Agatston Coronary Artery Calcium Research Articles

Effects of overhydration, Kt/Vurea, β2-microglobulin on coronary artery calcification and mortality in haemodialysis patients.

We studied the effects of overhydration (OH), Kt/Vurea and β2-microglobulin (β2-MG) on coronary artery calcification and mortality in patients undergoing haemodialysis (HD). The Agatston coronary artery calcium score (CACS), postdialysis body composition using bioimpedance analysis, single-pool Kt/Vurea and predialysis β2-MG at baseline were assessed and followed up for 3 years in patients undergoing HD. We performed logistic regression analyses for a CACS ≥400 and Cox proportional hazard analyses for all-cause and cardiovascular mortality. The study involved 338 patients with a median age of 67 (56-74) years, dialysis duration of 70 (33-141) months and diabetes prevalence of 39.1% (132/338). Patients with a CACS ≥400 (n = 222) had significantly higher age, dialysis duration, male prevalence, diabetes prevalence, C-reactive protein, predialysis β2-MG, OH, extracellular water/total body water and overhydration/extracellular water (OH/ECW) but significantly lower Kt/Vurea than patients with a CACS <400 (n = 116) (p < .05). OH/ECW, Kt/Vurea and predialysis β2-MG were significant predictors of a CACS ≥400 (p < .05) after adjusting for age, dialysis duration, serum phosphate and magnesium. In all patients, cut-off values of OH/ECW, Kt/Vurea and predialysis β2-MG for a CACS ≥400 were 16%, 1.74 and 28 mg/L, respectively. After adjusting for dialysis duration, OH/ECW ≥16%, Kt/Vurea ≥1.74 and β2-MG ≥28 mg/L were significant predictors of 3-year all-cause mortality but not 3-year cardiovascular mortality. Higher OH/ECW, higher predialysis β2-MG and lower Kt/Vurea values are significant risk factors for a CACS ≥400 and 3-year all-cause mortality in patients undergoing maintenance HD.

Absolute iron deficiency, coronary artery calcification and cardiovascular mortality in maintenance haemodialysis patients.

The effects of iron on vascular calcification in rats and vascular smooth muscle cells were recently reported, but clinical studies on iron and vascular calcification are scant. We studied the associations of absolute iron deficiency, coronary artery calcification and mortality in patients with maintenance haemodialysis (MHD). Transferrin saturation (TSAT), ferritin, mean corpuscular haemoglobin (MCH) and Agatston coronary artery calcium score (CACS) were studied at baseline in MHD patients and followed up for 3 years. Cox proportional hazard analyses for mortality and linear regression analyses for CACS were performed. In 306 patients, the median age was 67 (56-81) years, dialysis duration was 76 (38-142) months, and diabetes prevalence was 42.5%. Fifty-two patients had died by 3 years. Patients with absolute iron deficiency (TSAT <20% and ferritin <100 ng/mL) (n = 102) showed significantly higher CACS (p = .0266) and C-reactive protein (p = .0011), but a lower frequency of iron formulation administration compared with patients without absolute iron deficiency at baseline (n = 204). Absolute iron deficiency was a significant predictor for 3-year cardiovascular (CV) mortality (hazard ratio: 2.08; p = .0466), but not for 3-year all-cause mortality. CACS was significant predictor for both 3-year CV and all-cause mortality (p <.05). Absolute iron deficiency and MCH were significant determinants of CACS (p < .05). MHD patients with absolute iron deficiency showed significantly higher CACS than others, and absolute iron deficiency was a significant risk factor for coronary artery calcification and 3-year CV mortality in MHD patients, but was not a significant predictor for 3-year all-cause mortality.

Visual Ordinal Coronary Artery Calcium Score from Non-Gated Chest CT Predicts Mortality After Severe Chronic Obstructive Pulmonary Disease Exacerbation.

