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Background: Atherosclerosis is the underlying process causing coronary artery calcification. Pathophysiology of aortic and mitral valve calcification has several similarities with coronary atherosclerosis, but their correlation has not been clear, especially in patients with coronary atherosclerosis. Purpose: This study aims to investigate the correlation between the calcium score of the coronary arteries, aortic, and mitral valves in patients with coronary atherosclerosis. Methods: This was a cross-sectional, correlation study. Stratified randomization was done based on the coronary artery calcium score category. The calcium score was calculated using Agatston technique. Statistical tests were done to look for the correlations between the coronary artery and aortic valve calcium score, coronary artery and mitral valve calcium score, as well as coronary artery and aortic + mitral valve calcium score. Results: There are ninety-seven subjects (coronary calcium score "mild" 34 subjects, "moderate" 30 subjects, "severe" 33 subjects) with a mean age of 63.85 (± 9.80) years old. The median coronary artery calcium score was 158.7 (Agatston Unit (AU; 1–3917.7), aortic valve 12.6 AU (0–3747), and mitral valve 0.1 AU (0–1247.5 AU). There was a very weak correlation between coronary artery calcium score with aortic, mitral, and aortic + mitral valve calcium score. Conclusions: There was no statistically significant correlation between the calcium score of the coronary artery and the calcium score of the aortic valve, as well as the calcium score of the mitral valve in patients with coronary atherosclerosis. However, the secondary analysis showed a correlation between them varied depending on the severity of coronary artery calcification, which could shed light on a better understanding of the atherosclerotic process in the coronary artery, aortic, and mitral valve. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT). Materials and methods: We retrospectively reviewed 226 patients (100 males, mean age 79.4 ± 6.7 years) undergoing 64-slice CT for pre-TAVI evaluation from January 2018 to April 2021. The population was divided into CS quartiles. Results: Overall, 173 patients underwent TAVI procedure, of whom 61% presented paravalvular leak after the procedure, 28% presented bleeding or vascular complications, 25% presented atrioventricular block, and 8% developed acute kidney injury. The prevalence of paravalvular leak and vascular complications was higher in the upper CS quartiles for aortic valve and ilio-femoral arteries. Conclusions: Aortic valve and vascular CS could help to predict post-TAVI early complications. [ABSTRACT FROM AUTHOR]

Calcium controls numerous events within the vessel wall. Permeability of the endothelium is calcium dependent, as are platelet activation and adhesion, vascular smooth muscle proliferation and migration, and synthesis of fibrous connective tissue. Double-helix computerized tomography is a noninvasive technique that can detect, measure, and compare coronary calcification in the coronary arteries. Despite some convincing evidence about the prognostic value and usefulness of coronary artery calcium score (CACS) in the stratification of cardiovascular risk in the high risk general population and also in hypertensive patients, current guidelines for the management of hypertension, do not include such evaluation among the recommended procedures to be performed in the majority of patients even with the intent to detect hypertension-mediated organ damage (HMOD) in an early phase. On the contrary, the European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes, the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, and the 2018 Cholesterol Clinical Practice Guidelines indicate that the evaluation of CACS may be of some usefulness in specific subpopulations, although this view is not accepted in the US Preventive Services Task Force document. Very recently, the European Society of Cardiology Guidelines on cardiovascular disease prevention in clinical practice stated that CACS estimation may be considered to improve risk classification around treatment decision thresholds. In conclusion, the use of CACS as a diagnostic tool is still controversial. While some evidence exists about is ability to improve stratification of cardiovascular risk in primary prevention, in particular in selected patients who are at intermediate or borderline risk of atherosclerotic cardiovascular disease, there is insufficient evidence to use it as a standard means to assess HMOD. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate an effective and user-friendly AI platform based on a few unbiased clinical variables integrated with advanced CT automatic analysis for COVID-19 patients' risk stratification. Material and Methods: In total, 1575 consecutive COVID-19 adults admitted to 16 hospitals during wave 1 (February 16-April 29, 2020), submitted to chest CT within 72 h from admission, were retrospectively enrolled. In total, 107 variables were initially collected; 64 extracted from CT. The outcome was survival. A rigorous AI model selection framework was adopted for models selection and automatic CT data extraction. Model performances were compared in terms of AUC. A web–mobile interface was developed using Microsoft PowerApps environment. The platform was externally validated on 213 COVID-19 adults prospectively enrolled during wave 2 (October 14-December 31, 2020). Results: The final cohort included 1125 patients (292 non-survivors, 26%) and 24 variables. Logistic showed the best performance on the complete set of variables (AUC = 0.839 ± 0.009) as in models including a limited set of 13 and 5 variables (AUC = 0.840 ± 0.0093 and AUC = 0.834 ± 0.007). For non-inferior performance, the 5 variables model (age, sex, saturation, well-aerated lung parenchyma and cardiothoracic vascular calcium) was selected as the final model and the extraction of CT-derived parameters was fully automatized. The fully automatic model showed AUC = 0.842 (95% CI: 0.816–0.867) on wave 1 and was used to build a 0–100 scale risk score (AI-SCoRE). The predictive performance was confirmed on wave 2 (AUC 0.808; 95% CI: 0.7402–0.8766). Conclusions: AI-SCoRE is an effective and reliable platform for automatic risk stratification of COVID-19 patients based on a few unbiased clinical data and CT automatic analysis. [ABSTRACT FROM AUTHOR]

Purpose: 18F-NaF-PET/CT can detect mineral metabolism within atherosclerotic plaques. To ascertain whether their 18F-NaF uptake purports progression, this index was compared with subsequent morphologic evolution. Methods: 71 patients underwent two consecutive 18F-NaF-PET/CTs (PET1/PET2). In PET1, non-calcified 18F-NaF hot spots were identified in the abdominal aorta. Their mean/max HU was compared with those of a non-calcified control region (CR) and with corresponding areas in PET2. A target-to-background ratio (TBR), mean density (HU), and calcium score (CS) were calculated on calcified atherosclerotic plaques in PET1 and compared with those in PET2. A VOI including the entire abdominal aorta was drawn; mean TBR and total CS were calculated on PET1 and compared with those PET2. Results: Hot spots in PET1 (N = 179) had a greater HU than CR (48 ± 8 vs 37 ± 9, P <.01). Mean hot spots HU increased to 59 ± 12 in PET2 (P <.001). New calcifications appeared at the hot spots site in 73 cases (41%). Baseline atherosclerotic plaque's (N = 375) TBR was proportional to percent HU and CS increase (P <.01 for both). Aortic CS increased (P <.001); the whole-aorta TBR in PET1 correlated with the CS increase between the baseline and the second PET/CT (R =.63, P <.01). Conclusions: 18F-NaF-PET/CT depicts the early stages of plaques development and tracks their evolution over time. [ABSTRACT FROM AUTHOR]

