Coronary Artery Calcium Research Articles

Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5

Background Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients. Methods In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). Results A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03–39.61) and TAC (OR 6.16; 95% CI 1.76–21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38–16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH). Conclusion Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.

Radiomics and deep learning features of pericoronary adipose tissue on non-contrast computerized tomography for predicting non-calcified plaques

Background Inflammation of coronary arterial plaque is considered a key factor in the development of coronary heart disease. Early the plaque detection and timely treatment of the atherosclerosis could effectively reduce the risk of cardiovascular events. However, there is no study combining radiomics with deep learning techniques to predict non-calcified plaques (NCP) in coronary artery at present. Objective To investigate the value of combination of radiomics and deep learning features based on non-contrast computerized tomography (CT) scans of pericoronary adipose tissue (PCAT), integrating with clinical risk factors of patients, in identifying coronary inflammation and predicting the presence of NCP. Methods The clinical and imaging data of 353 patients were analyzed. The region of interest (ROI) of PCAT was manually outlined on non-contrast CT scan images, like coronary CT calcium score sequential images, then the radiomics and deep learning features in ROIs were extracted respectively. In training set (Center 1), after performing feature selection, radiomics and deep learning feature models were established, meanwhile, clinical models were built. Finally, combined models were developed out via integrating clinical, radiomics, and deep learning features. The predictive performance of the four feature model groups (clinical, radiomics, deep learning, and three combination) was assessed by seven different machine learning models through generation of receiver operating characteristic curves (ROC) and the calculation of area under the curve (AUC), sensitivity, specificity, and accuracy. Furthermore, the predictive performance of each model was validated in an external validation set (Center 2). Results For the single model comparation, eXtreme Gradient Boosting (XGBoost) showed the best performance among the clinical model group in the validation set. And Random Forest (RF) exhibited the best indicative performance not only among the radiomics feature group but also in the deep learning feature model group. What's more, among the combined model group, RF still displayed the best predictive performance, with the value of AUC, sensitivity, specificity, and accuracy in the validation set are 0.963, 0.857, 0.929, and 0.905. Conclusion The RF model in the combined model group based on non-contrast CT scan PCAT can predict the presence of NCP more accurately and has the potential for preliminary screening of the NCP.

Cardiac biomarkers for detection of coronary artery disease in the community

To investigate whether coronary artery disease (CAD) burden is associated with plasma levels of the myocardial biomarkers Troponin I (TropI) and NT-proBNP in a large population-based sample using a cross-sectional design. Coronary computerized tomography (CT) angiography was performed in 25,859 subjects without a history of atherosclerotic disease from SCAPIS study (age 50–65, 52% women). TropI and NT-proBNP were measured in plasma. Segment involvement score (SIS) was the primary exposure and TropI the primary outcome. Both SIS and coronary artery calcium score, were associated with TropI levels following adjustment for age, sex and multiple confounders (p < 0.001), with similar relationships in men and women. Proximal segments from all three coronary arteries were related to TropI levels independently of one another. Adding TropI to traditional risk factors marginally increased discrimination of atherosclerosis as compared to risk factors alone (C-statistics + 0.0005, p = 0.014). SIS was related also to NT-proBNP levels, mainly in men, but with lower estimates than TropI. The burden of CAD was related to TropI levels in both men and women. All three major coronary arteries contributed to this relationship. Adding TropI to traditional risk factors resulted in only marginally improved discrimination of coronary atherosclerosis.

Coronary artery calcium and atherosclerotic cardiovascular disease risk scores in patients with calcium pyrophosphate deposition disease.

Calcium pyrophosphate deposition (CPPD) disease is associated with an increased risk for cardiovascular (CV) events. We examined the atherosclerotic burden by coronary artery calcium scores (Agatston score) and compared 10-year atherosclerotic CV (ASCVD) risk scores in patients with vs without chondrocalcinosis, a radiographic marker of CPPD. We performed a cross-sectional analysis at an academic medical center, 1991-2022. Among all patients with an Agatston score in routine care, we defined a cohort with chondrocalcinosis detected before the coronary artery calcium scan. Comparators without chondrocalcinosis were matched 2:1 on age and sex-the primary analysis excluded statin users. We compared Agatston scores between the chondrocalcinosis cohort and comparators. We also tested for differences between cohorts in 10-year ASCVD risk score frequencies (low, borderline/intermediate, or high). 756 patients with chondrocalcinosis were matched to 1554 comparators (mean age 68 years, 53% female). CV risk factor burden was high in both cohorts, and statin use was infrequent. The unadjusted Agatston score was non-significantly higher in the chondrocalcinosis cohort (mean 359.1, SD 737.9) than in matched comparators (mean 297.1, SD 644.9) (p= 0.08). High 10-year ASCVD risk scores were significantly more common in the chondrocalcinosis cohort than comparators (p< 0.01). Coronary atherosclerosis burden by CAC was not significantly different between patients with chondrocalcinosis and matched comparators, though 10-year ASCVD risk scores were higher in the chondrocalcinosis cohort, suggesting that factors beyond coronary artery calcification contribute to the increased CV event rate in patients with CPPD disease.

