Adel H A Allam1,2, Randall C Thompson3,4, Michael A Eskander5, Mohamed A Mandour Ali1, Ayman Sadek1, Chris J Rowan6, M Linda Sutherland7, James D Sutherland8, Bruno Frohlich9, David E Michalik10,11, Caleb E Finch12, Jagat Narula13, Gregory S Thomas14,15, L Samuel Wann16. 1. Al Azhar University, Cairo, Egypt. 2. Alpha Scan, 45 Anas Ibn Malik Street, Mohandseen, Giza, Egypt. 3. Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. 4. University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. 5. University of California, Irvine Health, Orange, CA, USA. eskandem@uci.edu. 6. Renown Institute for Heart and Vascular Health, Reno, NV, USA. 7. Newport Diagnostic Center, Newport, CA, USA. 8. South Coast Radiological Medical Group, Laguna Hills, CA, USA. 9. National Museum of Natural History Smithsonian Institution, Washington, DC, DC, USA. 10. University of California, Irvine School of Medicine, Irvine, CA, USA. 11. Miller Women's and Children's Hospital, Long Beach, CA, USA. 12. Leonard Davis School of Gerontology and Dornsife College, University of Southern California, Los Angeles, CA, USA. 13. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 14. Long Beach Memorial, Long Beach, CA, USA. 15. University of California, Irvine, Orange, CA, USA. 16. Ascension Healthcare, Milwaukee, WI, USA.
Abstract
BACKGROUND: Patients with normal myocardial perfusion imaging (MPI) have a good prognosis. However, pre-clinical coronary and extracoronary atherosclerosis may exist in the absence of myocardial ischemia. METHODS: 154 Egyptian patients (mean age 53 years) underwent whole-body non-contrast CT following normal MPI. RESULTS: Atherosclerosis in the form of calcification was observed in ≥1 vascular bed in 115 of 154 (75%) patients. This included the iliofemoral (62%), abdominal aorta (53%), thoracic aorta (47%), coronary (47%), and carotid (25%) vascular beds. Mean total body calcium score was 3172 ± 530 AU. Extracoronary atherosclerosis in patients with a zero coronary artery calcium (CAC) score was common, occurring in the above-listed beds 42%, 36%, 29%, and 7% of the time, respectively. CAC was rarely present without iliofemoral or abdominal aortic calcification. CONCLUSION: Quantitative assessment of calcification in different vascular beds demonstrates that extracoronary atherosclerosis is common in patients who have normal MPI. Atherosclerotic calcifications are most common in the iliofemoral arteries and abdominal aorta, which typically predate coronary calcifications. An imaging strategy to detect extracoronary atherosclerosis could lead to greater understanding of the natural history of atherosclerosis in its long pre-clinical phase and possibly to earlier preventive strategies.
BACKGROUND:Patients with normal myocardial perfusion imaging (MPI) have a good prognosis. However, pre-clinical coronary and extracoronary atherosclerosis may exist in the absence of myocardial ischemia. METHODS: 154 Egyptian patients (mean age 53 years) underwent whole-body non-contrast CT following normal MPI. RESULTS:Atherosclerosis in the form of calcification was observed in ≥1 vascular bed in 115 of 154 (75%) patients. This included the iliofemoral (62%), abdominal aorta (53%), thoracic aorta (47%), coronary (47%), and carotid (25%) vascular beds. Mean total body calcium score was 3172 ± 530 AU. Extracoronary atherosclerosis in patients with a zero coronary artery calcium (CAC) score was common, occurring in the above-listed beds 42%, 36%, 29%, and 7% of the time, respectively. CAC was rarely present without iliofemoral or abdominal aortic calcification. CONCLUSION: Quantitative assessment of calcification in different vascular beds demonstrates that extracoronary atherosclerosis is common in patients who have normal MPI. Atherosclerotic calcifications are most common in the iliofemoral arteries and abdominal aorta, which typically predate coronary calcifications. An imaging strategy to detect extracoronary atherosclerosis could lead to greater understanding of the natural history of atherosclerosis in its long pre-clinical phase and possibly to earlier preventive strategies.
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