Assessment Of Coronary Calcification Research Articles

Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity.

The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.

The Serum NLRP1 Level and Coronary Artery Calcification: From Association to Development of a Risk-Prediction Nomogram.

To investigate the correlation between inflammasomes and coronary artery calcification (CAC), and develop and validating a nomogram for predicting the risk of CAC in patients with coronary artery disease (CAD). A total of 626 patients with CAD at the Affiliated Hospital of Xuzhou Medical University were enrolled in this study. The patients were divided into the calcification group and the non-calcification group based on the assessment of coronary calcification. We constructed a training set and a validation set through random assignment. The least absolute shrinkage and selection operator (LASSO) regression and multivariate analysis were performed to identify independent risk factors of CAC in patients with CAD. Based on these independent predictors, we developed a web-based dynamic nomogram prediction model. The area under the receiver operating characteristic curve (AUC-ROC), calibration curves, and decision curve analysis (DCA) were used to evaluate this nomogram. Age, smoking, diabetes mellitus (DM), hyperlipidemia, the serum level of nucleotide-binding oligomerization domain (NOD)-like receptor protein 1 (NLRP1), alkaline phosphatase (ALP) and triglycerides (TG) were identified as independent risk factors of CAC. The AUC-ROC of the nomogram is 0.881 (95% confidence interval (CI): 0.850-0.912) in the training set and 0.825 (95% CI: 0.760-0.876) in the validation set, implying high discriminative ability. Satisfactory performance of this model was confirmed using calibration curves and DCA. The serum NLRP1 level is an independent predictor of CAC. We established a web-based dynamic nomogram, providing a more accurate estimation and comprehensive perspective for predicting the risk of CAC in patients with CAD.

Obtaining a Coronary Artery Calcium Score with Myocardial Perfusion Imaging

A coronary artery calcium score adds diagnostic and prognostic information to myocardial perfusion imaging and has been shown to alter management. Whenever feasible, coronary calcium assessment should be performed routinely in patients without known coronary artery disease at the time of myocardial perfusion imaging.

Advances in Single-Photon Emission Computed Tomography

The clinical presentation of coronary artery disease (CAD) has changed during the last 20years with less ischemia on stress testing and more nonobstructive CAD on coronary angiography. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging should include the measurement of myocardial flow reserve and assessment of coronary calcium for the diagnosis of nonobstructive CAD and coronary microvascular disease. SPECT/CT systems provide reliable attenuation correction for better specificity and low-dose CT for coronary calcium evaluation. SPECT MFR measurement is accurate, well validated, and repeatable.

Radiation dose optimization for photon-counting CT coronary artery calcium scoring for different patient sizes: a dynamic phantom study

PurposeTo systematically assess the radiation dose reduction potential of coronary artery calcium (CAC) assessments with photon-counting computed tomography (PCCT) by changing the tube potential for different patient sizes with a dynamic phantom.MethodsA hollow artery, containing three calcifications of different densities, was translated at velocities corresponding to 0, < 60, 60–75, and > 75 beats per minute within an anthropomorphic phantom. Extension rings were used to simulate average- and large -sized patients. PCCT scans were made with the reference clinical protocol (tube potential of 120 kilovolt (kV)), and with 70, 90, Sn100, Sn140, and 140 kV at identical image quality levels. All acquisitions were reconstructed at a virtual monoenergetic energy level of 70 keV. For each calcification, Agatston scores and contrast-to-noise ratios (CNR) were determined, and compared to the reference with Wilcoxon signed-rank tests, with p < 0.05 indicating significant differences.ResultsA decrease in radiation dose (22%) was achieved at Sn100 kV for the average-sized phantom. For the large phantom, Sn100 and Sn140 kV resulted in a decrease in radiation doses of 19% and 3%, respectively. Irrespective of CAC density, Sn100 and 140 kVp did not result in significantly different CNR. Only at Sn100 kV were there no significant differences in Agatston scores for all CAC densities, heart rates, and phantom sizes.ConclusionPCCT at tube voltage of 100 kV with added tin filtration and reconstructed at 70 keV enables a ≥ 19% dose reduction compared to 120 kV, independent of phantom size, CAC density, and heart rate.Key Points• Photon-counting CT allows for reduced radiation dose acquisitions (up to 19%) for coronary calcium assessment by reducing tube voltage while reconstructing at a normal monoE level of 70 keV.• Tube voltage reduction is possible for medium and large patient sizes, without affecting the Agatston score outcome.

