Calcium Burden Research Articles

Echocardiographic factors related to coronary artery calcium burden in patients with newly diagnosed type 2 diabetes mellitus

Abstract Introduction Newly diagnosed type 2 diabetes mellitus (NDT2DM) could be linked to cardiac complications. A multinational cohort of adults under 55 years old, who had acute myocardial infarction, showed NDT2DM in 14.5% of patients. Timely diagnosis and treatment of diabetes mellitus (DM) can help mitigate the risk of long-term complications, particularly in the context of ischemic heart disease. The computed tomography (CTCS) calcium score in the coronary arteries is a reliable predictor of coronary heart disease events. Echocardiography is a time-efficient and cost-effective technique, delivering accurate and reproducible diagnostic and prognostic insights in individuals with DM. Purpose The objective of this study was to determine the echocardiographic factors associated with subclinical atherosclerotic plaques in coronary arteries, as uncovered by CTCS, in patients with NDT2DM. Methods In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. Calcification was identified as a structure >1 mm attached to or located within the lumen of a coronary vessel with intensity >130 HU. The Agatston method was used to determine the CTCS. Patients were categorized into five groups based on their calcium score (0, 0-10, 11-100, 101-400 and >400), and all obtained echocardiographic features were compared between the groups. Exclusion criteria included: stable angina pectoris, acute coronary disease, severe anemia, patients with history of stroke, moderate/severe renal insufficiency, liver insufficiency, claustrophobic patients, and pregnant women. Results Of the 101 asymptomatic patients with NDT2DM, 53 (52.5%) were males, with mean age of 54.4 ± 11.6 years and mean duration of diabetes of 2.8 ± 5.3 months. The total volume and mass of calcium in our patients was 210 and 180, respectively. In the table the differences between the 5 groups regarding echocardiographic characteristics are shown. The only echocardiographic parameters that differed significantly between the groups were the left atrium (P=0.001), interventricuar (P=0.005) and posterior wall thickness (P=0.017), as well as the degree of left ventricular hypertrophy (P=0.007). However, mean left atrial diameter across the groups was within reference range values, whereas left ventricular wall thickness was mildly hypertrophied in the >400 CTCS group. Conclusions NDT2DM patients with higher calcium burden tend to have thicker left ventricular walls. Hence, for individuals with NDT2DM, it is advisable to conduct echocardiography at the earliest opportunity, given its accessibility and cost-effectiveness. Special consideration should be given to even mild left ventricular hypertrophy, prompting additional assessments for coronary artery disease. Early and thorough cardiovascular management should be initiated accordingly.

Relationship of left ventricular longitudinal strain to coronary artery calcium load in patients with newly diagnosed type 2 diabetes mellitus

Abstract Introduction Cardiovascular complications commonly manifest after longstanding Type 2 Diabetes Mellitus. Newly diagnosed Type 2 Diabetes Mellitus (NDT2DM) is much less studied. The coronary artery computed tomography calcium score (CTCS) has become a widely accessible, accurate, and reliable tool for assessing the risk of major cardiovascular events, particularly in asymptomatic individuals. Additionally, myocardial strain, specifically echocardiographic Global Longitudinal Strain (GLS), measures the systolic function of the left ventricle (LV), enabling the early detection of systolic dysfunction. GLS is also increasingly recognized for its prognostic value in coronary artery disease. Purpose The objective of this study was to analyze the relationship and predictors of subclinical calcified atherosclerotic plaques in coronary arteries, measured by CTCS, to LV longitudinal strain in patients with NDT2DM. Methods In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. The Agatston method was used to determine the CTCS. For Speckle Tracking Echocardiography, images from the apical four-chamber, three-chamber and two-chamber views with ECG gating were attained. The endocardial border was manually adjusted at end-systole. The software system automatically generated the strain values for each segment, the average LV GLS, end-diastolic, end-systolic LV volumes and LV ejection fraction. With Spearman’s correlation test we analysed the relationship between LV longitudinal strain parameters and the level of CTCS. We also performed the multiple regression analysis to identify LV longitudinal strain predictors for high CTCS. Results Mean age was 54.4 ± 11.6 years, 53 (52.5%) were males, and mean time since diagnosis of diabetes was 2.8 ± 5.3 months. Only 8 (7.9%) patients did not have calcified atherosclerotic plaques or a CTCS of zero, 7 (6.9%) a CTCS of 1-10, 43 (42.6%) a CTCS of 11-100, 23 (22.8%) a CTCS 101-400 and 20 (19.8%) patients had CTCS >400. The mean total volume of calcium in these patients was 210. LAD had the highest CTCS, followed by RCA, LCx and left main coronary artery. Table 1 shows the correlation between CTCS and LV longitudinal strain parameters, while table 2 depicts predictors for higher CTCS. Conclusions LVGLS does not appear to correlate with the coronary artery calcium burden in patients with NDT2DM. However, regional LV longitudinal strain may serve as a predictor for asymptomatic calcified coronary artery plaques. Given that the LAD exhibits the highest CTCS, the predictive regions might correspond to this affected artery. Thus, a comprehensive analysis of both global and regional LV longitudinal strain could be beneficial for the early detection of patients at risk for cardiovascular complications. Correlation of CTCS and LV strain LV strain predictors for CTCS