Background: Imaging-based measures of atherosclerosis such as coronary artery calcium score (CACS) and coronary flow reserve (CFR) as well as carotid atherosclerotic plaque burden (cPB) are predictors of cardiovascular events in the general population. The objective of this study was to correlate CACS, cPB, myocardial blood flow (MBF), and CFR in patients with end-stage renal disease (ESRD). Methods and results: 39 patients (mean age 53 ± 12 years) with ESRD prior to kidney transplantation were enrolled. MBF and CFR were quantified at baseline and under hyperemia by 13N-NH3-PET/CT. CACS was calculated from low-dose CT scans acquired for PET attenuation correction. cPB was assessed by 3D ultrasound. Uni- and multivariate regression analyses between these and clinical parameters were performed. Median follow-up time for clinical events was 4.4 years. Kaplan–Meier survival estimates with log-rank test were performed with regards to cardiovascular (CV) events and death of any cause. CACS and cPB were associated in ESRD patients (r = 0.48; p ≤ 0.01). While cPB correlated with age (r = 0.43; p < 0.01), CACS did not. MBFstress was negatively associated with age (r = 0.44; p < 0.01) and time on dialysis (r = 0.42; p < 0.01). There were negative correlations between MBFstress and CACS (r = − 0.62; p < 0.001) and between MBFstress and cPB (r = − 0.43; p < 0.01). Age and CACS were the strongest predictors for MBFstress. CFR was impaired (< 2.0) in eight patients who also presented with higher cPB and higher CACS compared to those with a CFR > 2.0 (p = 0.06 and p = 0.4). In contrast to MBFstress, there was neither a significant correlation between CFR and CACS (r = − 0.2; p = 0.91) nor between CFR and cPB (r = − 0.1; p = 0.55). CV event-free survival was associated with reduced CFR and MBFstress (p = 0.001 and p < 0.001) but not with cPB or CACS. Conclusions: CACS, cPB, and MBFstress are associated in patients with ESRD. Atherosclerosis is earlier detected by MBFstress than by CFR. CV event-free survival is associated with impaired CFR and MBFstress. [ABSTRACT FROM AUTHOR]

Objective: A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS). Methods: This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment. Results: The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs. Conclusion: MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted. Key Points: • A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review considers the framework of high-risk vs. population approaches as proposed in the Rose's axiom within the context of cardiovascular diseases, including its benefits and limitations. We also contextualize the use of precision medicine in primary prevention therapy and contrast that with population approach. Recent Findings: Although the high-risk strategy aims at individualized care, the complexity of pharmacologic regimens and other limitations reduces its real-life impact. On the other hand, broad population strategies include treatment of a substantial number of low-risk individuals who are unlikely to benefit from treatment. The use of additional strategies to identify those low-risk individuals, instead of targeting at identifying the high-risk population, is and alternative strategy to be considered. Evidence of the potential use of coronary artery calcium score and polypills for this strategy is discussed. Summary: A more targeted population approach to primary prevention in cardiovascular diseases with the use of polypills and coronary artery calcium score might be considered in a structured mass-strategy approach to risk reduction. [ABSTRACT FROM AUTHOR]

Objective: Postoperative acute mesenteric ischemia (AMI) in the long-term hemodialysis (HD) patients could be a disastrous complication leading to high mortality. The objective is to evaluate the association between the presence of superior mesenteric artery calcification (SMAC) and early and late outcomes after aortic valve replacement (AVR) in HD patients. Methods: Between April 2003 and December 2018, the enrolled 46 HD patients (19 women; mean age 72 years) who underwent AVR for severe aortic valve stenosis were retrospectively reviewed. 25 patients (54.3%) who had severe calcifications of superior mesenteric artery (SMA) were defined as the SMAC group, and the calcification extent of SMA was evaluated on preoperative non-contrast CT using Agaston calcium score [calcification area (cm2) × max CT value (HU)]. The operative outcomes were compared with those of the non-SMAC group comprising 21 patients (45.7%). Results: The following factors in SMAC group were statistically higher compared with those of the non-SMAC group: age (73.6 ± 7.2 vs 69.3 ± 7.1 years; p = 0.04), celiac artery calcification (76.4% vs 17.6%; p < 0.001), calcium score of SMA (692.3 ± 300.0 vs 123.5 ± 180.7; p < 0.001), the incidence of AMI (24.0% vs 4.7%; p = 0.001), and hospital mortality (16.0% vs 0%; p = 0.02). In multivariate analysis, the presence of SMAC was significantly associated with AMI (OR 3.8, p = 0.05) and hospital mortality (OR 2.4, p = 0.02). Calcium score of SMA in patients complicated with AMI was significantly higher than those without AMI (815.7 ± 300.5 vs 366.9 ± 351.2; p < 0.01). Conclusion: Quantitative evaluation of SMAC could be a predictive marker of incidence of AMI after AVR in HD patients. [ABSTRACT FROM AUTHOR]

In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice. [ABSTRACT FROM AUTHOR]

The use of hybrid systems is increasingly growing in Europe and this is progressively important for the final result of diagnostic tests. As an integral part of the hybrid imaging system, computed tomography (CT) plays a crucial role in myocardial perfusion imaging diagnostics. Throughout Europe, a variety of equipment is available and also different university curricula of the nuclear medicine technologist are observed. Hence, the Technologist Committee of the European Association of Nuclear Medicine proposes to identify, through a bibliographic review, the recommendations for best practice in computed tomography applied to attenuation correction and calcium score in myocardial perfusion imaging, which courses in the set of knowledge, skills, and competencies for nuclear medicine technologists. This document aims at providing recommendations for CT acquisition protocols and CT image optimization in nuclear cardiology. [ABSTRACT FROM AUTHOR]

