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Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography

Daniel S. Berman, MD, FACC^*,,*, Nathan D. Wong, PhD, FACC, Heidi Gransar, MS^*,, Romalisa Miranda-Peats, MPH^*,, John Dahlbeck, BS^*,, Sean W. Hayes, MD^*,, John D. Friedman, MD, FACC^*,, Xingping Kang, MD^*,, Donna Polk, MD, MPH^*,, Rory Hachamovitch, MD, FACC, Leslee Shaw, PhD^*, and Alan Rozanski, MD, FACC^*,

^* Departments of Imaging and Medicine and the Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
Heart Disease Prevention Program, University of California, Irvine, California, USA
Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

View larger version (17K): [in a new window]   Figure 1 The frequency of an ischemic myocardial perfusion single-photon emission computed tomography (5% ischemic) (gray bars) and of a moderate to severe ischemia (>10% ischemic) (black bars) for patients divided into six coronary artery calcium (CAC) score groupings.

View larger version (34K): [in a new window]   Figure 2 Distribution of coronary artery calcium (CAC) scores for the 1,119 patients manifesting a normal myocardial perfusion single-photon emission computed tomography (MPS) (left) and the 76 patients with an ischemic MPS (right).

View larger version (17K): [in a new window]   Figure 3 The frequency of an ischemic myocardial perfusion single-photon emission computed tomography (MPS) (5% ischemic) (gray bars) and moderate to severe ischemic MPS (>10% ischemic) (black bars) according to five groupings of age-gender adjusted coronary artery calcium percentile score.

View larger version (29K): [in a new window]   Figure 4 The frequency of an abnormal myocardial perfusion single-photon emission computed tomography (MPS) study according to coronary artery calcium (CAC) percent ranking and absolute CAC score (patients with percentile rankings <50% are not shown owing to the very low frequency of abnormal MPS studies in such patients). Within each of three CAC percentile groups, patients are further divided on the basis of their absolute CAC score, condensed into three subgroups: CAC scores of 1 to 99, 100 to 399, and 400. The first set of numbers below each bar represents the absolute CAC score; the second set represents the mean age ± SD; and the third set represents the number of patients within each of the nine subgroups that are illustrated. Note that regardless of percentile ranking, the frequency of an ischemic MPS study was relatively high when the absolute CAC score was 400, and relatively low when the CAC score was <100.

View larger version (19K): [in a new window]   Figure 5 The frequency of an ischemic myocardial perfusion single-photon emission computed tomography for each of the six coronary artery calcium (CAC) score subgroups, further subdivided on the basis of symptoms (chest pain and/or shortness of breath) being absent (gray bars) or present (black bars).

View larger version (19K): [in a new window]   Figure 6 Receiver operating characteristic curve analysis showing incremental prognostic value of coronary artery calcium score in predicting likelihood of 5% ischemia. CCS = coronary calcium score; CRF = coronary risk factors; Sx = symptoms.