Cracking the Code of Calcification: How Presence and Burden among Intracranial Arteries Influence Stroke Incidence and Recurrence.

Intracranial atherosclerosis accounts for about 8% of all strokes in Western societies but the influence of arterial calcification on plaque instability is a topic on ongoing debate. Explore the association between the presence and burden of calcium in atherosclerotic plaques among intracranial arteries with the risk of clinical or silent stroke events through a systematic review and meta-analysis. Adhering to PRISMA guidelines, studies from PubMed and Embase were analyzed up to May 2024. Adult populations undergoing CT/CTA scans for symptomatic and asymptomatic atherosclerosis among intracranial vessels. Statistical analyses were performed to identify the impact of calcium presence and relative burden on stroke incidence or recurrence. Risk of bias was evaluated with QUADAS-2 criteria while GRADE system was used to assess quality of evidence. The study synthesized data from 8 longitudinal studies, creating two different models: Calcium presence (heterogeneity: Q 9.19; I2 42.61%) and calcium burden (heterogeneity: Q 6.01; I2 0.01%). As for calcium presence and stroke events, 6839 patients were considered, and two statistical models were made. Our analysis established a significant association between the presence of calcium and stroke events. [OR= 1.54, 95% CI 1.06, 2.24, p=0.001]. A subsequent effect size analysis showed a similar correlation's strength [OR = 1.56, 95% CI 1.11, 2.19, p = 0.001]. As for calcium burden and stroke events, 4885 patients were considered with effect size analysis establishing a positive correlation [OR = 1.31, 95% CI, 1.17, 1.46, p =< 0.001). A decrease in correlation strength was found between calcium presence [OR = 1.56] and burden [OR = 1.31] with stroke events. Despite strict exclusion criteria, heterogeneity across studies and between different statistical models of the present study persisted. Valuable data loss among excluded studies could have affected the findings of this meta-analysis. Unified calcium scoring pattern and individual arterial segment analysis was not widely adopted by included literature. Our meta-analysis showed a weak, yet present association between presence and burden of calcification among intracranial arterial vessels and clinical or silent stroke events. Considering the high prevalence of intracranial calcification in the general population, widespread intracranial calcium assessment for stroke prediction has currently poor evidence. Investigation on specific intracranial vessels or exploration of newer calcium patterns could be essential to enhance the predictive accuracy of calcification in stroke incidence or recurrence. IAC = Intracranial Arterial Calcification; HU = Hounsfield Unit; RE = Random Effect.

Development of a scoring system to predict endovascular crossing of femoropopliteal artery chronic total occlusions: the endo VAscular CROSsing score for chronic total occlusions (EVACROSS-CTO).

To develop a predictive score for the prediction of successful endovascular crossing in femoropopliteal artery chronic total occlusions (CTOs). In this retrospective study, 84 patients were divided 70%:30% into a training and a testing cohort. Parameters such as cap morphology, side branches, bridging collaterals, flush occlusion, and length were derived from preprocedural CT angiography. Lesions were segmented and calcification burden was assessed by thresholding. A score (EVACROSS-CTO) was built based on multivariate logistic regression. Receiver Operating Characteristics (ROC) curve analysis determined the optimal score threshold, with reported accuracy, sensitivity, specificity, and AUC. Factors including age > 50 years (P = 0.036, OR = 53.7), calcification percentage >10% (P = 0.011, OR = 16.63), the presence of a flush occlusion (P = 0.02, OR = 15.564), the presence of a distal side branch (P = 0.018, OR = 9.879) and the presence of a proximal side branch (P = 0.064, OR = 23.369) were identified as suitable for inclusion in the score. Score values were assigned based on the relative odds ratio for each factor with a maximum score of 22. EVACROSS-CTO was able to predict the success of endovascular recanalization with an AUC-ROC of 79.8% (95%CI 58.5-100%). A score >16 yielded a sensitivity of 75% with a specificity of 70.6% for the prediction of treatment failure. A score was developed by incorporating variables derived from pre-procedural CT angiography, demonstrating promising predictive capacity in determining the success of endovascular recanalization of CTOs. EVACROSS-CTO incorporates imaging variables for the prediction of endovascular recanalization success. This score will allow improved pre-procedural planning for femoropopliteal chronic total occlusion management.

