Coronary Artery Calcium Research Articles

Risk Profile and Prognostic Implications of Premature Advanced Coronary Atherosclerotic Disease Among Young to Early Middle-aged Adults: The Coronary Artery Calcium Consortium.

Premature advanced subclinical coronary atherosclerosis among young adults is an under-recognized and unique disease phenotype that has not been well characterized. We used data from 44,047 participants with no prior CVD history (59.8% male) from the Coronary Artery Calcium (CAC) Consortium. We defined advanced disease as CAC ≥90th percentile for age, sex, and race, and compared risk factor profile of persons with advanced disease to those without CAC and those with CAC <90th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of premature advanced disease with all-cause, cardiovascular, and CHD mortality. Of 44,047 participants, 18,561 (42.2%) had CAC. Among those with CAC, 6,680 (36.0%) had CAC ≥90th percentile. Notably, 76.4% of those with CAC ≥90th percentile had multivessel CAC compared to 40.6% of those with CAC <90th percentile. After a mean follow-up of 12.5±3.6 years, the incidence per 1,000 person-years of all-cause (2.93 vs 1.85 vs 1.11), cardiovascular (1.11 vs 0.39 vs 0.21), and CHD mortality (0.65 vs 0.19 vs 0.08) was highest in the advanced disease group compared to CAC <90th percentile and the no CAC group. Persons with CAC ≥90th percentile had a higher multivariable-adjusted risk of all-cause (HR:2.17[1.83-2.57]), cardiovascular (SHR:3.89[2.78-5.44]), and CHD mortality (SHR:5.45[3.38-8.78]), compared to those without CAC. In the subgroup analysis, there was no difference in mortality between men and women with advanced CAC. Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥ 90th percentile have the highest risk of early death and should be identified in future guidelines as a focus for aggressive clinical prevention.

Automated proximal coronary artery calcium identification using artificial intelligence: advancing cardiovascular risk assessment.

Proximal coronary artery calcium (CAC) may improve prediction of major adverse cardiac events (MACE) beyond the CAC score, particularly in patients with low CAC burden. We investigated whether the proximal CAC can be detected on gated cardiac computer tomography (CT) and whether it provides prognostic significance with artificial intelligence (AI). A total of 2016 asymptomatic adults with baseline CAC CT scans from a single site were followed up for MACE for 14 years. An AI algorithm to classify CAC into proximal or not was created using expert annotations of total and proximal CAC and AI-derived cardiac structures. The algorithm was evaluated for prognostic significance on AI-derived CAC segmentation. In 303 subjects with expert annotations, the classification of proximal versus not proximal CAC reached an area under receiver operating curve of 0.93 (95% confidence interval [CI] 0.91-0.95). For prognostic evaluation, in an additional 588 subjects with mild AI-derived CAC scores, the AI proximal involvement was associated with worse MACE-free survival (P=0.008) and higher risk of MACE when adjusting for CAC score alone (hazard ratio [HR] 2.28, 95% CI 1.16-4.48, P=0.02) or CAC score and clinical risk factors (HR 2.12, 95% CI 1.03-4.36, P=0.04). The AI algorithm could identify proximal CAC on CAC CT. The proximal location had modest prognostic significance in subjects with mild CAC scores. The AI identification of proximal CAC can be integrated into automatic CAC scoring and improves the risk prediction of CAC CT.

Correlation between metabolic dysfunction-associated steatotic liver disease and subclinical coronary atherosclerosis in eastern China

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the presence of at least one cardiovascular disease (CVD) risk factor, underscoring its potential to elevate CVD risk in affected individuals. However, evidence linking MASLD to subclinical coronary atherosclerosis remains scarce, and further investigations are necessary to elucidate the independent role of varying MASLD severities as a CVD risk factor.MethodsThis study analyzed 7,507 participants aged ≥ 40 who underwent comprehensive health evaluations at the Shanghai Health and Medical Center. Logistic regression analysis was utilized to explore the relationship between MASLD severity and the presence of coronary artery calcification (CAC). Correlation analysis was performed to assess the association between MASLD severity and CAC staging.ResultsAfter adjusting for established CVD risk factors, MASLD showed a significant association with CAC, which intensified with increasing MASLD severity. Among individuals with hypertension, MASLD was markedly correlated with CAC. In contrast, in non-hypertensive participants, only moderate and severe MASLD were significantly associated with CAC, while mild MASLD demonstrated no notable link, even after adjustment for CVD risk factors. Moreover, correlation analysis revealed a positive association between MASLD severity and CAC staging, indicating that higher MASLD severity aligned with more advanced CAC stages.ConclusionThis study highlighted that MASLD severity was independently associated with subclinical atherosclerosis, irrespective of traditional CVD risk factors, in an urban eastern Chinese population without a prior history of coronary atherosclerosis. The strongest associations were observed in individuals with severe MASLD, emphasizing the importance of assessing MASLD severity in CVD risk stratification.

