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Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 1990–1998 | Cite as

Is coronary calcium scoring too late? Total body arterial calcium burden in patients without known CAD and normal MPI

  • Adel H. A. Allam
  • Randall C. Thompson
  • Michael A. Eskander
  • Mohamed A. Mandour Ali
  • Ayman Sadek
  • Chris J. Rowan
  • M. Linda Sutherland
  • James D. Sutherland
  • Bruno Frohlich
  • David E. Michalik
  • The HORUS research team
  • Caleb E. Finch
  • Jagat Narula
  • Gregory S. Thomas
  • L. Samuel Wann
Original Article

Abstract

Background

Patients with normal myocardial perfusion imaging (MPI) have a good prognosis. However, pre-clinical coronary and extracoronary atherosclerosis may exist in the absence of myocardial ischemia.

Methods

154 Egyptian patients (mean age 53 years) underwent whole-body non-contrast CT following normal MPI.

Results

Atherosclerosis in the form of calcification was observed in ≥1 vascular bed in 115 of 154 (75%) patients. This included the iliofemoral (62%), abdominal aorta (53%), thoracic aorta (47%), coronary (47%), and carotid (25%) vascular beds. Mean total body calcium score was 3172 ± 530 AU. Extracoronary atherosclerosis in patients with a zero coronary artery calcium (CAC) score was common, occurring in the above-listed beds 42%, 36%, 29%, and 7% of the time, respectively. CAC was rarely present without iliofemoral or abdominal aortic calcification.

Conclusion

Quantitative assessment of calcification in different vascular beds demonstrates that extracoronary atherosclerosis is common in patients who have normal MPI. Atherosclerotic calcifications are most common in the iliofemoral arteries and abdominal aorta, which typically predate coronary calcifications. An imaging strategy to detect extracoronary atherosclerosis could lead to greater understanding of the natural history of atherosclerosis in its long pre-clinical phase and possibly to earlier preventive strategies.

Keywords

Atherosclerosis Myocardial perfusion imaging X-ray computed tomography Coronary artery disease Abdominal aorta Calcium 

Abbreviations

ILF

Iliofemoral

AAo

Abdominal aorta

TAo

Thoracic aorta

CRA

Carotid arteries

TBC

Total body calcium score

CA

Coronary arteries

Notes

Acknowledgements

We thank statistician Kevin Kennedy, M.S. of the Saint Luke’s Mid America Heart Institute, Kansas City, MO, for his expert assistance.

Disclosure

None.

Supplementary material

12350_2017_925_MOESM1_ESM.tif (1.5 mb)
Online Appendix Figure 1 Mean age of men and women without arterial calcification, one-to-two vascular beds with calcification, and calcification of greater than three vascular beds (TIFF 1579 kb)
12350_2017_925_MOESM2_ESM.tif (3.1 mb)
Online Appendix Figure 2 (A) Prevalence of calcification within three arterial beds based on the presence of calcium within the coronary and/or carotid artery vascular beds. (B) Mean calcium score within three arterial beds based on the presence of calcium within the coronary and/or carotid artery vascular beds. Values are mean ± SE. P < 0.001 between three groups (TIFF 3199 kb)
12350_2017_925_MOESM3_ESM.pptx (739 kb)
Supplementary material 3 (PPTX 739 kb)

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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Adel H. A. Allam
    • 1
    • 16
  • Randall C. Thompson
    • 2
    • 3
  • Michael A. Eskander
    • 4
  • Mohamed A. Mandour Ali
    • 1
  • Ayman Sadek
    • 1
  • Chris J. Rowan
    • 5
  • M. Linda Sutherland
    • 6
  • James D. Sutherland
    • 7
  • Bruno Frohlich
    • 8
  • David E. Michalik
    • 9
    • 10
  • The HORUS research team
  • Caleb E. Finch
    • 11
  • Jagat Narula
    • 12
  • Gregory S. Thomas
    • 13
    • 14
  • L. Samuel Wann
    • 15
  1. 1.Al Azhar UniversityCairoEgypt
  2. 2.Saint Luke’s Mid America Heart InstituteKansas CityUSA
  3. 3.University of Missouri–Kansas City School of MedicineKansas CityUSA
  4. 4.University of California, Irvine HealthOrangeUSA
  5. 5.Renown Institute for Heart and Vascular HealthRenoUSA
  6. 6.Newport Diagnostic CenterNewportUSA
  7. 7.South Coast Radiological Medical GroupLaguna HillsUSA
  8. 8.National Museum of Natural History Smithsonian InstitutionWashington, DCUSA
  9. 9.University of CaliforniaIrvine School of MedicineIrvineUSA
  10. 10.Miller Women’s and Children’s HospitalLong BeachUSA
  11. 11.Leonard Davis School of Gerontology and Dornsife CollegeUniversity of Southern CaliforniaLos AngelesUSA
  12. 12.Icahn School of Medicine at Mount SinaiNew YorkUSA
  13. 13.Long Beach MemorialLong BeachUSA
  14. 14.University of California, IrvineOrangeUSA
  15. 15.Ascension HealthcareMilwaukeeUSA
  16. 16.Alpha ScanGizaEgypt

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