Coronary calcium score and emphysema extent on different CT radiation dose protocols in lung cancer screening.

To assess the consistency of automated measurements of coronary artery calcification (CAC) burden and emphysema extent on computed tomography (CT) images acquired with different radiation dose protocols in a lung cancer screening (LCS) population. The patient cohort comprised 361 consecutive screenees who underwent a low-dose CT (LDCT) scan and an ultra-low-dose CT (ULDCT) scan at an incident screening round. Exclusion criteria for CAC measurements were software failure and previous history of CVD, including coronary stenting, whereas for emphysema assessment, software failure only. CT images were retrospectively analyzed by a fully automated AI software for CAC scoring, using three predefined Agatston score categories (0-99, 100-399, and ≥ 400), and emphysema quantification, using the percentage of low attenuation areas (%LAA). Demographic and clinical data were obtained from the written questionnaire completed by each participant at the first visit. Agreement for CAC and %LAA categories was measured by the k-Cohen Index with Fleiss-Cohen weights (Kw) and Intraclass Correlation Coefficient (ICC) with 95% Confidence Interval (CI). An overlap of CAC strata was observed in 275/327 (84%) volunteers, with an almost perfect agreement (Kw = 0.86, 95% CI 0.82-0.90; ICC = 0.86, 95% CI 0.79-0.90), while an overlap of %LAA strata was found in 204/356 (57%) volunteers, with a moderate agreement (Kw = 0.57, 95% CI 0.51-0.63; ICC = 0.57, 95% CI 0.21-0.75). Automated CAC quantification on ULDCT seems feasible, showing similar results to those obtained on LDCT, while the quantification of emphysema tended to be overestimated on ULDCT images. Question Evidence demonstrating that coronary artery calcification and emphysema can be automatedly quantified on ultra-low-dose chest CT is still awaited. Findings Coronary artery calcification and emphysema measurements were similar among different CT radiation dose protocols; their automated quantification is feasible on ultra-low-dose CT. Clinical relevance Ultra-low-dose CT-based LCS might offer an opportunity to improve the secondary prevention of cardiovascular and respiratory diseases through automated quantification of both CAC burden and emphysema extent.

Longitudinal anemia status and risk for adverse outcomes in former smokers with COPD

BackgroundAnemia is a prevalent comorbidity in COPD associated with increased morbidity. However, the significance of longitudinal anemia status and variation in anemia status trends over time in COPD are not known. Furthermore, individuals with COPD and smoking history often have multiple comorbidities, in particular cardiovascular disease. The objective of this study was to evaluate the association between longitudinal anemia status and COPD outcomes, accounting for comorbid cardiovascular disease.MethodsSerial hemoglobin measures and clinical outcomes were obtained in former smokers with moderate to severe COPD from two clinical studies over a 6-to-9-month period. In the first analysis, the association between repeated measures of time-varying anemia status and outcomes was assessed by generalized estimating equations adjusted for covariates including cardiovascular disease. In the second analysis, each participant’s anemia risk profile during the study period was characterized as high versus low anemia risk-growth rate. Mean differences in the progression of COPD outcomes over time between the two groups were assessed using a generalized linear mixed model. Effect modification by baseline coronary artery calcium (CAC) burden was explored.ResultsThere were 159 individuals with mean age of 66.5 years (± 8.3) and mean FEV1% predicted of 51.4% (± 17.0), of which 41% were ever-anemic during the study period. Repeated measures of anemia status were associated with higher St. George’s Respiratory Questionnaire (SGRQ) scores (β 2.5, 95% CI: 0.1,4.8, p = 0.04), lower 6-minute walk distance (6MWD) (β -38.6, 95% CI: -67.7,-7.4, p = 0.02), and higher rate of moderate-to-severe exacerbations over the prospective follow-up period (IRR 1.8, 95% CI: 1.1,2.8, p = 0.02). There was effect modification by CAC burden such that with higher burden the mean difference in COPD outcome by anemia status was greater for a subset of symptom scores. Participants with profiles of increasing anemia risk had higher estimated rates of decline in the FEV1% predicted and 6MWD and increase in SGRQ scores compared to those with stable or decreasing anemia risk.ConclusionsLongitudinal anemia status trends may be predictive of COPD disease trajectory. Anemia status by repeated measures analysis is associated with COPD morbidity with potentially stronger associations in the setting of high CAC burden.

