Elsevier

Journal of Nuclear Cardiology

Volume 30, Issue 6, December 2023, Pages 2349-2360
Journal of Nuclear Cardiology

Review Article
Combined evaluation of CAC score and myocardial perfusion imaging in patients at risk of cardiovascular disease: where are we and what do the data say

https://doi.org/10.1007/s12350-023-03288-2Get rights and content

Abstract

Advances in the prevention and treatment of cardiovascular disease (CVD) over the last decades have led to a marked reduction in mortality for CVD. Nevertheless, atherosclerosis leading to coronary artery disease and stroke remains one of the most common causes of death in the world. The usefulness of imaging tests in the early identification of disease led to identify subjects at major risk of poor outcomes, suggesting risk factor modification. The aim of this article is to analyze the state of art of combined imaging in patients at risk of CVD referred to MPI evaluation, to highlight the present and potential features able to provide incremental prognostic information to help clinicians in patient management and to reduce adverse events.

Section snippets

Global risk factor algorithms and the emerging role of coronary artery calcium score

Considering the presence of a high prevalence of CVD risk factors among patients who develop clinical disease, interest has focused on developing global risk factor algorithms for predicting CVD. Several algorithms were proposed during the late 1990s and 2000s. The Systematic Coronary Risk Evaluation project3 formulated a CVD risk estimation algorithm (HEARTSCORE) that has been adopted by the Joint European Societies’ guidelines on CVD prevention. Some investigators developed other specific

Key points from published evidence by CAC data

  • (1)

    Global risk factor algorithms are clinically used for predicting CVD to an initial strategy of patient management.

  • (2)

    ECG gated NCCT using a quantitative evaluation of coronary calcium by Agatston score was widely used to perform an accurate evaluation of the amount of calcium to predict CVD risk.

  • (3)

    The guidelines for coronary artery calcium scoring chest CT scans recommended (Class I) that CAC should be evaluated and reported on all noncontrast chest CT examination using one of the scoring

Two different imaging techniques and modalities

The combined evaluation of CAC score and myocardial perfusion has been widely used in the evaluation of patients with suspected CAD and in risk stratifying such patients, referring to a specific therapeutic approach. A huge spectrum of published articles is available combining data by a separate evaluation of CAC score and perfusion, using two different imaging techniques and modalities. Table 1 lists some studies providing diagnostic and prognostic data using a dedicated CT scan (gated or

Key points from published evidence by combined CAC and perfusion evaluation

  • (1)

    The combined evaluation of CAC score and myocardial perfusion has been widely used in risk stratify patients with suspected CAD to refer to a specific therapeutic approach.

  • (2)

    Most published data available performed a separate evaluation of CAC score and perfusion abnormalities, using two different imaging techniques and modalities.

  • (3)

    As major predictors of events in patients with suspected CAD resulted in the extent of atherosclerotic burden, assessed by CAC, and the extent and severity of

Conclusion and future directions

The choice of the most useful imaging techniques in some categories of patients is still challenging, as in patients at intermediate risk of CAD. To the state of art, combined imaging has already demonstrated to be extremely useful in patients risk stratification and various tools are available to help clinicians in preventing and predicting outcomes of CVD in selected categories of patients. Nevertheless, more data for specific endpoints need to be conducted in the setting of patients at risk

Disclosures

None declared.

Funding

Open access funding provided by Università degli Studi di Napoli Federico II within the CRUI-CARE Agreement.

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