Myocardial perfusion, ventricular function and quantification of calcium in the evaluation of patients with coronary artery disease

Objective: To determine if there is a relationship between the amount of coronary calcium and the perfusion and ventricular function status in a group of patients with known or suspected coronary artery disease. Methods: One hundred and thirty-five patients (mean age: 60 +/- 10 years, 59% female) were included. All underwent gated-SPECT two-day (stress-rest) myocardial perfusion imaging as well as calcium scoring (CaS) by multislice CT. Patients were divided into four groups according to the CaS: 0 (Group 1), from 1-100 (Group 2), from 101-400 (Group 3) and more than 400 Agatston units (Group 4). A clinical two-year follow-up was done. Results: In 80 patients (59%) coronary calcium was detected; while in 55 (41%) the CaS was 0. No significant difference regarding the stress variables was found among the groups. The perfusion defect was significantly greater in group 4 patients. Both left ventricular ejection fraction (LVEF) at rest and poststress were significantly higher in groups 1 and 3 than in group 4. The poststress LVEF was higher than the LVEF at rest in all groups except group 4, where the mean.FEVI (poststress minus rest) was -0.21 +/- 7.76. During the follow-up there were 16 adverse events (from these, 15 of cardiovascular origin, 80% in group 4). Conclusions: Higher coronary calcium values were associated to myocardial ischemia on SPECT, considering both perfusion and poststress ventricular function abnormalities.