Calcification of heart structures in patients with suspected coronary heart disease depending on renal function

Cardiovascular disease is the leading cause of death in the world. The use of the coronary artery calcification score (CACS) allows to determine the risk of coronary artery disease (CAD). Chronic kidney disease (CKD) is a one of the major risk factors for coronary artery disease. With a decrease in renal function, impaired calcium-phosphorus metabolism leads to excessive tissue calcification. It is likely that patients with different kidney function experience different types of calcium deposition. The use of CACS is an opportunity to assess the condition of the coronary arteries without using a contrast agent, which is very important for patients with CKD. One of the most accessible and significant research methods for clinical screening use is computed tomography with non-invasive assessment of coronary calcium (quantitative analysis of the calcium index). To evaluate it, the method of A. Agatston is used, which allows to measure calcium in units. Our aim was to investigate the pattern of calcification of heart structures depending on renal function in patients with suspected coronary heart disease. The patients in the presented study had a high incidence of diabetes mellitus (49.4%) and arterial hypertension (83.1%). In patients with suspected coronary artery disease, borderline values of systolic and diastolic blood pressure and total cholesterol were found. In the majority of the patients CACS was 1-100 Agatston units (AU). After the distribution of patients into groups depending on glomerular filtration rate (GFR), it was found that the groups of patients with lower GFR, were of older age. The proportion of patients with total CACS &gt;100 AU was the highest in the group of patients with GFR 30-59 ml/min. There were no significant differences in the structure of general and vascular CACS between patients with GFR 90-120 ml/min and GFR 60-89 ml/min. Valvular CACS was significantly lower in patients with GFR &lt;60 ml/min. In all cases of visual comparison of CACS depending on GFR, significantly higher CACS indices differed in patients with GFR &lt;60 ml/min compared to patients with GFR ≥60 ml/min.

Post mortem coronary calcification scoring – no software required

• Coronary artery calcium scoring can predict significant coronary artery disease (CAD). • Predicting CAD reduced the need for post mortem coronary angiography. • Visual coronary calcification assessment can accurately identify severe calcification. • This technique can be rapidly and accurately applied by radiographers. Coronary artery calcification (CAC) has been used to predict the likelihood of significant coronary artery disease in post mortem CT (PMCT) and thereby reduce the requirement for coronary angiography. Quantifying calcification using the Agatston (or other) scores requires dedicated cardiac CT software. The aim of this study was to determine if a semi-quantitative visual assessment could accurately and quickly assess the degree of calcification. 100 scans were retrospectively reviewed by 2 observers experienced in CAC scoring to develop the visual scoring system with received operator curve analysis used to determine the best cut-off to predict an Agatston score >400 (severe). The visual scoring approach was taught to radiographers and studied prospectively in a further 100 cases compared with software derived Agatston scores. There was good inter-observer agreement of visual assessment for severe calcification. Analysis suggested a stepwise approach - a quick overview for any vessel mainly calcified throughout its length and a second review of the proximal 5cm of each vessel. If any vessel shows >50% calcification, or if all 3 vessels showed more than just occasional calcified foci: overall category was severe. This approach showed good accuracy in identifying severe calcification with 3 false positive results with Agatston scores between 200 and 400. These studies demonstrate that CAC scoring is possible by visual calcification assessment (VCA). This has the advantages of reducing the invasiveness of the examination and increasing the number of cases that can be scanned in the same time frame.

Comprehensive Assessment of Coronary Calcification in Intravascular OCT Using a Spatial-Temporal Encoder-Decoder Network.