Artificial intelligence-derived coronary artery calcium scoring saves time and achieves close to radiologist-level accuracy accuracy on routine ECG-gated CT.

Artificial Intelligence (AI) has been proposed to improve workflow for coronary artery calcium scoring (CACS), but simultaneous demonstration of improved efficiency, accuracy, and clinical stability have not been demonstrated. 148 sequential patients who underwent routine calcium-scoring computed tomography were retrospectively evaluated using a previously validated AI model (syngo. CT CaScoring VB60, Siemens Healthineers, Forscheim, Germany). CACS was performed by manual (Expert alone), semi-automatic (AI + expert review), and automatic (AI alone) methods. Time to complete and intraclass correlation coefficients were the primary endpoints. Secondary endpoints included differences in multiethnic study of atherosclerosis (MESA) percentiles and stratification by calcium severity. AI and expert CACS agreement was excellent (ICC = 0.951; 95% CI 0.933-0.964). The global median time was 15 ± 2s for AI ("Automatic"), 38 ± 13s for the AI + manual review ("Semiautomatic") and 45 ± 24s for the manual segmentation. Automatic segmentation was faster than manual segmentation for all CACS severities (P < 0.001). AI computational time was independent of calcium burden. Global mean bias in Agatston score across all patients was 7.4 ± 102.6. The mean bias for global MESA score percentile was 2.1% ± 12%. 95% of error corresponded to a ± 10% difference in MESA score. The use of AI for CACS performs excellent accuracy, saves approximately 60% of time in comparison to manual review, and demonstrates low bias for clinical risk profiles. Time benefits are magnified for patients with high CACS. However, a semi-automatic approach is still recommended to minimize potential errors while maintaining efficiency.

Outcomes of coronary intravascular lithotripsy for the treatment of calcified nodules: a pooled analysis of the Disrupt CAD studies.

Coronary intravascular lithotripsy (IVL) safely facilitates stent implantation in severely calcified lesions. This analysis sought to determine the relative impact of IVL on acute and long-term outcomes specifically in calcified nodules (CNs). Individual patient-level data (N=155) were pooled from the Disrupt CAD optical coherence tomography (OCT) substudies. Severely calcified lesions with and without CNs were compared by OCT for acute procedural results and for target lesion failure (TLF) at 2 years - a composite of cardiac death, target vessel myocardial infarction, and ischaemia-driven target lesion revascularisation. A CN was identified in 18.7% (29/155) of lesions. When comparing lesions with and without CNs, there were no significant differences in preprocedure minimal lumen area or diameter stenosis; however, the mean calcium angle and calcium volume were greater in CN lesions. Despite a higher calcium burden, the final minimal stent area (CN: 5.7 mm2 [interquartile range [IQR] 4.4, 8.3] vs non-CN: 5.7 mm2 [IQR 4.7, 7.2]; p=0.80) and stent expansion (CN: 79.3% [IQR 64.3, 87.0] vs 80.2% [IQR 68.9, 92.4]; p=0.30) were comparable between the two groups. In the CN group, the final stent area and expansion at CN sites were 7.6 mm2 (IQR 5.5, 8.5) and 89.7% (IQR 79.8, 102.5), respectively. The cumulative incidence of TLF at 2 years was 13.9% and 8.0% in the CN and non-CN groups, respectively (p=0.32). Despite a greater calcium volume in CNs, IVL use was associated with comparable stent expansion and luminal gain in both CN and non-CN lesions. Further studies powered for clinical outcomes comparing different plaque modification techniques in this lesion subset are warranted.

The Agatston score is a predictor of contrast-induced nephropathy in patients with stable coronary artery disease after percutaneous coronary intervention.

Agatston coronary artery calcium (CAC) scoring is the primary scoring method used to determine the summed value of calcium burden. The Agatston CAC score method is a non-invasive, rapid, easily accessible tool that helps identify the weighted sum of the calcium burden in arteries using multi-detector computed tomography. The Agatston CAC score is a significant prognostic indicator for vascular diseases in the long term. To investigate the relationship between the Agatston CAC score and contrast-induced acute kidney injury (C-AKI) in patients with stable coronary artery disease (CAD) following a percutaneous coronary intervention (PCI). This retrospective study included 360 patients with stable CAD who received PCI between January 2023 and December 2023. The Agatston score was measured non-invasively on computed tomography before the coronary angiography. Receiver operating characteristics (ROC) curve analysis was used to determine the sensitivity and specificity of the Agatston CAC score and the optimal cutoff value for predicting C-AKI. The 360 patients included in the study were divided into two groups. 71 patients were classified as C-AKI+ while 289 patients were classified as C-AKI-. There was no significant difference in terms of gender, but the C-AKI+ group was significantly older. The C-AKI+ group was observed to have significantly higher levels of uric acid, Agatston score and Mehran score. Regression analyses showed that age, uric acid, Agatston score and Mehran score were independent risk factors for C-AKI. The Agatston CAC score was found to be an independent risk factor for C-AKI in patients with stable CAD with PCI.

