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Use of coronary calcium scanning for predicting inducible myocardial ischemia: Influence of patients’ clinical presentation

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

Abstract

Background

The selection of patients for cardiac stress tests is generally based on assessment of chest pain symptoms, age, gender, and risk factors, but recent data suggest that coronary artery calcium (CAC) measurements can also be used to predict inducible myocardial ischemia. However, the potential influence of clinical factors on the relationship between CAC measurements and inducible ischemia has not yet been investigated.

Methods and Results

We prospectively performed CAC scanning in 648 patients undergoing exercise myocardial perfusion single photon emission computed tomography. The frequency of ischemia on myocardial perfusion single photon emission computed tomography was assessed according to CAC magnitude after dividing patients according to chest pain symptom class and Bayesian likelihood of angiographically significant coronary artery disease (ASCAD), Estimates of ASCAD likelihood and CAC scores were poorly correlated. The frequency of inducible myocardial ischemia was very low among patients with a low ASCAD likelihood if CAC scores were less than 400. By contrast, the threshold for increasing ischemia occurred at low CAC scores among patients with a high ASCAD likelihood. When characterized by chest pain classification, asymptomatic and nonanginal chest pain patients had a low frequency of ischemia if CAC scores were less than 400, whereas lower CAC scores did not exclude ischemia among typical angina or atypical angina patients.

Conclusions

CAC scores predict myocardial ischemia, with a threshold score of greater than 400 among patients with a low likelihood of ASCAD and those who are asymptomatic or have nonanginal chest pain. These data appear to extend the pool of patients for whom CAC scanning may be useful in ascertaining the need for cardiac stress testing.

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Authors and Affiliations

  1. Department of Cardiology, St Luke’s Roosevelt Hospital Center, New York, NY

    Alan Rozanski, Heidi Gransar, Romalisa Miranda-Peats, Sean W. Hayes & John D. Friedman

  2. Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Bldg, Room 1258, 90048, Los Angeles, CA

    Heidi Gransar, Romalisa Miranda-Peats, Sean W. Hayes, John D. Friedman & Daniel S. Berman

  3. Department of Medicine, Burns and Allen Research Institute, Cedards-Sinai Medical Center, 8700 Beverly Bldg, Room 1258, 90048, Los Angeles, CA

    Heidi Gransar, Romalisa Miranda-Peats, Sean W. Hayes, John D. Friedman & Daniel S. Berman

  4. Medicine David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calil

    Daniel S. Berman

  5. Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, Irvine, Calif

    Nathan D. Wong

  6. Emory University, School of Medicine, Atlanta, Ga.

    Leslee J. Shaw

Authors
  1. Alan Rozanski
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  2. Heidi Gransar
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  3. Nathan D. Wong
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  4. Leslee J. Shaw
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  5. Romalisa Miranda-Peats
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  6. Sean W. Hayes
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  7. John D. Friedman
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  8. Daniel S. Berman
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Corresponding author

Correspondence to Daniel S. Berman.

Additional information

This study was supported by a grant from the Eisner Foundation, Los Angeles. Calif.

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Rozanski, A., Gransar, H., Wong, N.D. et al. Use of coronary calcium scanning for predicting inducible myocardial ischemia: Influence of patients’ clinical presentation. J Nucl Cardiol 14, 669–679 (2007). https://doi.org/10.1016/j.nuclcard.2007.07.005

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  • DOI: https://doi.org/10.1016/j.nuclcard.2007.07.005

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