June 26, 2026Open Access
Coronary Artery Calcification and Myocardial Perfusion in Asymptomatic Adults
Key Result
Severe coronary artery calcification (score ≥400) in asymptomatic adults was associated with increased odds of reduced myocardial perfusion reserve compared to a score of 0 (OR 4.99; 95% CI 1.73-14.4).
Key Points
- To assess the relationship between coronary artery calcification (CAC) and myocardial perfusion in asymptomatic individuals.
- Analyzed 222 asymptomatic adults aged 45-84 years, free of coronary heart disease (CHD).
- Measured myocardial blood flow (MBF) using MRI during rest and hyperemia.
- Calculated perfusion reserve as the ratio of hyperemic to resting MBF; determined Agatston CAC score via CT.
- Mean hyperemic MBF and perfusion reserve decreased with increasing CAC levels.
- Odds ratios indicated a significant increase in reduced perfusion reserve with higher CAC scores, ranging from 2.16 to 4.99.
- The relationship between perfusion reserve and CAC weakened with increased age (p<0.05).
Study Design
Type
Cross-Sectional (n=222)
Multicenter
No
Structured PICO
Is coronary artery calcification associated with impaired myocardial perfusion in asymptomatic adults without clinical CHD?
P
Population
222 asymptomatic men and women aged 45 to 84 years, free of coronary heart disease diagnosis, evaluated for coronary artery calcification and myocardial perfusion.
E
Exposure
Coronary artery calcification (CAC) score categories (0.1 to 99.9, 100 to 399, and >=400)
C
Comparator
CAC score of 0 (reference)
O
Outcome
Myocardial blood flow (MBF) during rest and adenosine-induced hyperemia, and perfusion reserve (ratio of hyperemic to resting MBF)surrogate
In asymptomatic adults without clinical CHD, increasing severity of coronary artery calcification is associated with progressively impaired myocardial perfusion reserve.
Main Result
Odds Ratio: 4.99 (95% CI 1.73–14.4)
Abstract
OBJECTIVES: This study assessed the cross-sectional association between coronary artery calcification (CAC) and myocardial perfusion in an asymptomatic population. BACKGROUND: Clinical studies showed that the prevalence of stress-induced ischemia increased with CAC burden among patients with coronary heart disease (CHD). Whether an association between CAC and myocardial perfusion exists in subjects without a history of CHD remains largely unknown. METHODS: A total of 222 men and women, ages 45 to 84 years old and free of CHD diagnosis, in the Minnesota field center of the MESA (Multi-Ethnic Study of Atherosclerosis) were studied. Myocardial blood flow (MBF) was measured using magnetic resonance imaging during rest and adenosine-induced hyperemia. Perfusion reserve was calculated as the ratio of hyperemic to resting MBF. Agatston CAC score was determined from chest multidetector computed tomography. RESULTS: Mean values of hyperemic MBF and perfusion reserve, but not resting MBF, were monotonically lower across increasing CAC levels. After adjusting for age and gender, odds ratios (95% confidence intervals) of reduced perfusion reserve ( or =400 were 1.00 (reference), 2.16 (0.96 to 4.84), 2.81 (1.04 to 7.58), and 4.99 (1.73 to 14.4), respectively. Further adjustment for other coronary risk factors did not substantially modify the association. However, the inverse association between perfusion reserve and CAC attenuated with advancing age (p for interaction < 0.05). CONCLUSIONS: Coronary vasodilatory response was associated inversely with the presence and severity of CAC in asymptomatic adults. Myocardial perfusion could be impaired by or manifest the progression to subclinical coronary atherosclerosis in the absence of clinical CHD.