Current Cardiovascular Imaging Reports

, Volume 5, Issue 3, pp 173–178 | Cite as

Role of Calcium Scoring in the Patient with a Normal SPECT

Cardiac Nuclear Imaging (RJ Gropler, Section Editor)

Abstract

Effective medical management and strategies of secondary prevention for coronary artery disease (CAD) have greatly contributed to the dramatic improvement in heart disease mortality rates seen in the United States during the past decade. Myocardial perfusion imaging (MPI) is useful for diagnosing cardiac ischemia and is a powerful tool for risk stratification of patients with CAD. Indeed, patients with a normal MPI have a very good short to intermediate prognosis. Coronary artery calcium scoring (CACS) using multi-slice or electron beam CT assists in the diagnosis of subclinical CAD, potentially allowing risk factor reduction to begin before physiological significant CAD and coronary events develop. Combining CACS during MPI or performing it after MPI to assist in detecting CAD in patients with normal MPI studies is being utilized with increasing frequency. The additional information obtained by CACS allows the detection of many patients with subclinical disease, alters the prognostic advice to them, leads to alteration in prescribed medical treatment and patient lifestyle, and results in improved risk factor profiles. These cardiovascular risk factor modification and lifestyle changes will presumably result in a reduction in mortality and morbidity related to cardiovascular disease. This review discusses the clinical implications in the diagnosis and treatment of CAD when coronary artery calcium scoring is performed in patients who have a normal myocardial perfusion imaging study.

Keywords

Coronary calcium scoring Single photon emission computed tomography Myocardial perfusion imaging Cardiac nuclear imaging 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of major importance•• Of major importance

  1. 1.
    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Fitzpatrick LA, Severson A, Edwards WD, Ingram RT. Diffuse calcification in human coronary arteries: Osteopontin and atherosclerosis. J Clin Investig. 1994;94:1597–604.PubMedCrossRefGoogle Scholar
  3. 3.
    Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36:1253–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenber H, Gardin JM. Coronary artery calcium evaluation by electron beam tomography and its relation to new cardiovascular events. Am J Cardiol. 2000;86:495–8.PubMedCrossRefGoogle Scholar
  5. 5.
    •• Hecht HS. A paradigm shift: Coronary computed tomographic angiography before stress testing. Am J Cardiol. 2009;104:613–8. This article suggests using CACS prior to MPI..PubMedCrossRefGoogle Scholar
  6. 6.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Hacker M, Becker C. The incremental value of coronary artery calcium scores to myocardial single photon emission computer tomography in risk assessment. J Nucl Cardiol. 2011;18:700–11.PubMedCrossRefGoogle Scholar
  8. 8.
    • Erbel R, Moehlenkamp S, Moebus S, et al. Risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis.; The Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2010;56:1397–406. This article demonstrates that CACS will reclassify patients to different CV risk categories..PubMedCrossRefGoogle Scholar
  9. 9.
    • Thompson RC, McGhie AI, Moser Jr KW, O’Keefe JH, Stevens TL, House J, et al. Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging. J Nucl Cardiol. 2005;12:392–400. This article reclassifies patients with subclinical CAD.PubMedCrossRefGoogle Scholar
  10. 10.
    • Bybee KA, Lee J, Markiewicz R, Longmore R, McGhie AI, O’Keefe JH, Hsu BL, Kennedy K, Thompson RL, Bateman TM. Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging. J Nucl Cardiol. 2010;17:188–96. This article describes reclassification of patients with CAD.PubMedCrossRefGoogle Scholar
  11. 11.
    Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, et al. Relationship between stress-induced myocardial ischemia and artherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004;44:923–30.PubMedCrossRefGoogle Scholar
  12. 12.
    • Ghadri JR, Pazhenkottil AP, Nikoulou RN, Goetti R, Buechel RR, Husmann L, Herzog BA, et al. Very high coronary artery calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart. 2011;97:998–1003. This article describes that patients with very high CACS may have normal SPECT MPI and significant coronary stenosis..PubMedCrossRefGoogle Scholar
  13. 13.
    Budoff MJ, Shaw LJ, Liu ST, Weinstein S, Mosler T, Tseng P, Flores F, Callister T, Raggi P, Berman DS. Long-prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860–70.PubMedCrossRefGoogle Scholar
  14. 14.
    • Rozanski A, Rana JS, Berman DS. Combination of myocardial perfusion imaging and coronary artery calcium scanning: potential synergies for improving risk assessment in subjects with suspected coronary artery disease. Curr Atherosclerosis Rep. 2011;13:381–9. This article describes that prognostic information obtained from MPI declines at about 3 years..CrossRefGoogle Scholar
  15. 15.
    • Min JK, Lin FY, Gidseg DS, Weinsaft JW, Berman DS, Shaw LJ, et al. Determinants of coronary calcium conversion among patients with a normal coronary calcium scan: What is the “warranty period” for remaining normal? J Am Coll Cardiol. 2010;55:1110–7. This article describes the “warranty period” obtained from a CACS..PubMedCrossRefGoogle Scholar
  16. 16.
    •• Chang SM, Nabi F, Xu J, Peterson LE, Achari A, Pratt CM, et al. The coronary artery score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol. 2009;54:1872–82. This article describes the separation in mortality and cardiac event rates from a CACS and suggests the longer term prognostic information from CACS..PubMedCrossRefGoogle Scholar
  17. 17.
    Taylor A, Bindeman J, Le T, Bauer K, Boyd C, Feuerstein I, Lee JK, Grace KA, O’Malley PG. Community-based provision of statin and aspirin after the of coronary artery calcium within a community- based screening cohort. J Am Coll Cardiol. 2008;51:1337–41.PubMedCrossRefGoogle Scholar
  18. 18.
    •• Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (early identification of subclinical atherosclerosis by noninvasive imaging research) prospective randomized trial. J Am Coll Cardiol. 2011;57:1622–32. This article describes the impact of CACS on physician and patient behavior to begin preventative care and lifestyle modification..PubMedCrossRefGoogle Scholar
  19. 19.
    Greenland P, Alpert J, Beller G, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults. Circulation. 2010;122:2748–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of CardiologySaint Luke’s Mid America Heart Institute and University of Missouri-Kansas CityKansas CityUSA

Personalised recommendations