Coronary Artery Calcium Research Articles

Sex-specific associations between total cholesterol and non-high-density lipoprotein cholesterol and the presence and extent of coronary artery calcifications.

Investigate sex-specific associations between total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C) and the burden of atherosclerosis assessed by coronary artery calcium (CAC) score. A total of 10,049 participants (women: 958, men: 9,091) aged 49-75 years, without known cardiovascular disease (CVD) or current use of lipid-lowering medication, were included from the Danish Risk Score study and the Danish Cardiovascular Screening Trial cohorts. Logistic regression models and zero-inflated negative binomial regression models were used to estimate odds ratio (OR), the incidence rate ratio (IRR), and 95% confidence intervals (CI) for the association between total cholesterol, non-HDL-C, and CAC presence (CAC > 0) and extent. All analyses were adjusted for age, BMI, diabetes, smoking, hypertension, and family history of CVD. The OR for presence of CAC and total cholesterol was 1.09 (95% CI: 0.94;1.27) in women and 1.26 (95% CI: 1.19;1.33) in men. The OR for presence of CAC and non-HDL-C was 1.12 (95% CI: 0.96;1.29) in women and 1.25 (95% CI: 1.18;1.33) in men. No significant association between increased total cholesterol and extent of CAC was found, regardless of sex (women: IRR: 0.99; 95% CI: 0.83;1.19; men: IRR: 1.04; 95% CI: 0.997;1.07). Non-HDL-C was significantly associated with extent of CAC in men (IRR: 1.04; 95% CI: 1.001;1.08), but not in women (IRR: 0.93; 95% CI: 0.78;1.12). Total cholesterol was associated with presence of CAC and non-HDL-C were associated with presence and extent of the CAC score in men. No association by total cholesterol or non-HDL-C were found among women.

Screening for coronary artery disease among cancer survivors: rationale and design of the REDEEM-CAD study

BackgroundCancer survivors are reported to be at a heightened risk of coronary artery disease (CAD) due to shared risk factors, potentially cardiotoxic cancer treatments and premature aging in survivors. Early identification of those who are at greater risk, followed by protective treatment, can prevent CAD progression. However, to date there was a relative paucity of prospective data to optimally guide management of atherosclerotic coronary risk among cancer survivors.MethodsThe REDEEM-CAD (Risk-guidEd DisEasE Management plan to prevent CAD in patients with previous cancer) study is a prospective cohort study conducted in Victoria and Tasmania, Australia aiming to evaluate the efficacy of a comprehensive CAD screening strategy. Cancer survivors aged ≥ 40 years with cancer treatment ≥ 5 years prior are eligible for the study. Consented participants will be stratified into low, intermediate or high risk of major atherosclerotic adverse events based on clinical assessment and biochemistry tests. Subsequently, those within the intermediate risk will be referred for coronary artery calcium (CAC) scoring, with computed tomography coronary angiography (CTCA) completed where CAC > 0 and < 400. Participants with high risk or CAC > 400 will be informed about strategies (including lipid-lowering therapy) to manage asymptomatic CAD. Those with low clinical risk or CAC = 0 will conclude their participation while those with CTCA imaged at baseline will be referred for a follow-up CTCA 2-year post-baseline. The primary endpoint is to identify the prevalence of CAD, identified via CAC scoring, among cancer survivors classified as intermediate risk. Secondary endpoint includes the absolute change in total coronary plaque volume over 24 months among those imaged at baseline and follow-up.SummaryThe REDEEM-CAD study will be the first study to systematically evaluate risk of CAD in cancer survivors, and subsequent responsiveness to coronary risk reduction. This will offer valuable insights into the efficacy of the CAD screening strategies among cancer survivors and the impact of treatment on managing plaque progression.Trial registrationNCT05366153.