Background: Patients with peripheral artery disease (PAD) frequently have concomitant coronary artery disease (CAD) and display a higher risk for myocardial infarction, stroke, and death due to cardiovascular events. In order to prevent cardiovascular events, there is an increasing interest in new markers of atherosclerosis. Vascular calcifications (VC) are often present in the early stages of atherogenesis and could be considered an early marker. The aim of this study is to correlate the extent of lower limbs, aortic, and coronary arterial calcification diagnosed by non-contrast multislice CT with the severity of coronary artery disease diagnosed by conventional coronary angiography. Results: There is borderline significant association between CAD (Gensini score) and each of total lower limb and aorto-iliac calcifications. There is significant association between the number of diseased coronaries and lower limb calcifications. Also, there is significant association between the coronary artery calcifications and lower limb arterial calcifications (total and segmental). Diabetes mellitus and hypertension are significantly associated with lower limb calcification (total, aorto-iliac, and infra-popliteal). Moreover, lower limb arterial calcifications (total and segmental) are positively correlated with increasing age. Conclusion: Lower limb arterial calcifications, as diagnosed by non-contrast MSCT, is a noninvasive measure for evaluation of the atherosclerotic burden that correlate to the CAD; it can aid to refine risk stratification and the need for more aggressive preventive strategies. [ABSTRACT FROM AUTHOR]

In a clinical practice of the angiography, the blood vessel analysis is substantially important mainly in a sense of an objectification and modeling of the pathological spots such as the blood vessel calcifications. An amount of the calcification is commonly just estimated by naked eyes; therefore, the automatic modeling may be beneficial in a context of an extraction of the blood vessel features well representing a level of the blood vessel deterioration. In this work, we have proposed a fully automatic software environment (BloodVessCalc) for processing the blood vessel images acquired by the CT (computer tomography). The main function of the SW is the multiregional image segmentation allowing for an extraction of the physiological blood vessel location from the calcification spots. This model offers the calcium score calculation in a form of amount of the calcification. In the last part of our analysis, the predictive intervals of the average value and median for calcium score are calculated. [ABSTRACT FROM AUTHOR]

To evaluate the influence of dose reduction in combination with iterative reconstruction (IR) on coronary calcium scores (CCS) in a dynamic phantom on state-of-the-art CT systems from different manufacturers. Calcified inserts in an anthropomorphic chest phantom were translated at 20 mm/s corresponding to heart rates between 60 and 75 bpm. The inserts were scanned five times with routinely used CCS protocols at reference dose and 40 and 80% dose reduction on four high-end CT systems. Filtered back projection (FBP) and increasing levels of IR were applied. Noise levels were determined. CCS, quantified as Agatston and mass scores, were compared to physical mass and scores at FBP reference dose. For the reference dose in combination with FBP, noise level variation between CT systems was less than 18%. Decreasing dose almost always resulted in increased CCS, while at increased levels of IR, CCS decreased again. The influence of IR on CCS was smaller than the influence of dose reduction. At reference dose, physical mass was underestimated 3-30%. All CT systems showed similar CCS at 40% dose reduction in combinations with specific reconstructions. For some CT systems CCS was not affected at 80% dose reduction, in combination with IR. This multivendor study showed that radiation dose reductions of 40% did not influence CCS in a dynamic phantom using state-of-the-art CT systems in combination with specific reconstruction settings. Dose reduction resulted in increased noise and consequently increased CCS, whereas increased IR resulted in decreased CCS. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS).Methods: Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience.Results: One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT.Conclusion: Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience.Key Points: • Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient experience. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the reliability of ungated, high-pitch dual-source CT for coronary artery calcium (CAC) screening.Materials and Methods: One hundred and eighty-five smokers underwent a dual-source CT examination with acquisition of two sets of images during the same session: (a) ungated, high-pitch and high-temporal resolution acquisition over the entire thorax (i.e., chest CT); (b) prospectively ECG-triggered acquisition over the cardiac cavities (i.e., cardiac CT).Results: Sensitivity and specificity of chest CT for detecting positive CAC scores were 96.4 % and 100 %, respectively. There was excellent inter-technique agreement for determining the quantitative CAC score (ICC = 0.986). The mean difference between the two techniques was 11.27, representing 1.81 % of the average of the two techniques. The inter-technique agreement for categorizing patients into the four ranks of severity was excellent (weighted kappa = 0.95; 95 % CI 0.93-0.98). The inter-technique differences for quantitative CAC scores did not correlate with BMI (r = 0.05, p = 0.575) or heart rate (r = -0.06, p = 0.95); 87.2 % of them were explained by differences at the level of the right coronary artery (RCA: 0.8718; LAD: 0.1008; LCx: 0.0139; LM: 0.0136).Conclusion: Ungated, high-pitch dual-source CT is a reliable imaging mode for CAC screening in the conditions of routine chest CT examinations.Key Points: • CAC is an independent risk factor for major cardiac events. • ECG-gated techniques are the reference standard for calcium scoring. • Great interest is directed toward calcium scoring on non-gated chest CT examinations. • Reliable calcium scoring can be obtained with dual-source CT in a high-pitch mode. [ABSTRACT FROM AUTHOR]

The aims of this study were to identify the distribution of coronary artery calcium score (CACS) by age group and cardiovascular (CV) risk factors and to evaluate the association between CV risk factors and CACS classification in asymptomatic adults. The study included 31,545 asymptomatic Koreans, over 20 years of age with no previous history of malignancy, proven coronary artery disease, or stroke, who underwent CACS computed tomography at the Health Promotion Center, Samsung Medical Center, between January 2005 and June 2013. Mean (±SD) age was 53.8 (±8.5) years overall, 56.1 (±8.3) in men, and 53.3 (±8.5) in women. They were classified into five groups based on their resting CACS: none (CAC = 0), minimal (0 < CAC ≤ 10), mild (10 < CAC ≤ 100), moderate (100 < CAC ≤ 400), and extensive (400 > CAC). Older age groups exhibited higher CACS values. The proportion of CACS classification in our study was 55.5 % with no CACS, 9.5 % with minimal CACS, 19.8 % with mild CACS, 10.8 % with moderate CACS, and 4.3 % with extensive CACS. Adjusted odds ratios (ORs) were calculated for CV risk factors to determine their association with CACS. When analyzed according to sex, in males, the adjusted OR for CACS increased with the presence of hypertension (HT), diabetes mellitus (DM), obesity, chronic kidney disease, and smoking status. While, in females, the adjusted OR for CACS increased with the presence of HT, DM, and obesity. CV risk factors appear to be significantly associated with CACS in the Korean population. [ABSTRACT FROM AUTHOR]

