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Noninvasive screening for coronary atherosclerosis and silent ischemia in asymptomatic high-risk populations

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Abstract

Asymptomatic subjects at risk for adverse cardiovascular events, based on clinical risk models, are further risk-stratified by noninvasive imaging of coronary atherosclerosis and silent ischemia. Coronary atherosclerosis can be detected by imaging coronary artery calcification (CAC). CAC scores more than 400 are associated with a higher cardiac event rate. Silent ischemia can be detected by stress perfusion imaging employing single photon emission CT or positron emission tomography. Asymptomatic type 2 diabetics and those with advanced kidney disease represent high-risk populations. Asymptomatic diabetics with high CAC scores have a higher prevalence and extent of silent ischemia than those with low scores. The greater the extent of CAC, the worse the outcome. For asymptomatic chronic kidney disease patients, the larger the extent of stress perfusion abnormalities, the higher the cardiac mortality rate. New molecular imaging approaches for assessing myocardial metabolism and detecting vulnerable coronary plaques hold promise for risk stratification.

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  1. University of Virginia Health System, Box 800158, Charlottesville, VA, 22908, USA

    George A. Beller

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Beller, G.A. Noninvasive screening for coronary atherosclerosis and silent ischemia in asymptomatic high-risk populations. curr cardiovasc imaging rep 2, 213–222 (2009). https://doi.org/10.1007/s12410-009-0026-5

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