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Objectives: Endovascular aneurysm repair, though minimally invasive and has the benefit of relatively low perioperative complication rates, it is associated with significant long term reintervention rates related to endoleaks. Several variables have been studied to predict the outcomes of endovascular aneurysm repair, 1 of which is the calcium burden of the vasculature. This prompted us to study the association between calcium burden measured by the standardized Agatston scoring system and the outcomes of Endovascular aneurysm repair. Methods: This is a retrospective study of patients who underwent Endovascular aneurysm repair from 2008 to 2020 at our institution and who had a non-contrast computerized tomography scan preoperatively, accounting for 87 patients. The calcium burden of the vasculature was measured by the Agatston scoring system allowing for better reproducibility, and the outcome variables included mortality and endoleaks. Results: Patients with higher median total calcium scores (≥12966.9) had significantly lesser survival (79.8% vs 52.3% (P =.002) at five years compared to patients with lower median total calcium score (<12966.9). Also, patients with type 2 endoleaks had higher calcium scores in above the aneurysm level ((1591.2 vs 688.2), P =.05)) compared to patients with no type 2 endoleaks. Conclusion: Calcium score assigned using a standardized Agatston scoring system can be used as a predictor of mortality risk assisting in deciding the treatment of choice for patients. [ABSTRACT FROM AUTHOR]

This study aimed to verify whether increased body mass index (BMI) increases the noise in computed tomography (CT) images due to heightened effective thickness, impacting calcium scores. Calcium scores were measured in 30 sets of images from normal weight patients. Calcium scores were also measured in 30 sets of images from hypothetical overweight and obese patients, generated by extracting the noise from overweight and obese patients, respectively, and inserting it into the images of normal weight patients. In addition, a phantom study was performed using three calcium phantoms with intensities below the threshold of 130 Hounsfield units and three calcium phantoms with intensities above this threshold. Calcium scores were measured in the absence and presence of a bolus at the heart level to simulate an obese patient. All calcium scores were measured by three radiologists. In the patient study, the total calcium scores of the hypothetical overweight and hypothetical obese groups were 14.93% (p = 0.014) and 22.19% (p = 0.012) higher than those of the normal weight group. In the phantom study, the total calcium score of the six calcium phantoms without a bolus was 1.61% higher at a tube voltage of 120 kV than at 100 kV, and 12.06% higher at a slice thickness of 1 mm than at 3 mm. The total calcium score of the six calcium phantoms with a bolus was 0.13% higher at a tube voltage of 120 kV than at 100 kV, and 14.76% higher at a slice thickness of 1 mm than at 3 mm. These results can be used as a reference to train automated calcium scoring programs on effective thickness through deep learning to reduce calcium score errors caused by increased BMI. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the progression of coronary artery calcification (CAC) and associated risk factors in a systemic lupus erythematosus (SLE) cohort. Methods. We reassessed the presence of CAC in patients with SLE who were screened 9 years before, using multidetector computed tomography. Clinical variables (cumulated disease activity and damage accrual), antiphospholipid syndrome and SLE serology, and cardiovascular (CV) risk factors (hypertension, BMI [kg/m²], modified Framingham risk score, lipid profile, menopausal status) were assessed longitudinally. Results. We included 104 patients from the parent study. Most of them were women (94.2%), with a mean age of 41.0 (SD 8.3) years and mean disease duration of 14.8 (SD 2.9) years. We documented CAC in 17 patients (16.3%). Seven cases were from the parent study and 10 were incident cases. The cumulative incidence of CAC was 9% and the incidence density was 1 per 100 person-years. CAC occurred more frequently in the age groups 30-39 years and 40-44 years. All patients with previous CAC had worsening of their calcium indexes, and none developed clinical CV events. When comparing prevalent CAC cases (n = 17) vs patients without calcification (n = 87), both groups were similar in traditional CV risk factors, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) area under the curve (AUC), and Systemic Lupus International Collaborating Clinics (SLICC) score, but were more likely to be postmenopausal and have higher apolipoprotein B (apoB) levels. Patients with previous CAC had higher apoB levels, SLEDAI-2K AUC scores, and anticardiolipin IgG antibodies than incident cases. Conclusion. CAC in patients with SLE progressed over time but was not associated with adverse CV events during the first 9 years of follow-up. ApoB levels and postmenopausal status might be associated with this progression. [ABSTRACT FROM AUTHOR]

Objective. Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting. Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. Methods. Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. Results. The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). Conclusion. Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization. [ABSTRACT FROM AUTHOR]

Aims We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification. Methods and results Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77–0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77–0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77–0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers. Conclusion The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD. Study registration Clinical trial registration: NCT00470587. [ABSTRACT FROM AUTHOR]

Objective. Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting. Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. Methods. Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. Results. The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). Conclusion. Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.

Background: Coronary tortuosity (CorT) is frequently observed in invasive angiography, though its aetiology and clinical significance remain ambiguous. Prior research has indicated possible links between CorT and factors such as hypertension, age, and calcium scores in the left anterior descending (LAD) artery. The aim of this study was to examine and optimize the usage of coronary computed tomography angiography (CCTA) with vessel tracking to explore these associations. Methods: Observational sub‐study of the single centre randomised controlled CATCH‐trial. From the original study 600 participants, who underwent CCTA, 250 were randomly selected. Clinical data and patient risk factors were sourced from medical records and structured interviews. Tortuosity of the LAD was quantified by calculating the ratio of the actual vessel‐length to the straight‐line distance. Results: The final study population comprised 194 patients (56 patients were excluded due to poor image quality or inability to perform adequate vessel tracking). After adjusting for confounding variables, tortuosity was significantly associated with hypertension (p < 0.001), female gender (p = 0.01), and increasing age (p = 0.045). No significant correlation was observed between CorT and calcium scores. Univariate analysis indicated that higher CorT levels were linked to lower metabolic equivalents of task (METs) in bicycle tests (p = 0.003); however, this relationship became nonsignificant (p = 0.97) upon adjustment for age, gender, and hypertension. Conclusions: Our findings suggest that increased CorT is most prevalent in patients with hypertension, advancing age, and female gender. Although higher tortuosity levels did not significantly impact METs during physical activity, further research is warranted to explore the underlying mechanisms of this relationship. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the most common cause of death worldwide, including infection and inflammation related conditions. Multiple studies have demonstrated potential advantages of hybrid positron emission tomography combined with computed tomography (PET/CT) as an adjunct to current clinical inflammatory and infectious biochemical markers. To quantitatively analyze vascular diseases at PET/CT, robust segmentation of the aorta is necessary. However, manual segmentation is extremely time‐consuming and labor‐intensive. Purpose: To investigate the feasibility and accuracy of an automated tool to segment and quantify multiple parts of the diseased aorta on unenhanced low‐dose computed tomography (LDCT) as an anatomical reference for PET‐assessed vascular disease. Methods: A software pipeline was developed including automated segmentation using a 3D U‐Net, calcium scoring, PET uptake quantification, background measurement, radiomics feature extraction, and 2D surface visualization of vessel wall calcium and tracer uptake distribution. To train the 3D U‐Net, 352 non‐contrast LDCTs from (2‐[18F]FDG and Na[18F]F) PET/CTs performed in patients with various vascular pathologies with manual segmentation of the ascending aorta, aortic arch, descending aorta, and abdominal aorta were used. The last 22 consecutive scans were used as a hold‐out internal test set. The remaining dataset was randomly split into training (n = 264; 80%) and validation (n = 66; 20%) sets. Further evaluation was performed on an external test set of 49 PET/CTs. The dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to assess segmentation performance. Automatically obtained calcium scores and uptake values were compared with manual scoring obtained using clinical softwares (syngo.via and Affinity Viewer) in six patient images. intraclass correlation coefficients (ICC) were calculated to validate calcium and uptake values. Results: Fully automated segmentation of the aorta using a 3D U‐Net was feasible in LDCT obtained from PET/CT scans. The external test set yielded a DSC of 0.867 ± 0.030 and HD of 1.0 [0.6–1.4] mm, similar to an open‐source model with a DSC of 0.864 ± 0.023 and HD of 1.4 [1.0–1.8] mm. Quantification of calcium and uptake values were in excellent agreement with clinical software (ICC: 1.00 [1.00–1.00] and 0.99 [0.93–1.00] for calcium and uptake values, respectively). Conclusions: We present an automated pipeline to segment the ascending aorta, aortic arch, descending aorta, and abdominal aorta on LDCT from PET/CT and to accurately provide uptake values, calcium scores, background measurement, radiomics features, and a 2D visualization. We call this algorithm SEQUOIA (SEgmentation, QUantification, and visualizatiOn of the dIseased Aorta) and is available at https://github.com/UMCG‐CVI/SEQUOIA. This model could augment the utility of aortic evaluation at PET/CT studies tremendously, irrespective of the tracer, and potentially provide fast and reliable quantification of cardiovascular diseases in clinical practice, both for primary diagnosis and disease monitoring. [ABSTRACT FROM AUTHOR]