A Systematic Review of Oxidative Stress Markers and Risk of Coronary Artery Calcification

Background: Early diagnosis of atherosclerosis, particularly in its subclinical phase, is crucial for reducing mortality and morbidity associated with cardiovascular diseases. This study aims to investigate the relationship between oxidative stress markers and coronary artery calcification (CAC), enhancing our understanding of the pathophysiology of CAC. Methods: In October 2022, we conducted a systematic search of the Web of Science, Scopus, PubMed, and Embase databases without language or time restrictions, screening a total of 557 records. We excluded studies involving animals, in vitro experiments, reviews, case reports, clinical trials, editorials, and clinical guidelines. Eligible human observational studies (cohort and cross-sectional) that examined the link between CAC and oxidative stress markers were included. The Newcastle-Ottawa Scale was employed to assess the quality of the included studies. Results: Our systematic review encompassed 40 studies, all of which included both male and female participants, predominantly using cross-sectional designs. Participants included individuals at low, intermediate, or high risk of coronary artery disease, patients with type 2 diabetes, those with existing cardiovascular disease, and asymptomatic individuals. The studies investigated various oxidative stress markers, including serum uric acid and 8-isoprostane, both of which showed strong correlations with CAC incidence and severity. Conclusion: Oxidative stress markers may positively correlate with CAC scores, indicating a potential avenue for identifying individuals at heightened risk. This review underscores the need for further studies to facilitate early diagnosis of cardiovascular complications and the establishment of novel pharmacological targets.

Intravascular Lithotripsy for Coronary Artery Calcification: An Expert Review.

Coronary artery calcification is an impediment to percutaneous coronary interventions by obstructing the device pathway or stent deployment. To facilitate percutaneous coronary intervention in such complex lesions, high-pressure balloon dilations, atherectomy procedures, and specialty balloons are used but they all come with considerable limitations and periprocedural complications like dissection and perforation. To surpass these disadvantages, intravascular lithotripsy was introduced which acts by delivering high-pressure pulsatile sonic waves circumferentially thereby destroying the calcium deposits. It is a safe and effective treatment modality in treating severe coronary artery calcification and facilitating stent delivery with minimal complications.

Association of aortic valve size with the degree of aortic valve calcification in severe high-gradient aortic stenosis.

Less pronounced calcification of the aortic valve (AVC) was observed in women with aortic stenosis (AS) as compared to men. Since women have smaller aortic valves (AV), this could explain a lower calcium load. We aimed to analyze the association of AV size with AVC independent from sex. Consecutive patients with high-gradient AS, who underwent cardiac computed tomography (CT), were assessed. AV annulus area and AVC with the Agatston score were measured on CT. In total, 601 patients (mean age 80±7 years, 45% female) were included. Women had smaller AV annulus areas (4.12±0.67cm2 vs 5.15 ±0.78cm2, p<0.001) and lower Agatston scores (2018 [1456-3017] vs. 3394 [2562-4530]; p<0.001) than men. We found a significant correlation (r=0.594, p<0.001) and independent association (β=926.20, p<0.001) of AV annulus area with AVC. On separate regression analyses for men and women, AVC was independently associated with AV annulus area in both sexes (βmen=887.77; βwomen=863.48, both p<0.001). When patients were stratified into AV size quartiles, patients in the lower quartiles were more likely to have AVC values below recommended sex-specific AVC thresholds. In the lowest quartile 28% of female and 27% of male patients had Agatston scores below 1200AU (women) and 2000AU (men) while this proportion decreased to 6% and 2%, respectively, in the quartiles with the largest annulus areas. In high-gradient AS, AVC strongly depends on AV annulus area. This association is not dependent on sex. Thus, AVC should be indexed to AV size in addition to sex.