The association between epicardial fat and coronary artery disease (CAD) might be affected by general adiposity. We aimed to determine whether the percentage of epicardial adipose tissue (%EAT), defined as the mass ratio of epicardial fat to body fat, could improve prediction of asymptomatic CAD. We consecutively enrolled 846 adults who underwent coronary computed tomography angiography as part of a health check-up and assessed their coronary stenosis severity and epicardial fat mass. Body fat mass was measured by bioelectrical impedance analysis. Subjects with CAD history, hyperthyroidism, pitting edema, or subjects taking diuretics or thiazolidinedione were excluded. Obstructive CAD was defined as at least one coronary artery with 50 % or greater obstruction, and severe CAD was defined as 70 % or greater obstruction. The %EAT had the maximum area under the curve for predicting the presence of CAD and superior discriminative performance to EAT and other EAT-indexed parameters. Multivariable logistic regression analysis revealed that %EAT >0.41 % was a predictor of obstructive CAD [odds ratio 3.59 (95 % confidence interval 2.28-5.64)], and %EAT >0.47 % was a predictor of severe CAD [4.01 (2.01-7.99)] after adjustment for calcium score and Framingham risk score. This prediction was more pronounced in subjects with higher body fat percentage (≥25 % for men and ≥35 % for women), Framingham risk score (≥10 %), or calcium score (≥100). A spillover of body fat at epicardium over a critical threshold is associated with significant coronary stenosis. This association was independent of obesity, coronary calcium burden, and Framingham risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the frequency and distribution pattern of calcifications in all and in only non-assessable coronary arterial segments in symptomatic patients with coronary heart disease. Materials and methods: Among 2355 consecutive coronary CT angiographies performed using a 320-row ADCT, 1129 studies performed by prospective one-beat scanning without metallic and motion artifacts were evaluated. Frequency and degree of calcification were assessed for each coronary segment. Evaluations were performed in all and in only non-assessable segments, and the results were compared. Results: Calcified segments were observed in 15.6 % of patients and 2.4 % of segments. The most extensively calcified segments were those in the proximal left anterior descending branch. 1.1 % of all of the segments were not assessable due to calcification, and 90 % of those non-assessable segments had high-grade calcifications. When the calcium score value was 1000 or 2000, the expected frequency of non-assessable segments was 27.5 or 53.5 %, respectively. Conclusion: There were specific features of the distribution of coronary arterial calcifications. It is important to be familiar with these features when deciding whether or not to perform subtraction CCTA. [ABSTRACT FROM AUTHOR]

This study aims to correlate coronary artery enhancement levels with quality of vessel visualization and calcified plaque visualization using a 128-slice dual-source CT (DSCT) scanner. Coronary CT angiography exams from 52 patients, mean age of 55 years (range, 22-90) and mean weight of 184 lbs (range, 120-320 lbs), were reviewed retrospectively. Contrast infusion rates ranged from 4.5 to 7 mL/s (mean, 5.8 mL/s). Postcontrast density of the largest calcified plaque and postcontrast density of the left main (LM) and right coronary arteries (RCA) were recorded. Enhancement quality was graded as 1 = suboptimal, 2 = adequate for diagnosis, and 3 = excellent. Pre- and postcontrast acquisitions were compared for calcified plaque conspicuity. The largest calcified plaque density was a mean of 862 HU (range, 376 to 1,384 HU) on the postcontrast scan. The mean LM and RCA coronary artery enhancement levels for studies of excellent enhancement quality ( N = 43) were 468 and 457 HU, respectively, higher than mean enhancement levels of 320 and 322 HU for adequate enhancement quality ( N = 8) ( p < 0.0001 and 0.009). One study was graded as a nondiagnostic enhancement quality. Twenty-five subjects had calcified plaque, 3/8 with adequate and 22/43 with excellent enhancement quality. At least one calcified plaque measuring <2 mm was isodense to contrast enhancement on axial images in 5/25; all five were in the highest enhancement quality group. High coronary artery enhancement quality using 128-DSCT is associated with mean proximal coronary artery enhancement levels over 400 HU. High levels of enhancement may obscure small, calcified plaques. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the severity of coronary artery disease (CAD) and the plaque composition in neuropathic type 2 diabetic subjects with and without Charcot neuroarthropathy (CN) undergoing multidetector computed tomography coronary angiography (MDCT-CA). The study was a single-center, observational, with unmatched case-control design. We selected 17 CN patients and 18 patients with diabetic neuropathy (DN) without CN. In all the patients, multidetector computed tomography was performed to assess the coronary artery calcium score (CACS) and degree of coronary artery stenosis. Patients were classified as positive in the presence of significant CAD if there was at least one stenosis >50 % on MDCT-CA. The invasive coronary angiography was performed in case of significant stenosis detected with MDCT-CA, both as reference to standard and eventually as treatment. Groups were matched for age, sex, and traditional CAD risk factors. As compared to DN individuals, CN exhibited higher rates of significant coronary stenoses ( p = 0.027; OR 7.7 [1.3-43.5]). However, no significant differences were observed in the CACS, which reflects plaque burden, in the two groups ( p = 0.759). No significant differences were observed comparing CACS distribution in all subjects for stenosis higher/equal or lower than 50 % ( p = 0.320). Finally, no significant differences were observed comparing CACS distribution in CN and DN subjects for coronary stenoses higher/equal or lower than 50 %. Our results suggest that CN patients have a higher prevalence of severe coronary plaques compared to DN patients. Nevertheless, coronary plaques in CN patients did not exhibit an increased degree of calcification. [ABSTRACT FROM AUTHOR]

Offspring of long-lived parents have a low prevalence of cardiovascular disease in middle age. The purposes of this study were to investigate calcium scores in offspring as compared to controls and to determine the influence of cardiovascular risk factors. CT coronary artery calcium score was measured in offspring of long-lived families ( n = 244, 125 males) and their partners ( n = 223, 96 males) who served as controls. Calcium scores were analyzed separately for sexes. Subjects were grouped by very low calcium score ≤10 and scores above 10. Nonparametric Mann-Whitney test, chi-squared tests, and logistic regression analyses were performed to determine the association between calcium scores, familial longevity, and cardiovascular risk factors. More offspring of long-lived parents had lower calcium scores than controls. In men, 34 % of offspring had score ≤10 versus 21 % of controls (odds ratio (OR) and 95 % confidence interval (CI) 2.0, 1.08-3.7, p = 0.028). In women, 70 % of offspring had score ≤10 versus 54 % of controls (OR 1.9, 95 % CI 1.13-3.4, p = 0.019). Differences remained significant after correction for age (men, p = 0.043 and women, p = 0.003) and further correction for major risk factors in women, indicating genetic influence for lower calcium scores. In men, the association was found to be influenced by cardiovascular risk factors. Men and women with a familial propensity to become long-lived have lower coronary artery calcium scores than controls. Low scores may indicate a younger biologic arterial age associated with a low risk for incident cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose To determine the influence of dose reduction on coronary calcium scoring using hybrid and model-based iterative reconstruction (IR) techniques. Methods Fifteen ex vivo hearts were scanned in a phantom representing an average adult person at routine dose and three levels of dose reduction; 27, 55 and 82 % reduced-dose, respectively. All images were reconstructed using filtered back-projection (FBP), hybrid IR (iDose, levels 1, 4 and 7) as well as model-based IR iterative model reconstruction (IMR, levels 1, 2 and 3). Agatston, mass and volume scores found with iDose and IMR were compared to FBP reconstruction (routine dose) as well as objective image quality. Results With FBP calcium scores remained unchanged at 82 % reduced dose. With IR Agatston scores differed significantly at routine dose, using IMR level 3 and iDose level 7, and at 82 % reduced dose, using IMR levels 1-3 and iDose level 7. The maximum median difference was 5.3 %. Mass remained unchanged at reduced dose levels while volume was significantly lower at 82 % reduced dose with IMR (maximum median difference 5.0 %). Objective image quality improved with IR, at 82 % reduced dose the CNR of iDose level 7 was similar to the reference dose CNR, and IMR levels 1-3 resulted in an even higher CNR. Conclusion Calcium scores were not affected by radiation-dose reduction with FBP and low levels of hybrid IR. Objective image quality increased significantly using hybrid and model-based IR. Therefore low level hybrid IR has the potential to reduce radiation-dose of coronary calcium scoring with up to 82 %. [ABSTRACT FROM AUTHOR]