Coronary calcification is a strong indicator of coronary artery disease and a key determinant of the outcome of percutaneous coronary intervention. We propose a fully automated method to segment and quantify coronary calcification in intravascular OCT (IVOCT) images based on convolutional neural networks (CNN). All possible calcified plaques were segmented from IVOCT pullbacks using a spatial-temporal encoder-decoder network by exploiting the 3D continuity information of the plaques, which were then screened and classified by a DenseNet network to reduce false positives. A novel data augmentation method based on the IVOCT image acquisition pattern was also proposed to improve the performance and robustness of the segmentation. Clinically relevant metrics including calcification area, depth, angle, thickness, volume, and stent-deployment calcification score, were automatically computed. 13844 IVOCT images with 2627 calcification slices from 45 clinical OCT pullbacks were collected and used to train and test the model. The proposed method performed significantly better than existing state-of-the-art 2D and 3D CNN methods. The data augmentation method improved the Dice similarity coefficient for calcification segmentation from 0.615±0.332 to 0.756±0.222, reaching human-level inter-observer agreement. Our proposed region-based classifier improved image-level calcification classification precision and F1-score from 0.725±0.071 and 0.791±0.041 to 0.964±0.002 and 0.883±0.008, respectively. Bland-Altman analysis showed close agreement between manual and automatic calcification measurements. Our proposed method is valuable for automated assessment of coronary calcification lesions and in-procedure planning of stent deployment.

Coronary microvascular dysfunction in patients with psoriasis

BackgroundPsoriasis is a common chronic inflammatory skin disorder that is associated with excess cardiovascular risk. Inflammation is a key mediator in the onset and progression of these cardiometabolic abnormalities; however, the excess cardiovascular risk conferred by psoriatic disease remains understudied. We investigated the prevalence and severity of CMD in patients with psoriasis and determined whether CMD is a result of CV risk factors and atherosclerotic burden. MethodsThis was a consecutive retrospective cohort study of patients with psoriasis, normal myocardial perfusion, and LV ejection fraction (EF) > 50% (N = 62) and matched controls without psoriasis (N = 112). Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. Atherosclerotic burden was determined by semi-quantitative computed tomography (CT) coronary calcium assessment. ResultsThe prevalence of CMD (defined as MFR < 2) was 61.3% in patients with psoriatic disease, compared to 38.4% in a matched control population (P = .004). Furthermore, patients with psoriasis had a more severe reduction in adjusted MFR (2.3 ± .81 vs 1.92 ± .65, respectively, P = .001). The degree of atherosclerotic burden, as assessed by qualitative calcium score, was similar between psoriasis and controls. ConclusionsPatients with psoriasis without overt CAD demonstrated a high prevalence of coronary vasomotor abnormalities that are not entirely accounted for by the commonly associated coronary risk factors or the burden of atherosclerosis.

Comparability of coronary risk assessment methods with chest ultra-LDCT and CT coronography with ECG synchronization

Purpose. To assess the comparability of coronary calcium values measured on ultralow-dose computed tomography studies without ECG-synchronization versus a) non-contrast computed tomography with ECG synchronization, b) CT coronography with ECG synchronization.Materials and methods. The study comprised 283 studies: 68 patients who underwent contrast-free ultra-LDCT without ECG synchronization and contrast-free CT with ECG synchronization performed in a single visit, and 49 patients with contrast-free ultra-LDCT without ECG synchronization, non-contrast CT with ECG synchronization, and CT coronography with ECG synchronization and intravenous injection of contrast agent, also carried out in one visit, meeting all inclusion and exclusion criteria of the study.Quantitative coronary calcium values were calculated with the Agatston score and the CAC-DRS scale (score of calcification degree from 0 to 3 and the number of affected arteries from 0 to 4 points). The degree of coronary artery stenosis was analyzed with CAD-RADS scale (0-5).The above parameters were compared using visual/quantitative assessment of coronary calcium on ultra-LDCT without ECG synchronization and visual/quantitative assessment for CT with ECG synchronization, as well as the degree of stenosis on CT coronography in the same patients.Results. Based on the results of accuracy indices comparison, the possibility to use quantitative scale (Agatston score, CAC-DRS quantitative scale) to assess coronary calcification in the lung cancer screening in comparison with ECG-synchronized CT was determined during interpretation of ultra-LDCT without ECG synchronization. The correlation matrix to assess correlation between visual, quantitative scales of coronary artery changes and calcification at ultra-LDCT without ECG synchronization and quantitative scale at CT with ECG synchronization vs. CT coronography identifies very strong positive statistically significant correlations.Conclusion. Methods of coronary calcinosis assessment with chest ultra-LDCT and CT with ECG synchronization are comparable, therefore it is possible to assess coronary calcium in lung cancer screening by ultra-LDCT data at a reliable-high level using both quantitative and visual CAC-DRS scales.

