July 28, 2009 – Researchers may be able to predict future severe cardiac events in patients with known, stable coronary artery disease (CAD) using coronary calcium scoring, according to a study published today in the online edition of Radiology. "The amount of calcium in the coronary vessels, as measured by CT, is of high predictive value for subsequent serious or fatal heart attack in these patients, independent of the patient's age, sex and other coronary risk factors," said the study's lead author, Marcus Hacker, M.D., resident physician in the department of nuclear medicine, leader of the research unit for nuclear cardiology and assistant medical director at Ludwig Maximilians University in Munich, Germany. CAD is the most common type of heart disease. According to the National Heart, Lung and Blood Institute, it is the leading cause of death in the U.S. for both men and women, killing more than 500,000. Single photon emission computed tomography (SPECT) myocardial perfusion imaging is a nuclear medicine diagnostic procedure that provides excellent three-dimensional images of the coronary arteries to assist in the diagnosis and treatment of CAD. Currently, calcium scoring to measure the amount of calcium in the arteries is used as a screening exam and in cases of suspected CAD, but not in cases of known CAD. Dr. Hacker and colleagues set out to determine if calcium scoring would lend additional prognostic value to SPECT findings in patients with known, stable CAD. For the study, 260 patients with CAD underwent coronary artery calcium scoring in addition to SPECT myocardial perfusion imaging. Over a median period of 5.4 years, the patients were followed up for severe cardiac events. Twenty-three of the 260 patients had a fatal or severe heart attack, and 40 additional patients underwent bypass surgery. The results showed that patents with an initial calcium score greater than 400 were at significantly increased risk for severe cardiac events. "We found that coronary calcium seems to play an important role in predicting subsequent heart attack or sudden cardiac death, and adds prognostic value to SPECT findings," said coauthor Christopher Uebleis, M.D., member of the research unit for nuclear cardiology at Ludwig Maximilians University. Dr. Hacker pointed out that combining calcium scoring and SPECT can help to identify patients with known CAD who are at highest risk for serious or fatal heart attacks. "In these patients, intensified medical therapy, shorter follow-up intervals and, if necessary, bypass procedures may be required to prevent future severe cardiac events." For more information: www.radiologyinfo.org
SPECT Calcium Scoring May Signal Serious Heart Attack Risk
Hepatic 18F-FDG, 18F-FAC, and 18F-DFA accumulation are affected in a mouse model of autoimmune hepatitis. (A) Histochemical and immunohistochemical analyses of liver sections from vehicle- and ConA-treated mice. Scale bars represent 50 microns. Transverse PET/CT images (B) and quantification (C) of vehicle- and ConA-treated mice injected with 18F-FDG, 18F-FAC, and 18FDFA. Livers are outlined in a white dotted line. Quantification represents radiotracer accumulation in the liver normalized to a background organ. Image courtesy of Salas J.R., Chen B.Y., Wong A., et al.