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Background and Aims: The aim of this study is to evaluate the association of coronary computed tomography angiography derived (CCTA) plaque characteristics and the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) bifurcation angle with severity of coronary artery disease (CAD). Methods: All the stable patients with suspected CAD who underwent CCTA between January to December 2021 were included. Correlation between CCTA‐derived aggregated plaque volume (APV), LAD‐LCX angle, remodeling index (RI), coronary calcium score with Gensini score in conventional angiography were assessed. One hundred and twenty‐two patients who underwent both CCTA and coronary angiography were analyzed. Results: Our analysis showed that the median (percentile 25% to percentile 75%) of the APV, LAD‐LCx angle, and calcium score were 31% (17%−47%), 58° (39°−89°), and 31 (0−186), respectively. Also, the mean ± SD of the RI was 1.05 ± 0.20. Significant correlation between LAD‐LCx bifurcation angle (0.0001−0.684), APV (0.002−0.281), RI (0.0001−0.438), and calcium score (0.016−0.217) with Gensini score were detected. There was a linear correlation between the mean LAD‐LCx bifurcation angle and the Gensini score. The sensitivity and specificity for the cut‐off value of 47.5° for the LAD‐LCX angle were 86.7% and 82.1%, respectively. Conclusion: There is a direct correlation between the LAD‐LCx angle and the Gensini score. In addition to plaque characteristics, anatomic‐based CCTA‐derived indices can be used to identify patients at higher risk for CAD. [ABSTRACT FROM AUTHOR]

Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 publications, 11 studies met the inclusion criteria. In total, 7 studies utilized manual methods, while 4 studies utilized automated technologies, including artificial intelligence and deep learning for image analyses. Age, systolic blood pressure, serum calcium, and lipoprotein(a) levels were found to be independent risk factors for aortic calcification. Mortality from CVDs was correlated with abdominal aorta calcification. Patients requiring reintervention after endovascular recanalization exhibited a significantly higher volume of calcification in their iliac arteries. Conclusions: This review reveals a diverse landscape of measurement methods for aorto-iliac calcifications; however, they lack a standardized reproducibility assessment. Automatic methods employing artificial intelligence appear to offer broader applicability and are less time-consuming. Assessment of calcium scoring could be routinely employed during preoperative workups for risk stratification and detailed surgical planning. Additionally, its correlation with clinical outcomes could be useful in predicting the risk of reinterventions and amputations. [ABSTRACT FROM AUTHOR]

• Among 762 patients with LDL-C≥190 mg/dL without a history of ASCVD or heart failure, coronary artery calcification (CAC), and thoracic aortic calcification (TAC) scores were associated with increased rates of HF hospitalizations. However, only CAC demonstrated an independent association with HF hospitalizations. • EAT, and NAFLD are known cardiometabolic risk factors but were not associated with increased HF hospitalizations in this cohort. • Adding ordinal CAC score to traditional risk factors improved risk stratification for HF hospitalizations. • Given the number of non-cardiac chest CT scans performed in clinical practice, this could represent an opportunity to capitalize on risk information. Coronary artery calcium (CAC), thoracic aorta calcification (TAC), non-alcoholic fatty liver disease (NAFLD), and epicardial adipose tissue (EAT) are associated with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). We aimed to determine whether these cardiometabolic and atherosclerotic risk factors identified by non-contrast chest computed tomography (CT) are associated with HF hospitalizations in patients with LDL-C≥ 190 mg/dL. We conducted a retrospective cohort analysis of patients with LDL-C ≥190 mg/dL, aged ≥40 years without established ASCVD or HF, who had a non-contrast chest CT within 3 years of LDL-C measurement. Ordinal CAC, ordinal TAC, EAT, and NAFLD were measured. Kaplan-Meier curves and multivariable Cox regression models were built to ascertain the association with HF hospitalization. We included 762 patients with median age 60 (53–68) years, 68% (n=520) female, and median LDL-C level of 203 (194–216) mg/dL. Patients were followed for 4.7 (interquartile range 2.75–6.16) years, and 107 (14%) had a HF hospitalization. Overall, 355 (47%) patients had CAC=0, 210 (28%) had TAC=0, 116 (15%) had NAFLD, and median EAT was 79 mL (49-114). Moderate-Severe CAC (log-rank p <0.001) and TAC (log-rank p=0.006) groups were associated with increased HF hospitalizations. This association persisted when considering myocardial infarction (MI) as a competing risk. NAFLD and EAT volume were not associated with HF. In patients without established ASCVD and LDL-C≥190 mg/dL, CAC was independently associated with increased HF hospitalizations while TAC, NAFLD, and EAT were not. Association of cardiometabolic and atherosclerotic markers on non-contrast Chest CT with Heart Failure Hospitalization in Patients with Severe Hypercholesterolemia. * Unadjusted Hazard Ratio for the moderate-to-severe category. ASCVD: atherosclerotic cardiovascular disease, CAC: coronary artery calcification. HF: heart failure, LDL-C: low-density lipoprotein cholesterol, NAFLD: non-alcoholic fatty liver disease, TAC: thoracic aorta calcification. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background While coronary artery calcification (CAC) is recognized as a reliable marker for coronary atherosclerosis, the relationship between the concentration of C-reactive protein (CRP) and the incidence and progression of CAC remains controversial. Method PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies until October 2023. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was employed to calculate pooled odd ratios (OR) and corresponding 95% confidence intervals, considering heterogeneity among the studies. Results Out of the 2545 records, 42 cross-sectional and 9 cohort studies were included in the systematic review. The meta-analysis on 12 eligible cross-sectional studies revealed no significant association between CAC and CRP [pooled OR: 1.03 (1.00, 1.06)]. Additionally, an insignificant association was found between CAC and CRP through meta-analysis on three eligible cohort studies [pooled OR: 1.05 (0.95, 1.15)] with no considerable heterogeneity across studies. Sensitivity analyses indicated that the meta-analysis models were robust. There was no evidence of publication bias. Conclusion Based on the meta-analysis findings, elevated levels of CRP did not emerge as a valuable prognostic maker for CAC incidence and progression prediction.