Chronic obstructive pulmonary disease (COPD) patients often undergo chest CT for various indications. Coronary artery calcium (CAC) can be quantified visually on ungated chest CT using an ordinal score that has been shown to correlate well with traditional Agatston CAC scoring. The prognostic role of CAC was studied mainly in stable COPD patients. We aim to study the association between ordinal CAC and mortality amongst patients admitted for acute exacerbation of COPD (AECOPD). Retrospective study of AECOPD cases with no previous coronary revascularization admitted between 1st January 2016 to 30th June 2017 with a chest CT performed during admission or within 365 days prior. Ordinal CAC scoring (scale of 0-12) was performed by an experienced CT cardiologist blinded to patient data and outcomes. Patient demographics and future clinical events were retrieved from electronic medical records. There were 93 patients included (87.1% male, mean age 75 years) with the majority (59.1%) in GOLD Stage III. There were 21 (22.6%) patients with no CAC as well as 39 (41.9%) and 33 (35.5%) with ordinal CAC of 1-3 and 4-12, respectively. There were no significant differences in Charlson Comorbidity Index (CCI) and the proportion of patients with traditional cardiovascular risk factors (namely hypertension, dyslipidaemia, diabetes and smoking status) between the ordinal CAC score groups. Over a median follow-up period of 2.9 (1.1-3.9) years, there were 51 (54.8%) deaths. An ordinal CAC score of 4-12 was the only significant predictor of mortality after multivariate Cox-regression analysis adjustment for age, gender, body mass index, prior exacerbations, FEV1, cardiovascular risk factors and CCI [HR 3.944, (95% confidence interval 1.647-9.433, p = 0.002)]. Ordinal CAC measured from a current or recent ungated chest CT is an independent predictor of all-cause mortality in admitted AECOPD patients with no previous coronary revascularization.

Abstract 14960: Coronary Artery Calcium Distribution Patterns Are Independently Predictive of Adverse Cardiovascular Events: Observations From the Dallas Heart Study

Introduction: The coronary artery calcium (CAC) diffusivity index (DI) may improve risk stratification for those with Agatston CAC &gt; 0 in older individuals. We aimed to assess whether the distribution of CAC would improve risk prediction of cardiovascular (CV) events beyond the traditional Agatston CAC score in a younger population. Methods: Among Dallas Heart Study 2 (DHS2) participants with Agatston CAC &gt; 0 and no history of CVD (35% of entire cohort), we studied 1013 participants with CAC DI at DHS2. The raw CAC DI was calculated as 1 - (CAC in most affected vessel/total CAC) and categorized into concentrated (&lt;25th%), standard (25-75th%), and diffuse (&gt;75th%) patterns. Multivariable Cox proportional hazards regression and C statistics were calculated for coronary events (CHD) and all CVD, and all-cause mortality. Models were adjusted for total Agatston score, race, gender, BSA, smoking history, diabetes, and statin use. Results: Mean age of the DHS2 study cohort was 55 ± 9.4 years (48% women, 45% Black). The median follow up was 9 ± 2.5 years (55 CHD, 97 CVD, and 120 all-cause mortality events) (Figure, A) . CAC DI was modestly correlated with Agatston CAC (Spearman rho = 0.60, p&lt;0.01). In models adjusted for total Agatston score, risk factors, and demographics, compared with a concentrated pattern, a diffuse CAC pattern was associated with incident CHD (HR [95%CI]: 5.32 [1.68-16.86]); CVD (HR [95%CI]: 3.21 [1.66-6.21]), and all-cause mortality (HR [95%CI]: 2.02 [1.18-3.47] (Figure, B) . Findings were similar for continuous CAC DI. Addition of continuous CAC DI to adjusted models including Agatston CAC improved the C-statistic for CHD (0.79 to 0.81, p&lt;0.01) and CVD (0.71 to 0.73, p&lt;0.01). Conclusions: Beyond the validated Agatston score, higher CAC DI at baseline improves risk prediction of incident CHD and CVD events in a younger population-based cohort. Further studies are warranted to evaluate the clinical utility of assessing distribution patterns of CAC.

Serum oxalate concentration is associated with coronary artery calcification and cardiovascular events in Japanese dialysis patients

Coronary artery calcification (CAC) is associated with cardiovascular disease (CVD). CAC might contain calcium oxalate, and a high serum oxalate (SOx) concentration is associated with cardiovascular mortality in dialysis patients. We assessed the associations between SOx and CAC or CVD events in Japanese hemodialysis patients. This cross-sectional and retrospective cohort study was done in 2011. Seventy-seven hemodialysis patients’ Agatston CAC score was measured, and serum samples were collected. SOx concentrations were measured in 2021 by using frozen samples. Also, new-onset CVD events in 2011–2021 were retrospectively recorded. The association between SOx concentration and CAC score ≥ 1000, and new-onset CVD events were examined. Median SOx concentration and CAC score were 266.9 (229.5–318.5) µmol/L and 912.5 (123.7–2944), respectively. CAC score ≥ 1000 was associated with SOx [adjusted odds ratio (OR) 1.01, 95% confidence interval (CI), 1.00–1.02]. The number of new-onset CVD events was significantly higher in patients with SOx ≥ median value [hazard ratio (HR) 2.71, 95% CI 1.26–6.16]. By Cox proportional hazard models, new-onset CVD events was associated with SOx ≥ median value (adjusted HR 2.10, 95% CI 0.90–4.91). SOx was associated with CAC score ≥ 1000 and new-onset CVD events in Japanese hemodialysis patients.