Cardiovascular Diseases, Vital Organ Fibrosis, and Chronic Inflammation Associated with High-Intensity and/or High-Volume Exercise Training: Double-Edged Sword Effects of Vigorous Physical Activity in Elderly People and/or in Middle-Age Cancer-Therapy-Treated Patients

Cardiotoxicity, cardiovascular diseases (CVDs), hypertension, hepatotoxicity, and respiratory problems occurring several months to several years post-chemotherapy and/or radiotherapy are increasingly documented by scientists and clinicians. Anthracyclines, for example, were discovered in the late 1960s to be dose-dependently linked to induced cardiotoxicity, which frequently resulted in cardiomyopathy and heart failure. Most of those changes have also been associated with aging. While it is well known that exercise can slow down cellular aging processes, lessen the effects of chemotherapy, improve the effectiveness of cancer treatments, and prevent health problems in the general population, it remains unclear how exercise volume or intensity may affect the overall benefits of physical activity on health. For instance, higher rates of sudden cardiac arrest or coronary artery calcification have been found in marathon and ultra-marathon runners. Several additional pathological consequences have also been reported recently on many organs of those athletes. This review reports the most recent evidence suggesting that excessive intensity and/or volume may have deleterious effects on health. These findings are in clear contrast with the popular belief that all forms of physical activity can generally reduce the pathological changes associated with aging or cancer therapies. In conclusion, high-intensity training (HIT) and/or high-volume training (HVT) should not be recommended for middle-age and elderly people who have had cancer therapies or not in order to avoid an exacerbation of the consequences of aging or long-term cancer treatment effects on vital organ structures and functions.

Coronary artery calcification progression and renal involvement in patients with systemic lupus erythematosus: a longitudinal cohort study.

To investigate if progression of coronary artery calcification (CAC) in patients with systemic lupus erythematosus (SLE) is associated with renal and traditional cardiovascular risk factors as well as incidence of myocardial infarctions. CAC progression was evaluated by cardiac computed tomography (CT) at baseline and after 5 years. Multivariable Poisson regression was applied to investigate associations between CAC progression and baseline values for traditional cardiovascular risk factors, CAC, SLE disease duration, lupus nephritis, and renal function. Regarding renal function, three groups were defined based on eGFR. Further, we analysed association between CAC progression and myocardial infarction during follow-up. Of the 147 SLE patients, 99 had cardiac CT at baseline and 5-year follow-up, with a total of 502 patient-years. At baseline, their median age was 47 years, median SLE disease duration was 14 years, 88% were women, 58% had lupus nephritis, and the median eGFR was 99 mL/min/1.73m2. 38/99 (39%) had CAC progression. CAC progression was associated with smoking (ever) (relative risk [RR] 1.69, CI95% 1.19-2.40), SLE disease duration (RR per year 1.03, CI95% 1.01-1.04), and CAC presence (RR 2.52, CI95% 1.68-3.78) at baseline. During follow-up, myocardial infarction occurred in three (7.9%) CAC progressors and in two (3.3%) patients who did not have CAC at any time (RR 2.1, CI95% 0.0-5.5). In this study, progression of CAC was associated with smoking, SLE disease duration and the prior presence of CAC, but it was inconclusive as to associations with renal involvement and incidence of MI.

Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis.

Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG/-Echo), have an increased risk of adverse cardiovascular events compared with patients with a normal (negative) ECG and a normal stress Echo (-ECG/-Echo). However, it is unclear if +ECG/-Echo discordance is associated with a greater burden of subclinical coronary atherosclerosis. Project Baseline Health Study participants who underwent a stress Echo and coronary artery calcium (CAC) scan were stratified by stress Echo result: -ECG/-Echo or +ECG/-Echo. Multivariable regression investigated the association between stress Echo results and CAC burden. Event-free survival from a composite of adverse cardiovascular events was compared between groups. Among 1630 asymptomatic participants in this observational cohort study, 1503 (92.2%) had a -ECG/-Echo, 105 (6.4%) had a +ECG/-Echo, and 22 (1.3%) had a +Echo. The +ECG/-Echo group had a significantly greater burden of coronary atherosclerosis than the -ECG/-Echo group (mean CAC score, 198±470 versus 53±186; P<0.001; CAClog, 2.2±2.7 versus 1.2±2.0; P<0.001). The -ECG/-Echo group was more likely to have CAC=0 compared with the +ECG/-Echo group (65.9% versus 53.3%; P=0.01), whereas the +ECG/-Echo group more commonly had CAC ≥100 (28.6% versus 11.4%; P<0.001). After adjustment, CAClog scores were 52% higher in the +ECG/-Echo group than in the -ECG/-Echo group (P=0.002). Compared with the -ECG/-Echo group, the +ECG/-Echo group was 4.5× more likely to have a CAC score ≥400 (adjusted odds ratio, 4.54 [95% CI, 1.95-10.05]; P<0.001). After a median follow-up of 4.3 years, a trend toward increased adverse cardiovascular events was observed among participants with +ECG/-Echo. Individuals with a +ECG/-Echo have a higher burden of subclinical coronary atherosclerosis than those with a -ECG/-Echo, which may explain, at least in part, the increased risk for adverse cardiac events in this population. Further study is needed to determine the optimal strategy for mitigating cardiovascular risk in these patients. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03154346.

Cardiac function and coronary plaque development following masculinizing gender-affirming hormone therapy: A prospective cohort study.

Myocardial dysfunction and the presence of calcified and non-calcified coronary plaques are predictors of cardiovascular disease. Masculinizing gender-affirming hormone therapy may increase cardiovascular risk, highlighting the need for prospective studies to evaluate cardiovascular outcomes during gender-affirming hormone therapy. To evaluate changes in cardiac morphology, systolic and diastolic function, and development of coronary plaques after masculinizing gender-affirming hormone therapy. Prospective study including 47 transmasculine persons (gender-affirming hormone therapy-naïve, TransM_TN, n=15 and gender-affirming hormone therapy-ongoing, TransM_TO, n=32). Included persons were evaluated at study inclusion and after one year of masculinizing gender-affirming hormone therapy. At baseline, the median age of TransM_TN was 22 years (interquartile range 19-28 years) and TransM_TO 26 years (interquartile range 24-37 years) with a median gender-affirming hormone therapy duration of 4 years (interquartile range 2-5 years). Cardiac morphology including left ventricular wall thickness, volume, and mass, as well as left ventricular systolic and diastolic function was evaluated using echocardiography. Coronary artery calcifications and non-calcified coronary plaque were assessed using coronary computed tomography angiography. Paired and unpaired statistical analyses were performed within and between TransM_TN and TransM_TO groups. In TransM_TN, diastolic function decreased during follow-up with decreased septal and lateral left ventricular relaxation (14-11cm/s, p=0.04 and 18-15cm/s, p=0.02, respectively). No significant changes were observed in cardiac morphology, systolic function, or formation of coronary artery calcifications and non-calcified coronary plaque in TransM_TN or TransM_TO groups. At baseline, left ventricular end-diastolic internal diameter was significantly higher in TransM_TO compared to TransM_TN, 4.6cm (interquartile range 4.3-5.0cm) versus 4.4cm (interquartile range 4.2-4.6cm), p<0.05. Other baseline cardiac outcomes were comparable between TransM_TN and TransM_TO. Diastolic function declined after the initiation of masculinizing gender-affirming hormone therapy and individuals on long-term masculinizing gender-affirming hormone therapy had larger left ventricular dimensions compared to individuals before gender-affirming hormone therapy initiation. Cardiac morphology, systolic function, and coronary plaque formation remained stable during masculinizing gender-affirming hormone therapy.

Coronary atherosclerosis in athletes: emerging concepts and preventive strategies.

There should be no assumption that an athlete is immune to coronary artery disease (CAD), even when traditional cardiovascular (CV) risk factors appear well-managed. Excelling in certain aspects of health does not equate to total CV protection. Recent data from cardiac imaging studies have raised the possibility that long-term, high-volume, high-intensity endurance exercise is associated with coronary atherosclerosis. Whilst the risk of CV events has not been shown to rise with athletic activity, the potential for CAD should not be overlooked as it is the leading cause of sudden cardiac death in athletes >35 years of age (i.e. 'Masters athletes'). Evaluating both traditional and non-traditional risk factors for CAD is the most important part of pre-participation evaluation in Masters athletes. When managing athletes at risk of CAD it is important to adopt a shared decision-making approach regarding lifestyle adaptation and lipid-lowering treatments. In the great majority of athletes, after excluding the presence of symptoms and inducible ischaemia, this advice should include encouragement to continue exercising as available data indicate that higher levels of fitness are associated with a markedly attenuated incidence of coronary events regardless of the severity of coronary disease. Future research is needed to establish the relationship between clinically relevant CAD outcomes and coronary artery calcification in Masters Athletes, the role of sex, as well as exploration of the mechanisms underpinning these unexpected CV adaptations.

