{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T13:41:58Z","timestamp":1765806118954,"version":"3.44.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Coronary artery calcium (CAC) is a strong predictor of cardiovascular outcomes, with patients having high CAC experiencing event rates similar to those in secondary prevention populations. Emerging evidence suggests that patients with extremely high CAC (\u22651000) represent a distinct high-risk group. Therefore, this study aims to evaluate the prognostic value of myocardial flow reserve (MFR) in patients with very high CAC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Consecutive patients who had a clinically indicated positron emission tomography were enrolled and followed prospectively for incident outcomes (all-cause death and myocardial infarction). Multivariable-adjusted Cox proportional hazards models were used to study the association between MFR and incident events (composite of all-cause death and myocardial infarction) among those with CAC \u2265400.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The study population consisted of 3091 patients; mean (SD) age 69.6 (10.1) years, 36.8% female, 64.5% White, 46.0% with a CAC score of 400 to 999, and 54.0% with a CAC score of \u22651000. The median (interquartile range) MFR was 1.9 (1.45\u20132.35). Over a median (interquartile range) follow-up time of 1.36 (0.45\u20132.50) years, there were 278 incident events (81 myocardial infarctions and 217 deaths). In adjusted analyses, an MFR \u22652 was inversely associated with a lower risk of incident events; hazard ratio, 0.65 (95% CI, 0.38\u20131.12) for a CAC score of 400 to 999 and hazard ratio, 0.44 (95% CI, 0.28\u20130.69) for a CAC score of \u2265 1000. There was no significant interaction between MFR and CAC score;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.53.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Among patients with CAC \u2265400, positron emission tomography\u2013derived MFR \u22652 is inversely associated with a lower risk of all-cause death and myocardial infarction.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.125.018361","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T09:00:15Z","timestamp":1754557215000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic Value of PET-Derived Myocardial Flow Reserve in Patients With Very High Coronary Artery Calcium Score"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6933-790X","authenticated-orcid":true,"given":"Mahmoud","family":"Al Rifai","sequence":"first","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, TX (M.A.R., M.A., A.I.A., T.A., M.H.A.-M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Alwan","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, TX (M.A.R., M.A., A.I.A., T.A., M.H.A.-M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5886-7999","authenticated-orcid":true,"given":"Ahmed Ibrahim","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, TX (M.A.R., M.A., A.I.A., T.A., M.H.A.-M.)."},{"name":"Yale University School of Medicine, New Haven, CT (A.I.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0306-8911","authenticated-orcid":true,"given":"Talal","family":"Alnabelsi","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, TX (M.A.R., M.A., A.I.A., T.A., M.H.A.-M.)."},{"name":"University of Kentucky Medical Center, Gill Heart and Vascular Institute, Lexington (T.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Aljizeeri","sequence":"additional","affiliation":[{"name":"King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (A.A.)."},{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (A.A.)."},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (A.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2348-0484","authenticated-orcid":true,"given":"Mouaz H.","family":"Al-Mallah","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, TX (M.A.R., M.A., A.I.A., T.A., 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