Evaluation of Clinical Applicability of Coronary Artery Calcium Assessment on Non–Gated Chest Computed Tomography, Compared With the Classic Agatston Score on Cardiac Computed Tomography

Given current pretest probability (PTP) estimations tend to overestimate patients' risk for obstructive coronary artery disease, evaluation of patients' coronary artery calcium (CAC) is more precise. The value of CAC assessment with the Agatston score on cardiac computed tomography (CT) for risk estimation has been well indicated in patients with stable chest pain. CAC can be equally well assessed on routine non-gated chest CT, which is often available. This study aims to determine the clinical applicability of CAC assessment on non-gated CT in patients with stable chest pain compared with the classic Agatston score on gated CT. Consecutive patients referred for evaluation of the Agatston score, who had a previously performed non-gated chest CT for evaluation of noncardiac diseases, were included. CAC on non-gated CT was ordinally scored. Subsequently, patients were stratified according to CAC severity and PTP. The agreement and correlation between the classic Agatston score and CAC on non-gated CT were evaluated. The discriminative power for risk reclassification of both CAC assessment methods was assessed. Invasive coronary angiography was used as the gold standard, when available. A total of 140 patients aged between 30 and 88years were included. The agreement between ordinally scored CAC and the Agatston score was excellent (κ=0.82) and the correlation strong (r=0.94). Most patients (80%) with an intermediate PTP had no or mild CAC on non-gated CT. They were reclassified at low risk with 100% accuracy compared with invasive coronary angiography. Similarly, 86% of patients had an Agatston score <300. These patients were reclassified with 98% accuracy. In patients with high PTP, the accuracy remained substantial and comparable, 94% and 89%, respectively. In conclusion, we believe this is the first study to assess the clinical applicability of CAC on non-gated CT in patients with stable chest pain, compared with the classic Agatston score. The agreement between methods was excellent and the correlation strong. Furthermore, CAC assessment on non-gated CT could reclassify patients' risk for obstructive coronary artery disease as accurately as could the classic Agatston score.

The Role of Coronary Artery Calcium Score to Assess Risk of Cardiovascular Disease in Irradiated Esophageal Cancer Patients

Coronary artery calcium (CAC) score is an important predictive imaging marker of cardiovascular disease (CVD). While studies have found positive association between CAC score and cardiac toxicity in irradiated lung and breast cancer patients, there are no studies assessing CAC scores in esophageal cancer (EC). While a cardiac-gated CT is required for standard Agatston CAC score, visual assessment of CAC via ordinal scoring on non-gated CT has shown good concordance with Agatston score. In this study, we sought to examine whether visual assessment of CAC, measured on standard of care, non-contrast chest CT, predicts the development of adverse cardiovascular events (ACVE) in irradiated EC patients. This is a single institution retrospective study of EC patients treated with RT from 2010-2021. We included patients with available PET/CT at diagnosis or chest CT simulation scan without contrast, and excluded those with history of percutaneous coronary intervention, coronary bypass surgery, or prior thoracic RT. Pre-treatment characteristics, clinical factors, and grade ≥ 3 (G3+) adverse cardiovascular events (ACVE) (CTCAEv5.0) were evaluated. Visual assessment of CAC was performed using ordinal method (CAC scored from 0 to 12), by a thoracic radiologist. Fine and Gray regression was used to compute hazard ratios for time to first ACVE. Univariate analyses using Cox proportional hazards were used for overall survival (OS). ACVEs were recorded from start of oncologic treatment and OS calculated after completion of RT. A total of 118 patients were analyzed with a median follow-up of 16 months. Median age was 67 years, 65% male, 43% white, 59% with EC of distal esophagus, and 59% had squamous cell carcinoma. Median mean heart dose was 21.93 Gy (range 0.15-36.94). 24% developed G3+ ACVEs: atrial fibrillation 9%, stroke 6%, heart failure 4%, pulmonary embolism 4%, pericardial effusion 3%, myocardial infarction 2%, heart block 2%, and cardiac death 1%. On univariate analyses, CAC >1 vs. CAC ≤ 1 trended towards increased risk of ACVE (HR = 1.95, 95% CI = 0.89-4.26; p = 0.094), however it is not predictive of OS (HR = 1.31, 95% CI = 0.75-2.30; p = 0.343). Proportion of patients with ACVEs was greater in CAC>1 group (Table). When compared to patients with CAC ≤ 1, those with CAC >1 were older (median age 62 vs 72 years, p = 0.0015), less likely to be never smokers (38% vs 30%, p = 0.0437), and more likely to have hypertension (43% vs 64%, p = 0.0197), and hyperlipidemia (30% vs 47%, p = 0.0557). This is the first study to investigate the relationship between CAC score and ACVEs in EC. While the study was underpowered (likely due to low rates of recorded ACVEs), to detect a significant association between CAC score and ACVEs, there was a trend towards increased risk of ACVEs in patients with a CAC score >1 by visual ordinal scoring. Further prospective evaluation with a larger cohort is warranted.