Background and Objective: Cardiovascular diseases and nonalcoholic fatty liver disease are the most common non-communicable diseases in most developed countries, and due to lifestyle changes, their incidence is increasing day by day. The present study aimed to assess the correlation of fatty liver with epicardial fat volume and coronary artery calcium score. Materials and Methods: This cross-sectional study was conducted on 136 patients referred to Hamadan Farshchian Cardiovascular Hospital for computed tomography (CT) angiography. They were selected using a consecutive sampling method. Using a 128-slice multidetector CT scanner, the coronary artery calcium score based on the Agatston criteria and epicardial fat volume were measured. A liver ultrasound was performed using a GE voluson E6 and a 3-5 MHz depth probe, and the severity of the fatty liver was determined based on the echogenicity of the liver on the ultrasound. Data analysis was conducted using the SPSS software (version 26). Results: The mean age scores of patients were 52.90±12.10 years. Regarding gender, 50.5% and 49.5% of cases were male and female, respectively. In terms of fatty liver grade, 64 (47.1%), 48 (35.3%), 21 (15.4%), and 3 (2.2%) cases had grades zero, I, II, and III, respectively. The mean calcium score was 30.76±35.40, and epicardial fat volume was 86.84±36.56. The severity of fatty liver demonstrated no significant relationship with calcium score and epicardial fat (P>0.05). Conclusion: As evidenced by the obtained results, the severity of fatty liver had no relationship with the amount of coronary epicardial fat and coronary artery calcium.

BackgroundCoronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial.MethodsPubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies.ResultsOf the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)].ConclusionsAccording to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC.Registration numberCRD42021292077.

Background: While coronary artery calcification (CAC) is recognized as a reliable marker for coronary atherosclerosis, the relationship between the concentration of C-reactive protein (CRP) and the incidence and progression of CAC remains controversial. Method: PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies until October 2023. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was employed to calculate pooled odd ratios (OR) and corresponding 95% confidence intervals, considering heterogeneity among the studies. Results: Out of the 2545 records, 42 cross-sectional and 9 cohort studies were included in the systematic review. The meta-analysis on 12 eligible cross-sectional studies revealed no significant association between CAC and CRP [pooled OR: 1.03 (1.00, 1.06)]. Additionally, an insignificant association was found between CAC and CRP through meta-analysis on three eligible cohort studies [pooled OR: 1.05 (0.95, 1.15)] with no considerable heterogeneity across studies. Sensitivity analyses indicated that the meta-analysis models were robust. There was no evidence of publication bias. Conclusion: Based on the meta-analysis findings, elevated levels of CRP did not emerge as a valuable prognostic maker for CAC incidence and progression prediction. [ABSTRACT FROM AUTHOR]

Purpose: Clinical evidence suggests an association between comorbidities and outcome in patients with glioblastoma (GBM). We hypothesised that the internal carotid artery (ICA) calcium score could represent a promising prognostic biomarker in a competing risk analysis in patients diagnosed with GBM. Methods: We validated the use of the ICA calcium score as a surrogate marker of the coronary calcium score in 32 patients with lung cancer. Subsequently, we assessed the impact of the ICA calcium score on overall survival in GBM patients treated with radio-chemotherapy. Results: We analysed 50 GBM patients. At the univariate analysis, methyl-guanine-methyltransferase gene (MGMT) promoter methylation (p = 0.048), gross total tumour resection (p = 0.017), and calcium score (p = 0.011) were significant prognostic predictors in patients with GBM. These three variables also maintained statistical significance in the multivariate analysis. Conclusions: the ICA calcium score could be a promising prognostic biomarker in GBM patients. [ABSTRACT FROM AUTHOR]

The modern management of coronary artery disease (CAD) uses coronary computed tomography angiography (CCTA) to enhance plaque evaluation and cardiovascular risk assessment. CCTA identifies high-risk plaques, and the latest CT technologies based on calculation of fat attenuation index (FAI) allow assessment of inflammation at the level of the target coronary artery. We present a series of case studies with chest pain and positive CCTA, in whom a significant stenosis was detected in the left anterior descendent coronary artery, and the existence of high-risk, inflamed plaques was documented even in the context of a zero calcium score. A severe narrowing of the left anterior descending artery, exhibiting the pattern of high-risk anatomy, was associated with a very high inflammation depicted by FAI analysis in all three cases, an association that may be extremely dangerous. In this case series, CCTA examination led to immediate stenting of the obstructive stenosis, sealing the dangerous plaque. [ABSTRACT FROM AUTHOR]

Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate management of risk factors and obtaining personalized preventive therapy. This systematic review aims to assess the prognostic value of CAC score in asymptomatic individuals. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the prognostic value of CAC score in asymptomatic individuals. The quality of the included studies was assessed by the QUIPS tool. A total of 45 articles were selected. Many of these (25 studies) evaluated the prognostic value of CAC score in asymptomatic subjects. In comparison, others (20 studies) evaluated the association of CAC score with other clinical parameters and imaging modalities or the comparison with computed tomography coronary angiography (CTCA). Our findings showed that the CAC score provides valuable prognostic information for predicting CAD risk in asymptomatic individuals.