Abstract 9903: CT Number Predicts Calcium Thickness in Optical Coherence Tomography Guided Percutaneous Coronary Intervention

Introduction: Optical coherence tomography (OCT) can assess calcium thickness, which is the key factor for predicting good stent expansion in calcified lesions. However, OCT can underestimate coronary calcium severity due to its penetration limitation and lipid accumulation while multi-slice computed tomography (CT) allows for a noninvasive assessment of coronary calcification. This study aimed to compare cross-sectional CT and OCT images for the assessment of calcification. Methods and Results: We investigated 33 lesions using coronary CT and OCT for the assessment of calcification. Of the 33 lesions, 211 regions of interest were set every 30 degrees in both the CT and OCT cross-sectional images. In 88 (41.7%) regions of interest with CT-detected calcium, the thickness of calcium was not detectable in the corresponding OCT image due to limited penetration, lipid attenuation, and guidewire artifact. There was an excellent correlation between CT number and thickness of calcium in the corresponding OCT image (R=0.797, P&lt;0.001). Receiver-operator curve analysis also showed fair discrimination between calcium thickness less than 500 μm and 500 μm or higher at a CT number of 1021 HU. Conclusions: Cross-sectional CT imaging could complement the underestimation of calcium severity in OCT-guided PCI, predicting the calcium thickness by CT number.

Prediction of Coronary Calcification and Stenosis: Role of Radiomics From Low-Dose CT

We aimed to assess relationship between single-click, whole heart radiomics from low-dose computed tomography (LDCT) for lung cancer screening with coronary artery calcification and stenosis. The institutional review board-approved, retrospective study included all 106 patients (68 men, 38 women, mean age 64 ± 7 years) who underwent both LDCT for lung cancer screening and had calcium scoring and coronary computed tomography angiography in our institution. We recorded the clinical variables including patients' demographics, smoking history, family history, and lipid profiles. Coronary calcium scores and grading of coronary stenosis were recorded from the radiology information system. We calculated the multiethnic scores for atherosclerosis risk scores to obtain 10-year coronary heart disease (MESA 10-Y CHD) risk of cardiovascular disease for all patients. Deidentified LDCT exams were exported to a Radiomics prototype for automatic heart segmentation, and derivation of radiomics. Data were analyzed using multiple logistic regression and kernel Fisher discriminant analyses. Whole heart radiomics were better than the clinical variables for differentiating subjects with different Agatston scores (≤400 and >400) (area under the curve [AUC] 0.92 vs 0.69). Prediction of coronary stenosis and MESA 10-Y CHD risk was better on whole heart radiomics (AUC:0.86-0.87) than with clinical variables (AUC:0.69-0.79). Addition of clinical variables or visual assessment of coronary calcification from LDCT to whole heart radiomics resulted in a modest change in the AUC. Single-click, whole heart radiomics obtained from LDCT for lung cancer screening can differentiate patients with different Agatston and MESA risk scores for cardiovascular diseases.

Focused, low tube potential, coronary calcium assessment prior to coronary CT angiography: A prospective, randomized clinical trial

Coronary artery calcium (CAC) scanning is commonly performed before coronary CT angiography (CTA) based partly on its potential to influence CTA scan parameters. Encompassing the whole heart and performed at high tube potential (120​kVp), standard (Agatston) CAC scanning adds to patient radiation exposure. Most CAC exists in the proximal and mid coronary segments and is easily visualized at low kVp. We tested the impact of a modified calcium scan on coronary CTA acquisition decision-making and image quality in a randomized clinical trial. Providers documented planned CTA acquisition parameters prior to CAC scanning in a blinded manner. Standard Agatston CAC scans proceeded in typical fashion whereas modified scans utilized 80​kVp and reduced z-axis length focused on the proximal-to-mid coronary arteries. CTA providers reviewed the CAC burden then documented final acquisition parameters. The study included 172 patients (48% female; mean age 59​±​6.7). As planned, the calcium scan effective dose was significantly lower in the modified CAC scan group (0.14 vs. 0.74​mSv using a 0.014 k-factor or 0.26 vs. 1.38​mSv using a 0.026 k-factor; both p​<​0.001). Initially selected CTA parameters were changed at an identical rate following visual CAC assessment (59%). There was no significant difference in coronary CTA image quality (median quality score​=​4 in both groups, p​=​0.26), noise (31.0 vs 31.4 HU; p​=​0.81), or signal/noise ratio (17.9 vs 16.8; p​=​0.26). A low-kVp scan with focused field-of-view provides actionable information regarding the presence and severity of CAC prior to coronary CTA. Coronary CTA parameters based on patient variables are frequently modified after assessing CAC burden in the CTA suite. CLINICALTRIALS. NCT02972242.