Comparing fully automated AI body composition biomarkers at differing virtual monoenergetic levels using dual-energy CT.

To investigate the behavior of artificial intelligence (AI) CT-based body composition biomarkers at different virtual monoenergetic imaging (VMI) levels using dual-energy CT (DECT). This retrospective study included 88 contrast-enhanced abdominopelvic CTs acquired with rapid-kVp switching DECT. Images were reconstructed into five VMI levels (40, 55, 70, 85, 100keV). Fully automated algorithms for quantifying CT number (HU) in abdominal fat (subcutaneous and visceral), skeletal muscle, bone, calcium (abdominal Agatston score), and organ size (area or volume) were applied. Biomarker median difference relative to 70keV and interquartile range were reported by energy level to characterize variation. Linear regression was performed to calibrate non-70keV data and to estimate their equivalent 70keV biomarker attenuation values. Relative to 70keV, absolute median differences in attenuation-based biomarkers (excluding Agatston score) ranged 39-358, 12-102, 5-48, 9-75 HU for 40, 55, 85, 100keV, respectively. For area-based biomarkers, differences ranged 6-15, 3-4, 2-7, 0-5 cm2 for 40, 55, 85, 100keV. For volume-based biomarkers, differences ranged 12-34, 8-68, 12-52, 1-57 cm3 for 40, 55, 85, 100keV. Agatston score behavior was more spurious with median differences ranging 70-204 HU. In general, VMI < 70keV showed more variation in median biomarker measurement than VMI > 70keV. This study characterized the behavior of a fully automated AI CT biomarker toolkit across varying VMI levels obtained with DECT. The data showed relatively little biomarker value change when measured at or greater than 70keV. Lower VMI datasets should be avoided due to larger deviations in measured value as compared to 70keV, a level considered equivalent to conventional 120 kVp exams.

Cardiovascular Disease in Patients with Chronic Kidney Disease: Current Understanding, Preventative Strategies, and Future Directions.

Chronic kidney disease (CKD) presents a significant burden on global health, with cardiovascular disease (CVD) being a leading cause of mortality in this population. Despite advancements in pharmacotherapies, preventing CVD in CKD patients remains challenging due to the intricate interplay of traditional risk factors and novel pathophysiological processes. This review aims to elucidate the current understanding of CVD prevention in CKD, encompassing epidemiology, risk factors, diagnostic considerations, and pharmacological therapeutic strategies. CKD patients exhibit a unique cardiovascular risk profile characterized by traditional risk factors such as hypertension and dyslipidemia, as well as CKD-specific factors including albuminuria, vascular calcification, and valvulopathies. The utility of coronary artery calcium scoring in risk stratification and the efficacy of aspirin, lipid-lowering agents, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists in CVD prevention are discussed. Despite promising findings, challenges such as lack of specific guidelines and data gaps persist, highlighting the need for multidisciplinary efforts to address the CVD burden in the CKD population effectively. Further research is warranted to optimize preventative strategies and improve outcomes in this high-risk population.

Association of diastolic blood pressure and coronary artery calcium in South Asian American adults.

DBP is associated with atherosclerosis and cardiovascular disease, independent of SBP. However, prior evaluation of the association of DBP with coronary artery calcium (CAC) has not included South Asian adults, a population that is at excess risk of atherosclerotic cardiovascular disease. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the association of sex-specific DBP tertiles and CAC score at least 100 with robust Poisson regression adjusted for age, sex, SBP, BP medication use, and other cardiovascular risk factors. We examined these associations stratified by antihypertensive medication use, and secondarily the association of baseline DBP tertile with incident CAC at least 100 over median 4.7 years of follow-up. Among 1155 participants (48% women, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 33% were on antihypertensive medications, and 22% had CAC at least 100. Relative to DBP in tertile 1, DBP in tertiles 2 and 3 was associated with a significantly higher prevalence of CAC at least 100 [adjusted prevalence ratio 1.30 [95% confidence interval (CI) 1.03-1.65] and 1.47 (1.12-1.93), respectively]. These significant associations were primarily observed in participants who were not on antihypertensive medications. Baseline DBP tertile was not associated with incident CAC at least 100. Among South Asian adults in MASALA, DBP in the second or third tertiles vs. tertile 1 were associated with a higher prevalence of CAC at least 100 after adjustment for covariates including SBP. DBP may be an important clinical ASCVD risk factor among South Asian adults.

