{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T06:03:40Z","timestamp":1780725820003,"version":"3.54.1"},"reference-count":45,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Advances"],"published-print":{"date-parts":[[2025,3]]},"DOI":"10.1016\/j.jacadv.2025.101618","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T10:50:23Z","timestamp":1740048623000},"page":"101618","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging"],"prefix":"10.1016","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-4754","authenticated-orcid":false,"given":"Damianos G.","family":"Kokkinidis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Kyriakoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip W.","family":"Chui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hwa","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Khera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0972-9589","authenticated-orcid":false,"given":"Albert J.","family":"Sinusas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Velazquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Feher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"2","key":"10.1016\/j.jacadv.2025.101618_bib1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s12350-018-1211-1","article-title":"Future growth and success of nuclear cardiology","volume":"25","author":"Beller","year":"2018","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"9","key":"10.1016\/j.jacadv.2025.101618_bib2","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1001\/jamacardio.2016.3153","article-title":"Cardiac stress test trends among US patients younger than 65 years, 2005-2012","volume":"1","author":"Kini","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"5","key":"10.1016\/j.jacadv.2025.101618_bib3","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/0735-1097(94)90597-5","article-title":"Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect: study in 1,926 patients with follow-up at 33\u00a0months","volume":"23","author":"Machecourt","year":"1994","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"9","key":"10.1016\/j.jacadv.2025.101618_bib4","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1093\/ehjci\/jex014","article-title":"Comparison of the prognostic value of negative non-invasive cardiac investigations in patients with suspected or known coronary artery disease\u2013a meta-analysis","volume":"18","author":"Smulders","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1067\/mnc.2003.127624","article-title":"Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images","volume":"10","author":"Klodas","year":"2003","journal-title":"J\u00a0Nucl Cardiol"},{"key":"10.1016\/j.jacadv.2025.101618_bib6","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1067\/mnc.2001.114520","article-title":"Prediction of severe coronary artery disease and long-term outcome in patients undergoing vasodilator SPECT","volume":"8","author":"Ho","year":"2001","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"3","key":"10.1016\/j.jacadv.2025.101618_bib7","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.nuclcard.2004.02.005","article-title":"The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging","volume":"11","author":"Travin","year":"2004","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1067\/mnc.2002.127625","article-title":"Prognostic significance of ischemic electrocardiographic changes during adenosine infusion in patients with normal myocardial perfusion imaging","volume":"10","author":"Abbott","year":"2003","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/MCA.0b013e32831a8828","article-title":"Stress-induced ST-segment deviation in relation to the presence and severity of coronary artery disease in patients with normal myocardial perfusion imaging","volume":"20","author":"Weinsaft","year":"2009","journal-title":"Coron Artery Dis"},{"key":"10.1016\/j.jacadv.2025.101618_bib10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/0002-8703(95)90236-8","article-title":"Prognostic significance of ST-segment depression during adenosine perfusion imaging","volume":"130","author":"Marshall","year":"1995","journal-title":"Am Heart J"},{"key":"10.1016\/j.jacadv.2025.101618_bib11","article-title":"Incremental value of exercise ECG to myocardial perfusion single-photon emission computed tomography for prediction of cardiac events","volume":"12","author":"Kraen","year":"2023","journal-title":"J\u00a0Am Heart Assoc"},{"issue":"11","key":"10.1016\/j.jacadv.2025.101618_bib12","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/MNM.0000000000000733","article-title":"Future cardiac events in patients with ischemic ECG changes during adenosine infusion as a myocardial stress agent and normal cardiac scan","volume":"38","author":"Amer","year":"2017","journal-title":"Nucl Med Commun"},{"key":"10.1016\/j.jacadv.2025.101618_bib13","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1007\/s12350-010-9259-6","article-title":"Patients with adenosine-induced ST-segment depressions and normal myocardial perfusion imaging: cardiac outcomes at 24\u00a0months","volume":"17","author":"Sharma","year":"2010","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"6","key":"10.1016\/j.jacadv.2025.101618_bib14","doi-asserted-by":"crossref","first-page":"3491","DOI":"10.1007\/s12350-022-03089-z","article-title":"2022 ASNC\/AAPM\/SCCT\/SNMMI guideline for the use of CT in hybrid nuclear\/CT cardiac imaging","volume":"29","author":"Al-Mallah","year":"2022","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"3","key":"10.1016\/j.jacadv.2025.101618_bib15","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.jacc.2006.10.001","volume":"49","author":"Greenland","year":"2007","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"10","key":"10.1016\/j.jacadv.2025.101618_bib16","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.jcmg.2022.03.031","article-title":"The