Automated Quantitative Assessment of Coronary Calcification Using Intravascular Ultrasound

Coronary calcification represents a challenge in the treatment of coronary artery disease by stent placement. It negatively affects stent expansion and has been related to future adverse cardiac events. Intravascular ultrasound (IVUS) is known for its high sensitivity in detecting coronary calcification. At present, automated quantification of calcium as detected by IVUS is not available. For this reason, we developed and validated an optimized framework for accurate automated detection and quantification of calcified plaque in coronary atherosclerosis as seen by IVUS. Calcified lesions were detected by training a supported vector classifier per IVUS A-line on manually annotated IVUS images, followed by post-processing using regional information. We applied our framework to 35 IVUS pullbacks from each of the three commonly used IVUS systems. Cross-validation accuracy for each system was >0.9, and the testing accuracy was 0.87, 0.89 and 0.89 for the three systems. Using the detection result, we propose an IVUS calcium score, based on the fraction of calcium-positive A-lines in a pullback segment, to quantify the extent of calcified plaque. The high accuracy of the proposed classifier suggests that it may provide a robust and accurate tool to assess the presence and amount of coronary calcification and, thus, may play a role in image-guided coronary interventions.

Subclinical atherosclerosis: how and when to treat it?

Atherosclerosis is a condition characterized by a long, initial, asymptomatic phase. Progression of disease could lead to acute coronary events, such as acute myocardial infarction, unstable angina, or sudden cardiac death. However, there are imaging techniques, namely vascular echography and assessment of coronary calcium, capable to make the diagnosis of atherosclerosis at an early stage. There are several studies demonstrating the ability of statins to delay, and in some situation even revert the progression of this condition. Subclinical atherosclerosis is highly prevalent in people with optimal control of the risk factors, and the imaging techniques have been shown to provide an added value over the traditional risk factors: by identifying directly the condition, these techniques allow the reclassification of low-risk to intermediate- or high-risk subjects, thus directing the primary prevention therapeutic strategies, based on high efficacy statins, aimed at delaying or reversing the progression of the disease.

Feasibility and Accuracy of Aortic Valve Calcium Quantification on Computed Tomographic Angiography in Aortic Stenosis

Traditionally, quantification of aortic valve calcium (AVC) has been performed with noncontrast computed tomography (NCCT) using the Agatston method. This study sought to derive and validate a systematic method enabling AVC quantification using computed tomographic angiography (CTA) in patients with aortic stenosis (AS). The study included 134 consecutive patients with AS who underwent both NCCT and CTA and were subdivided into derivation (n= 71) and validation cohorts (n= 63). AVC on NCCT (AVCNCCT) was quantified using the Agatston method using the software developed for semiautomatic assessment of coronary calcium. On CTA, the mean contrast attenuation of the aorta in Hounsfield units (AortaHU) and SD was measured in the region of interest at the level of the sinotubular junction. Using an adjusted calcium detection threshold of AortaHU+ 2 SD, we calculated AVC on CTA (AVCCTA) using the same software without modifying other variables. Correlation between AVCNCCT and AVCCTA in the derivation cohort was excellent (r=0.9679; P < .001). We used a linear regression model to derive a formula for predicting AVCCTA that enabled conversion of AVCCTA to AVCDerived (AVCDerived= 1.821× AVCCTA). Applying this formula in validation cohort, we calculated AVCDerived, which showed excellent agreement with AVCNCCT (intraclass correlation coefficient, 0.9648; 95% confidence interval, 0.9427-0.9782). Excellent correlation was also found between categorized AVCNCCT and AVCDerived scores (κ= 0.9044; 95% confidence interval, 0.7989-1.0000), with 95.24% (60 of 63) of scores falling within the same severity category. AVC quantification on CTA is feasible with high accuracy and reliability and shows excellent agreement with the standard AVCNCCT score. With the systematic approach using "dynamic thresholds" being largely independent of the scan acquisition protocol, AVCDerived can potentially replace AVCNCCT, eliminating the need for separate NCCT acquisition solely for AVC quantification.