Deep learning to predict cardiovascular mortality from aortic disease in heavy smokers

Aortic angiopathy is a common manifestation of cardiovascular disease (CVD) and may serve as a surrogate marker of CVD burden. While the maximum aortic diameter is the primary prognostic measure, the potential of other features to improve risk prediction remains uncertain. This study developed a deep learning framework to automatically quantify thoracic aortic disease features and assessed their prognostic value in predicting CVD mortality among heavy smokers. Using non-contrast chest CTs from the National Lung Screening Trial (NLST), aortic features quantified included maximum diameter, volume, and calcification burden. Among 24,770 participants, 440 CVD deaths occurred over a mean 6.3-year follow-up. Aortic calcifications and volume were independently associated with CVD mortality, even after adjusting for traditional risk factors and coronary artery calcifications. These findings suggest that deep learning-derived aortic features could improve CVD risk prediction in high-risk populations, enabling more personalized prevention strategies.

Predictors of debulking devices use by coronary artery calcification classification using cardiac CT

Abstract Background Multi-slice computed tomography (CT) is useful for the non-invasive detection and quantification of coronary calcium burden. However, a definitive parameter based on CT imaging for predicting the need for debulking devices, such as rotational atherectomy (RA) and orbital atherectomy (OAS), has yet to be established. Purpose We aimed to develop a calcification risk score using cardiac CT to predict the use of debulking devices during coronary intervention. Methods In this retrospective, multi-center, observational study in Japan, patients who underwent percutaneous coronary intervention (PCI) were screened. Inclusion criteria were (1) cardiac CT within 6 months prior to PCI, (2) moderate or severe coronary calcification detected on CT, and (3) de novo lesions in a native coronary artery. A total of 349 lesions in 343 patients from 13 hospitals, there were 124 lesions that were treated with debulking devices and 225 lesions without debulking devices. Cardiac CT images were analyzed for circumferential degree, longitudinal length, intracoronary distribution of calcification, peak density, mean density, vessel bend and presence of bifurcation lesions. Data from a random two-thirds (the derivation cohort, n=247) were used to develop a new risk prediction model, which was then tested in the remaining one-third (the validation cohort, n=102). Odds ratios and the risk prediction model were developed using a logistic regression model. The predicted risk was translated into a simplified scoring system (Figure 1A). Results RA was used in 111 lesions and OAS in 23 lesions. Factors selected in the model included circumferential degree (≥270°: 3 points), bifurcation (2 points), longitudinal length (≥8mm: 1 point), and mean density (≥600 HU: 1 point) (Figure 1B). This model demonstrated good discrimination (c-statistic=0.772) and calibration (Hosmer–Lemeshow χ²-statistic=0.885; P=0.64) in the validation cohort (Figure 2). Conclusions The new prediction model based on cardiac CT performed well in predicting the need for debulking devices. This could serve as an objective tool to support a clinical decision to use debulking devices even in cases where intravascular imaging is not applicable.Study flow and Cardiac CT calcium scoreDiscrimination and Calibration

Functional and prognostic impacts of serum albumin with thoracic arterial calcification among asymptomatic individuals

Although several studies have demonstrated the cardiovascular (CV) implication of hypoalbuminemia and arterial calcification among hemodialysis patients, little is known regarding their cardiac correlates and relevant CV outcomes in asymptomatic individuals. We assessed the potential CV interrelation between serum albumin (SA) and aortic calcification. Among 2,723 asymptomatic individuals underwent cardiovascular health check-up, we assessed serum albumin (SA) level, thoracic aortic calcification (TAC) and coronary artery calcification (CAC) by multi-detector computed tomography, and ultrasound-determined carotid plaque burden. We related these measures to cardiac structure/function and CV outcomes. Lower SA level was associated with higher TAC score and volume rather than carotid plaque or coronary calcification burden in fully adjusted models. By categorizing the study population into 4 groups by SA (>, ≤ 4.6 mg/dL) and presence of TAC, subjects classified into low SA/TAC(+) category were oldest with highest prevalent CV disease. Both lower SA and TAC(+) were independently associated with impaired myocardial systolic/diastolic mechanics and higher CV events during a median of 6.6 years (IQR: 5.1, 6.8 years) follow-up. Participants classified into low SA/TAC(+) category showed highest risk for CV events (adjusted HR: 3.78 [95% CI: 2.11, 6.77], high SA/TAC[-] as reference) in fully adjusted Cox model. Among symptom-free individuals, TAC was closely associated with low SA concentration in relation to unfavorable cardiac mechanics and may serve as a useful prognosticator for adverse CV events.