PURPOSE: The coronary artery calcium (CAC) score is used in decision-making for preventive medications in patients with borderline clinical risk scores. Both absolute and percentile CAC scores can be used; however, a percentile CAC score is especially useful in young patients and women. The aim of this study is to present CAC score percentiles across age categories in women and men using a large database. METHODS: Bilkent City Hospital database was screened for patients who underwent CAC score measurements between January 2021 and March 2022. Of the 4,487 patients, 546 were excluded due to 1) a history of coronary stent implantation or bypass surgery or 2) missing information regarding a history of revascularization or calcium scores. Therefore, the final study population included 3,941 participants. The percentiles for age categories within each sex were tabulated, and percentile plots were created for each sex using locally weighted scatterplot smoothing regression. RESULTS: The proportion of men included in the study was higher compared with that of women (57.09% vs. 42.91%). The mean age was 52.20 ± 11.11 years, and it was higher in women than in men (54.07 ± 10.47 vs. 50.80 ± 11.37, respectively; P < 0.001). A zero CAC score was observed in 2,381 (60.42%) patients; the percentage was higher in women than in men (68.60% vs. 54.27%; P < 0.001). When the cut-off value for the high-risk category was taken as the 75th percentile, a non-zero CAC score directly assigned a patient into the high-risk category in women aged

The modern management of coronary artery disease (CAD) uses coronary computed tomography angiography (CCTA) to enhance plaque evaluation and cardiovascular risk assessment. CCTA identifies high-risk plaques, and the latest CT technologies based on calculation of fat attenuation index (FAI) allow assessment of inflammation at the level of the target coronary artery. We present a series of case studies with chest pain and positive CCTA, in whom a significant stenosis was detected in the left anterior descendent coronary artery, and the existence of high-risk, inflamed plaques was documented even in the context of a zero calcium score. A severe narrowing of the left anterior descending artery, exhibiting the pattern of high-risk anatomy, was associated with a very high inflammation depicted by FAI analysis in all three cases, an association that may be extremely dangerous. In this case series, CCTA examination led to immediate stenting of the obstructive stenosis, sealing the dangerous plaque.

This study aimed to verify whether increased body mass index (BMI) increases the noise in computed tomography (CT) images due to heightened effective thickness, impacting calcium scores. Calcium scores were measured in 30 sets of images from normal weight patients. Calcium scores were also measured in 30 sets of images from hypothetical overweight and obese patients, generated by extracting the noise from overweight and obese patients, respectively, and inserting it into the images of normal weight patients. In addition, a phantom study was performed using three calcium phantoms with intensities below the threshold of 130 Hounsfield units and three calcium phantoms with intensities above this threshold. Calcium scores were measured in the absence and presence of a bolus at the heart level to simulate an obese patient. All calcium scores were measured by three radiologists. In the patient study, the total calcium scores of the hypothetical overweight and hypothetical obese groups were 14.93% (p = 0.014) and 22.19% (p = 0.012) higher than those of the normal weight group. In the phantom study, the total calcium score of the six calcium phantoms without a bolus was 1.61% higher at a tube voltage of 120 kV than at 100 kV, and 12.06% higher at a slice thickness of 1 mm than at 3 mm. The total calcium score of the six calcium phantoms with a bolus was 0.13% higher at a tube voltage of 120 kV than at 100 kV, and 14.76% higher at a slice thickness of 1 mm than at 3 mm. These results can be used as a reference to train automated calcium scoring programs on effective thickness through deep learning to reduce calcium score errors caused by increased BMI.

Computed tomography aortic valve calcium (AVC) score has accepted value for diagnosing and predicting outcomes in aortic stenosis (AS). Multi-energy CT (MECT) allows virtual non-contrast (VNC) reconstructions from contrast scans. We aim to compare the VNC-AVC score to the true non-contrast (TNC)-AVC score for assessing AS severity. We prospectively included patients undergoing a MECT for transcatheter aortic valve replacement (TAVR) planning. TNC-AVC was acquired before contrast, and VNC-AVC was derived from a retrospectively gated contrast-enhanced scan. The Agatston scoring method was used for quantification, and linear regression analysis to derive adjusted-VNC values. Among 109 patients (55% female) included, 43% had concordant severe and 14% concordant moderate AS. TNC scan median dose-length product was 116 ​mGy∗cm. The median TNC-AVC was 2,107 AU (1,093–3,372), while VNC-AVC was 1,835 AU (1293-2,972) after applying the coefficient (1.46) and constant (743) terms. A strong correlation was demonstrated between methods (r ​= ​0.93; p ​< ​0.001). Using accepted thresholds (>1,300 AU for women and >2,000 AU for men), 65% (n ​= ​71) of patients had severe AS by TNC-AVC and 67% (n ​= ​73) by adjusted-VNC-AVC. After estimating thresholds for adjusted-VNC (>1,564 AU for women and >2,375 AU for men), 56% (n ​= ​61) had severe AS, demonstrating substantial agreement with TNC-AVC ( κ ​= ​0.77). MECT-derived VNC-AVC showed a strong correlation with TNC-AVC. After adjustment, VNC-AVC demonstrated substantial agreement with TNC-AVC, potentially eliminating the requirement for an additional scan and enabling reductions in both radiation exposure and acquisition time. We studied 109 prospectively included patients undergoing multi-energy CT (MECT) for transcatheter aortic valve replacement (TAVR). True non-contrast (TNC)- aortic valve calcium (AVC) score was prospectively acquired and virtual non-contrast (VNC)-AVC score derived from a contrast-enhanced scan. Agatston method was used and a correction proportionality constant was applied to VNC values. A total of 43% had concordant severe and 14% concordant moderate aortic stenosis (AS). MECT-derived VNC-AVC showed a strong correlation with TNC-AVC. After adjustment, VNC-AVC demonstrated substantial agreement with TNC-AVC, potentially eliminating the requirement for an additional scan and enabling reductions in both radiation exposure and acquisition time. [ABSTRACT FROM AUTHOR]

Cardiac computed tomography angiography (CCTA) has emerged as a cost-effective and time-saving technique for excluding coronary artery disease. One valuable tool obtained by CCTA is the coronary artery calcium (CAC) score. The use of CAC scoring has shown promise in the risk assessment and stratification of cardiovascular disease. CAC scores can be complemented by plaque analysis to assess vulnerable plaque characteristics and further refine risk assessment. This paper aims to provide a comprehensive understanding of the value of the CAC as a prognostic tool and its implications for patient risk assessment, treatment strategies and outcomes. CAC scoring has demonstrated superior ability in stratifying patients, especially asymptomatic individuals, compared to traditional risk factors and scoring systems. The main evidence suggests that individuals with a CAC score of 0 have a good long-term prognosis, while an elevated CAC score is associated with increased cardiovascular risk. Finally, the clinical power of CAC scoring and the development of new models for risk stratification could be enhanced by machine learning algorithms. [ABSTRACT FROM AUTHOR]