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial.

Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial. Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. Images of 1769 patients were assessed (56​% male, 58​±​9 years). Diabetes mellitus was present in 196 (11​%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p​<​0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p​<​0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p​=​0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95​% confidence interval 1.09 to 3.17, p​=​0.024). Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

Combined single-photon emission computed tomography-myocardial perfusion imaging with coronary calcium score for assessing coronary disease.

Coronary artery disease (CAD) underestimation represents a major pitfall of single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI). Coronary artery calcium score (CACS) has emerged as a sensitive tool for the assessment of suspect CAD; however, the integration of SPECT-MPI with CACS has been seldom evaluated, so far, and was therefore the aim of the present study. Patients undergoing SPECT-MPI with CACS and subsequent coronary angiography were included. ROC curves were used to identify the CACS values best predictive for CAD. In SPECT-MPI negative patients, the formula: defined the optimal CACS cut-points. The Systematic Coronary Risk Evaluation 2 was applied for 10-year cardiovascular risk estimation. Significant CAD was defined for an epicardial coronary stenosis >70 or 50% for the left main. Among 124 patients, 61 (49.19%) displayed positive SPECT-MPI, whereas 69 (56%) had significant CAD at angiography. Sensitivity, specificity, and positive predictive value (PPV) for SPECT-MPI were, respectively, 74, 82, and 84%. Considering 63 SPECT-MPI negative cases, the index values for CACS at the optimal cutoff value of 1949 were: sensitivity 28%, specificity 89%, and PPV 50%, allowing to further detect five (8%) of the patients with significant CAD. The increased discriminative power of the combined SPECT-MPI with CACS was not conditioned by the pretest cardiovascular risk. Among patients with suspect CAD undergoing SPECT-MPI, the addition of CACS in negative cases allows to detect a consistent further 8% of patients with significant CAD, thus limiting the risk of disease underestimation and offering potential prognostic benefits.

Repeatability of AI-based, automatic measurement of vertebral and cardiovascular imaging biomarkers in low-dose chest CT: the ImaLife cohort.

To evaluate the repeatability of AI-based automatic measurement of vertebral and cardiovascular markers on low-dose chest CT. We included participants of the population-based Imaging in Lifelines (ImaLife) study with low-dose chest CT at baseline and 3-4 month follow-up. An AI system (AI-Rad Companion chest CT prototype) performed automatic segmentation and quantification of vertebral height and density, aortic diameters, heart volume (cardiac chambers plus pericardial fat), and coronary artery calcium volume (CACV). A trained researcher visually checked segmentation accuracy. We evaluated the repeatability of adequate AI-based measurements at baseline and repeat scan using Intraclass Correlation Coefficient (ICC), relative differences, and change in CACV risk categorization, assuming no physiological change. Overall, 632 participants (63 ± 11 years; 56.6% men) underwent short-term repeat CT (mean interval, 3.9 ± 1.8 months). Visual assessment showed adequate segmentation in both baseline and repeat scan for 98.7% of vertebral measurements, 80.1-99.4% of aortic measurements (except for the sinotubular junction (65.2%)), and 86.0% of CACV. For heart volume, 53.5% of segmentations were adequate at baseline and repeat scans. ICC for adequately segmented cases showed excellent agreement for all biomarkers (ICC > 0.9). Relative difference between baseline and repeat measurements was < 4% for vertebral and aortic measurements, 7.5% for heart volume, and 28.5% for CACV. There was high concordance in CACV risk categorization (81.2%). In low-dose chest CT, segmentation accuracy of AI-based software was high for vertebral, aortic, and CACV evaluation and relatively low for heart volume. There was excellent repeatability of vertebral and aortic measurements and high concordance in overall CACV risk categorization. Question Can AI algorithms for opportunistic screening in chest CT obtain an accurate and repeatable result when applied to multiple CT scans of the same participant? Findings Vertebral and aortic analysis showed accurate segmentation and excellent repeatability; coronary calcium segmentation was generally accurate but showed modest repeatability due to a non-electrocardiogram-triggered protocol. Clinical relevance Opportunistic screening for diseases outside the primary purpose of the CT scan is time-consuming. AI allows automated vertebral, aortic, and coronary artery calcium (CAC) assessment, with highly repeatable outcomes of vertebral and aortic biomarkers and high concordance in overall CAC categorization.

