Advertisement

Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: A 3-year serial hybrid [15O]H2O PET/CT imaging study

      Highlights

      • Higher baseline coronary artery calcium (CAC) was associated with decreased hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR).
      • CAC burden showed a significant independent inverse relationship with hMBF and CFR.
      • CAC burden and its progression during 3 years follow-up were not associated with evolution of absolute myocardial perfusion.

      Abstract

      Background and aims

      The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion.

      Methods

      Fifty-three patients (26% female) with de novo single-vessel coronary artery disease underwent [15O]H2O positron emission tomography/computed tomography at 1 month (baseline), 1 year, and 3 years after complete revascularization with percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH trial.

      Results

      Baseline CAC score was 0 in 9%, 0.1–99.9 in 40%, 100–399.9 in 36% and ≥400 in 15% of patients, respectively. Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL min−1·g−1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p < 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time was not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years of follow-up.

      Conclusions

      Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sangiorgi G.
        • Rumberger J.A.
        • Severson A.
        • et al.
        Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology.
        J. Am. Coll. Cardiol. 1998; 31: 126-133
        • Dekker M.
        • Waissi F.
        • Bank I.E.M.
        • et al.
        Automated calcium scores collected during myocardial perfusion imaging improve identification of obstructive coronary artery disease.
        Int J Cardiol Heart Vasc. 2020; 26: 100434
        • Danad I.
        • Raijmakers P.G.
        • Appelman Y.E.
        • et al.
        Quantitative relationship between coronary artery calcium score and hyperemic myocardial blood flow as assessed by hybrid 15O-water PET/CT imaging in patients evaluated for coronary artery disease.
        J. Nucl. Cardiol. 2012; 19: 256-264
        • Curillova Z.
        • Yaman B.F.
        • Dorbala S.
        • et al.
        Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging.
        Eur. J. Nucl. Med. Mol. Imag. 2009; 36: 1603-1610
        • El Mahdiui M.
        • Smit J.M.
        • van Rosendael A.R.
        • et al.
        Relationship between coronary artery calcification and myocardial ischemia on computed tomography myocardial perfusion in patients with stable chest pain.
        J. Nucl. Cardiol. 2019; https://doi.org/10.1007/s12350-019-01869-8
        • Ye Z.X.
        • Cheng H.M.
        • Chiou K.R.
        • et al.
        Relation of coronary artery calcium to flow-mediated dilation and C-reactive protein levels in asymptomatic patients with heterozygous familial hypercholesterolemia.
        Am. J. Cardiol. 2007; 100: 1119-1123
        • Li J.
        • Flammer A.J.
        • Nelson R.E.
        • et al.
        Normal vascular function as a prerequisite for the absence of coronary calcification in patients free of cardiovascular disease and diabetes.
        Circ. J. 2012; 76: 2705-2710
        • Polonsky T.S.
        • McClelland R.L.
        • Jorgensen N.W.
        • et al.
        Coronary artery calcium score and risk classification for coronary heart disease prediction.
        J. Am. Med. Assoc. 2010; 303: 1610-1616
        • Budoff M.J.
        • Mayrhofer T.
        • Ferencik M.
        • et al.
        Prognostic value of coronary artery calcium in the PROMISE study (prospective multicenter imaging study for evaluation of chest pain).
        Circulation. 2017; 136: 1993-2005
        • Dewey M.
        • Siebes M.
        • Kachelriess M.
        • et al.
        Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia.
        Nat. Rev. Cardiol. 2020; 17: 427-450
        • Schindler T.H.
        • Nitzsche E.U.
        • Olschewski M.
        • et al.
        PET-measured responses of MBF to cold pressor testing correlate with indices of coronary vasomotion on quantitative coronary angiography.
        J. Nucl. Med. 2004; 45: 419-428
        • Assante R.
        • Zampella E.
        • Arumugam P.
        • et al.
        Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease.
        J. Nucl. Cardiol. 2017; 24: 494-501
        • Stuijfzand W.J.
        • Schumacher S.P.
        • Driessen R.S.
        • et al.
        Myocardial blood flow and coronary flow reserve during 3 Years following bioresorbable vascular scaffold versus metallic drug-eluting stent implantation: the VANISH trial.
        JACC Cardiovasc. Interv. 2019; 12: 967-979
        • Stuijfzand W.J.
        • Raijmakers P.G.
        • Driessen R.S.
        • et al.
        Evaluation of myocardial blood flow and coronary flow reserve after implantation of a bioresorbable vascular scaffold versus metal drug-eluting stent: an interim one-month analysis of the VANISH trial.
        EuroIntervention. 2016; 12: e584-e594
        • Danad I.
        • Raijmakers P.G.
        • Appelman Y.E.
        • et al.
        Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [15O]H2O PET/CT study.
        Eur. J. Nucl. Med. Mol. Imag. 2012; 39: 102-112