Is there an association between coronary artery inflammation and coronary atherosclerotic burden?

As for the coronary artery inflammation and coronary atherosclerotic burden, which are used to assess the risk of adverse cardiac events in patients, it is unclear whether there is any certain correlation between them. Therefore, the purpose of this study was to explore the potential relationship between coronary artery inflammation and coronary atherosclerotic burden. A total of 346 eligible patients underwent assessment of computed tomography (CT) attenuation values of pericoronary adipose tissue (PCAT) in the right coronary artery and Agatston coronary artery calcium (CAC) based on coronary CT angiography. These measurements were utilized to evaluate coronary inflammation and atherosclerotic burden, respectively. Patients with a CAC score of 0 were categorized into groups based on the presence or absence of coronary artery disease (CAD). CAC scores of 10, 100, and 400 were chosen as cutoff values to compare differences in PCAT attenuation values across different CAC scores. When comparing all CAD patients to non-CAD patients, a significantly higher PCAT attenuation was observed in CAD patients (-87.54±9.39 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation in CAD patients with a CAC score of 0 was significantly higher than that in patients with a CAC score greater than 0 and in non-CAD patients with a CAC score of 0 (-82.63±8.70 vs. -90.38±8.59 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation values did not exhibit significant differences among different CAC scores (all P>0.05); however, it was highest in CAD patients with a CAC score of 0 (P<0.05). Body mass index, hyperlipidemia, hypertension, and PCAT attenuation were identified as independent risk factors in both CAD patients with a CAC score of 0 and patients with a CAC score greater than 0 (all P<0.05). The results of this study suggest that a direct relationship between coronary inflammation and coronary atherosclerotic burden is not evident. Nonetheless, it is noteworthy that coronary inflammation was most pronounced in CAD patients with a CAC score of 0, while CAC score did not demonstrate an association with inflammation.

#5365 T2DM MODIFIES THE RELATIONSHIP BETWEEN CAC AND ADVERSE KIDNEY OUTCOME IN PATIENTS WITH CKD

Abstract Background and Aims Kidney function decline faster in patients with type 2 diabetes mellitus (T2DM) than in those without. We previously showed that coronary artery calcification (CAC) is a strong risk of adverse kidney outcome. Here, we examined whether T2DM could modify the relationship between CAC and the progression of chronic kidney disease (CKD). Method 2067 participants from the KoreaN Cohort Study for Outcome in Patients With CKD were enrolled. The main exposures were T2DM and CAC. The primary outcome was CKD progression defined as a composite of a 50% decline in estimated glomerular filtration rate or kidney failure with replacement therapy. Multivariable cause-specific hazard function was employed to determine the association between the main exposures and the primary outcome. Results During 8633 person-years of follow-up, the primary outcome occurred in 565 (27.3%) participants. In the multivariable cause-specific hazard model, both T2DM and CAC Agatston score (CACS) &amp;gt;0 were associated with a 1.80- and a 1.41-fold increased risk of CKD progression compared with counterparts. There was a significant interaction between T2DM and CAC for the primary outcome. In patients without T2DM, CACS &amp;gt;0 was not associated with the primary outcome compared with CACS of 0. However, in patients with T2DM, CACS &amp;gt;0 was associated with a significantly higher risk of CKD progression (adjusted hazard ratio, 2.12; 95% confidence interval, 1.64-2.75). In addition, a 1-SD increase in CACS was associated with 1.11-fold higher risk of CKD progression. Notably, this association was also significant in patients with T2DM who had CACS of 0. The slope of eGFR decline was steeper in patients with T2DM and the magnitude of decline was greater when CACS &amp;gt;0. Conclusion CAC were more strongly associated with risk of CKD progression in patients with T2DM than in those without. Thus, clinical implication of CAC may differ depending on the presence of T2DM.

Artificial intelligence using a deep learning versus expert computed tomography human reading in calcium score and coronary artery calcium data and reporting system classification.