PURPOSE The coronary artery calcium (CAC) score is used in decision-making for preventive medications in patients with borderline clinical risk scores. Both absolute and percentile CAC scores can be used; however, a percentile CAC score is especially useful in young patients and women. The aim of this study is to present CAC score percentiles across age categories in women and men using a large database. METHODS Bilkent City Hospital database was screened for patients who underwent CAC score measurements between January 2021 and March 2022. Of the 4,487 patients, 546 were excluded due to 1) a history of coronary stent implantation or bypass surgery or 2) missing information regarding a history of revascularization or calcium scores. Therefore, the final study population included 3,941 participants. The percentiles for age categories within each sex were tabulated, and percentile plots were created for each sex using locally weighted scatterplot smoothing regression. RESULTS The proportion of men included in the study was higher compared with that of women (57.09% vs. 42.91%). The mean age was 52.20 ± 11.11 years, and it was higher in women than in men (54.07 ± 10.47 vs. 50.80 ± 11.37, respectively; P < 0.001). A zero CAC score was observed in 2,381 (60.42%) patients; the percentage was higher in women than in men (68.60% vs. 54.27%; P < 0.001). When the cut-off value for the high-risk category was taken as the 75th percentile, a non-zero CAC score directly assigned a patient into the high-risk category in women aged <55 years and men aged <45 years. Percentile plots were also provided for each sex. CONCLUSION In this large-scale study, including patients referred for CAC scoring and/or coronary computed tomography angiography, CAC score percentiles were provided for women and men across the selected age categories which may be in therapeutic decision-making. As an approximate rule of thumb, a non-zero CAC score corresponds to the high-risk category in women aged <55 years and in men aged <45 years. [ABSTRACT FROM AUTHOR]

Background: Coronary calcification is a strong indicator of coronary artery disease, and patients with a "zero" coronary calcification score have a much lower risk of future cardiac events than those with even small amounts of calcium. However, false‐negative (incorrect zero scores) may occur if small calcifications are missed at CT due to limited spatial resolution. Purpose: To demonstrate lower limits of detection for coronary calcification using an ultra‐high‐resolution (UHR) mode on a clinical photon‐counting‐detector CT (PCD‐CT), compared to a conventional energy‐integrating‐detector CT (EID‐CT). Methods: Chicken eggshell fragments (0.4–0.8 mm) mimicking coronary calcifications were scanned on a clinical PCD‐CT (NAEOTOM Alpha) in UHR mode and a conventional EID‐CT (SOMATOM Force) with matched tube potential and radiation dose levels to the PCD‐CT. PCD‐CT images were reconstructed with a sharp kernel (Qr68) and a quantum iterative algorithm (QIR‐3). Two sets of EID‐CT images were reconstructed: routine clinical kernel (Qr36, ADMIRE‐3) and a sharper kernel (Qr54) with similar noise to PCD‐CT images. With institutional review board approval, in vivo exams performed with the PCD‐CT in UHR mode were compared against patients' clinical EID‐CT exams. The visibility of calcifications on PCD‐CT and EID‐CT images was assessed and compared qualitatively. Results: PCD‐CT images visualized all calcified fragments, while EID‐CT failed to detect those below 0.6 mm using a routine protocol. EID‐CT with Qr54 improved visibility but distorted boundaries. Calcifications were less visible on EID‐CT than PCD‐CT as phantom sizes increased. 0.6‐ and 0.7‐mm calcified fragments were barely visible on 35‐ and 40‐cm phantom EID‐CT images. Patient cases showed small calcifications missed on EID‐CT but detected on PCD‐CT. Conclusion: At matched radiation dose, PCD‐CT in UHR mode provided higher spatial resolution and improved the detectability of small calcified fragments for different phantom/patient sizes in comparison to EID‐CT. [ABSTRACT FROM AUTHOR]

Coronary artery calcium scanning is a routine test for assessing the severity of atherosclerosis in asymptomatic individuals. This inexpensive, noninvasive test quantifies the calcium deposition in the 4 principal coronary arteries. Correct interpretation is important to the physician (for recommending therapy) and to the patient (for determining his or her lifetime risk of a cardiovascular event). A score of 0 indicates that a cardiovascular event is extremely unlikely in the next 5 years. In contrast, a score greater than 0 portends a coronary event. The higher the score, the greater the risk. Both the arterial location of the calcium and the number of coronary arteries involved alter the interpretation of the calcium score. At any given age, females have significantly lower scores than males. One-third of individuals with scores greater than 1000 will have a cardiovascular event within 3 years. For all elevated calcium scores, aggressive treatment is warranted, including significant lifestyle changes and medications to reduce low-density lipoprotein cholesterol. Understanding the importance of the coronary artery calcium score will result in improved therapy and patient compliance. [ABSTRACT FROM AUTHOR]

Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300–850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 ​= ​0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 ​= ​79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method. This systematic review examines the role of aortic valve calcification (AVC) on transcatheter aortic valve implantation (TAVI) outcomes. Sixty-eight studies were included, reporting varied methodologies for quantifying AVC. AVC quantification methodology with contrast-enhanced CT was found to be variable. A positive association between calcium burden and increased risk of adverse outcomes, including permanent pacemaker implantation, paravalvular leak, and aortic rupture, was reported. AVC negatively impacts TAVI outcomes independently of the quantification method. [ABSTRACT FROM AUTHOR]

(1) Background: Cardiovascular disease is the leading cause of mortality worldwide; the prevention and early detection of coronary artery disease are of critical importance; and the coronary artery calcium score is a powerful method in the assessment of coronary artery disease. Among European countries, Romania ranks as a country with a very high risk of cardiovascular diseases, but the data are limited in regard to the prevalence of the calcium score. (2) Methods: A retrospective study was conducted to establish the coronary calcium score in a group of patients investigated via cardiac CT and to determine the correlation with the presence of cardiovascular risk factors. (3) Results: According to the Agatston calcium score, 50% of the patients had a positive calcium score. High calcium scores above 400 UA were present in 12.6% of patients. Regarding the association between the presence of cardiovascular risk factors and the levels of coronary artery calcification, a mild level of calcification was associated with age over 50 years (X2 = 3.88, p = 0.04, OR = 3.25; 95% CI 0.94–11.14); a moderate level of calcification with the age of patients over 50 years (X2 = 6.54, p = 0.01, OR = 5.58; 95% CI 1.29–24.16), dyslipidemia (X2 = 7.28, p = 0.007, OR = 3.37; 95% CI 1.34–8.51), and arterial hypertension (X2 = 5.37, p = 0.02, OR = 2.88; 95% CI 1.14–7.27); a severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90–54.81); and a very severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90–54.81), smoking (X2 = 8.07, p = 0.004, OR = 4.44; 95% CI 1.47–13.44), and diabetes (X2 = 13.65, p = 0.001, OR = 6.59; 95% CI 2.5–20.18). (4) Conclusion: Half of the patients investigated by using cardiac CT had a calcium score of zero. Predictors for coronary calcium scores in relation to risk factors varied. For the very severe coronary calcification level, the strongest predictor was the presence of smoking and diabetes, which increased the odds for very severe calcification by 13.46 times. Patients who had multiple cardiovascular risk factors, hypertension, diabetes, and smoking were 9.18 times more likely to have very severe calcification. [ABSTRACT FROM AUTHOR]

Background Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown. Methods and Results This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization. All patients underwent invasive mitral valve assessment via direct left atrial and left ventricular pressure measurement. Computed tomography within 1 year of cardiac catheterization and with adequate visualization of the mitral annulus was included. MAC calcium score quantification by Agatston method was obtained offline using dedicated software (Aquarius, TeraRecon, V.4). Median patient age was 66.9±11.2 years, 47% of patients were women, 50% had coronary artery disease, 40% had atrial fibrillation, 47% had prior cardiac surgery, and 33% had prior chest radiation. Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using the Gorlin formula was 1.87±0.9 cm2. Median MAC calcium score for the cohort was 7280±7937 Hounsfield units. MAC calcium score correlated with the presence of atrial fibrillation (P=0.02) but was not associated with other comorbidities. There was no correlation between MAC calcium score and mitral valve area (r=0.07; P=0.6) or mitral valve gradient (r=−0.03; P=0.8). Conclusions MAC calcium score did not correlate with invasively measured mitral valve gradient and mitral valve area in patients with MAC‐related mitral stenosis, suggesting that calcium score should not be used as a surrogate for invasive hemodynamic parameters.