Impact of burden and distribution of aortic valve calcification on the hemodynamic performance and procedural outcomes of a self-expanding, intra-annular transcatheter aortic valve system.

Aortic valve calcification (AVC) has been explored as a powerful predictor of procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). However, little evidence exists on its impact on intra-annular devices' performance. We aimed to investigate the impact of AVC burden and distribution pattern on the occurrence of paravalvular leak (PVL), conduction disturbances requiring permanent pacemaker implantation (PPI) and 30-day clinical outcomes in patients undergoing TAVI with a self-expanding, intra-annular device. According to AVC, 103 patients enrolled in a single medical centre from November 2019 to December 2022 were divided into tertiles. Valve Academic Research Consortium (VARC)-3 definitions were used to classify procedural complications and outcomes. Patients in the highest AVC tertile showed an increased occurrence of mild or more PVL and conduction disorders (p < 0.001 and p = 0.006). AVC tertiles (highest tertile) emerged as an independent predictor of PVL (OR 7.32, 95%CI 3.10-17.28, p < 0.001) and post-TAVI conduction disturbances (OR 3.73, 95%CI 1.31-10.60, p = 0.013) but not of PPI (OR 1.44, 95%CI 0.39-5.35, p = 0.579). Considering calcium distribution, ROC analyses revealed that annular AVC but not left ventricle outflow tract (LVOT) calcium burden significantly indicated the development of PVL (AUC 0.863, 0.77-0.93, p < 0.001) and conduction disorders/PPI (AUC 0.797, 0.70-0.89, p < 0.001 and 0.723, 0.58-0.86, p = 0.018, respectively). After adjustment for age and sex, the highest tertile remained an independent predictor of the 30-day composite outcome (death, myocardial infarction, stroke, major vascular complications, type 3/4 bleedings, acute kidney injury, PPI and ≥ moderate PVL) (OR 3.26; 95%CI 1.26-8.40, p = 0.014). A higher AVC is associated with an increased risk of PVL and conduction disturbances after TAVI with a self-expanding, intra-annular device. However, our findings suggest a minor role for LVOT calcification compared with annular AVC in the performance of this specific prosthesis.

Association of Cardiovascular Risk Factors and Coronary Calcium Burden with Epicardial Adipose Tissue Volume Obtained from PET-CT Imaging in Oncological Patients.

Whole-body positron emission tomography (PET)-computed tomography (CT) imaging performed for oncological purposes may provide additional parameters such as the coronary artery calcium (CAC) and epicardial adipose tissue (EAT) volume with cost-effective prognostic information in asymptomatic people beyond traditional cardiovascular risk factors. We evaluated the feasibility of measuring the CAC score and EAT volume in cancer patients without known coronary artery disease (CAD) referred to whole-body 18F-FDG PET-CT imaging, regardless of the main clinical problem. We also investigated the potential relationships between traditional cardiovascular risk factors and CAC with EAT volume. A total of 109 oncological patients without overt CAD underwent whole-body PET-CT imaging with 18F-fluorodeoxyglucose (FDG). Unenhanced CT images were retrospectively viewed for CAC and EAT measurements on a dedicated platform. Overall, the mean EAT volume was 99 ± 49 cm3. Patients with a CAC score ≥ 1 were older than those with a CAC = 0 (p < 0.001) and the prevalence of hypertension was higher in patients with detectable CAC as compared to those without (p < 0.005). The EAT volume was higher in patients with CAC than in those without (p < 0.001). For univariable age, body mass index (BMI), hypertension, and CAC were associated with increasing EAT values (all p < 0.005). However, the correlation between the CAC score and EAT volume was weak, and in multivariable analysis only age and BMI were independently associated with increased EAT (both p < 0.001), suggesting that potential prognostic information on CAC and EAT is not redundant. This study demonstrates the feasibility of a cost-effective assessment of CAC scores and EAT volumes in oncological patients undergoing whole-body 18F-FDG PET-CT imaging, enabling staging cancer disease and atherosclerotic burden by a single test already included in the diagnostic work program, with optimization of the radiation dose and without additional costs.