Artificial intelligence (AI) applied to cardiac imaging may provide improved processing, reading precision and advantages of automation. Coronary artery calcium (CAC) score testing is a standard stratification tool that is rapid and highly reproducible. We analyzed CAC results of 100 studies in order to determine the accuracy and correlation between the AI software (Coreline AVIEW, Seoul, South Korea) and expert level-3 computed tomography (CT) human CAC interpretation and its performance when coronary artery disease data and reporting system (coronary artery calcium data and reporting system) classification is applied. A total of 100 non-contrast calcium score images were selected by blinded randomization and processed with the AI software versus human level-3 CT reading. The results were compared and the Pearson correlation index was calculated. The CAC-DRS classification system was applied, and the cause of category reclassification was determined using an anatomical qualitative description by the readers. The mean age was age 64.5 years, with 48% female. The absolute CAC scores between AI versus human reading demonstrated a highly significant correlation (Pearson coefficient R = 0.996); however, despite these minimal CAC score differences, 14% of the patients had their CAC-DRS category reclassified. The main source of reclassification was observed in CAC-DRS 0-1, where 13 were recategorized, particularly between studies having a CAC Agatston score of 0 versus 1. Qualitative description of the errors showed that the main cause of misclassification was AI underestimation of right coronary calcium, AI overestimation of right ventricle densities and human underestimation of right coronary artery calcium. Correlation between AI and human values is excellent with absolute numbers. When the CAC-DRS classification system was adopted, there was a strong correlation in the respective categories. Misclassified were predominantly in the category of CAC = 0, most often with minimal values of calcium volume. Additional algorithm optimization with enhanced sensitivity and specificity for low values of calcium volume will be required to enhance AI CAC score utilization for minimal disease. Over a broad range of calcium scores, AI software for calcium scoring had an excellent correlation compared to human expert reading and in rare cases determined calcium missed by human interpretation.

Significance of coronary artery calcification for predicting major adverse cardiovascular events: results from the NADESICO study in Japan

BackgroundWe aimed to determine the usefulness and sex differences of assessment of coronary artery calcification (CAC) with cardiovascular risk factors and major adverse cardiovascular events (MACE) in Japanese patients. MethodsIn a nationwide, multicenter, prospective cohort study, 1187 patients with suspected coronary artery disease who underwent coronary computed tomography were enrolled. MACE included cardiovascular death, myocardial infarction, stroke, revascularization, and hospitalization for unstable angina, heart failure, or aortic disease. The concordance (C)-statistics were used to assess the relationships among the Suita risk score, CAC score, and incident MACE, with emphasis on sex differences. ResultsThe final analysis included 982 patients (mean age, 64.7 ± 6.6 years; male patients, 53.9 %). MACE developed in 65 male and 21 female patients during a median follow-up of 1480 days. The C-statistics calculated using Suita score for MACE were 0.650, 0.633, and 0.569 in overall, male, and female patients, respectively. In overall patients, the C-statistic significantly increased in combined models of Agatston CAC scores of ≥100, 200, 300, or 400 and the Suita score. In each sex, the C-statistics significantly increased in the model that added an Agatston CAC score of ≥100 and ≥200 (+0.049 and +0.057) in male patients, and ≥400 (+0.119) in females, respectively. ConclusionsAdding assessment of Agatston CAC scores to Suita score was useful to improve the predictive ability for future MACE in Japanese patients. Agatston CAC scores of ≥100 or 200 in male and ≥400 in female patients in addition to Suita score improved the MACE risk prediction.

Coronary Artery Calcium Density and Cardiovascular Events by Volume Level: The MESA.

The Agatston coronary artery calcium (CAC) score provides robust cardiovascular disease risk prediction but upweights plaque area by a density factor. Density, however, has been shown to be inversely associated with events. Using CAC volume and density separately improves risk prediction, but it is unclear how to apply this method clinically. We aimed to evaluate the association between CAC density and cardiovascular disease across the spectrum of CAC volume to better understand how to incorporate these metrics into a single score. We performed an analysis of MESA (Multi-Ethnic Study of Atherosclerosis) participants with detectable CAC to evaluate the association between CAC density and events by level of CAC volume using multivariable Cox regression models. In a cohort of 3316 participants, there was a significant interaction (P<0.001) between CAC volume and density for coronary heart disease (CHD) risk (myocardial infarction, CHD death, resuscitated cardiac arrest). Models using CAC volume and density resulted in improvement in the C-index (0.703, SE 0.012 versus 0.687, SE 0.013) and a significant net reclassification improvement (0.208 [95% CI, 0.102-0.306]) compared with the Agatston score for CHD risk prediction. Density was significantly associated with lower CHD risk at volumes ≤130 mm3 (hazard ratio, 0.57 per unit of density [95% CI, 0.43-0.75]), but the inverse association at volumes >130 mm3 was not significant (hazard ratio, 0.82 per unit of density [95% CI, 0.55-1.22]). The lower risk for CHD associated with higher CAC density varied by level of volume, and volume ≤130 mm3 is a potentially clinically useful cut point. Further study is needed to integrate these findings into a unified CAC scoring method.

