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FOCUS ISSUE: CARDIAC IMAGING: CLINICAL RESEARCH

Relationship Between Coronary Artery Calcification Detected by Electron-Beam Computed Tomography and Abnormal Stress Echocardiography

Association and Prognostic Implications

Gautam Ramakrishna, MD^_*, Jerome F. Breen, MD, Sharon L. Mulvagh, MD, FACC^_*, Robert B. McCully, MD, FACC^_* and Patricia A. Pellikka, MD, FACC^_*,_*

^_* Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Department of Radiology, Mayo Clinic, Rochester, Minnesota

Manuscript received February 2, 2006; revised manuscript received March 22, 2006, accepted April 17, 2006.

^_* Reprint requests and correspondence: Dr. Patricia A. Pellikka, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: pellikka.patricia{at}mayo.edu).

OBJECTIVES: The purpose of this study was to compare the results and prognostic value of electron-beam computed tomography (EBCT) and exercise echocardiography.

BACKGROUND: Although patients with elevated coronary artery calcium scores (CACS) might be referred for exercise echocardiography, the association of EBCT CACS with wall motion score index (WMSI) is not known.

METHODS: Patients without known coronary artery disease who underwent both clinically indicated EBCT and exercise echocardiography within a 3-month period were identified. Exercise WMSI was based on a 16-segment model (normal = 1; abnormal >1). The EBCT CACS was derived with the Agatston scoring system. Follow-up was obtained for the combined end point of death and myocardial infarction.

RESULTS: The study population included 556 patients (age 54 ± 10 years; 65% male). Correlation between EBCT CACS and exercise WMSI was limited (r = 0.17, p < 0.0001) but statistically significant. The proportion of patients with abnormal exercise WMSI increased with increasing CACS severity (chi-square = 19.1, p < 0.001). However, even in those with CACS >400, 66% had normal exercise WMSI. Age, CACS, and chest pain were independently associated with abnormal exercise WMSI. Events occurred in 12 (2%) patients. Wall motion score index (risk ratio [RR] 3.7, p = 0.023) and age (RR 1.9, p = 0.019) were associated with events.

CONCLUSIONS: Electron-beam computed tomography CACS was predictive of abnormal exercise WMSI, but the majority of patients with elevated CACS had normal WMSI. Wall motion score index and age were the best predictors of events. Prospective studies are indicated to establish the relative roles of these tests in risk stratification.

Abbreviations and Acronyms   CACS = coronary artery calcium score   CAD = coronary artery disease   CI = confidence interval   EBCT = electron-beam computed tomography   HU = Hounsfield units   MI = myocardial infarction   RR = risk ratio   SPECT = single-photon emission computed tomography   WMSI = wall motion score index

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