Coronary artery calcium measurement on attenuation correction computed tomography using artificial intelligence: correlation with coronary flow capacity and prognosis

PurposeThis study aimed to test whether the coronary artery calcium (CAC) burden on attenuation correction computed tomography (CTac), measured using artificial intelligence (AI-CACac), correlates with coronary flow capacity (CFC) and prognosis.Materials and methodsWe retrospectively enrolled patients who underwent [13N]ammonia positron emission tomography (PET) between September 2021 and May 2023. CTac data were obtained from all the patients. Patients with (history of) acute coronary syndrome, previous coronary stent insertion or bypass surgery, or left ventricular ejection fraction < 40% were excluded. The total Agatston score measured using a dedicated AI-CAC quantification software on CTac was defined as AI-CACac. The correlations between AI-CACac and PET-measured myocardial blood flow (MBF) and CFC and significant ischaemia (summed difference score ≥ 7) were analysed. Their prognostic values for major cardiovascular events (MACE), including death, nonfatal myocardial infarction, hospitalisation due to angina pectoris or heart failure, and late (> 90 days) revascularisation, were also evaluated.ResultsIn total, 289 patients were included in this study. Significant negative correlations were found between AI-CACac and stress MBF (ρ = −0.363, p < 0.001) and MFR (ρ = −0.305, p < 0.001). AI-CACac > 10 was associated with a significantly higher prevalence of impaired CFC (31% vs. 7%, p < 0.001) and significant ischaemia (20% vs. 7%), which remained significant after adjusting for other risk factors. MACE occurred in 49 (17%) patients (median follow-up, 284 days), and those who experienced MACE had significantly higher AI-CACac (median, 166 vs. 56; p = 0.039). However, multivariable analysis revealed an independent prognostic association among impaired CFC, diabetes, smoking, but not for AI-CACac.ConclusionAI-measured CACac correlates well with PET-measured MBF and CFC, but its prognostic significance requires further validation.

Relation of JAK2 V617F allele burden and coronary calcium score in patients with essential thrombocythemia.

JAK2 V617F (JAK2) mutation is associated with clonal hemopoiesis in myeloproliferative neoplasms as well as with faster progression of cardiovascular diseases. Little is known about the relationship between allele burden and the degree of atherosclerotic alteration of coronary vasculature. We previously reported that carotid artery stiffness progressed faster in patients with JAK2 positive essential thromocythemia (ET) patients. After a four-year follow-up we investigated whether mutation burden of a JAK2 allele correlates with a higher coronary calcium score. Thirty-six patients with JAK2 positive ET and 38 healthy matched control subjects were examined twice within four years. At each visit clinical baseline characteristics and laboratory testing were performed, JAK2 mutation burden was determined, and coronary calcium was measured. JAK2 allele burden decreased in 19 patients, did not change in 5 patients, and increased in 4 patients. The coronary calcium Agatston score increased slightly in both groups. Overall, there was no correlation between JAK2 allele burden and calcium burden of coronary arteries. However, in patients with the JAK2 mutation burden increase, the coronary calcium score increased as well. The average JAK2 allele burden decreased in our patients with high-risk ET during the four-year period. However, in the small subgroup whose JAK2 mutation burden increased the Agatston coronary calcium score increased as well. This finding, which should be interpreted with caution and validated in a larger group, is in line with emerging evidence that JAK2 mutation accelerates atherosclerosis and can be regarded as a non-classical risk factor for cardiovascular disease.

Intracranial arteriosclerosis is not associated with cerebral amyloid deposition.

Intracranial arteriosclerosis and cerebral amyloid beta (Aβ) are both involved in the etiology of Alzheimer's disease (AD) dementia, but the direct link between these two pathologies remains elusive. In 633 participants (mean age 69 years, 51% women) from the population-based Rotterdam Study, we quantified cerebral Aβ accumulation on amyloid positron emission tomography (PET). We assessed calcification of the intracranial internal carotid (ICAC) and vertebrobasilar arteries (VBAC) as proxies of arteriosclerosis on non-enhanced computed tomography (CT). Using logistic and linear regression, we studied the relationship of presence, burden, and type of calcification with the presence and burden of Aβ. We found no associations of ICAC [odds ratio (OR): 0.85, 95% confidence interval (CI): 0.43, 1.72] or VBAC [OR: 0.59, CI: 0.26, 1.24] with cerebral Aβ. The results did not vary across ICAC subtypes. Intracranial arteriosclerosis was not associated with cerebral Aβ, underscoring their independence in the etiology of AD dementia. Comprehensive assessment of intracranial arteriosclerosis (e.g., including subtypes).Intracranial arteriosclerosis in different arteries and cerebral Aβ are not related.Arteriosclerosis and Aβ likely influence Alzheimer's disease dementia independently.

