Higher Coronary Calcium Scores Linked to Myocardial Ischemia on Cardiac MRI

Myocardial ischemia was detected in 26.0 percent of patients undergoing stress perfusion cardiac magnetic resonance imaging following coronary artery calcium scoring, according to study findings from 215 adult patients. The prevalence of ischemia increased alongside calcium burden, appearing in 17.1 percent of individuals with scores between 300 and 999 Agatston units (14 of 82 patients) and in 41.6 percent of those with scores of 1,000 Agatston units or higher (42 of 101 patients).

The study evaluated 215 patients aged 18 years or older who received coronary artery calcium scoring for cardiovascular risk stratification followed by stress cardiac magnetic resonance between 2013 and 2026. The cohort had an average age of 69.3 ± 9.1 years, was 60.9 percent male, and had a mean 10-year PREVENT risk score of 18.6 ± 8.7 percent. Investigators set out to determine the prevalence and predictors of myocardial ischemia and to assess how stress cardiac magnetic resonance subsequently guided clinical management.

Coronary artery calcium score emerged as the sole independent predictor of myocardial ischemia, with an adjusted odds ratio of 1.07 per 100 Agatston units (95% confidence interval 1.03 to 1.10; p < 0.001). This association remained consistent across clinical risk score categories and diabetes status, with no significant interaction observed (all p for interaction > 0.05). Furthermore, the number of ischemic myocardial segments rose significantly with higher calcium scores (p < 0.001), and receiver operating characteristic analysis identified an optimal cutoff threshold of 1,093 Agatston units or greater for detecting ischemia, yielding an area under the curve of 0.75 (p < 0.001).

The authors concluded that myocardial ischemia occurred in approximately one-fourth of patients with coronary calcium undergoing stress magnetic resonance and tracked with higher calcium burdens. Because stress imaging may influence subsequent care in this population, the researchers noted that larger prospective studies are warranted to validate these findings and evaluate long-term prognosis.

Coronary artery calcium scoring functions effectively to stratify cardiovascular risk, whereas stress perfusion cardiac magnetic resonance imaging accurately detects myocardial ischemia.

Stress perfusion cardiac magnetic resonance also demonstrated a measurable impact on patient care, resulting in medication changes for 37.2 percent of individuals and invasive procedures for 18.1 percent.

Subject of Research: Association between coronary artery calcium score and myocardial ischemia on stress perfusion CMR

Article Title: Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging

Article References: Kaolawanich, Y., Meechuen, M., Laohabut, I., Ruengchaisiwawaith, T., & Boonyasirinant, T. (2026). Association between coronary artery calcium score and myocardial ischemia assessed by stress perfusion cardiac magnetic resonance imaging. PLOS One, 21(10), e0361659. https://doi.org/10.1371/journal.pone.0361659

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0361659

Keywords: coronary artery calcium, myocardial ischemia, cardiac magnetic resonance, stress perfusion CMR, Agatston score, cardiovascular risk, PREVENT score, perfusion imaging, Association, between, coronary, artery