High- vs. Low-Intensity Statin Therapy and Changes in Coronary Artery Calcification Density after One Year.

Statin therapy promotes the progression of coronary artery calcification (CAC). Comparing patients on high (HIST) vs. low-to-intermediate intensity statin therapy (LIST), randomized controlled trials with a one-year follow-up failed to document a relevant difference in the Agatston score and CAC volume. We evaluated whether statin intensity modifies CAC density at one year. We performed a pooled analysis of two randomized-controlled trials (BELLES, EBEAT), comparing the effects of HIST (Atorvastatin 80 mg) vs. LIST (Pravastatin 40 mg, Atorvastatin 10 mg) on CAC measures after one year. The differences in CAC density and its change were compared using the two-sided t-test. Data from 852 patients (66.7% female) with available baseline and follow-up CT were evaluated from both trials. HIST vs. LIST more effectively reduced LDL-cholesterol (annualized change: -45.8 ± 38.5 vs. -72.9 ± 46.0 mg/dL, p &lt; 0.001). Mean CAC density increased from 228.8 ± 35.4 HU to 232.6 ± 37.0 HU (p &lt; 0.0001) at one-year follow-up. Comparing patients on HIST vs. LIST, CAC density at follow-up (HIST: 231.9 ± 36.1 HU vs. LIST: 233.3 ± 37.7 HU, p = 0.59) and its change from baseline (HIST: 4.0 ± 19.1 HU vs. LIST: 3.6 ± 19.6 HU, p = 0.73) did not differ. Subgroup analyses, stratifying by LDL reduction (&lt;median: 2.0 ± 24.3 HU, ≥median: 3.6 ± 21.9 HU, p = 0.34), Agatston score at baseline (&lt;100: 2.6 ± 22.5 HU vs. 3.2 ± 25.6 HU, p = 0.82; ≥100: 4.8 ± 17.0 HU vs. 3.8 ± 16.6 HU, p = 0.44, for HIST vs. LIST; respectively), and equal number of lesions in both CT scans (3.7 ± 20.3 HU vs. 7.0 ± 22.2 HU, p = 0.24) showed similar results. HIST vs. LIST leads to a higher reduction in cholesterol levels, which does not translate into relevant differences in the change of CAC density at one-year follow-up.

Transient left bundle branch block associated with very high coronary artery calcium: a case report.

Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 diabetes, and hyperlipidemia presenting with dyspnea. Initial electrocardiogram (ECG) demonstrated normal conduction with a heart rate of 76 beats/min, but new T-wave inversions in V1-V4 and a high-sensitivity troponin-I (hsTnI) value of 6 ng/L (normal < 6 ng/L). Repeat ECG in the emergency department showed normal sinus rhythm (heart rate of 80 beats/min); however, it subsequently demonstrated a left bundle branch block (LBBB) with a repeat hsTnI of 7 ng/L. Stress testing with pharmacologic single-photon emission computerized tomography did not show scintigraphic evidence of ischemia but noted extensive CAC and a concern for balanced ischemia. Subsequent coronary computed tomography angiography (CCTA) showed nonobstructive disease and a total Agatston CAC score of 1262. Invasive evaluation with left heart catheterization was deferred given the patient's unchanged symptoms and CCTA findings. Statin therapy was intensified and aspirin, metoprolol succinate, and antihypertension therapies were continued. Initiation of glucose-lowering therapy and lipoprotein(a) testing was strongly recommended on follow-up. Our case suggests that CAC ⩾ 1000 may be incidentally associated with transient LBBB during the workup of coronary artery disease. Here, we specifically show that functional testing that incorporates measurement of CAC burden can help to improve ASCVD-preventive pharmacotherapy initiation and intensification beyond the identification of obstructive disease alone.