Lesion-specific coronary artery calcium score to predict stent underexpansion

BackgroundPrevious intracoronary imaging studies have shown that coronary artery calcium (CAC) is an independent risk factor of stent underexpansion; however, limited preintervention assessments of CAC have been performed using noninvasive methods. We aimed to determine the association between lesion-specific CAC score and stent underexpansion.MethodsIn this retrospective observational study, we included 416 lesions from 359 patients who underwent intravascular ultrasound (IVUS)-guided stent implantation. CAC of each lesion was quantified using the Agatston method derived from either nongated noncontrast chest CT (NCCT) or electrocardiogram-gated coronary CT angiography (CCTA). The primary endpoint was stent underexpansion defined as minimum stent area of &amp;lt;80% of the average reference lumen area.ResultsOverall, stent underexpansion occurred in 144 (34.6%) of 416 lesions. Lesion-specific CAC score was significantly negatively correlated with the stent expansion rate (in NCCT cohort, r = 0.8113, P &amp;lt; 0.05; in CCTA cohort, r = 0.8024, P &amp;lt; 0.05). The optimal cutoff values of lesion-specific CAC score to predict stent underexpansion were &amp;gt;200 in both NCCT (sensitivity, 91.4%; specificity, 66.8%) and CCTA (sensitivity, 84.6%; specificity, 64.3%) cohort, which were associated with 24.94-fold increased risk of stent underexpansion in NCCT cohort and 13.56-fold increased risk of stent underexpansion in CCTA cohort.ConclusionsIn this study, we found that lesion-specific CAC scores in both NCCT and CCTA cohorts were significantly independently associated with an increased risk of stent underexpansion, and the cutoff value to predict stent underexpansion was &amp;gt;200.

Clinical impact of direct rotational atherectomy in patients with complex coronary artery lesions

Owing to limited data on the optimal timing of rotational atherectomy (RA), we sought to evaluate the clinical impact of the early application of the RA strategy. Consecutive patients with severe coronary artery calcification were enrolled, who underwent percutaneous coronary intervention (PCI) using RA between January 2010 and October 2019 at 9 tertiary centers. Direct RA was defined as the early application of RA before the balloon was expanded to a size more than or equal to 2.0 mm. The primary endpoint was the composite outcome of technical failure or severe coronary dissection (type D, E, or F) during entire procedure. Of 581 lesions, 360 (62.0%) lesions underwent direct RA. The technical success rate was higher in the direct RA group than in the indirect RA group (97.5% vs. 93.7%, p = 0.021). The primary endpoint was more frequently observed in the indirect RA group than in the direct RA group (24.4% vs. 11.9%, p < 0.001). Multivariate logistic regression analysis revealed that the risk of the primary endpoint was higher in the indirect RA group than in the direct RA group (odds ratio 2.512, 95% CI 1.547–4.078, p < 0.001). Early application of RA may reduce the incidences of in-hospital adverse events and procedure-related complications.

AI-derived automated quantification of cardiac chambers and myocardium from non-contrast CT: Prediction of major adverse cardiovascular events in asymptomatic subjects.

The significance of left ventricular mass and chamber volumes from non-contrast computed tomography (CT) for predicting major adverse cardiovascular events (MACE) has not been studied. Our objective was to evaluate the role of artificial intelligence-enabled multi-chamber cardiac volumetry from non-contrast CT for long-term risk stratification in asymptomatic subjects without known coronary artery disease. Our study included 2022 asymptomatic individuals (55.6±9.0 years; 59.2% male) from the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial. Multi-chamber cardiac volumetry was performed using deep-learning algorithms from routine non-contrast CT scans for coronary artery calcium scoring. MACE was defined as cardiac death, acute coronary syndrome, and late (>180 days) revascularization. A total of 215 individuals (11%) suffered MACE at a mean follow-up of 13.9±3 years. Individuals with MACE had higher left ventricular mass (115.1g vs. 105.2g, p<0.001). In a multivariable analysis adjusted for cardiovascular risk factors and medications, left ventricular mass (HR 2.76, p<0.001) and coronary artery calcium score (HR 1.34, p<0.001) were independent predictors of long-term MACE. Adding left ventricular mass to the coronary calcium score improved the Receiver Operating Characteristic Area Under the Curve (AUC 0.753 vs 0.767, p=0.031) with continuous net reclassification index of 18% (p=0.011). Left ventricular mass (HR 3.89, p<0.001), but not the coronary artery calcium score predicted cardiovascular death. Left ventricular mass quantified automatically by AI from routine non-contrast CT independently predicted long-term MACE over and above the coronary calcium score in asymptomatic participants without known coronary artery disease.