Rota-Tripsy or step-up-approach rotational atherectomy for severe coronary artery calcification treatment: a comparative effectiveness study

Step-up-approach rotational atherectomy has been widely recognized in the treatment of severe calcified plaques. As an alternative, the rota-tripsy procedure is a novel strategy for the modification of calcification lesions. This study aimed to evaluate and compare the efficacy and safety of rota-tripsy and step-up-approach rotational atherectomy, given the limited clinical data available. Clinical data of 3652 patients with coronary calcification were retrospectively collected from February 2021 to February 2024. The cases were divided into two groups based on the technical approach. The primary efficacy endpoint was procedural success (stent expansion rate > 70% and no hospital major adverse cardiac events [MACEs]). The primary safety endpoint was the absence of serious angiographic complications and 30 days MACEs. A total of 37 patients (38 calcified lesions) screened and included in the study, with 18 cases (19 lesions) in group A and 19 cases in group B. The results showed no significant differences in primary efficacy endpoint. However, group A recorded a lower incidence of angiographic complications (P = 0.02) and shorter dose area product and fluoroscopy/interval times compared with group B (P < 0.01). For management of severe coronary calcification, both rota-tripsy and step-up-approach rotational atherectomy had favorable short-term clinical results; however, rota-tripsy provided improved safety and efficiency.

Prognostic importance of extensive coronary calcium on lung cancer screening chest computed tomography.

Low-dose chest computed tomography (CT) is used for lung cancer screening, but can also detect coronary artery disease as coronary artery calcium. We sought to determine the prevalence and prognostic utility of coronary artery calcium in a population at high risk of cancer. We reviewed CT scans from consecutive participants screened for lung cancer between March 2017 and November 2018 as part of the Ontario Health Lung Cancer Screening Pilot for People at High Risk. We quantified coronary artery calcium using an estimated Agatston score. We identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from The Ottawa Hospital to December 2023. Among 1486 people who underwent screening CT, coronary artery calcium was detected in 1232 (82.9%) and was extensive in 439 (29.5%). On multivariable analysis, extensive coronary artery calcium was associated with the composite primary outcome (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.35-3.38), all-cause death (HR 2.39, 95% CI 1.34-4.27), and cardiovascular events (HR 2.06, 95% CI 1.13-3.77). Extensive coronary artery calcium remained predictive of cardiovascular events after we adjusted for noncardiovascular death as a competing risk (HR 2.05, 95% CI 1.09-3.85). Among people undergoing low-dose chest CT for lung cancer screening, extensive coronary artery calcium was an independent predictor of all-cause death and cardiovascular events, even after adjustment for noncardiovascular death. The opportunity to identify and reduce risks from coronary artery disease may represent an additional benefit of lung cancer screening.

Endothelial cell Ass1 inhibits arteriosclerotic calcification in diabetes mellitus

Endothelial cell (EC) dysfunction is an important pathological feature of early calcification in diabetic plaques. Argininosuccinic synthase 1 (Ass1) is important in protecting EC activity. Therefore, this study aimed to explore the effect of endothelial Ass1 on calcification in diabetic plaques and its potential regulatory mechanism. In this study, serum Ass1 levels were measured in 84 patients, and the study showed that the serum Ass1 level in patients with diabetes was significantly decreased compared with the non-diabetic group, and the serum Ass1 level in patients with coronary artery calcification was significantly decreased compared with the non-coronary artery calcification group. The ApoE-/- mouse diabetic plaque calcification model and the mouse aortic endothelial cell (MAEC) calcification model were constructed, and the influence of endothelial cell Ass1 on diabetic plaque calcification was further investigated by adeno-associated virus and plasmid intervention. Molecular biology studies have shown that endothelial Ass1 overexpression can reduce plaque calcification and inhibit MAEC osteogenic differentiation in diabetic mice, and Ass1 has protective effects on EC and blood vessels in mice. 4D-label-free proteomic sequencing, bioinformatics analysis, and IP experiments were performed on ApoE-/- mouse aorta after adeno-associated virus intervention. It was found that the differential protein Ptk2b was closely related to vascular calcification (VC) and interacted with the target protein Ass1. The above studies indicate that endothelial Ass1 affects calcification formation in diabetic plaques, and the mechanism may be related to Ptk2b. Ass1 may be a new target for the treatment of diabetic VC.