The coronary artery calcium (CAC) score is a marker of advanced coronary atherosclerosis. Numerous prospective cohorts have validated CAC as an independent marker that improves prognostication in atherosclerotic cardiovascular disease (ASCVD) beyond traditional risk factors. Accordingly, CAC is now incorporated into international cardiovascular guidelines as a tool to inform medical decision-making. Particular interest concerns the significance of zero CAC score (CAC=0). While many studies report CAC=0 to virtually exclude obstructive coronary artery disease (CAD), non-negligible rates of obstructive CAD despite CAC=0 are reported in certain populations. Overall, the current literature supports the power of zero CAC as a strong downward risk classifier in older patients, whose CAD burden predominantly involves calcified plaque. However, with their higher burden of non-calcified plaque, CAC=0 does not reliably exclude obstructive CAD in patients under 40 years. Illustrating this point, we present a cautionary case of a 31-year-old patient found to have severe two-vessel CAD despite CAC=0. We highlight the value of coronary computed tomography angiography (CCTA) as the gold-standard non-invasive imaging modality when the diagnosis of obstructive CAD is in question.

Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 publications, 11 studies met the inclusion criteria. In total, 7 studies utilized manual methods, while 4 studies utilized automated technologies, including artificial intelligence and deep learning for image analyses. Age, systolic blood pressure, serum calcium, and lipoprotein(a) levels were found to be independent risk factors for aortic calcification. Mortality from CVDs was correlated with abdominal aorta calcification. Patients requiring reintervention after endovascular recanalization exhibited a significantly higher volume of calcification in their iliac arteries. Conclusions: This review reveals a diverse landscape of measurement methods for aorto-iliac calcifications; however, they lack a standardized reproducibility assessment. Automatic methods employing artificial intelligence appear to offer broader applicability and are less time-consuming. Assessment of calcium scoring could be routinely employed during preoperative workups for risk stratification and detailed surgical planning. Additionally, its correlation with clinical outcomes could be useful in predicting the risk of reinterventions and amputations.

Abstract 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.

Introduction: epidemiological risk factors for coronary artery disease are closely related to the existence, evolution and complications of the disease. Objective: to design mathematical models predictive of coronary artery disease diagnosed by calcium score from epidemiological variables. Methods: a cross-sectional analytical study was carried out. The population consisted of 820 patients with chest pain and calcium score, the sample (246) was selected by simple random probability sampling. Logistic regression was employed from a logistic regression model (using the forward stepwise option) for each of the four coronary vessels, each model was fitted to the variables and those with coefficients significantly different from zero (p<0.05) were identified using the Wald statistic. We estimated the point Odd Ration and confidence intervals, performed internal validation and explored the performance through model discrimination with the analysis of the area under the curve and calibration through the Hosmer-Lemeshow Chi-square statistic. Results: the predominant age group was older than 60 years (61.4%), male sex (65.9%) and arterial hypertension (68.7%). The mathematical models for each coronary vessel exclude the variable age. The following are important predictors: diabetes and smoking. The internal validation technique supports the good performance of the mathematical models obtained. Conclusion: the result reinforces the need for predictive studies to ensure cardiovascular risk stratification by calcium score and epidemiological variables on which effective action should be taken to improve patient prognosis. [ABSTRACT FROM AUTHOR]

Objectives: With an incidence of 4.1 for women and 6.4 for men/1000 person-years, cardiovascular disease is the primary cause of morbidity and mortality for both men and women worldwide.[1] In asymptomatic patients, subclinical atherosclerosis has been detected utilising several non-invasive methods, such as computed tomography (CT) coronary angiography and Neck Vessel Doppler (NVD) to test coronary calcification. The goal of the present study was to assess the role of NVD in correlation with coronary CT angiography (CCTA) in assessing the coronary artery disease (CAD) burden in diabetic women and men patients. Materials and Methods: This study was conducted on 30 female patients and 30 male patients aged 40-60 years, who were referred for CCTA for suspected CAD at Nizam's Institute of Medical Sciences Hospital, Hyderabad. This study was an observational and prospective study of diabetes mellitus patients. All subjects underwent NVD and CCTA scan on the same day. Carotid intimal media thickness (CIMT) was considered the largest of the two separate values (left and right CIMT). The analysis examined factors associated with coronary artery calcification defined as a coronary artery calcium (CAC) score >0. Results: The mean age at assessment was 52.6 years in the diabetic male group and 53.7 in the diabetic female group. 63% of the study population was also hypertensive in the male group and 77% of the study population was also hypertensive in the female group. Mean CIMT was 1.01 mm in the diabetic male group and 1.02 mm in the diabetic female group. Twenty-two (73.3%) patients in the diabetic male group had a CAC score >0, of which 4 (18.18%) had severe coronary artery calcification (CAC score >400 Au), 7 (31.81%) had moderate coronary artery calcification (CAC score 100-400 Au), 11 (50%) had mild coronary artery calcification (CAC score 1-99 Au), and 8 out of 30 (26.67%) had no coronary artery calcification (CAC score <0 Au). Twenty (66.67%) patients in the diabetic female group had a CAC score >0, of which 2 (10%) had severe coronary artery calcification (CAC score >400 Au), 7 (35%) had moderate coronary artery calcification (CAC score 100-400 Au), 11 (55%) had mild coronary artery calcification (CAC score 1-99Au) and 10 out of 30 (33.33%) had no coronary artery calcification (CAC score <0 Au). Mean CIMT and carotid plaque were significantly associated with CAC (P = 0.046 and P = 0.026, respectively, in the diabetic male's group and P = 0.008 and P = 0.011, respectively, in the diabetic female's group). The significance was more profound in the diabetic female group when compared to the diabetic male group. Conclusion: NVD giving various surrogate parameters such as CIMT and plaque, in correlation with CCTA (CAC score), can play a significant role in assessing the CAD burden in men and women with diabetes and hypertension, thereby helping the clinician to assess the future risk for stroke or myocardial ischemic events to take active interventions. [ABSTRACT FROM AUTHOR]