Coronary artery calcifications are not associated with epicardial adipose tissue volume and attenuation on computed tomography in 1,945 individuals with various degrees of glucose disorders.

The quantification of coronary artery calcifications (CAC) is a mainstay in radiological assessment of coronary atherosclerosis and cardiovascular risk, but reflect advanced, possibly late-stage changes in the arteries. Increased volume and changes in attenuation of the epicardial adipose tissue (EAT) on computed tomography (CT) have been linked to adverse cardiovascular events, and these changes in the EAT might reflect earlier stages of the processes leading to clinically manifest atherosclerosis. The relationship between EAT and CAC is subject to a knowledge gap, especially in individuals with no previously known coronary artery disease. Fully automated EAT analysis with an artificial intelligence-based model was performed in a population sample enriched for pre-diabetics, comprising a total of 1,945 individuals aged 50-64years, where non-contrast CT images, anthropometric and laboratory data was available on established cardiovascular risk factors. Uni- and multivariable linear regression, gradient-boosting and correlation analyses were performed to determine the explanatory value of EAT volume and attenuation data with regards to CAC data. Neither EAT volume nor EAT attenuation was associated with the presence or severity of CAC, when adjusting for established cardiovascular risk factors, and had only weak explanatory value in gradient-boosting and correlation analyses. Age was the strongest predictor of CAC in both sexes. No independent association was found between CAC and total EAT volume or attenuation. Importantly, these findings do not rule out early stage or local effects on coronary atherosclerosis from the EAT immediately surrounding the coronary arteries.

Associations of long-term exposure to temperature with coronary artery calcification risk among middle-aged adults: The Coronary Artery Risk Development in Young Adults (CARDIA) study.

The impact of ambient temperature on population health has drawn increasing attention as climate change drives more extreme temperatures globally. However, little research has investigated its connection to subclinical cardiovascular diseases. This study aims to examine the impact of long-term exposure to temperature on coronary artery calcification (CAC) among middle-aged Black and White adults in four U.S. areas with varying climate and weather conditions. This study compiled long-term environmental temperature data and individual coronary artery Agatston score (0 vs. >0) from the Coronary Artery Risk Development in Young Adults study. It employed logistic regression and examined the influences of multiple temperature metrics, including average temperature and variation in the summer, winter, or during the year. Subgroup analyses by sex and race were also conducted. Increased average temperatures were associated with lower odds in the presence of CAC (winter average: odds ratio, 0.988 [95% CI, 0.979-0.998]; yearly average: 0.981 [0.964-0.999]), and yearly variation in temperatures was positively related to individuals' CAC risk (1.031 [1.005-1.057]). With statistical adjustment, female participants' CAC risk was significantly related to winter and yearly average temperatures (0.964 [0.932-0.998] and 0.943 [0.891-0.999], respectively), and White participants' CAC risk would increase with greater annual temperature variations (1.181 [1.023-1.363]). This study appears to be the first to examine the impact of long-term exposure to ambient temperature on subclinical cardiovascular diseases. Increased risks of CAC are linked to decreased average winter/yearly temperatures among females and greater yearly temperature variations among White adults.

