Relationship between coronary flow reserve and coronary calcium burden in patients with suspected coronary artery disease : A retrospective analysis
- 1Department of Radiology, Jingxian Hospital, Anhui 242500, China.
Abstract
Coronary artery calcium (CAC) measures atherosclerotic burden, while coronary flow reserve (CFR) measures coronary vasodilator function. The study aimed to assess the relationship between CAC burden and CFR and to define clinical and imaging factors independently associated with compromised CFR. This retrospective observational study included 467 patients aged 16 to 93 years who underwent clinically indicated CAC assessment and quantitative ^82Rb PET/computed tomography myocardial perfusion imaging with pharmacological vasodilator stress between January 2024 and June 2026. CAC was categorized as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. CFR was calculated as stress-to-rest myocardial blood flow, with CFR < 2.0 defined as impaired. Correlation, multivariable linear regression, and multivariable logistic regression analyses were performed. Mean age was 61.8 ± 13.7 years, with 59.1% male participants; 39.6% had impaired CFR. Mean CFR decreased progressively from 2.43 ± 0.62 in patients with CAC = 0 to 1.57 ± 0.47 with CAC ≥ 400 (P for trend < .001), while impaired CFR increased from 25.9% to 67.1%. CFR was inversely correlated with CAC (Spearman r = −0.43, P < .001). After adjustment, CAC 100 to 399 and ≥400 remained independently associated with impaired CFR (adjusted OR 2.41, 95% confidence interval 1.35 to 4.30 and OR 3.28, 95% confidence interval 1.72 to 6.25, respectively). Age, diabetes, and abnormal myocardial perfusion were also independently associated with impaired CFR. CAC was independently associated with lower CFR and a higher prevalence of impaired CFR. This association remained after multivariable adjustment, and also on sensitivity analysis, indicating that these 2 approaches to coronary assessment complement each other. The results of this study are presented as associations, due to its retrospective cross sectional design.
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BibTeX
@article{zhang2026relationship,
title = {{Relationship between coronary flow reserve and coronary calcium burden in patients with suspected coronary artery disease : A retrospective analysis}},
author = {Lingling Zhang and Fan Wu},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051289},
url = {https://europepmc.org/article/PMC/PMC13727230},
note = {CC BY},
}
RIS
TY - JOUR
TI - Relationship between coronary flow reserve and coronary calcium burden in patients with suspected coronary artery disease : A retrospective analysis
AU - Lingling Zhang
AU - Fan Wu
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051289
UR - https://europepmc.org/article/PMC/PMC13727230
AB - Coronary artery calcium (CAC) measures atherosclerotic burden, while coronary flow reserve (CFR) measures coronary vasodilator function. The study aimed to assess the relationship between CAC burden and CFR and to define clinical and imaging factors independently associated with compromised CFR. This retrospective observational study included 467 patients aged 16 to 93 years who underwent clinically indicated CAC assessment and quantitative ^82Rb PET/computed tomography myocardial perfusion imaging with pharmacological vasodilator stress between January 2024 and June 2026. CAC was categorized as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. CFR was calculated as stress-to-rest myocardial blood flow, with CFR < 2.0 defined as impaired. Correlation, multivariable linear regression, and multivariable logistic regression analyses were performed. Mean age was 61.8 ± 13.7 years, with 59.1% male participants; 39.6% had impaired CFR. Mean CFR decreased progressively from 2.43 ± 0.62 in patients with CAC = 0 to 1.57 ± 0.47 with CAC ≥ 400 (P for trend < .001), while impaired CFR increased from 25.9% to 67.1%. CFR was inversely correlated with CAC (Spearman r = −0.43, P < .001). After adjustment, CAC 100 to 399 and ≥400 remained independently associated with impaired CFR (adjusted OR 2.41, 95% confidence interval 1.35 to 4.30 and OR 3.28, 95% confidence interval 1.72 to 6.25, respectively). Age, diabetes, and abnormal myocardial perfusion were also independently associated with impaired CFR. CAC was independently associated with lower CFR and a higher prevalence of impaired CFR. This association remained after multivariable adjustment, and also on sensitivity analysis, indicating that these 2 approaches to coronary assessment complement each other. The results of this study are presented as associations, due to its retrospective cross sectional design.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -