Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging
- 1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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.
Related
- Quantitative Myocardial Perfusion With Simultaneous-Multislice Stress CMR for Detection of Significant Coronary Artery Disease
- Simultaneous multi slice (SMS) balanced steady state free precession first-pass myocardial perfusion cardiovascular magnetic resonance with iterative reconstruction at 1.5 T
- WITHDRAWN: Segmental Variability of Bolus-dispersion-induced Myocardial Blood Flow in Quantitative Myocardial Perfusion MRI: A CFD-based Analysis
- Atrial fibrillation is independently associated with impaired myocardial perfusion
- Multicellular Communication Networks in Myocardial Ischemia-Reperfusion Injury: Spatial and Temporal Organization of Injury and Repair
BibTeX
@article{kaolawanich2026association,
title = {{Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging}},
author = {Yodying Kaolawanich and Methat Meechuen and Issarayus Laohabut and Thanawat Ruengchaisiwawaith and Thananya Boonyasirinant},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361659},
url = {https://doi.org/10.1371/journal.pone.0361659},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging
AU - Yodying Kaolawanich
AU - Methat Meechuen
AU - Issarayus Laohabut
AU - Thanawat Ruengchaisiwawaith
AU - Thananya Boonyasirinant
PY - 2026
DA - 2026/10/30
JO - PLOS One
DO - 10.1371/journal.pone.0361659
UR - https://doi.org/10.1371/journal.pone.0361659
AB - 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.
SN - 1932-6203
ER -