To study the role of 320-detector coronary computed tomography angiography (CTA) in assessing native coronary arteries in patients treated with coronary stents. 123 patients with coronary stenting received both CTA and conventional coronary angiography (CCA) within 1 day. The clinical parameters, coronary calcium scoring, CTA and CCA were analyzed to determine the prevalence of significant stenosis of native coronary arteries (SSNCA), the predictive value of CTA and the factors correlating with SSNCA and newly developed SSNCA after stenting (NDSSNCAS), with CCA as the standard of reference, using both vessel-based analysis (VBA) and patient-based analysis (PBA). Both the source and the reconstructed images were analyzed by CTA. All native coronary arteries were interpretable independent of cardiac motion. CTA showed a sensitivity/specificity of 93.5 %/97.3 % and 92.5 %/92.5 % in diagnosing SSNCA in VBA and PBA, respectively. The significant factors related to SSNCA were higher calcium scores ( P = 0.003), a higher serum glucose level ( P = 0.048), a greater number of vessels without previous stent placement ( P = 0.003) and fewer stents implanted within the vessels ( P = 0.003). The risk factors showed no significant correlation from PBA on SSNCA or from NDSSNCAS on either VBA or PBA. CTA demonstrates excellent correlation with CCA. The prevalence of SSNCA is significantly correlated with the presence of higher calcium scores in the arteries, a higher serum glucose level, a greater number of vessels without previous stent placement and fewer stents implanted within the vessels; PBA on SSNCA and NDSSNCAS on both VBA and PBA showed no significance. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To elucidate early coronary atherosclerotic changes in premenopausal systemic lupus erythematosus (SLE) female patients without clinical cardiovascular manifestation using a 64-slice Multi-detector computed tomography (MDCT) scan to detect coronary calcification and measure coronary calcium score (CCS), and to find out its correlation to some traditional and non-traditional risk factors. Methodology: Sixty consecutive premenopausal SLE female patients, and sixty age and sex matched healthy subjects without known systemic, immunological, or cardiovascular disease (served as a control group) underwent clinical examination, serological analysis, and 64-slice MDCT-based coronary calcium scoring. All the clinical, serological, and MDCT parameters of the patients were correlated. Results: Coronary calcification (CC) was seen in 21 patients (35%), the number of atherosclerotic calcified plaques ranged from 0 to 19. Calcium scores ranged from 0 to 843. In contrast to control subjects, SLE patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol level, low-density lipoprotein (LDL), immunoglobulin G (IgG) and IgM anti-cardiolipin antibodies, serum intracellular adhesion molecule (sICAM) and E-selectin levels. SLE patients had highly significantly more atherosclerotic plaques (3±0.66 compared to 0.1±0.07, p <0.001) and higher CCS (59.2±20.3 compared to 2.6±1.85, p <0.001). Significant positive correlation was found between both number of atherosclerotic plaques and CCS and total cholesterol level, LDL, cumulative prednisone dose, SLE disease activity index (SLEDAI), ESR, CRP, sICAM-1, E-Selectin, and anti-cardiolipin antibodies (p <0.05 in all). Conclusion: Pre-menopausal SLE female patients free from clinical atherosclerotic vascular disease have an increased number of atherosclerotic plaques and CCS, which correlate positively with SLEDAI disease activity score, serum CRP, anticardiolipin antibodies, sICAM-1, E-Selectin, LDL level, total cholesterol level, and cumulative prednisone dose. In addition, we conclude that MDCT is a non-invasive, sensitive, reproducible, and reliable tool for accurate measurement of coronary calcification. [Copyright &y& Elsevier]

Objectives: To evaluate how far fracture status and bone mineral density (BMD) correlate with the vascular calcification score (CS). Methods: On 29 complete human cadavers (17 female, 12 male; mean age at death was 85.57 years), multi-detector computed tomography was performed to assess the spine fracture status (fracture vs non-fracture [FX vs non-FX]) and CS of the coronary arteries (Coro-CS), the aorta (Aorta-CS) and the pelvic vessels (Iliac-CS). Quantitative computed tomography of the lumbar spine was performed to estimate overall BMD (osteoporotic [BMD <80 mg/cm] vs non-osteoporotic [BMD ≥80 mg/cm]). Results: Gender-specific differences in statistical significance were only observed for Aorta-CS and Iliac-CS but not for Coro-CS. When comparing the osteoporotic with the non-osteoporotic group, statistically significant differences were only found for Iliac-CS ( P < 0.05); however, linear regression analysis showed none of the CSs to significantly correlate with BMD. Conclusions: In our small post-mortem elderly population, statistically significant associations of fracture status and BMD with CS were only observed between the osteoporotic and non-osteoporotic groups for the pelvic vessels but not for the coronary arteries and the aorta. Key Points: • Gender-specific differences were observed for aortic and iliac calcification score (CS). • There was no difference in coronary CS between females and males. • Only iliac CS was different in osteoporotic and non-osteoporotic subjects. • In linear regression analysis, CS showed no correlation with BMD. • In univariate analysis, gender was a BMD and iliac CS confounder. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia (CAE) is usually considered a variant of coronary artery atherosclerosis; however, a definite link has not yet been confirmed. As not all patients with CAE are symptomatic, the real incidence is unknown. The aim of this study was to evaluate the prevalence of CAE and its clinical and angiographic characteristics as well as its relation to coronary artery calcification and any associated vascular abnormality by using multidetector computed tomography (MDCT). We prospectively enrolled 2,600 patients (mean age 55 ± 10 years) who were scheduled for computed tomography coronary angiography (CTCA). CTCA was performed using 64-MDCT with dedicated software for calcium measurement. CAE was defined as an arterial segment with a diameter of >1.5 times the diameter of the adjacent normal segment. The presence of ≥70 % diameter stenosis of any major epicardial vessel was considered an obstructive lesion. CAE was encountered in 192 (7.4 %) patients and showed gender predominance in men (88 %). Patients with CAE were more hypertensive but less diabetic. Left anterior descending artery was the most commonly affected vessel. Only 16 % of CAE patients had no atherosclerotic lesion. Coronary artery calcium score (CACS) and prevalence of ascending aorta aneurysm were shown to be significantly higher in CAE patients compared to patients having no ectasia. A significant negative correlation was noted between CACS and Markis classification. CTCA is a feasible technique to identify and evaluate morphology of CAE. The link between CACS and CAE may favor the consideration that ectasia is an advanced form of atherosclerosis. [ABSTRACT FROM AUTHOR]