New approaches for assessing coronary changes in multi-layer spiral computed tomography

The article presents an overview of qualitative and quantitative methods for coronary calcification assessment by computed tomography (CT). Coronary calcium is one of the well-known predictors of coronary artery disease and its complications. Coronary artery calcification is a common significant finding on routine and low-dose CT. In the review, the Coronary Artery Calcium Data and Reporting System (CAC-DRS) and the Coronary Artery Disease Reporting and Data System (CAD-RADS) are analyzed. Recommendations are given for the further management of patients with stable or acute chest pain in accordance with the CAD-RADS classification. The main aim of CAD-RADS is the standardization of accounting for coronary computed tomography angiography (CCTA) results for facilitating the interpretation by clinicians and subsequent management of patients. Such an approach should lead to an increase of healthcare quality.

Serum untargeted lipidomic profiling reveals dysfunction of phospholipid metabolism in subclinical coronary artery disease.

Purpose: Disturbed metabolism of cholesterol and triacylglycerols (TGs) carries increased risk for coronary artery calcification (CAC). However, the exact relationship between individual lipid species and CAC remains unclear. The aim of this study was to identify disturbances in lipid profiles involved in the calcification process, in an attempt to propose potential biomarker candidates.Patients and methods: We studied 70 patients at intermediate risk for coronary artery disease who had undergone coronary calcification assessment using computed tomography and Agatston coronary artery calcium score (CACS). Patients were divided into three groups: with no coronary calcification (NCC; CACS: 0; n=26), mild coronary calcification (MCC; CACS: 1–250; n=27), or severe coronary calcification (SCC; CACS: >250; n=17). Patients’ serum samples were analyzed using liquid chromatography-mass spectrometry in an untargeted lipidomics approach.Results: We identified 103 lipids within the glycerolipid, glycerophospholipid, sphingolipid, and sterol lipid classes. After false discovery rate correction, phosphatidylcholine (PC)(16:0/20:4) in higher levels and PC(18:2/18:2), PC(36:3), and phosphatidylethanolamine(20:0/18:2) in lower levels were identified as correlates with SCC compared to NCC. There were no significant differences in the levels of individual TGs between the three groups; however, clustering the lipid profiles showed a trend for higher levels of saturated and monounsaturated TGs in SCC compared to NCC. There was also a trend for lower TG(49:2), TG(51:1), TG(54:5), and TG(56:8) levels in SCC compared to MCC.Conclusion: In this study we investigated the lipidome of patients with coronary calcification. Our results suggest that the calcification process may be associated with dysfunction in autophagy. The lipidomic biomarkers revealed in this study may aid in better assessment of patients with subclinical coronary artery disease.

Metformin and Type 2 Diabetes Prevention.

IN BRIEF Metformin, an established therapy for the treatment of type 2 diabetes, has demonstrated safety and effectiveness in the prevention or delay of type 2 diabetes in people at high risk. The Diabetes Prevention Program randomized clinical trial demonstrated that intensive lifestyle intervention and metformin therapy reduced progression to diabetes by 58 and 31%, respectively, compared to placebo in people at risk of type 2 diabetes. Although lifestyle intervention was beneficial in all groups, metformin had a selectively greater effect in those who were more obese, had a higher fasting glucose, had a history of gestational diabetes, or were younger. Long-term effects included an 18% diabetes reduction with metformin compared to placebo over 15 years, a reduction in microvascular complications among those who did not progress to diabetes (without difference among treatment arms), and suggestion by coronary calcium assessment of a possible impact on atherosclerosis in men. Although long-term follow-up to assess later-stage outcomes is underway, current efforts to address gaps in evidence and translation remain of significant public health interest.

P1777Non-ECG triggered CT assessment of coronary calcium does not equate to cardiac-gated true Agatston calcium scoring

P1777Non-ECG triggered CT assessment of coronary calcium does not equate to cardiac-gated true Agatston calcium scoring