{ "abstract": "Background: Coronary artery calcium (CAC) scoring effectively stratifies cardiovascular risk, and stress perfusion cardiac magnetic resonance (CMR) accurately detects myocardial ischemia. We aimed to investigate the prevalence and factors associated with myocardial ischemia on CMR in patients with CAC, and to assess the clinical impact of myocardial ischemia following CMR. Methods: This study included 215 patients aged ≥18 years who underwent CAC scoring for risk stratification, followed by stress CMR between 2013 and 2026. The prevalence and predictors of myocardial ischemia were investigated. Receiver operating characteristic (ROC) analysis was performed to assess the association between CAC scores and myocardial ischemia. Additionally, subsequent clinical management following CMR was determined. Results: The mean age was 69.3 ± 9.1 years (60.9% male). The average 10-year PREVENT risk score was 18.6 ± 8.7%. Overall, myocardial ischemia was present in 26.0% of patients (56/215): 17.1% in the CAC 300–999 Agatston units (AU) group (14/82) and 41.6% in the CAC ≥ 1,000 AU group (42/101). CAC score was the only independent predictor of myocardial ischemia (adjusted OR 1.07, 95%CI 1.03 − 1.10; p < 0.001 per 100 AU). Across clinical risk score categories and diabetes status, CAC score was consistently associated with myocardial ischemia, with no significant interactions observed (all p for interaction >0.05).The number of ischemic segments increased with increasing CAC scores (p < 0.001). ROC analysis demonstrated an optimal cutoff threshold of CAC ≥ 1,093 AU for detecting myocardial ischemia (AUC 0.75, p < 0.001). The clinical impact of stress CMR included medication changes in 37.2% of patients, while 18.1% underwent invasive procedures. Conclusions: In patients with CAC scores undergoing stress CMR, the prevalence of myocardial ischemia was approximately one-fourth and was associated with higher CAC scores. Stress CMR may influence clinical management in this population. Larger or prospective studies validating these findings and evaluating prognosis are warranted.", "abstract_shown": true, "affiliations": [ "Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand." ], "article_type": "Research Article", "arxiv": null, "author_total": 5, "authors": [ { "affs": [ 0 ], "name": "Yodying Kaolawanich", "orcid": "0000-0003-1262-9212" }, { "affs": [ 0 ], "name": "Methat Meechuen" }, { "affs": [ 0 ], "name": "Issarayus Laohabut" }, { "affs": [ 0 ], "name": "Thanawat Ruengchaisiwawaith" }, { "affs": [ 0 ], "name": "Thananya Boonyasirinant", "orcid": "0000-0002-9149-3407" } ], "bibtex": "https://research.draconitic.com/paper/8ca9516p65vj0.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0361659", "fulltext_url": "https://europepmc.org/articles/PMC13722317", "id": "8ca9516p65vj0", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0361659", "language": "eng", 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"heading", "People and Places" ], [ "heading", "Population Groupings" ], [ "heading", "Radiology and Imaging" ], [ "heading", "Research Article" ], [ "heading", "Research and Analysis Methods" ], [ "heading", "Surgical and Invasive Medical Procedures" ], [ "heading", "Thai People" ], [ "heading", "Tomography" ], [ "heading", "Vascular Medicine" ], [ "plos", "/Biology and life sciences/Neuroscience/Neuroimaging/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Cardiology" ], [ "plos", "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular diseases/Cardiovascular disease risk" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Medical conditions/Cardiovascular diseases/Cardiovascular disease risk" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Ischemia" ], [ "plos", "/People and places/Population groupings/Ethnicities/Asian people/Thai people" ], [ "plos", "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Neuroimaging/Computed axial tomography" ] ], "openalex": null, "pdf_url": "https://europepmc.org/articles/PMC13722317?pdf=render", "pmcid": "PMC13722317", "pmid": "42962045", "published": "2026-10-30", "publisher": "Public Library of Science", "ris": 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"title": "Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging", "title_text": "Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:51Z", "url": "https://research.draconitic.com/paper/8ca9516p65vj0", "venue": "PLOS One", "versions": [] }