Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI
ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether tripl...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2011-06, Vol.97 (12), p.998-1003 |
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| creator | Ghadri, Jelena R Pazhenkottil, Aju P Nkoulou, Rene N Goetti, Robert Buechel, Ronny R Husmann, Lars Herzog, Bernhard A Wolfrum, Mathias Wyss, Christophe A Templin, Christian Kaufmann, Philipp A |
| description | ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative SPECT MPI in patients with very high CAC.BackgroundNo data exist on the clinical value of high CAC in patients with normal SPECT MPI.Methods50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as the standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered to represent significant stenosis.ResultsThe median total CAC was 1975 (range 1018–8046). In 37/50 (74%) patients, coronary angiography revealed one-vessel disease (1-VD) (n=15), 2-VD (n=10) or 3-VD (n=12). Twenty-six revascularisations (percutaneous coronary intervention/coronary artery bypass grafting) were performed in seven (6/1), seven (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.ConclusionsIn patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD. |
| doi_str_mv | 10.1136/hrt.2010.217281 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_867723715</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4020955261</sourcerecordid><originalsourceid>FETCH-LOGICAL-b468t-d33a53cefe69a756f0189e1dc5ee05c8eec76d3b6db1918409a3411b5fd6eabe3</originalsourceid><addsrcrecordid>eNqFkc1v1DAQxSMEoh9w5oYsIVQJKa0_Yjs5VlFLKy1QlaVCXCzHmbDeJs5iO4X-9_UqSytx4WTPzG9GT-9l2RuCjwlh4mTl4zHFqaJE0pI8y_ZJIco8tb4_T3_GeS4wk3vZQQhrjHFRleJltkdJUUpC5X7mbsDfo5X9uUJm9KPTqTK6N3YaUEgdQJMbdLgNaGxC9JOJ9g6eUO3jdr-1AXQAZB3a6GjBxYB-27hCbvSD7tHXq7N6iT5dXb7KXnS6D_B69x5m387PlvVFvvjy8bI-XeRNkh_zljHNmYEORKUlFx0mZQWkNRwAc1MCGCla1oi2IRUpC1xpVhDS8K4VoBtgh9nRfHfjx18ThKgGGwz0vXYwTkGVQkrKJOGJfPcPuR4n75I4RWSJJRGUykSdzJTxYwgeOrXxdkgOKILVNgmVklDbJNScRNp4u7s7NQO0j_xf6xPwfgfokBzvvHbGhieuoFhSTBOXz5wNEf48zrW_VUIyydXnm1rJmv1YXi8u1HXiP8x8M6z_q_IBmTeurw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1780716227</pqid></control><display><type>article</type><title>Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Ghadri, Jelena R ; Pazhenkottil, Aju P ; Nkoulou, Rene N ; Goetti, Robert ; Buechel, Ronny R ; Husmann, Lars ; Herzog, Bernhard A ; Wolfrum, Mathias ; Wyss, Christophe A ; Templin, Christian ; Kaufmann, Philipp A</creator><creatorcontrib>Ghadri, Jelena R ; Pazhenkottil, Aju P ; Nkoulou, Rene N ; Goetti, Robert ; Buechel, Ronny R ; Husmann, Lars ; Herzog, Bernhard A ; Wolfrum, Mathias ; Wyss, Christophe A ; Templin, Christian ; Kaufmann, Philipp A</creatorcontrib><description>ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative SPECT MPI in patients with very high CAC.BackgroundNo data exist on the clinical value of high CAC in patients with normal SPECT MPI.Methods50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as the standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered to represent significant stenosis.ResultsThe median total CAC was 1975 (range 1018–8046). In 37/50 (74%) patients, coronary angiography revealed one-vessel disease (1-VD) (n=15), 2-VD (n=10) or 3-VD (n=12). Twenty-six revascularisations (percutaneous coronary intervention/coronary artery bypass grafting) were performed in seven (6/1), seven (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.ConclusionsIn patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/hrt.2010.217281</identifier><identifier>PMID: 21487127</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Aged ; Angina pectoris ; balanced ischaemia ; Biological and medical sciences ; Biomarkers - metabolism ; Calcinosis - diagnosis ; Calcium - metabolism ; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods ; Cardiology. Vascular system ; Cardiovascular disease ; Coronary Angiography - methods ; Coronary artery disease ; coronary artery disease (CAD) ; Coronary Artery Disease - diagnosis ; coronary