Atherosclerotic Diseases in Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have a high incidence of atherosclerotic diseases, such as ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. To prevent the incidence of atherosclerotic cardiovascular disease in patients with CKD, the pathology of arteriosclerosis should be determined. Vascular calcification is a characteristic of arteriosclerosis in patients with CKD. Recent studies have reported that coronary artery calcification is associated with acute coronary syndromes. CKD is frequently associated with heart failure. Furthermore, recent evidence suggests that coronary artery calcification affects asymptomatic myocardial ischemia. Hyperphosphatemia and calciprotein particles may be involved in the pathology of vascular calcification. Controlling the progression of vascular calcification and classical atherosclerotic risk factors is important to prevent the occurrence of atherosclerotic diseases in CKD.

Zero Coronary Artery Calcification: A Promising Value in Acute Chest Pain Evaluation

Zero Coronary Artery Calcification: A Promising Value in Acute Chest Pain Evaluation

Fully automated coronary artery calcium score and risk categorization from chest CT using deep learning and multiorgan segmentation: A validation study from National Lung Screening Trial (NLST).

The National Lung Screening Trial (NLST) has shown that screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. These patients are also at high risk of coronary artery disease, and we used deep learning model to automatically detect, quantify and perform risk categorisation of coronary artery calcification score (CACS) from non-ECG gated Chest CT scans. Automated calcium quantification was performed using a neural network based on Mask regions with convolutional neural networks (R-CNN) for multiorgan segmentation. Manual evaluation of calcium was carried out using proprietary software. This study used 80 patients to train the segmentation model and randomly selected 1442 patients were used for the validation of the algorithm. We compared the model generated results with Ground Truth. Automatic cardiac and aortic segmentation model worked well (Mean Dice score: 0.91). Cohen's kappa coefficient between the reference actual and the interclass computed predictive categories on the test set is 0.72 (95% CI: 0.61-0.83). Our method correctly classifies the risk group in 78.8% of the cases and classifies the subjects in the same group. F-score is measured as 0.78; 0.71; 0.81; 0.82; 0.92 in calcium score categories 0(CS:0), I (1-99), II (100-400), III (400-1000), IV (>1000), respectively. 79% of the predictive scores lie in the same categories, 20% of the predictive scores are one category up or down, and only 1.2% patients were more than one category off. For the presence/absence of coronary artery calcifications, our deep learning model achieved a sensitivity of 90% and a specificity of 94%. Fully automated model shows good correlation compared with reference standards. Automating the process could improve diagnostic ability, risk categorization, facilitate primary prevention intervention, improve morbidity and mortality, and decrease healthcare costs.

Advancements in the application of deep learning for coronary artery calcification

Advancements in the application of deep learning for coronary artery calcification

Risk factors that predict for presence of clinically significant, noncalcified plaque in younger adults.

Coronary artery calcium (CAC) scoring may be a useful tool for assessing cardiovascular disease in young adults, particularly in those with risk factors such as hypertension, dyslipidemia, or smoking. In this study, we aimed to address the risk factors for developing noncalcified plaque in young adults by assessing total plaque burden. A single-center retrospective cohort study was conducted among 1026 consecutive patients aged 18-45 years who underwent CAC scoring and coronary computed tomography (CT) angiograms for clinical indications. CAC scores and total plaque scores (TPS) were calculated using standard scoring protocols. Multiple logistic regression analysis was conducted to identify independent risk factors of significant, noncalcified plaque in subjects where CAC = 0. This single-center retrospective cohort study included 1026 patients aged 18-45 years who underwent CAC scoring and coronary CT angiograms for clinical indications. The mean age of the population was 38.8 years old. Sixty-three patients had a CAC score of 0 and a TPS >0. Of the patients with noncalcified plaque burden, 15% had a stenosis >50%, and 10% had a stenosis >70%. The odds of a subject having noncalcified plaque presence and CAC absent were significantly associated with being Hispanic, having diabetes, and having hyperlipidemia. In young adults aged 18-45 years old, we found diabetes, hyperlipidemia, and being of Hispanic origin to be significantly associated with noncalcified plaque burden.

Noncardiac chest computerized tomography scan as a predictor for plaque presence in coronary artery.