Application of computed tomography angiography imaging in coronary heart disease screening and analysis of associated risk factors.

Coronary heart disease (CHD) remains a leading cause of morbidity and mortality worldwide. Early detection and risk stratification are crucial for effective management. This study evaluates the efficacy of coronary computed tomography angiography (CTA) in CHD screening and analyses its correlation with traditional risk factors in an asymptomatic population. This study focused on 1,000 patients aged 40-80 years who visited two comprehensive tertiary hospitals in the region between January 2020 and December 2022. Patients with a history of coronary revascularisation, arrhythmia or poor image quality were excluded. CTA was used to assess the coronary artery calcium score (CACS), stenosis severity, plaque characteristics and myocardial perfusion and function. These parameters were analysed alongside traditional risk factors (e.g., age, sex, body mass index, blood pressure, glucose and lipid levels, smoking status and family history) using logistic regression to determine their correlation with CHD. This study found a significant correlation between the CACS and CHD severity. CTA results showed that 41.2% of patients had normal results, 28.8% had mild CHD, 20.0% had moderate CHD and 10.0% had severe CHD. Traditional risk factors were independently associated with CHD. Myocardial perfusion and function parameters also correlated significantly with CTA findings, declining progressively with increasing CHD severity. CTA provides a comprehensive assessment of CHD, correlating significantly with traditional risk factors and myocardial functional parameters. Its use in screening could facilitate the early detection and tailored management of CHD in asymptomatic individuals. Further research is warranted to establish its predictive value for long-term cardiovascular outcomes.

Evaluation of reliability and radiation dose reduction in coronary artery calcium scoring by using a low tube current and low kilo-voltage peak with advanced modelled iterative reconstruction

Objective The present study sought to compare the reliability and radiation dose of coronary artery calcium (CAC) scoring using low tube current (16 mAs), low kilo-voltage peak (100 kVp) and advanced modelled iterative reconstruction (ADMIRE 5) with the standard protocol (80 mAs, 120 kVp, ADMIRE 3). Material and methods A prospective single centre study including 200 consecutive patients with suspected coronary artery disease referred for CT coronary angiography was conducted. All 200 patients underwent CAC scoring using the low current-low kVp protocol as well as standard protocol and were subdivided into a derivation and validation cohorts. Results Correlation between CAC scores obtained using low current-low kVp protocol and standard protocol in derivation cohort was excellent (r = 0.99; p < 0.001). A linear regression model was used to derive a formula for predicting CAC that enabled conversion of CAC(low current-low kVp) to CAC(corrected) [CAC(corrected) = 1.067 × CAC(low current-low kVp)]. The formula was applied in validation cohort where CAC (corrected) showed excellent agreement with CAC(standard) (intraclass correlation coefficient, 0.9970; 95%CI, 0.9956–0.9980). Excellent agreement for risk classification (weighted kappa, 0.94379; 95%CI, 0.89629–0.99130) was observed between CAC(corrected) and CAC(standard) scores. The low current-low kVp protocol demonstrated an 88.87% reduction in radiation dose (0.0679 ± 0.01032 mSv vs. 0.610 ± 0.2403 mSv; p < 0.0001). Conclusion The low current-low kVp protocol for CAC scoring has comparable reliability to the standard technique with significant radiation dose reduction. This extremely low-dose protocol may prove useful as an alternative to standard CAC scoring, particularly for screening in the low-to-intermediate risk population.

Exclusion of a Giant Right Coronary Artery Aneurysm with Concomitant Bypass Grafting

Coronary artery aneurysms (CAAs) are defined as a dilation of 1.5 times the diameter of a normal adjacent coronary artery, and CAAs larger than 20 cm are classified as giant. CAAs are typically asymptomatic, but complications can be fatal. There is currently no consensus on treatment, although medical, percutaneous, and surgical options have all been previously described in the literature. Additionally, there is little published video footage of the surgical exclusion of giant coronary artery aneurysms. This report describes the case of a 53-year-old man with a persistent globus sensation who was found to have a 4.5 cm right coronary artery aneurysm with diffuse calcification of the right coronary artery. He underwent exclusion of the aneurysm and coronary artery bypass grafting (radial artery to the right coronary artery and left internal mammary artery to the left anterior descending artery). Due to heavy calcification in the vessel wall, the right coronary artery both proximal and distal to the aneurysm was ligated with a pericardial buttress. The patient had no major adverse events and was discharged six days after surgery. This report includes detailed video footage of the giant coronary artery aneurysm exclusion technique. This case and accompanying video footage will help prepare surgeons to manage adult patients with CAAs and diffuse coronary atherosclerosis.