Calcium artery calcium (CAC) scoring has become an integral part in the era of preventive cardiology, it has been extensively studied and been validated as a powerful tool for cardiovascular risk assessment in conjunction with other traditional well established scoring systems such as Framingham risk score. In addition, CAC testing has found its way into emergency department algorithms assessing low to intermediate risk patients presenting with chest pain, this strategy was recently adopted by the UK NICE guidelines, confidently ruling out cardiac origin of chest pain. Several studies have demonstrated that risk assessment using CAC was motivational to patients leading to better adherence to their preventive practices as well as to medications. Accordingly, this test has several recommendations for use by national and international guidelines. [ABSTRACT FROM AUTHOR]

To determine via meta-analysis the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTA) for assessment of significant obstructive coronary artery stenosis at different coronary artery calcium score (CACS) levels. Data of 12,053 versus 5,890 segments, 906 versus 758 arteries and 1,120 versus 514 patients in low versus high CACS subgroups from 19 eligible studies were compared. The per-patient prevalence of coronary artery disease was 48% versus 68%, respectively. Subgroups were stratified by different CACS thresholds ranging from 100 to 400. Meta-analyses of per-patient data comparing overall low versus high CACS subgroups resulted in a sensitivity of 97.5 (95.5-99)% versus 97 (94.5-98.5)%, specificity of 85 (82-88)% versus 66.5 (58-74.5)%, diagnostic odds ratio of 153 (81-290) versus 40 (20-83), positive predictive value of 85 (82-87)% versus 86 (84-88)%, negative predictive value of 97.5 (95-99)% versus 91 (88-94)% and overall accuracy of 91% versus 89% with 95% confidence interval, respectively. The drop in specificity was significant ( P = 0.035), while the sensitivity and overall accuracy were insignificantly changed ( P > 0.05). Meta-analyses of independent subgroups at CACS levels ≤10 and ≤100 demonstrated high specificities of 90 (94-100)% and 88.5 (81-91.5)%, whereas at CACS levels ≥400 the specificity declined significantly to 42 (28-56)% but with consistently retained high sensitivity of 97.5 (94-99)%. The specificity of CTA decreases with increasing CACS, while the sensitivity remains high independent of that. The suggested CACS thresholds are arbitrary and do not necessarily warrant cancelling angiography. Diagnostic studies are needed to explore whether a specific CACS threshold may serve as a pre-angiographic gatekeeper to prevent likely equivocal angiographies. [ABSTRACT FROM AUTHOR]

The influence of coronary calcification on the diagnostic performance of coronary computed tomography angiography (CTA) remains controversial. This study attempts to assess the effect of coronary calcium score (CS) on the diagnostic accuracy of detecting coronary artery disease (CAD) using 64-row multidetector computed tomography (MDCT). Over a period of 2 years and 9 months, 113 symptomatic patients (37-87 year-old, mean 62.3, 92 males) underwent 64-row MDCT for coronary CS and CTA. All had conventional coronary angiography (CCA) within 90 (mean 9.6) days. Coronary CTA was evaluated with CCA as the gold standard. Of 113 patients, 18 patients had a CS of 0, 18 had scores between 1 and 100, 27 between 101 and 400, and 50 had scores >400. With respect to patient-based analysis, the accuracy of CTA was 90.3%, the sensitivity was 95%, and the specificity was 78.8%. Regarding patients with CS > 400, the accuracy, sensitivity, and specificity were 92, 95.6, and 60%, respectively. On vessel-based analysis, the specificity of CTA in different vessels with CS ≦ 400 and CS > 400 was as follows: right coronary artery 87.1% versus 87.5% ( P = 0.924); left main artery 94.8% versus 66.7% ( P = 0.173); left anterior descending artery 77.1% versus 27.3% ( P = 0.001); and left circumflex artery 83.3% versus 42.8% ( P = 0.011). A high CS does not significantly affect the diagnostic accuracy and sensitivity of CTA; however, it significantly decreases the specificity, particularly the left anterior descending and left circumflex arteries. [ABSTRACT FROM AUTHOR]

With the suggestion of coronary artery calcium as an indicator of coronary artery disease 30 years ago, intense and controversial discussion regarding coronary artery calcium has been ongoing. Diverse techniques for evaluation of coronary artery calcium were suggested and validation of its feasibility has been followed up. Following establishment of reference standards, coronary artery calcium became widely utilized in clinical practice and scientific research. Originally coronary artery calcium scoring techniques were developed for prediction of cardiovascular risk. Additionally, coronary artery calcium scoring has been utilized as an indicator for other medical events. Recently, coronary artery calcium scoring used to be applied as a reference standard during scientific research. In this article, the topic of coronary artery calcium, from its introduction to its current usefulness, was discussed from the viewpoints of coronary artery calcium scoring techniques, imaging modalities, validation of the techniques, clinical feasibility of coronary artery calcium scoring beyond traditional cardiovascular risk prediction, and utilization of coronary artery calcium scoring as a reference standard. Popular coronary calcium scoring techniques comprises of Agatston, volume, and mass scores. Through validation of these techniques, pros and cons of each technique were analyzed and proper utility could be suggested. In parallel, the reference standards for Agatston and volume scores were established by age, sex, and race. Through the vigorous controversies, nowadays, the clinical feasibility of coronary artery calcium score as a surrogate marker of cardiovascular risk was acknowledged in the literature. [ABSTRACT FROM AUTHOR]