Coronary artery calcium, a marker of coronary atherosclerosis, is often identified on noncoronary chest computed tomography (CT). We wanted to evaluate the correlation between the presence of coronary plaques in coronary artery catheterization and coronary calcifications as shown in noncardiac chest CT. A retrospective case-control study consisting of cases (N = 63) and controls (N = 29), aged 18-70 years old, residing in northern Israel and treated in the Intensive Cardiac Care Unit of Ziv Medical Center, between January 2020 and November 2022. All participants underwent coronary catheterization and noncoronary CT scans in the 5 years before the catheterization procedure. Data were taken from the participants' electronic files while considering the potential of cardiovascular risk factors. The 92 participants had a mean age of 60.1 ± 10.3 years old. Multivariate logistic regression adjusted to age, sex, and hyperlipidemia showed that calcified coronary artery as shown on a previous noncardiac CT scan was positively and significantly associated with increasing risk of coronary plaque as presented in coronary catheterization: odds ratio = 5.93 (95% confidence interval: 1.85-19.07, P < 0.01) and was also associated with male sex who were more likely to have plaque on coronary catheterization than females: odds ratio = 3.77 (95% confidence interval: 1.29-11.32, P < 0.05). Coronary calcifications on a previous noncoronary CT scan and sex are positively and significantly associated with coronary plaque risk as present in coronary catheterization. Coronary evaluation on CT scans is important for early detection of coronary disease. Early treatment can avoid coronary disease complications and increase patient survival.

Agastaton coronary artery calcium score distribution by age and gender among 20-80 years old patients—data from a single center in Pakistan

Purpose: Coronary artery calcium (CAC) is an estimate of atherosclerotic burden and well-validated for risk assessment in middle to older aged adults. The coronary artery calcium (CAC) score is used in decision making for preventive medications in patients with borderline clinical risk scores. This study will be valuable addition to research data base as no such study has been conducted in our center to date. Methods: A retrospective study was conducted at Rawalpindi institute of cardiology and database was screened for patients who underwent CT cardiac angiography and calcium score assessment between January 2024 and June 2024. Study population included 500 patients. The absolute Agastaton calcium scores (zero, mild, moderate and severe) for age and gender were tabulated and statistical analysis was done to find mean age and prevalent gender for each category of calcium score. Results: Data of 500 patients was scrutinized. Of these, 183 patients were excluded due to revascularization (CABG or stents) or due to incomplete clinical information. Out of remaining 317patients, 180 were males and 137 were females. Zero calcium score was found in 146 patients. Mean age was 47 years and M&gt;F. Mild calcium score was found in 76 patients. Mean age was 53 years and M&gt;F. Moderate calcium score was found in 62 patients. Mean age was 55 years and M&gt;F. Severe calcium score was found in 33 patients. Mean age was 62 years and M&gt;F. Conclusion: In this study CAC scores were provided for men and women, with their mean age; which is helpful in therapeutic decision-making. Non-zero CAC score corresponded to more than half of population, with all categories more prevalent in males. As an approximate rule of thumb, there is direct relation in mean age with increase in the severity category of calcium score.

Coronary artery dominance influences the distribution of calcified plaques in the coronary tree.

