Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease

We assessed the relationship between coronary artery calcium (cac) score, myocardial blood flow (mbf) and coronary flow reserve (cfr) in patients undergoing hybrid 82rb positron emission tomography (pet)/computed tomography (ct) imaging for suspected cad. we also evaluated if cac score is able to predict a reduced cfr independently from conventional coronary risk factors. a total of 637 (mean age 58 ± 13 years) consecutive patients were studied. cac score was measured according to the agatston method and patients were categorized into 4 groups (0, 0.01-99.9, 100-399.9, and ≥400). baseline and hyperemic mbf were automatically quantified. cfr was calculated as the ratio of hyperemic to baseline mbf and it was considered reduced when <2. global cac score showed a significant inverse correlation with hyperemic mbf and cfr (both p < .001), while no correlation between cac score and baseline mbf was found. at multivariable logistic regression analysis age, diabetes and cac score were independently associated with reduced cfr (all p < .001). the addition of cac score to clinical data increased the global chi-square value for predicting reduced cfr from 81.01 to 91.13 (p < .01). continuous net reclassification improvement, obtained by adding cac score to clinical data, was 0.36. cac score provides incremental information about coronary vascular function over established cad risk factors in patients with suspected cad and it might be helpful for identifying those with a reduced cfr.