prognostic value of CAC zero among individuals presenting with chest pain: a meta-analysis","volume":"15","author":"Agha","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"issue":"3","key":"10.1016\/j.jacadv.2025.101618_bib17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcct.2007.10.001","article-title":"Prognostic significance of zero coronary calcium scores on cardiac computed tomography","volume":"1","author":"Shareghi","year":"2007","journal-title":"J\u00a0Cardiovasc Comput Tomogr"},{"issue":"7","key":"10.1016\/j.jacadv.2025.101618_bib18","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1161\/CIRCULATIONAHA.116.027034","article-title":"Value of progression of coronary artery calcification for risk prediction of coronary and cardiovascular events: result of the HNR study (Heinz Nixdorf Recall)","volume":"137","author":"Lehmann","year":"2018","journal-title":"Circulation"},{"issue":"4","key":"10.1016\/j.jacadv.2025.101618_bib19","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.115.003742","article-title":"Long-term prognosis after coronary artery calcium scoring among low-intermediate risk women and men","volume":"9","author":"Kelkar","year":"2016","journal-title":"Circ Cardiovasc Imaging"},{"issue":"6","key":"10.1016\/j.jacadv.2025.101618_bib20","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1007\/s12350-017-0866-3","article-title":"Automatic determination of cardiovascular risk by CT attenuation correction maps in Rb-82 PET\/CT","volume":"25","author":"I\u0161gum","year":"2018","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"9","key":"10.1016\/j.jacadv.2025.101618_bib21","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/ehjci\/jes079","article-title":"Measuring coronary artery calcification using positron emission tomography-computed tomography attenuation correction images","volume":"13","author":"Mylonas","year":"2012","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"23","key":"10.1016\/j.jacadv.2025.101618_bib22","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1016\/j.jacc.2010.05.057","article-title":"Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET\/CT and SPECT\/CT with standard Agatston score","volume":"56","author":"Einstein","year":"2010","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jacadv.2025.101618_bib23","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s12350-014-0026-y","article-title":"Single low-dose CT scan optimized for rest-stress PET attenuation correction and quantification of coronary artery calcium","volume":"22","author":"Kaster","year":"2015","journal-title":"J\u00a0Nucl Cardiol"},{"key":"10.1016\/j.jacadv.2025.101618_bib24","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s12350-022-03099-x","article-title":"Integration of coronary artery calcium scoring from CT attenuation scans by machine learning improves prediction of adverse cardiovascular events in patients undergoing SPECT\/CT myocardial perfusion imaging","volume":"30","author":"Feher","year":"2022","journal-title":"J\u00a0Nucl Cardiol"},{"key":"10.1016\/j.jacadv.2025.101618_bib25","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s12350-016-0395-5","article-title":"Visual identification of coronary calcifications on attenuation correction CT improves diagnostic accuracy of SPECT\/CT myocardial perfusion imaging","volume":"24","author":"Patchett","year":"2017","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"8","key":"10.1016\/j.jacadv.2025.101618_bib26","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","article-title":"Exercise standards for testing and training: a scientific statement from the American Heart Association","volume":"128","author":"Fletcher","year":"2013","journal-title":"Circulation"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib27","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10554-023-02980-1","article-title":"Comparison of the prognostic value between quantification and visual estimation of coronary calcification from attenuation CT in patients undergoing SPECT myocardial perfusion imaging","volume":"40","author":"Feher","year":"2023","journal-title":"Int J Cardiovasc Imaging"},{"issue":"12","key":"10.1016\/j.jacadv.2025.101618_bib28","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1056\/NEJM199109193251204","article-title":"Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease","volume":"325","author":"Mark","year":"1991","journal-title":"N\u00a0Engl J Med"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib29","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s12350-011-9457-x","article-title":"Electrocardiographic changes during vasodilator SPECT myocardial perfusion imaging: does it affect diagnosis or prognosis?","volume":"19","author":"Azemi","year":"2012","journal-title":"J\u00a0Nucl Cardiol"},{"key":"10.1016\/j.jacadv.2025.101618_bib30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jelectrocard.2022.05.011","article-title":"Significance of indeterminate and abnormal stress electrocardiography despite normal imaging in patients with suspected coronary artery disease\u2013An analysis of the PROMISE trial","volume":"73","author":"Mansour","year":"2022","journal-title":"J\u00a0Electrocardiol"},{"issue":"4","key":"10.1016\/j.jacadv.2025.101618_bib31","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1001\/jamainternmed.2019.6958","article-title":"Implications of abnormal exercise electrocardiography with normal stress echocardiography","volume":"180","author":"Daubert","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib32","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.117.006973","article-title":"Computed