Coronary artery dominance is determined by the coronary artery emitting the posterior descending artery. In the left dominant system, a greater proportion of coronary flow enters the left coronary artery, potentially influencing calcified plaque development in the left anterior descending artery (LAD). This retrospective single-center cohort study analyzed patients who underwent computed tomography angiography from September 2006 to December 2022 at Harbor-UCLA in Los Angeles, California. Coronary artery calcium (CAC) was quantified for the three coronary vessels. The LAD calcium score was divided by the total calcium score to calculate the LAD calcium percentage, which was compared between left and right dominant coronary systems. Multivariable linear regression assessed the association between LAD calcium percentage and coronary dominance, adjusting for age, gender, BMI, hyperlipidemia, hypertension, family history of cardiovascular disease, and past smoking. Among 9560 subjects, 6766 with CAC greater than zero were enrolled. The average age was 64.8 ± 10.7 years: 68% were male, and 9% had left dominant coronary systems. The median CAC was 51 [0-352] in the right dominant and 49 [0-358] in the left dominant system (P = 0.73). Adjusted analysis revealed that individuals with left dominant coronary systems had a 10.1% higher (CI 7.5-12.8%, P < 0.001) LAD calcium percentage than those with right dominant systems. Although coronary dominance does not influence overall plaque burden of atherosclerosis, it affects calcified plaque distribution. The left dominant system is associated with a higher proportion of calcified plaque in the LAD, potentially heightening the risk of adverse cardiovascular events.

Segmentation of coronary artery and calcification using prior knowledge based deep learning framework.

Computed tomography angiography (CTA) is used to screen for coronary artery calcification. As the coronary artery has complicated structure and tiny lumen, manual screening is a time-consuming task. Recently, many deep learning methods have been proposed for the segmentation (SEG) of coronary artery and calcification, however, they often neglect leveraging related anatomical prior knowledge, resulting in low accuracy andinstability. This study aims to build a deep learning based SEG framework, which leverages anatomical prior knowledge of coronary artery and calcification, to improve the SEG accuracy. Moreover, based on the SEG results, this study also try to reveal the predictive ability of the volume ratio of coronary artery and calcification for rotational atherectomy (RA). We present a new SEG framework, which is composed of four modules: the variational autoencoder based centerline extraction (CE) module, the self-attention (SA) module, the logic operation (LO) module, and the SEG module. Specifically, the CE module is used to crop a series of 3D CTA patches along the coronary artery, from which the continuous property of vessels can be utilized by the SA module to produce vessel-related features. According to the spatial relations between coronary artery lumen and calcification regions, the LO module with logic union and intersection is designed to refine the vessel-related features into lumen- and calcification-related features, based on which SEG results can be produced by the SEGmodule. Experimental results demonstrate that our framework outperforms the state-of-the-art methods on CTA image dataset of 72 patients with statistical significance. Ablation experiments confirm that the proposed modules have positive impacts to the SEG results. Moreover, based on the volume ratio of segmented coronary artery and calcification, the prediction accuracy of RA is 0.75. Integrating anatomical prior knowledge of coronary artery and calcification into the deep learning based SEG framework can effectively enhance the performance. Moreover, the volume ratio of segmented coronary artery and calcification is a good predictive factor forRA.

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 &amp;gt;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

Evaluation of novel cardiovascular risk calculators in patients with rheumatoid arthritis

Abstract Background Patients with rheumatoid arthritis (RA) have a higher cardiovascular risk (CVR) compared to the general population contributing to a decreased life expectancy. Systematic and periodic assessment of CVR is recommended in all patients with RA. The newly developed PREVENTTM calculator was designed to estimate the absolute risk of cardiovascular disease and provides an estimate of atherosclerotic cardiovascular disease and heart failure. Purpose This study aimed to evaluate the sensitivity and specificity of the new PREVENTTM algorithm to identify CP in RA patients without prior CVD and to compare these results with other CVR algorithms. Methods We performed a cross-sectional study that included patients with RA aged 40 to 79 who fulfilled the 2010 ACR/EULAR Classification Criteria for RA. Patients with previous CVD, pregnancy, or overlap syndrome were excluded. A B-mode carotid ultrasound was performed on all patients. The presence of CP was defined as diffuse carotid intima-media thickness (cIMT) ³1.2 mm or focal thickness ³0.5 mm. The CVR was evaluated using Globorisk, HEARTS, QRISK3, ERS-RA, SCORE2, and PREVENTTM algorithms. The result was multiplied by 1.5 in algorithms where RA is not included as a variable, according to EULAR 2015/2016 recommendations. ROC curve analysis was performed to evaluate the different CVR algorithms' performance to identify CP. Youden index was calculated to select the optimum cutoff point and posteriorly calculate sensitivity, specificity, and predictive values. A p-value of £0.05 was considered statistically significant. Statistical analysis was performed with SPSS version 29.0 (IBM Corp, Armonk, NY, USA). Results A total of 261 patients with RA were included, mostly women (n=244, 93.5%), with a mean age of 56±9.3 years, and a median disease duration of 7.7 (3.0-14.7) years. Dyslipidemia was the most prevalent CVR factor (n=104, 39.8%). The prevalence of CP was 38.0%. According to the ROC curves, the Globorisk, HEARTS, and QRISK3 algorithms showed a higher area under the curve (AUC) than the other algorithms. The HEARTS and QRISK3 algorithms showed the highest positive likelihood ratios, showing rates of 1.87 and 1.84, respectively, to identify RA patients with CP (Figure 1). Conclusion Our study showed that Globorisk, HEARTS, and QRISK3 calculators presented the best diagnostic accuracy to detect CP in patients with RA. The novel CVR calculator PREVENTTM did not show better performance than older calculators in our population. Imaging studies evaluating coronary artery calcium and CP may offer better alternatives in high-risk populations like patients with RA.

