary vascular function over established CAD risk factors in patients with suspected CAD and it might be helpful for identifying those with a reduced CFR.


Coronary artery calcium myocardial blood flow coronary flow reserve PET/CT coronary artery disease 



Coronary artery calcium


Coronary artery disease


Coronary flow reserve


Myocardial blood flow


Positron emission tomography


Computed tomography


Left anterior descending artery


Left circumflex artery


Right coronary artery



The authors have indicated that they have no financial conflict of interest.


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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Roberta Assante
    • 1
  • Emilia Zampella
    • 1
  • Parthiban Arumugam
    • 2
  • Wanda Acampa
    • 1
    • 3
  • Massimo Imbriaco
    • 1
  • Deborah Tout
    • 2
  • Mario Petretta
    • 4
  • Christine Tonge
    • 2
  • Alberto Cuocolo
    • 1
  1. 1.Department of Advanced Biomedical SciencesUniversity Federico IINaplesItaly
  2. 2.Nuclear Medicine CenterCentral Manchester University Teaching HospitalsManchesterUK
  3. 3.Institute of Biostructure and BioimagingNational Council of ResearchNaplesItaly
  4. 4.Department of Translational Medical SciencesUniversity Federico IINaplesItaly

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