calcium score ; Coronary heart disease ; CT scanning ; Female ; Heart ; Heart attacks ; Humans ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; myocardial perfusion ; Myocardial Perfusion Imaging - methods ; normal SPECT/MPI ; nuclear cardiology ; Prospective Studies ; Radiation Dosage ; radionuclide imaging ; Tomography</subject><ispartof>Heart (British Cardiac Society), 2011-06, Vol.97 (12), p.998-1003</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 (c) 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b468t-d33a53cefe69a756f0189e1dc5ee05c8eec76d3b6db1918409a3411b5fd6eabe3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://heart.bmj.com/content/97/12/998.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://heart.bmj.com/content/97/12/998.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24207202$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21487127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghadri, Jelena R</creatorcontrib><creatorcontrib>Pazhenkottil, Aju P</creatorcontrib><creatorcontrib>Nkoulou, Rene N</creatorcontrib><creatorcontrib>Goetti, Robert</creatorcontrib><creatorcontrib>Buechel, Ronny R</creatorcontrib><creatorcontrib>Husmann, Lars</creatorcontrib><creatorcontrib>Herzog, Bernhard A</creatorcontrib><creatorcontrib>Wolfrum, Mathias</creatorcontrib><creatorcontrib>Wyss, Christophe A</creatorcontrib><creatorcontrib>Templin, Christian</creatorcontrib><creatorcontrib>Kaufmann, Philipp A</creatorcontrib><title>Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative SPECT MPI in patients with very high CAC.BackgroundNo data exist on the clinical value of high CAC in patients with normal SPECT MPI.Methods50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as the standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered to represent significant stenosis.ResultsThe median total CAC was 1975 (range 1018–8046). In 37/50 (74%) patients, coronary angiography revealed one-vessel disease (1-VD) (n=15), 2-VD (n=10) or 3-VD (n=12). Twenty-six revascularisations (percutaneous coronary intervention/coronary artery bypass grafting) were performed in seven (6/1), seven (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.ConclusionsIn patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD.</description><subject>Aged</subject><subject>Angina pectoris</subject><subject>balanced ischaemia</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - metabolism</subject><subject>Calcinosis - diagnosis</subject><subject>Calcium - metabolism</subject><subject>Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Coronary Angiography - methods</subject><subject>Coronary artery disease</subject><subject>coronary artery disease (CAD)</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>coronary calcium score</subject><subject>Coronary heart disease</subject><subject>CT scanning</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>myocardial perfusion</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>normal SPECT/MPI</subject><subject>nuclear cardiology</subject><subject>Prospective Studies</subject><subject>Radiation Dosage</subject><subject>radionuclide imaging</subject><subject>Tomography</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFkc1v1DAQxSMEoh9w5oYsIVQJKa0_Yjs5VlFLKy1QlaVCXCzHmbDeJs5iO4X-9_UqSytx4WTPzG9GT-9l2RuCjwlh4mTl4zHFqaJE0pI8y_ZJIco8tb4_T3_GeS4wk3vZQQhrjHFRleJltkdJUUpC5X7mbsDfo5X9uUJm9KPTqTK6N3YaUEgdQJMbdLgNaGxC9JOJ9g6eUO3jdr-1AXQAZB3a6GjBxYB-27hCbvSD7tHXq7N6iT5dXb7KXnS6D_B69x5m387PlvVFvvjy8bI-XeRNkh_zljHNmYEORKUlFx0mZQWkNRwAc1MCGCla1oi2IRUpC1xpVhDS8K4VoBtgh9nRfHfjx18ThKgGGwz0vXYwTkGVQkrKJOGJfPcPuR4n75I4RWSJJRGUykSdzJTxYwgeOrXxdkgOKILVNgmVklDbJNScRNp4u7s7NQO0j_xf6xPwfgfokBzvvHbGhieuoFhSTBOXz5wNEf48zrW_VUIyydXnm1rJmv1YXi8u1HXiP8x8M6z_q_IBmTeurw</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Ghadri, Jelena R</creator><creator>Pazhenkottil, Aju P</creator><creator>Nkoulou, Rene N</creator><creator>Goetti, Robert</creator><creator>Buechel, Ronny R</creator><creator>Husmann, Lars</creator><creator>Herzog, Bernhard