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • et al.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J. Am. Coll. Cardiol. 1990; 15: 827
        • Harms H.J.
        • Knaapen P.
        • de Haan S.
        • et al.
        Automatic generation of absolute myocardial blood flow images using [15O]H2O and a clinical PET/CT scanner.
        Eur. J. Nucl. Med. Mol. Imag. 2011; 38: 930-939
        • Uren N.G.
        • Melin J.A.
        • De Bruyne B.
        • et al.
        Relation between myocardial blood flow and the severity of coronary-artery stenosis.
        N. Engl. J. Med. 1994; 330: 1782-1788
        • Budoff M.J.
        • Young R.
        • Lopez V.A.
        • et al.
        Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis).
        J. Am. Coll. Cardiol. 2013; 61: 1231-1239
        • Hecht H.S.
        Coronary artery calcium scanning: past, present, and future.
        JACC Cardiovasc Imaging. 2015; 8: 579-596
        • Budoff M.J.
        • Achenbach S.
        • Blumenthal R.S.
        • et al.
        Assessment of coronary artery disease by cardiac computed tomography.
        Circulation. 2006; 114: 1761-1791
        • Radford N.B.
        • DeFina L.F.
        • Barlow C.E.
        • et al.
        Progression of CAC score and risk of incident CVD.
        JACC Cardiovasc Imaging. 2016; 9: 1420-1429
        • Lehmann N.
        • Erbel R.
        • Mahabadi A.A.
        • et al.
        Value of progression of coronary artery calcification for risk prediction of coronary and cardiovascular events: result of the HNR study (heinz nixdorf recall).
        Circulation. 2018; 137: 665-679
        • Erbel R.
        • Lehmann N.
        • Churzidse S.
        • et al.
        Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study.
        Eur. Heart J. 2014; 35: 2960-2971
        • Engbers E.M.
        • Timmer J.R.
        • Ottervanger J.P.
        • et al.
        Prognostic value of coronary artery calcium scoring in addition to single-photon emission computed tomographic myocardial perfusion imaging in symptomatic patients.
        Circ Cardiovasc Imaging. 2016; 9
        • Bavishi C.
        • Argulian E.
        • Chatterjee S.
        • et al.
        CACS and the frequency of stress-induced myocardial ischemia during MPI: a meta-analysis.
        JACC Cardiovasc Imaging. 2016; 9: 580-589
        • Zampella E.
        • Acampa W.
        • Assante R.
        • et al.
        Combined evaluation of regional coronary artery calcium and myocardial perfusion by (82)Rb PET/CT in predicting lesion-related outcome.
        Eur. J. Nucl. Med. Mol. Imag. 2019; 47: 1698-1704
        • Wang L.
        • Jerosch-Herold M.
        • Jacobs D.R.
        • et al.
        Coronary artery calcification and myocardial perfusion in asymptomatic adults: the MESA (Multi-Ethnic study of atherosclerosis).
        J. Am. Coll. Cardiol. 2006; 48: 1018-1026
        • de Graaf M.A.
        • Roos C.J.
        • Mansveld J.M.
        • et al.
        Changes in ischaemia as assessed with single-photon emission computed tomography myocardial perfusion imaging in high-risk patients with diabetes without cardiac symptoms: relation with coronary atherosclerosis on computed tomography coronary angiography.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 863-870
        • Gould K.L.
        • Lipscomb K.
        • Hamilton G.W.
        Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve.
        Am. J. Cardiol. 1974; 33: 87-94
        • Johnson N.P.
        • Kirkeeide R.L.
        • Gould K.L.
        Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology?.
        JACC (J. Am. Coll. Cardiol.): Cardiovascular Imaging. 2012; 5: 193-202
        • Camici P.G.
        • Crea F.
        Coronary microvascular dysfunction.
        N. Engl. J. Med. 2007; 356: 830-840
        • Rodriguez-Granillo G.A.
        • Carrascosa P.
        • Bruining N.
        Progression of Coronary Artery Calcification at the Crossroads: Sign of Progression or Stabilization of Coronary Atherosclerosis? Cardiovascular Diagnosis and Therapy. vol. 6. 2016: 250-258 (3)
        • Puri R.
        • Nicholls S.J.
        • Shao M.
        • et al.
        Impact of statins on serial coronary calcification during atheroma progression and regression.
        J. Am. Coll. Cardiol. 2015; 65: 1273-1282
        • Shaw L.J.
        • Narula J.
        • Chandrashekhar Y.
        The never-ending story on coronary calcium: is it predictive, punitive, or protective?*.
        J. Am. Coll. Cardiol. 2015; 65: 1283-1285
        • Taqueti V.R.
        • Hachamovitch R.
        • Murthy V.L.
        • et al.
        Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization.
        Circulation. 2015; 131: 19-27
        • Kiviniemi T.
        Assessment of coronary blood flow and the reactivity of the microcirculation non-invasively with transthoracic echocardiography.
        Clin. Physiol. Funct. Imag. 2008; 28: 145-155
        • Shaw L.J.
        • Min J.K.
        • Nasir K.
        • et al.
        Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium.
        Eur. Heart J. 2018; 39: 3727-3735
        • Haider A.
        • Bengs S.
        • Luu J.
        • et al.
        Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome.
        Eur. Heart J. 2019; 41: 1328-1336