Impact of deep learning image reconstructions (DLIR) on coronary artery calcium quantification

BackgroundDeep learning image reconstructions (DLIR) have been recently introduced as an alternative to filtered back projection (FBP) and iterative reconstruction (IR) algorithms for computed tomography (CT) image reconstruction. The aim of this study was to evaluate the effect of DLIR on image quality and quantification of coronary artery calcium (CAC) in comparison to FBP.MethodsOne hundred patients were consecutively enrolled. Image quality–associated variables (noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR)) as well as CAC-derived parameters (Agatston score, mass, and volume) were calculated from images reconstructed by using FBP and three different strengths of DLIR (low (DLIR_L), medium (DLIR_M), and high (DLIR_H)). Patients were stratified into 4 risk categories according to the Coronary Artery Calcium - Data and Reporting System (CAC-DRS) classification: 0 Agatston score (very low risk), 1–99 Agatston score (mildly increased risk), Agatston 100–299 (moderately increased risk), and ≥ 300 Agatston score (moderately-to-severely increased risk).ResultsIn comparison to standard FBP, increasing strength of DLIR was associated with a significant and progressive decrease of image noise (p < 0.001) alongside a significant and progressive increase of both SNR and CNR (p < 0.001). The use of incremental levels of DLIR was associated with a significant decrease of Agatston CAC score and CAC volume (p < 0.001), while mass score remained unchanged when compared to FBP (p = 0.232). The underestimation of Agatston CAC led to a CAC-DRS misclassification rate of 8%.ConclusionDLIR systematically underestimates Agatston CAC score. Therefore, DLIR should be used cautiously for cardiovascular risk assessment.Key Points• In coronary artery calcium imaging, the implementation of deep learning image reconstructions improves image quality, by decreasing the level of image noise.• Deep learning image reconstructions systematically underestimate Agatston coronary artery calcium score.• Deep learning image reconstructions should be used cautiously in clinical routine to measure Agatston coronary artery calcium score for cardiovascular risk assessment.

Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy

AimValidation of coronary artery calcium (CAC) scores as prognostic factors of acute coronary events (ACE) development in breast cancer patients are demanded. We investigated prognostic impact of CAC on ACE development with cardiac exposure to radiation. MethodsWe evaluated breast cancer patients with (n = 511) or without (n = 600) adjuvant radiotherapy (RT) between 2005 and 2013. CAC Agatston scores were analyzed using a deep-learning-based algorithm. Individual mean heart dose (MHD) was calculated, and no RT was categorized as 0 Gy. The primary endpoint was the development of ACE following breast surgery. ResultsIn the RT and no-RT cohorts, 11.2% and 3.7% exhibited CAC >0, respectively. Over a 9.3-year follow-up period, the 10-year ACE rate was 0.7%. In the multivariate analysis, the CAC score was a significant risk factor for ACE (CAC >0 vs CAC = 0, 10-year 6.2% vs 0.2%, P < 0.001). In the subgroup with CAC >0, the 10-year ACE rates were 0%, 3.7%, and 13.7% for patients receiving mean heart doses of 0 Gy, 0–3 Gy, and >3 Gy, respectively (P = 0.133). Although CAC score was not predictive for non-ACE heart disease risk (P > 0.05), the 10-year non-ACE heart disease rates were 1.7%, 5.7%, and 7.1% for patients with CAC = 0 receiving MHD of 0 Gy, 0–3 Gy, and >3 Gy, respectively (P < 0.001). ConclusionsThe CAC score was a significant predictor of ACE in patients with breast cancer. Although further studies are required, CAC score screening on simulation CT in patients undergoing breast RT can help identify those with high risk for ACE on a per-patient basis.

523 Association Between Coronary Artery Calcium And Calcified Plaque Volume And Their Ability To Predict Obstructive Coronary Artery Disease: Clarify Registry

Introduction: Agatston coronary artery calcium (CAC) score is a strong predictor of cardiovascular mortality. However, the relationship between CAC and calcified plaque volume (CPV), which is measured on coronary computed tomography angiography (CCTA) is not well understood. Furthermore, it is unknown whether there is a difference between CAC and CPV in predicting the obstructive CAD.

Coronary Artery Calcium Scoring: Current Status and Future Directions.

Coronary artery calcium (CAC) scores obtained from CT scans have been shown to be prognostic in assessment of the risk for development of cardiovascular diseases, facilitating the prediction of outcome in asymptomatic individuals. Currently, several methods to calculate the CAC score exist, and each has its own set of advantages and disadvantages. Agatston CAC scoring is the most extensively used method. CAC scoring is currently recommended for use in asymptomatic individuals to predict the risk of developing cardiovascular diseases and the disease-specific mortality. In specific subsets of patients, the CAC score has also been recommended for reclassifying cardiovascular risk and aiding in decision making when planning primary prevention interventions such as statin therapy. The progression of CAC scores on follow-up images has been shown to be linked to risk of myocardial infarction and cardiovascular mortality. While the CAC score is a validated tool used clinically, several challenges, including various pitfalls associated with the acquisition, calculation, and interpretation of the score, prevent more widespread adoption of this metric. Recent research has been focused extensively on strategies to improve existing scoring methods, including measuring calcium attenuation, detecting microcalcifications, and focusing on extracoronary calcifications, and on strategies to improve image acquisition. A better understanding of CAC scoring approaches will help radiologists and other physicians better use and interpret these scores in their workflows. An invited commentary by S. Gupta is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Machine Learning for the Prevalence and Severity of Coronary Artery Calcification in Nondialysis Chronic Kidney Disease Patients: A Chinese Large Cohort Study.