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 &amp;gt;1 mm attached to or located within the lumen of a coronary vessel with intensity &amp;gt;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 &amp;gt;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 &amp;gt;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.

Differential Associations of Cigar, Pipe, and Smokeless Tobacco Use Versus Combustible Cigarette Use With Subclinical Markers of Inflammation, Thrombosis, and Atherosclerosis: The Cross-Cohort Collaboration-Tobacco Working Group.

Understanding the association of tobacco product use with subclinical markers is essential in evaluating health effects to inform regulatory policy. This is particularly relevant for noncigarette products (eg, cigars, pipes, and smokeless tobacco), which have been understudied because of their low prevalence in individual cohort studies. This cross-sectional study included 98 450 participants from the Cross-Cohort Collaboration-Tobacco data set. Associations between the use of tobacco products and subclinical markers (high-sensitivity C-reactive protein, interleukin-6, fibrinogen, D-dimer, coronary artery calcium, carotid intima-media thickness, carotid plaque, and ankle-brachial index) were evaluated. The analyses used multivariable linear and logistic regression models to examine current use status for each product, with additional analyses of "sole" and "exclusive" noncigarette use (versus never use of either cigarettes or a specific noncigarette tobacco). Sole use was defined as the current use of a given noncigarette tobacco without concurrent combustible cigarette use, whereas exclusive use was defined as current noncigarette tobacco use without any history of combustible cigarette use. A total of 20.0%, 3.0%, 0.8%, and 1.5% of participants were current cigarette, cigar, pipe, or smokeless tobacco users, respectively. Current cigarette use showed associations with higher levels of all markers compared with never cigarette use. Compared with the relevant reference group, current, sole, and exclusive cigar use was associated with 10% (95% CI, 1-20), 19% (95% CI, 12-26), and 11% (95% CI, 2-21) higher high-sensitivity C-reactive protein on the geometric mean scale. Similar associations were observed for pipe and smokeless tobacco use. For interleukin-6, we observed that sole cigar use was associated with a 15% (95% CI, 6-24) higher geometric mean level, whereas current, sole, and exclusive pipe use were associated with 22% to 32% (all P values <0.05) higher levels compared with their respective reference groups. Fibrinogen levels were 2% to 6% higher (all P values <0.05) among current users of cigars, pipes, and smokeless tobacco compared with their respective reference groups. Carotid plaque and carotid intima-media thickness were also moderately associated with noncigarette tobacco use. Use of noncigarette tobacco products is linked to subclinical markers relevant to cardiovascular harm. Inflammatory markers, such as high-sensitivity C-reactive protein and interleukin-6, have the potential for assessing early cardiovascular risk from these products and aiding regulatory authorities in evaluating their associated risks.