Our aim was to evaluate the plaque characteristics of coronary arteries related to significant stenosis with coronary CT angiography (CCTA) and to discuss the diagnostic accuracy of CCTA in patients with high calcium scores. After institutional review board approval, 110 patients (63 men; mean age: 67.1 ± 7.9 years) with Agatston scores >400 were retrospectively reviewed. Patients underwent Agatston calcium scoring and 64-slice CCTA, in addition to invasive coronary angiography (CAG). The composition (calcified, mixed, and non-calcified) and configuration (concentric, eccentric) of coronary artery plaques were analyzed on a per-segment basis by CCTA. We analyzed the differences in plaque composition and configuration between significant (≥50%) and non-significant (<50%) stenosis. Additionally, the diagnostic accuracy of stenosis according to plaque composition was evaluated by CCTA, using CAG as a reference method. Significant differences in plaque composition and configurations were observed between the two groups. In cases of significant stenosis, the proportions of concentric, mixed, and non-calcified plaques were significantly higher than those of eccentric and calcified plaques ( P < 0.001). The sensitivity and positive predictive value of mixed (97.4, 87.6%) and non-calcified plaques (97.8, 95.7%) were significantly higher than those of calcified plaques (87.6, 67.2%). Although CCTA has limited value due to low diagnostic accuracy of calcified plaques, knowledge about the high frequencies of mixed and non-calcified plaques in significant stenosis help to make an accurate assessment of CAD with CCTA in patients with high calcium scores. [ABSTRACT FROM AUTHOR]

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The purpose of the study was to assess the presence and extent of atherosclerosis determined by 64-slice CTA in patients with 0 coronary calcium score (CACS) and to evaluate the affect of demographic features and risk factors on the atheroma burden of these patients. 883 cases (378 (42.8%) male, 505 (57.2%) female, mean age 51.28) with zero CACS were included in the study. Cases underwent CTA because of carrying risk factors or having chest pain or atypical symptoms. A non-enhanced CT scan was obtained for calcium scoring immediately before CTA in all cases. CT examinations were performed by 64-slice scanner (Toshiba, Aquillon 64, Toshiba Medical Systems, Otowara, Japan). Coronary artery disease (CAD) was graded according to CTA findings and five groups were defined. In 703 cases (79.6%) CTA was normal while 180 (20.4%) cases had positive CTA findings and 43 cases (4.9%) had CTA obstructive lesion. Cases with positive CTA findings were significantly older than those with normal CTA Diabetes was a significant risk factor of CAD in both male and female cases. Dyslipidemia was associated with CAD in males and family history of CAD was a significant risk factor for females with positive CTA findings. This study demonstrated that considerable amount of patients with zero CAC score have positive CTA findings. Age and diabetes are the risk factors, which were associated with positive CTA findings in both sexes. Dyslipidemia was a significant risk factor in males and family history of CAD in females. Especially in patients with risk factors CTA is better than CAC scoring in determining the atheroma burden. [ABSTRACT FROM AUTHOR]

Calcium score (CS) is a useful tool in evaluating the risk of cardiovascular events in asymptomatic patients. The absence of detectable calcification determines excellent cardiovascular prognosis, with event rates lower than that of negative stress studies, probably due to the latter's inability to detect nonobstructive coronary artery disease (CAD). There are few primary prevention medications that would be cost-effective in such a low-risk patient population. The interval for retesting patients with zero CS is still open for debate but it should not be in less than 4 to 5 years. CS should not be used to rule out obstructive CAD in symptomatic patients, as its correlation with coronary stenosis is poor and obstructive CAD is commonly found among symptomatic zero CS patients. Most studies have found very low specificity values for CS to detect obstructive CAD in symptomatic patients, meaning it has limited ability to detect the true negative cases (ie, zero CS without obstructive CAD). [ABSTRACT FROM AUTHOR]

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Individuals with normal myocardial perfusion imaging (MPI) may still have substantial coronary artery disease (CAD), which would benefit from aggressive medical therapy. The role of coronary artery calcium-score (CAC) and/or coronary CT Angiography (CTA) to identify additional treatment candidates in this population is unknown. Ninety-four patients completed the study protocol and underwent CAC and CTA after MPI. In 81 patients who had a normal MPI, an algorithm using the clinical predictors, CAC, and then CTA was created to identify candidates for aggressive medical management; 24/81 patients had a high Framingham Risk Score (FRS) or diabetes, and need aggressive medical management, while 6/81 patients had a low FRS and low post-MPI probability of CAD. The use of CAC in 51/81 patients with intermediate clinical predictors would identify 23/51 patients with low risk (CAC < 100) and 11/51 patients (CAC > 400) for aggressive medical management. The remaining 17/51 patients with intermediate CAC scores (100-399) would require CTA, of which, would identify 8/17 additional patients with >50% stenosis for aggressive medical therapy. A stepwise approach including history, CAC and CTA can identify about 50% of the patients with normal MPI who have a higher risk and may benefit from aggressive medical management. [ABSTRACT FROM AUTHOR]

To assess whether absolute mass scores are comparable or differ between identical 64-slice MDCT scanners of the same manufacturer and to compare absolute mass scores to the physical mass and between scan modes using a calcified phantom. A non-moving anthropomorphic phantom with nine calcifications of three sizes and three densities was scanned 30 times on three 64-slice MDCT scanners of manufacturer A and on three 64-slice MDCT scanners of manufacturer B in both sequential and spiral scan mode. The mean mass scores and mass score variabilities of seven calcifications were determined for all scanners; two non-detectable calcifications were omitted. It was analyzed whether identical scanners yielded similar or significantly different mass scores. Furthermore mass scores were compared to the physical mass and mass scores were compared between scan modes. The mass score calibration factor was determined for all scanners. Mass scores obtained on identical scanners were similar for almost all calcifications. Overall, mass score differences between the scanners were small ranging from 1.5 to 3.4% for the total mass scores, and most differences between scanners were observed for high density calcifications. Mass scores were significantly different from the physical mass for almost all calcifications and all scanners. In sequential mode the total physical mass (167.8 mg) was significantly overestimated (+2.3%) for 4 out of 6 scanners. In spiral mode a significant overestimation (+2.5%) was found for system B and a significant underestimation (−1.8%) for two scanners of system A. Mass scores were dependent on the scan mode, for manufacturer A scores were higher in sequential mode and for manufacturer B in spiral mode. For system A using spiral scan mode no differences were found between identical scanners, whereas a few differences were found using sequential mode. For system B the scan mode did not affect the number of different mass scores between identical scanners. Mass scores obtained in the same scan mode are comparable between identical 64-slice CT scanners and identical 64-slice CT scanners on different sites can be used in follow-up studies. Furthermore, for all systems significant differences were found between mass scores and the physical calcium mass; however, the differences were relatively small and consistent. [ABSTRACT FROM AUTHOR]