Purpose:This study sought to determine whether machine learning (ML) can be used to better identify the risk factors and establish the prediction models for the prevalence and severity of coronary artery calcification (CAC) in nondialysis chronic kidney disease (CKD) patients and compare the performance of distinctive ML models with conventional logistic regression (LR) model.Materials and Methods:In all, 3701 Chinese nondialysis CKD patients undergoing noncontrast cardiac computed tomography (CT) scanning were enrolled from November 2013 to December 2017. CAC score derived from the cardiac CT was calculated with the calcium scoring software and was used to assess and stratify the prevalence and severity of CAC. Four ML models (LR, random forest, support vector machine, and k-nearest neighbor) and the corresponding feature ranks were conducted. The model that incorporated the independent predictors was shown as the receiver-operating characteristic (ROC) curve. Area under the curve (AUC) was used to present the prediction value. ML model performance was compared with the traditional LR model using pairwise comparisons of AUCs.Results:Of the 3701 patients, 943 (25.5%) patients had CAC. Of the 943 patients with CAC, 764 patients (20.6%) and 179 patients (4.8%) had an Agatston CAC score of 1 to 300 and ≥300, respectively. The primary cohort and the independent validation cohort comprised 2957 patients and 744 patients, respectively. For the prevalence of CAC, the AUCs of ML models were from 0.78 to 0.82 in the training data set and the internal validation cohort. For the severity of CAC, the AUCs of the 4 ML models were from 0.67 to 0.70 in the training data set and from 0.53 to 0.70 in the internal validation cohort. For the prevalence of CAC, the AUC was 0.80 (95% confidence interval [CI]: 0.77-0.83) for ML (LR) versus 0.80 (95% CI: 0.77-0.83) for the traditional LR model (P=0.2533). For the severity of CAC, the AUC was 0.70 (95% CI: 0.63-0.77) for ML (LR) versus 0.70 (95% CI: 0.63-0.77) for traditional LR model (P=0.982).Conclusions:This study constructed prediction models for the presence and severity of CAC based on Agatston scores derived from noncontrast cardiac CT scanning in nondialysis CKD patients using ML, and showed ML LR had the best performance.

Coronary artery calcification is a risk factor for intradialytic hypotension in patients undergoing hemodialysis.

We investigated the association between intradialytic hypotension (IDH) and coronary artery calcification and their effects on mortality in hemodialysis (HD) patients. Consecutive patients undergoing maintenance HD were enrolled. The study timeline included the baseline (day 1), exposure assessment (day 1-day 22), and outcome assessment (day 23-3 years) periods. IDH was defined as a nadir systolic blood pressure (SBP) of <100 mmHg or vasopressor use during at least 2 of 10 HD sessions in the exposure assessment period. The clinical data at baseline and the Agatston coronary artery calcium score (CACS) were assessed in the exposure assessment period. The median age and dialysis vintage were 67 years [60-75 years] and 73 months [37-138 months], respectively. IDH occurred in 37 patients (21.4%), and the CACS was higher in the IDH group than in the non-IDH group (p=0.08). IDH was associated with CACS, diabetes mellitus, mean predialysis SBP, and mean ultrafiltration volume (p < 0.05). The cutoff CACS for mortality was 1829 (sensitivity: 69%, specificity: 77%). In all, 45 all-cause deaths and 19 cardiovascular deaths occurred over 3 years. Patients with both IDH and a CACS of ≥1829 had a lower 3-year cumulative survival from cardiovascular death (66.7%) than those with a CACS of ≥1829 (80.3%), IDH (88.5%), or neither (95.5%) (p < 0.01). IDH, a CACS of ≥1829, and IDH + CACS of ≥1829 were predictors of 3-year all-cause and cardiovascular mortality (p < 0.05). The hazard ratio for cardiovascular mortality was highest in the group with IDH + CACS ≥ 1829. A high CACS may be a biomarker for IDH. Both IDH and CACS were risk factors for all-cause and cardiovascular mortality in patients undergoing HD, and there was a synergistic interaction between IDH and high CACS for cardiovascular mortality.