Background: Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence following PVI. Methods: This study included 80 patients with paroxysmal/persistent AF who underwent PVI. The patients were divided into two groups: Group 1–23 patients with recurrence and Group 2–57 patients without recurrence. Results: Patients with recurrence presented with a more enlarged left atrial diameter and reduced left ventricle EF, as assessed by echocardiography. Elevated calcium scores and right coronary artery (RCA) stenosis were correlated with a higher risk of AF recurrence (25.38 ± 4.1% vs. 9.76 ± 2.32%, p = 0.001). Patients with AF recurrence presented a higher left atrial volume index (LAVI) (61.38 ± 11.12 mm3/m2 vs. 46.34 ± 12.27 mm3/m2, p < 0.0001). The bi-atrial volume index (BAVI) was similarly higher in the AF recurrence group (98.23 ± 14.44 mm3/m2 vs. 76.48 ± 17.61 mm3/m2, p < 0.0001). Increased EAT volumes located around the LA (EAT-LA) were correlated with recurrence (25.55 ± 6.37 vs. 15.54 ± 8.44, p < 0.0001). Conclusions: RCA stenosis, together with atrial volumes and EAT-AS evaluated by CCTA, is associated with the risk of AF recurrence following PVI. [ABSTRACT FROM AUTHOR]

Obtaining accurate coronary artery calcium (CAC) score measurements from CCTA datasets with virtual non-iodine (VNI) algorithms would reduce acquisition time and radiation dose. We aimed to assess the agreement of VNI-derived and conventional true non-contrast (TNC)-based CAC scores and to identify the predictors of accuracy. CCTA datasets were acquired with either 120 or 140 ​kVp. CAC scores and volumes were calculated from TNC and VNI images in 197 consecutive patients undergoing CCTA. CAC density score, mean volume/lesion, aortic Hounsfield units and standard deviations were then measured. Finally, percentage deviation (VNI - TNC/TNC∗100) of CTA-derived CAC scores from non-enhanced scans was calculated for each patient. Predictors (including anthropometric and acquisition parameters, as well as CAC characteristics) of the degree of discrepancy were evaluated using linear regression analysis. While the agreement between TNC and VNI was substantial (mean bias, 6.6; limits of agreement, 178.5/145.3), a non-negligible proportion of patients (36/197, 18.3%) were falsely reclassified as CAC score ​= ​0 on VNI. The use of higher tube voltage significantly decreased the percentage deviation relative to TNC-based values (β ​= ​−0.21 [95%CI: 0.38 to −0.03], p ​= ​0.020) and a higher CAC density score also proved to be an independent predictor of a smaller difference (β ​= ​−0.22 [95%CI: 0.37 to −0.07], p ​= ​0.006). The performance of VNI-based calcium scoring may be improved by increased tube voltage protocols, while the accuracy may be compromised for calcified lesions of lower density. The implementation of VNI in clinical routine, however, needs to be preceded by a solution for detecting smaller lesions as well. Acquiring accurate virtual non-iodine (VNI) images from coronary artery CT angiography datasets could decrease both acquisition time and radiation dose associated with routine calcium scoring. In the current paper, the in-vivo agreement of Agatston scores obtained with a novel spectral reconstruction VNI algorithm and with conventional true non-contrast (TNC) images were investigated and potential predictors of performance were identified. The investigation revealed that VNI-based calculations correlate significantly with TNC calcium scores, demonstrating substantial agreement. On the other hand, increased tube voltage protocols and higher calcium densities may enhance the performance of such algorithms, manifesting in reduced percentage deviation from TNC calculations. [ABSTRACT FROM AUTHOR]

AimsAnecdotal reports have suggested increased soft tissue calcification in individuals with long-term exposures to high blood glucose. The association of costal cartilage calcification (CCC), a reliably quantifiable marker obtainable from non-contrast cardiac computed tomography (CT) with cumulative fasting blood glucose (FBG) exposure, is unknown. In this study, we aimed to determine the association between quantified CCC and cumulative glucose exposure using non-contrast coronary artery calcium (CAC) scoring computed tomography (CT) images in the Multi-Ethnic Study of Atherosclerosis (MESA).MethodsThe volume of bilateral CCC was quantified in high-density pixels (threshold of Hounsfield Unit>180) using the CAC scoring CT images acquired in the 5th MESA exam. Prior long-term cumulative exposure to FBG was calculated by area under the FBG-time curve over ten years before the time of the CT exam.ResultsA total of 2,305 participants (mean age: 69, female/male: 1.3) were included in this study. The median CCC volume was lower in females than males (1158 mm3 [IQR: 1751] vs. 3054 mm3 [3851], p

AimsCoronary artery calcium (CAC) scoring is an established tool for cardiovascular risk stratification. However, the lack of widespread availability and concerns about radiation exposure have limited the universal clinical utilization of CAC. In this study, we sought to explore whether machine learning (ML) approaches can aid cardiovascular risk stratification by predicting guideline recommended CAC score categories from clinical features and surface electrocardiograms.Methods and resultsIn this substudy of a prospective, multicentre trial, a total of 534 subjects referred for CAC scores and electrocardiographic data were split into 80% training and 20% testing sets. Two binary outcome ML logistic regression models were developed for prediction of CAC scores equal to 0 and ≥400. Both CAC = 0 and CAC ≥400 models yielded values for the area under the curve, sensitivity, specificity, and accuracy of 84%, 92%, 70%, and 75%, and 87%, 91%, 75%, and 81%, respectively. We further tested the CAC ≥400 model to risk stratify a cohort of 87 subjects referred for invasive coronary angiography. Using an intermediate or higher pretest probability (≥15%) to predict CAC ≥400, the model predicted the presence of significant coronary artery stenosis (P = 0.025), the need for revascularization (P

Cardiac computed tomography angiography (CCTA) has emerged as a cost-effective and time-saving technique for excluding coronary artery disease. One valuable tool obtained by CCTA is the coronary artery calcium (CAC) score. The use of CAC scoring has shown promise in risk assessment and stratification of cardiovascular disease. CAC scores can be complemented by plaque analysis to assess vulnerable plaque characteristics and further refine risk assessment. This paper aims to provide a comprehensive understanding of the value of the CAC as a prognostic tool and its implications for patient risk assessment, treatment strategies and outcomes. CAC scoring has demonstrated superior ability in stratifying patients, especially asymptomatic individuals, compared to traditional risk factors and scoring systems. The main evidence suggests that individuals with a CAC score of 0 had a good long-term prognosis, while elevated CAC score is associated with increased cardiovascular risk. Finally, the clinical power of CAC scoring and the develop of new models for risk stratification could be enhanced by machine learning algorithms.

