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Cardiac Imaging for Ischemia in Asymptomatic Patients: Use of Coronary Artery Calcium Scanning to Improve Patient Selection: Lessons from the EISNER Study

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Asymptomatic Atherosclerosis

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

We review emerging data that identify how coronary artery calcium (CAC) scanning can complement radionuclide cardiac stress testing for ischemia in the work-up of patients with suspected coronary artery disease (CAD). First, among screening populations, i.e., patients with low (<15%) Bayesian likelihood of CAD, stress imaging is characterized by a high false-positive test rate for CAD prediction and inability to detect hemodynamically insignificant stenoses. Because CAC scanning does not have these limitations and is a specific measure for atherosclerosis, it is a better screening test for CAD. Second, with respect to diagnostic testing, typically applied to patients with intermediate (15–85%) CAD likelihood, radionuclide imaging for ischemia has been validated as an effective diagnostic procedure. However, CAC scanning might complement this process by permitting more effective triaging of diagnostic patients for stress testing. This is because studies have demonstrated a threshold relationship between CAC scores and the frequency of myocardial ischemia. This threshold is typically low for patients with CAC scores <400, but a lower CAC threshold is observed among select risk factor subgroups, such as patients with diabetes and metabolic syndrome. Prospective work is thus needed to define the optimal CAC score criteria for triaging diagnostic patients for radionuclide stress testing on the basis of CAC scanning. Third, radionuclide stress testing is commonly used for risk stratification purposes in patients with both intermediate and high (>85%) pretest CAD likelihood. Of note, our data indicate when radionuclide stress testing is normal, a wide range of CAC scores is observed, including the presence of high CAC scores in approximately one-third of such patients. Thus, knowledge of CAC scores may represent important information for modifying projections of long-term risk and optimizing medical treatment when using stress tests for risk stratification purposes.

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Author information

Authors and Affiliations

  1. Department of Cardiology, St. Luke’s Roosevelt Hospital Center, New York, NY, USA

    Alan Rozanski

  2. Departments of Imaging and Medicine and the Burns and Allen Research Institute, Cedars-Sinai Medical Center and the Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Heidi Gransar

  3. Heart Disease Prevention Program, University of California at Irvine, Irvine, CA, USA

    Nathan D. Wong

  4. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Leslee J. Shaw

  5. Department of Cardiology, University Hospital, Basel, Switzerland

    Michael J. Zellweger

  6. Department of Cardiac Imaging and Nuclear Cardiology, Cedars-Sinai Medical School, Los Angeles, CA, USA

    Daniel S. Berman

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  1. Alan Rozanski
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  2. Heidi Gransar
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  4. Leslee J. Shaw
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  5. Michael J. Zellweger
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  6. Daniel S. Berman
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  1. Endothelix, Inc., El Rio 8275, Houston, 77054, USA

    Morteza Naghavi

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Rozanski, A., Gransar, H., Wong, N.D., Shaw, L.J., Zellweger, M.J., Berman, D.S. (2011). Cardiac Imaging for Ischemia in Asymptomatic Patients: Use of Coronary Artery Calcium Scanning to Improve Patient Selection: Lessons from the EISNER Study. In: Naghavi, M. (eds) Asymptomatic Atherosclerosis. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-179-0_30

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  • DOI: https://doi.org/10.1007/978-1-60327-179-0_30

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