Present guidelines discourage the use of CT coronary angiography (CTCA) in symptomatic angina patients. We examined the relation between coronary calcium score (CS) and the performance of CTCA in patients with stable and unstable angina in order to understand under which conditions CTCA might be a gate-keeper to conventional coronary angiography (CCA) in such patients. We included 360 patients between 50 and 70 years old with stable and unstable angina who were clinically referred for CCA irrespective of CS. Patients received CS and CCTA on 64-slice scanners in a multicenter cross-sectional trial. The institutional review board approved the study. Diagnostic performance of CTCA to detect or rule out significant coronary artery disease was calculated on a per patient level in pre-defined CS categories. The prevalence of significant coronary artery disease strongly increased with CS. Negative CTCA were associated with a negative likelihood ratio of <0.1 independent of CS. Positive CTCA was associated with a high positive likelihood ratio of 9.4 if CS was <10. However, for higher CS the positive likelihood ratio never exceeded 3.0 and for CS >400 it decreased to 1.3. In the 62 (17%) patients with CS <10, CTCA reliably identified the 42 (68%) of these patients without significant CAD, at no false negative CTCA scans. In symptomatic angina patients, a negative CTCA reliably excludes significant CAD but the additional value of CTCA decreases sharply with CS >10 and especially with CS >400. In patients with CS <10, CTCA provides excellent diagnostic performance. [ABSTRACT FROM AUTHOR]

Background: Non-invasive assessment of subclinical atherosclerosis by means of coronary artery calcium scoring (CACS) and multi-slice computed tomography (MSCT) coronary angiography could improve patients' risk stratification. However, data relating observations on CACS and MSCT coronary angiography to traditional risk assessment are scarce. Methods and Results: In 314 consecutive outpatients (54 ± 13 years, 56% males) without known CAD, CACS and 64-slice MSCT coronary angiography were performed. According to the Framingham risk score (FRS), 51% of patients were at low, 24% at intermediate and 25% at high risk, respectively. MSCT angiograms showing atherosclerosis were classified as showing obstructive (≥50% luminal narrowing) CAD or not. Both CACS and MSCT coronary angiography showed a high prevalence of normal coronary arteries in low FRS patients (70% and 61%, respectively). An increase in the prevalence of CACS >400 (4% low vs 19% intermediate vs 36% high), CAD (39% low vs 79% intermediate vs 91% high), and obstructive CAD (15% low vs 43% intermediate vs 58% high) was observed across the FRS categories ( P < .0001 for all comparisons). Conclusions: A strong positive relationship exists between FRS and the prevalence and extent of atherosclerosis. Especially in intermediate FRS patients, CACS and MSCT coronary angiography provide useful information on the presence of subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

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Coronary calcium score is a marker of coronary atherosclerosis and is an important factor of cardiac events. Ventricular hypertrophy and QT dispersion increase the risk of cardiac events. The purpose of the study was to investigate whether coronary calcium score may be related to the changes of QT, QT dispersion, heart chamber size, and wall thickness. The coronary calcium score was studied in 97 patients through multislice computed tomography (MSCT). There were 32 patients with high calcium score (≥200), 29 patients with low calcium score (1–199), and 36 patients with zero calcium score. The gender, age, incidence of hypertension, diabetics, smoking, and dyslipidemia were similar among the three groups. The QT dispersion, QTc dispersion, and R-wave amplitude in the high calcium score group were larger than those in the other two groups. There were similar P-wave duration. QRS duration, and PR interval among the three groups. The left ventricular anterior-posterior diameter and left ventricular wall thickness in the high coronary calcium score group were larger than those in the other two groups. Coronary calcium score had strong correlations with QT dispersion and left ventricular wall thickness. These findings may contribute further evidence regarding the increased risk of cardiac events in those patients with high coronary calcium score. [ABSTRACT FROM AUTHOR]

High reproducibility on coronary artery calcium scoring is a key requirement in monitoring the progression of coronary atherosclerosis. The purpose of this prospective study is to assess the reproducibility of 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT with respect to 2.5-mm-thickness images on spiral overlapping reconstruction. One hundred patients suspected of coronary artery disease were scanned twice repeatedly, both on prospective electrocardiograph-triggered step-and-shoot and retrospective electrocardiograph-gated spiral scans. Using 1.25-mm-thickness collimation, 1.25-mm- and 2.5-mm-thickness image sets on prospective scans and 2.5-mm-thickness image sets with 1.25-mm increment (overlapping) on retrospective scans were obtained. Coronary artery calcium scores, interscan variability and interobserver variability were evaluated. The mean interscan variability in coronary artery calcium measurement on 1.25-mm prospective/2.5-mm prospective/2.5-mm overlapping retrospective scans were Agatston: 10%/18%/12%, volume: 10%/12%/10% and mass: 8%/13%/11% for observer 1 and Agatston: 8%/14%/10%, volume: 7%/9%/10% and mass: 7%/10%/9% for observer 2, respectively. The mean interobserver variability was 5% to 14%. In conclusion, prospective electrocardiograph-triggered 64-slice CT using the 1.25-mm prospective scan shows the lowest variability. The 2.5-mm prospective scan on volume or mass scoring shows variability of around 10%, comparable to 2.5-mm-thickness spiral overlapping reconstruction images. [ABSTRACT FROM AUTHOR]

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Screening asymptomatic subjects to streamline measures for the prevention of cardiovascular events remains a major challenge. The established primary prevention risk-scoring methods use equations derived from large prospective cohort studies, but further fine-tuning of cardiovascular risk assessment remains important as 25 % of individuals with low estimated risk may experience cardiac events. Independent studies provided evidence that extended risk assessment using coronary artery calcium quantification may improve risk stratification as it can lead to reclassification of persons at increased risk. Particularly in intermediate-risk subjects, coronary artery calcium scoring can help to correctly identify individuals at highest risk. Data on the extent of calcification of the ascending and descending thoracic aorta might be useful for additional cardiovascular risk stratification. Future analyses and studies will be required to answer the question of whether the implementation of such data may allow further fine-tuning of cardiovascular risk prediction in specific subpopulations-for instance in women or men with an increased risk of stroke and/or symptomatic peripheral vascular disease. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults.Recent Findings: Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56.Summary: Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be “falsely reassuring,” however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC. [ABSTRACT FROM AUTHOR]