Keywords: Lipids; imaging; biomarkers; CT angiography; calcium score; Hs-CRP; Troponin; risk assesment EN Lipids imaging biomarkers CT angiography calcium score Hs-CRP Troponin risk assesment 2292 2304 13 07/04/23 20230701 NES 230701 Graph: Graphical Abstract Advantages of tailoring lipid lowering therapy with biomarkers versus imaging. The following debate will focus on whether biomarkers or imaging can help us answer the following questions better: How can we better identify the seemingly low-moderate risk patient who will benefit from lipid lowering therapy and the high risk patient who needs treatment intensification? The fact that acute ischemic events result from either rupture or erosion of an atherosclerotic plaque and the clear relationship between atherosclerotic disease burden and cardiovascular risk from multiple studies, including autopsy, invasive coronary angiography, intravascular imaging, and most recently computed tomography coronary angiography (CTCA),[[5], [7], [9], [11]] all support the argument that vascular imaging has the potential to play an important role in triaging patients to more intensive lipid lowering ( I Figure 1 i ). [Extracted from the article]

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]

Background: The Agatston score on noncontrast computed tomography (CT) scans is the gold standard for calcium load determination. However, contrast-enhanced CT is commonly used for patients with atherosclerotic cardiovascular diseases (ASCVDs), such as peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysm (AAA). Currently, there is no validated method to determine calcium load in the aorta and peripheral arteries with a contrast-enhanced CT. This study validated a length-adjusted calcium score (LACS) method for contrast-enhanced CT scans. Method: The LACS (calcium volume in mm3/arterial length in cm) in the abdominal aorta was calculated using four-phase liver CT scans of 30 patients treated between 2017 and 2021 at the University Medical Center Groningen (UMCG) with no aortic disease. Noncontrast CT scans were segmented with a 130 Hounsfield units (HU) threshold, and a patient-specific threshold was used for contrast-enhanced CTs. The LACS was calculated and compared from both segmentations. Secondly, the interobserver variability and the influence of slice thickness (0.75 mm vs. 2.0 mm) was determined. Results: There was a high correlation between the LACS from contrast-enhanced CT scans and the LACS of noncontrast CTs (R2 = 0.98). A correction factor of 1.9 was established to convert the LACS derived from contrast-enhanced CT to noncontrast CT scans. LACS interobserver agreement on contrast-enhanced CT was excellent (1.0, 95% confidence interval = 1.0–1.0). The 0.75 mm CT threshold was 541 (459–625) HU compared with 500 (419–568) HU on 2 mm CTs (p = 0.15). LACS calculated with both thresholds was not significantly different (p = 0.63). Conclusion: The LACS seems to be a robust method for scoring calcium load on contrast-enhanced CT scans in arterial segments with various lengths. [ABSTRACT FROM AUTHOR]

Background: Research has examined the relationships between coronary artery calcium (CAC) scores and mortality, mechanical ventilation, and intensive care unit admissions. This paper summarizes the predictive value of coronary artery calcification scoring for hospitalized COVID-19 patients in terms of mortality, mechanical ventilation, and intensive care unit admission. Methods: The patients in this single-center retrospective analysis have COVID-19 and were hospitalized at the Firouzabadi hospital in Tehran between 2019 and 2020. coronary artery calcificationscore was estimated based on chest non-contrast CT scans on the day of admission. Based on the coronary artery calcification score, the patients were categorized into Very Low, Mild to Moderate, and Moderate to Severe. After a univariate analysis of the critical factors, odds ratio (OR) analysis and multivariate analysis of variables that could be linked to COVID-19 advancement were carried out. Results: a total of 719 patients were examined. Among them, 414 patients were men. Mortality with a 17.1 % prevalence was statistically significant between CAS score levels (P < 0.001). This factor has high OR with mild to moderate and moderate to severe CAS (OR: 2.14; 95% CI: 1.71 to 3.06, and OR: 2.31; 95% CI: 1.84 to 3.57). Oxygen saturation was a significant statistic between CAS score levels (P = 0.02). This factor has a high OR with mild to moderate and moderate to severe CAS (OR: 1.09; 95% CI: 0.71 to 3.60, and OR: 2.38; 95% CI: 0.89 to 2.9). There was no statistical difference between the groups' outcomes of mechanical ventilation and admission types. Conclusion: In this study, the coronary artery calcification scores of patients with COVID-19 were compared, while the outcomes of interest mortality, mechanical ventilation, and intensive care unitU admission were closely investigated. In light of these findings, coronary artery calcificationscoring can help in patient stratification, enabling earlier therapies for disorders to progress quickly. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) risk amongst those with type 2 diabetes (T2D) is heterogenous. The role of imaging-based cardiometabolic biomarkers (e.g., coronary artery calcium [CAC] score, and hepatic triglyceride content [HTC]) in CVD risk stratification in T2D is unclear. To better understand this, we sought to evaluate the individual and joint associations between CAC and hepatic steatosis (HS) with clinical atherosclerotic CVD (ASCVD) in Dallas Heart Study (DHS) participants with and without T2D. We examined participants in the DHS, a multi-ethnic cohort study, without self-reported ASCVD. CAC scoring was performed via computed tomography with the mean of two consecutive scores used. HTC was measured using magnetic resonance spectroscopy, and HS was defined as HTC >5.5% The primary outcome was incident ASCVD, defined as coronary heart disease (CHD; myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery), ischemic stroke, transient ischemic attack, or CVD death. Cox regression analyses, and interaction testing was performed to evaluate the individual and joint associations between CAC and HS with ASCVD. The association between HS and coronary heart disease was validated in the UK Biobank (UKB). A total of 1252 DHS participants were included with mean age 44.8 ± 9.3 years, mean body mass index 28.7 ± 5.9 kg/m2, 55% female, and 59% black with an overall prevalence of T2D of 9.7%. CAC scores were significantly higher (p < 0.01) and HS was significantly more prevalent in those with T2D (p < 0.01). Over a median of 12.3 years, 8.3% of participants experienced ASCVD events. The ASCVD event rate was significantly higher in participants with T2D (20.5% vs 7.0%, p < 0.01). Continuous CAC was associated with ASCVD events in the overall cohort regardless of T2D status with a significant interaction present between CAC and T2D status on ASCVD, P interaction = 0.02. HTC was not associated with ASCVD risk in participants without T2D but was inversely associated with risk in participants with T2D (HR 0.91, 95% CI 0.83–0.99 per 1% increase in HTC, p = 0.02), P interaction = 0.02. Amongst 37,266 UKB participants, 4.5% had T2D. CHD events occurred in 2.2% of participants, with 10.2% of events occurring amongst those with T2D. An inverse relationship between HTC and CHD was also found amongst those with T2D in UKB with a significant interaction between T2D status and HTC on CHD (HR per 1% increase in HTC 0.95, 95% CI 0.91–0.99, p = 0.01, P interaction = 0.02). In the DHS, we found that CAC was associated with ASCVD risk independent of T2D status. We did not observe an association between HTC and ASCVD in participants without T2D, but there was an inverse association between HTC and ASCVD in those with T2D that was replicated in the UKB cohort. Further investigation is warranted to understand the possible protective association of HS in participants with T2D. [ABSTRACT FROM AUTHOR]