Nayfeh Malek, Al Rifai Mahmoud, Ahmed Ahmed Ibrahim, Nabi Faisal, Al-Mallah Mouaz
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX 77030, USA.
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Eur Heart J Cardiovasc Imaging. 2025 Jun 30;26(7):1176-1183. doi: 10.1093/ehjci/jeaf143.
It is important to evaluate the relationship between coronary plaque characteristics and myocardial blood flow (MBF) to determine coronary phenotypes that may predispose to cardiovascular disease. Objectives are to study the association between coronary artery calcium (CAC) volume and density and positron emission tomography (PET)-derived myocardial flow reserve (MFR) and their relationship with incident cardiovascular disease.
The study population consisted of consecutive patients who were referred for clinically indicated PET myocardial perfusion imaging between 2019 and 2024. CAC was assessed in a separate gated scan done just prior to PET and calculated using the Agatston score. Since the Agatston score includes calcified plaques (≥130 HU), soft and low-density plaques were not assessed. MFR was calculated as the ratio of stress to rest MBF. Patients with CAC = 0 and those with known coronary artery disease were excluded. The study population consisted of 3884 individuals with mean (SD) age 69 (±10.5) years. When CAC volume and density were included in the same model, CAC density was positively associated with MFR (β coefficient = 0.10, 95% CI 0.06, 0.15) and CAC volume was inversely associated with it (β coefficient -0.08, 95% CI -0.10, -0.05). During a median follow-up of 13.7 months, the primary outcome (death/myocardial infarction) occurred in 218 individuals (5.6%). When CAC volume and density were included in the same model including demographics and cardiovascular risk factors, CAC density was inversely and significantly associated with the primary outcome (HR = 0.67, 95% CI 0.47, 0.96) while CAC volume was positively and significantly associated with it (HR = 1.57, 95% CI 1.34, 1.82). Results were no longer significant after further adjustment for CAC, stress test parameters, and MFR.
At any level of CAC volume, higher CAC density is significantly associated with higher MFR but not associated with risk of death/myocardial infarction.
评估冠状动脉斑块特征与心肌血流（MBF）之间的关系对于确定可能易患心血管疾病的冠状动脉表型很重要。目的是研究冠状动脉钙化（CAC）体积和密度与正电子发射断层扫描（PET）衍生的心肌血流储备（MFR）之间的关联及其与心血管疾病事件的关系。
研究人群包括2019年至2024年间因临床需要接受PET心肌灌注成像的连续患者。在PET检查前进行的一次单独门控扫描中评估CAC，并使用阿加斯顿评分进行计算。由于阿加斯顿评分包括钙化斑块（≥130 HU），因此未评估软斑块和低密度斑块。MFR计算为应激时与静息时MBF的比值。排除CAC = 0的患者和已知冠状动脉疾病的患者。研究人群包括3884名个体，平均（标准差）年龄为69（±10.5）岁。当将CAC体积和密度纳入同一模型时，CAC密度与MFR呈正相关（β系数 = 0.10，95%置信区间0.06，0.15），而CAC体积与之呈负相关（β系数 -0.08，95%置信区间 -0.10，-0.05）。在中位随访13.7个月期间，218名个体（5.6%）发生了主要结局（死亡/心肌梗死）。当将CAC体积和密度纳入包括人口统计学和心血管危险因素的同一模型时，CAC密度与主要结局呈负相关且具有显著意义（HR = 0.67，95%置信区间0.47，0.96），而CAC体积与之呈正相关且具有显著意义（HR = 1.57，95%置信区间1.34，1.82）。在对CAC、应激试验参数和MFR进行进一步调整后，结果不再具有显著性。
在任何CAC体积水平下，较高的CAC密度与较高的MFR显著相关，但与死亡/心肌梗死风险无关。