Relationship of Subendocardial Perfusion to Myocardial Injury, Cardiac Structure, and Clinical Outcomes Among Patients With Hypertension.

Coronary microvascular dysfunction has been implicated in the development of hypertensive heart disease and heart failure, with subendocardial ischemia identified as a driver of sustained myocardial injury and fibrosis. We aimed to evaluate the relationships of subendocardial perfusion with cardiac injury, structure, and a composite of major adverse cardiac and cerebrovascular events consisting of death, heart failure hospitalization, myocardial infarction, and stroke. Layer-specific blood flow and myocardial flow reserve (MFR; stress/rest myocardial blood flow) were assessed by 13N-ammonia perfusion positron emission tomography in consecutive patients with hypertension without flow-limiting coronary artery disease (summed stress score <3) imaged at Brigham and Women's Hospital (Boston, MA) from 2015 to 2021. In this post hoc observational study, biomarkers, echocardiographic parameters, and longitudinal clinical outcomes were compared by tertiles of subendocardial MFR (MFRsubendo). Among 358 patients, the mean age was 70.6±12.0 years, and 53.4% were male. The median MFRsubendo was 2.57 (interquartile range, 2.08-3.10), and lower MFRsubendo was associated with older age, diabetes, lower renal function, greater coronary calcium burden, and higher systolic blood pressure (P<0.05 for all). In cross-sectional multivariable regression analyses, the lowest tertile of MFRsubendo was associated with myocardial injury and with greater left ventricular wall thickness and volumes compared with the highest tertile. Relative to the highest tertile, low MFRsubendo was independently associated with an increased rate of major adverse cardiac and cerebrovascular events (adjusted hazard ratio, 2.99 [95% CI, 1.39-6.44]; P=0.005) and heart failure hospitalization (adjusted hazard ratio, 2.76 [95% CI, 1.04-7.32; P=0.042) over 1.1 (interquartile range, 0.6-2.8) years median follow-up. Among patients with hypertension without flow-limiting coronary artery disease, impaired MFRsubendo was associated with cardiovascular risk factors, elevated cardiac biomarkers, cardiac structure, and clinical events.

Coronary artery calcium score and other risk factors in patients at moderate and high risk of cancer therapy-related cardiovascular toxicity

BackgroundThe presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity.MethodsThe study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed.ResultsA total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups.ConclusionsIn patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.

CharActeristics, sizing anD outcomes of stenotic, tapered, rapHe-type bicuspid aOrtic valves treated with trans-catheter device implantation: Insights the AD HOC registry

BackgroundRaphe-type bicuspid aortic valve (BAV) is a potential hostile scenario in trans-catheter aortic valve replacement (TAVR) due to pronounced calcium burden, possibly associated with tapered valve configuration. Trans-Catheter heart valve (THV) sizing strategy (annular vs. supra-annular) is controversial in this valve subtype. ObjectivesTo describe the phenotypical characteristics of severe, tapered, raphe-type, BAV stenosis undergoing TAVR and to explore safety and efficacy of modern-generation THVs, analysing the impact of annular and supra-annular sizing strategies on short- and mid-terms outcomes. MethodsThis is a retrospective, multicenter registry enrolling consecutive stenotic Sievers type 1 BAV treated with TAVR. Study population was divided into tapered and non-tapered configuration according to MSCT analysis. Matched comparison between annular and supra-annular sizing groups was performed in tapered population. ResultsFrom January 2016 to June 2023, 897 patients were enrolled. Of them, 696 patients displayed a tapered configuration. Of those, 510 received a THV according to annular sizing. After propensity score matching 186 matched pairs were selected. Technical success (96.2 % vs 94.1 %, OR 1.61 [0.61–4.24], p = 0.34), 30-day device success (83.6 % in both groups, OR 1.42 [0.78–2.57], p = 0.25) and 30-day early safety (71.8 % vs 70.5 %, OR 1.07 [0.68–1.68], p = 0.78) were similar between the annular and supra-annular sizing groups; a higher post-TAVR gradient was observed in supra-annular group, although it was only 2 mmHg mean. At mid-term follow-up, the rate of clinical efficacy was 84.7 %. ConclusionsTAVR with modern-generation devices is safe and effective for tapered raphe-type BAV, showing comparable results for annular and supra-annular sizing strategies.