A</creator><creator>Wolfrum, Mathias</creator><creator>Wyss, Christophe A</creator><creator>Templin, Christian</creator><creator>Kaufmann, Philipp A</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI</title><author>Ghadri, Jelena R ; Pazhenkottil, Aju P ; Nkoulou, Rene N ; Goetti, Robert ; Buechel, Ronny R ; Husmann, Lars ; Herzog, Bernhard A ; Wolfrum, Mathias ; Wyss, Christophe A ; Templin, Christian ; Kaufmann, Philipp A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b468t-d33a53cefe69a756f0189e1dc5ee05c8eec76d3b6db1918409a3411b5fd6eabe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Angina pectoris</topic><topic>balanced ischaemia</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - metabolism</topic><topic>Calcinosis - diagnosis</topic><topic>Calcium - metabolism</topic><topic>Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Coronary Angiography - methods</topic><topic>Coronary artery disease</topic><topic>coronary artery disease (CAD)</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>coronary calcium score</topic><topic>Coronary heart disease</topic><topic>CT scanning</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>myocardial perfusion</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>normal SPECT/MPI</topic><topic>nuclear cardiology</topic><topic>Prospective Studies</topic><topic>Radiation Dosage</topic><topic>radionuclide imaging</topic><topic>Tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghadri, Jelena R</creatorcontrib><creatorcontrib>Pazhenkottil, Aju P</creatorcontrib><creatorcontrib>Nkoulou, Rene N</creatorcontrib><creatorcontrib>Goetti, Robert</creatorcontrib><creatorcontrib>Buechel, Ronny R</creatorcontrib><creatorcontrib>Husmann, Lars</creatorcontrib><creatorcontrib>Herzog, Bernhard A</creatorcontrib><creatorcontrib>Wolfrum, Mathias</creatorcontrib><creatorcontrib>Wyss, Christophe A</creatorcontrib><creatorcontrib>Templin, Christian</creatorcontrib><creatorcontrib>Kaufmann, Philipp A</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghadri, Jelena R</au><au>Pazhenkottil, Aju P</au><au>Nkoulou, Rene N</au><au>Goetti, Robert</au><au>Buechel, Ronny R</au><au>Husmann, Lars</au><au>Herzog, Bernhard A</au><au>Wolfrum, Mathias</au><au>Wyss, Christophe A</au><au>Templin, Christian</au><au>Kaufmann, Philipp A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>97</volume><issue>12</issue><spage>998</spage><epage>1003</epage><pages>998-1003</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative SPECT MPI in patients with very high CAC.BackgroundNo data exist on the clinical value of high CAC in patients with normal SPECT MPI.Methods50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as the standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered to represent significant stenosis.ResultsThe median total CAC was 1975 (range 1018–8046). In 37/50 (74%) patients, coronary angiography revealed one-vessel disease (1-VD) (n=15), 2-VD (n=10) or 3-VD (n=12). Twenty-six revascularisations (percutaneous coronary intervention/coronary artery bypass grafting) were performed in seven (6/1), seven (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.ConclusionsIn patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>21487127</pmid><doi>10.1136/hrt.2010.217281</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angina pectoris balanced ischaemia Biological and medical sciences Biomarkers - metabolism Calcinosis - diagnosis Calcium - metabolism Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods Cardiology. Vascular system Cardiovascular disease Coronary Angiography - methods Coronary artery disease coronary artery disease (CAD) Coronary Artery Disease - diagnosis coronary calcium score Coronary heart disease CT scanning Female Heart Heart attacks Humans Male Medical imaging Medical sciences Middle Aged myocardial perfusion Myocardial Perfusion Imaging - methods normal SPECT/MPI nuclear cardiology Prospective Studies Radiation Dosage radionuclide imaging Tomography |
| title | Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI |
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