tomographic coronary angiography-derived plaque characteristics predict major adverse cardiovascular events: a systematic review and meta-analysis","volume":"11","author":"Nerlekar","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"issue":"2","key":"10.1016\/j.jacadv.2025.101618_bib33","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1067\/mnc.2002.120163","article-title":"Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT","volume":"9","author":"Links","year":"2002","journal-title":"J\u00a0Nucl Cardiol"},{"issue":"4","key":"10.1016\/j.jacadv.2025.101618_bib34","first-page":"193","article-title":"Artifacts and pitfalls in myocardial perfusion imaging","volume":"34","author":"Burrell","year":"2006","journal-title":"J\u00a0Nucl Med Technol"},{"issue":"6","key":"10.1016\/j.jacadv.2025.101618_bib35","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1080\/00015385.2018.1530081","article-title":"Prognostic significance of coronary artery calcium scoring and single-photon emission computed tomographic myocardial perfusion imaging on major adverse cardiac events in patients at low risk for suspected coronary artery disease","volume":"74","author":"Huang","year":"2019","journal-title":"Acta Cardiol"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib36","first-page":"31","article-title":"CT Attenuation correction and its impact on image quality of myocardial perfusion imaging in coronary artery disease: a systematic review","volume":"9","author":"Farrell","year":"2021","journal-title":"Asia Ocean J Nucl Med Biol"},{"issue":"1","key":"10.1016\/j.jacadv.2025.101618_bib37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2967\/jnmt.120.255943","article-title":"Added value of CT attenuation correction and prone positioning in improving breast and subdiaphragmatic attenuation in myocardial perfusion imaging","volume":"49","author":"Tawakol","year":"2021","journal-title":"J\u00a0Nucl Med Technol"},{"issue":"10","key":"10.1016\/j.jacadv.2025.101618_bib38","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1007\/s00259-019-04404-6","article-title":"Two decades of SPECT\/CT \u2013 the coming of age of a technology: an updated review of literature evidence","volume":"46","author":"Israel","year":"2019","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"3","key":"10.1016\/j.jacadv.2025.101618_bib39","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1053\/j.semnuclmed.2013.02.001","article-title":"Hybrid imaging worldwide-challenges and opportunities for the developing world: a report of a technical meeting organized by IAEA","volume":"43","author":"Kashyap","year":"2013","journal-title":"Semin Nucl Med"},{"issue":"4","key":"10.1016\/j.jacadv.2025.101618_bib40","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.121.012599","article-title":"Prognostic relationship between coronary artery calcium score, perfusion defects, and myocardial blood flow reserve in patients with suspected coronary artery disease","volume":"15","author":"Patel","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"10.1016\/j.jacadv.2025.101618_bib41","doi-asserted-by":"crossref","first-page":"652","DOI":"10.2967\/jnumed.122.264423","article-title":"Deep learning coronary artery calcium scores from SPECT\/CT attenuation maps improves prediction of major adverse cardiac events","volume":"64","author":"Miller","year":"2022","journal-title":"J\u00a0Nucl Med"},{"issue":"12","key":"10.1016\/j.jacadv.2025.101618_bib42","doi-asserted-by":"crossref","first-page":"4122","DOI":"10.1007\/s00259-022-05866-x","article-title":"Reproducibility of quantitative coronary calcium scoring from PET\/CT attenuation maps: comparison to ECG-gated CT scans","volume":"49","author":"Pieszko","year":"2022","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"11","key":"10.1016\/j.jacadv.2025.101618_bib43","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/j.amjcard.2016.08.037","article-title":"Impact of gender on the prognostic value of coronary artery calcium in symptomatic patients with normal single-photon emission computed tomography myocardial perfusion","volume":"118","author":"Engbers","year":"2016","journal-title":"Am J Cardiol"},{"issue":"13","key":"10.1016\/j.jacadv.2025.101618_bib44","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1161\/CIRCULATIONAHA.107.717512","article-title":"Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography\/computed tomography study","volume":"117","author":"Schenker","year":"2008","journal-title":"Circulation"},{"issue":"7","key":"10.1016\/j.jacadv.2025.101618_bib45","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1093\/ehjci\/jeae045","article-title":"Automated vessel-specific coronary artery calcification quantification with deep learning in a large multi-centre registry","volume":"25","author":"Williams","year":"2024","journal-title":"Eur Heart J Cardiovasc Imaging"}],"container-title":["JACC: Advances"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X25000353?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X25000353?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T05:32:41Z","timestamp":1780723961000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2772963X25000353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["S2772963X25000353"],"URL":"https:\/\/doi.org\/10.1016\/j.jacadv.2025.101618","relation":{},"ISSN":["2772-963X"],"issn-type":[{"value":"2772-963X","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging","name":"articletitle","label":"Article Title"},{"value":"JACC: Advances","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacadv.2025.101618","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.","name":"copyright","label":"Copyright"}],"article-number":"101618"}}