Allocation of Semaglutide According to Coronary Artery Calcium and BMI: Applying the SELECT Trial to MESA.

Implementation of semaglutide weight loss therapy has been challenging due to drug supply and cost, underscoring a need to identify those who derive the greatest absolute benefit. Allocation of semaglutide was modeled according to coronary artery calcium (CAC) among individuals without diabetes or established atherosclerotic cardiovascular disease (CVD). In this analysis, 3,129 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) without diabetes or clinical CVD met body mass index criteria for semaglutide and underwent CAC scoring on noncontrast cardiac computed tomography. Cox proportional hazards regression assessed the association of CAC with major adverse cardiovascular events (MACE), heart failure (HF), chronic kidney disease (CKD), and all-cause mortality. Risk reduction estimates from the SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) trial (median follow-up: 3.3 years) were applied to observed incidence rates for semaglutide 5-year number-needed-to-treat calculations. Mean age was 61.2 years, 54% were female, 62% were non-White, mean body mass index was 31.8kg/m2, and 49% had CAC. Compared with CAC=0, CAC≥300 conferred a 2.2-fold higher risk for MACE (HR: 2.16 [95%CI: 1.57-2.99]; P< 0.001). Higher risks for HF (HR: 2.80 [95%CI: 1.81-4.35]; P< 0.001), CKD (HR: 1.59 [95%CI: 1.15-2.22]; P = 0.006), and all-cause mortality (HR: 1.35 [95%CI: 1.08-1.69]; P = 0.009) comparing CAC≥300 vs CAC=0 were also observed. There were large 5-year number-needed-to-treat differences between CAC=0 and CAC≥300 for MACE (653 vs 79), HF (1,094 vs 144), CKD (1,044 vs 144), and all-cause mortality (408 vs 98). Measurement of CAC may enhance value of care with weight loss dose semaglutide in those without diabetes or clinical CVD, improving allocation of a limited health care resource.

Automated measurement of coronary artery calcifications and routine perioperative blood test predict survival in resected stage I lung cancer.

Automated measurement of coronary artery calcifications and routine perioperative blood test predict survival in resected stage I lung cancer.

Elevated uric acid predicts increased coronary artery calcification risk in advanced chronic kidney disease: a cross-sectional study

Elevated uric acid predicts increased coronary artery calcification risk in advanced chronic kidney disease: a cross-sectional study

A Severely Calcified, Undilatable, Coronary Artery Stenosis: Impact of Serial Lithotripsy on Calcium Fracture andLumenExpansion.

Percutaneous coronary intervention of a severely calcified coronary artery stenosis is associated with stent underexpansion and adverse outcomes. Intravascular lithotripsy (IVL) is a novel technology for fracturing calcified plaque in the coronary artery. We describe the first case of a severely calcified, undilatable coronary artery lesion. After 2 IVL cycles, the balloon expanded, but only 1 calcium fracture occurred by intravascular ultrasound. After 2 additional IVL cycles, there were multiple calcium fractures, and the stent expanded optimally. We concluded that serial IVL cycles lead to multiple calcium fractures and expand the stent optimally.

Evaluation of three diagnostic algorithms to reduce normal scan rates, radiation exposure and costs in patients with suspected chronic coronary syndrome referred for 82Rb-Positron Emission Tomography (82Rb-PET)

BackgroundThe majority of functional ischemia tests in patients with suspected chronic coronary syndromes (CCS) yield normal results. Implementing gatekeepers for patient preselection, such as pretest probability (PTP) and/or coronary artery...

Does incidental coronary artery calcium in CT pulmonary angiography predict cardiovascular outcome?

Does incidental coronary artery calcium in CT pulmonary angiography predict cardiovascular outcome?