Abdominal Compared With Coronary Artery Calcification and Incident Cardiovascular Events and Mortality in Black Adults.

Black adults show heightened cardiovascular risk compared with other groups despite comparable or lower coronary artery calcium (CAC) scores, indicating potential cardiovascular risk underestimation by CAC. Abdominal aortic calcification (AAC), preceding CAC, may predict cardiovascular events better in Black adults who are prone to early atherosclerotic cardiovascular disease and excess events at low CAC scores. We included 2551 participants from the JHS (Jackson Heart Study) visit 2 examination (2005-2008) without cardiovascular disease, followed through 2016. Cox regression estimated hazard ratios for incident cardiovascular events defined as a composite of myocardial infarction, stroke, heart failure, and all-cause mortality. The predictive value of CAC and AAC, when added to the American College of Cardiology/American Heart Association cardiovascular risk algorithm (pool cohort equation), was assessed. Mean age was 57±10 years; 66% were women. Over a follow-up period of 12.6 years, 287 (11.3%) cardiovascular events and 360 (14.1%) mortality cases were observed. Adjusting for demographic and clinical variables, each 2-fold increase in CAC and AAC was associated with cardiovascular events (CAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]; AAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]) and all-cause mortality CAC: hazard ratio, 1.04 [95% CI, 1.01-1.08]; AAC: hazard ratio, 1.05 [95% CI, 1.01-1.08]). The incremental value of CAC (0.17 [95% CI, 0.08-0.23]) and AAC (0.15 [95% CI, 0.07-0.29]) to the pool cohort equation by net reclassification index was comparable. Notably, 45% of participants with 0 CAC showed some degree of AAC. Each 2-fold increase in AAC was associated with an increased risk of cardiovascular events (hazard ratio, 1.07 [95% CI, 1.01-1.19]) but not all-cause mortality among participants with 0 CAC. AAC is comparable to CAC in predicting cardiovascular events and all-cause mortality among Black adults, potentially valuable when CAC is absent.

Severe coronary artery calcifications in chronic kidney disease patients, coupled with inflammation and bone mineral disease derangement, promote major adverse cardiovascular events (MACE) through vascular remodeling.

Cardiovascular (CV) diseases persist as the foremost cause of morbidity/mortality among chronic kidney disease (CKD) patients. This paper examines the values of coronary artery calcifications (CAC) and biomarkers of CV on major adverse CV events (MACE)/CV death in a sample of 425 non-dialysis CKD patients. At inclusion, patients underwent chest multidetector computed tomography for CAC scoring and biomarkers of CV risk including CRP, mineral metabolism markers, FGF-23, α-Klotho, osteoprotegerin, TRAP5b, sclerostin, Matrix-Gla-Protein (both dephosphorylated-uncarboxylated and total-uncarboxylated) and GDF-15 were measured. Patients were followed for a median of 3.61 years [25th-75th percentiles=1.92-6.70]. Our results reported that CAC was a major independent factor of MACE/CV mortality showing a hazard ratio of 1.71 95% confidence interval=[1.00-2.93] after adjustment for age, gender, diabetes and history of CV events for patients with CAC>300. Interestingly, CAC effect was further enhanced in the presence of low levels of 25(OH) vitamin D3 or α-Klotho and high levels of iPTH, hsCRP, FGF-23, osteoprotegerin, sclerostin, dp-ucMGP or GDF-15. CAC constitutes a significant CV risk, further exacerbated by inflammation, hyperparathyroidism and regulation of bone molecules implicated in calcification progression. This finding aligns with the original concept of multiple hits. Consequently, addressing the detrimental environment that fosters plaque vulnerability, reducing chronic low-grade inflammation, and normalizing mineral metabolism markers (such as vitamin D and PTH) and bone-regulating molecules may emerge as a viable therapeutic strategy.

Circulating RBP4 and FABP4 concentrations in patients with chronic schizophrenia are associated with increased epicardial adipose tissue volume and metabolic syndrome.

Schizophrenia has been linked to an elevated cardiovascular risk profile and premature onset of cardiovascular disease. Quantifying epicardial adipose tissue (EAT) volume provides insight into its correlation with coronary artery disease (CAD) severity and associated risk factors. Previous research indicates higher pericardial adipose tissue in individuals with schizophrenia compared to non-schizophrenic counterparts. RBP4, FABP3, and FABP4 have been implicated in CAD pathogenesis. In this study, we examined the potential increase in EAT volume in individuals with chronic schizophrenia and aimed to elucidate the relationship between circulating levels of RBP4, FABP3, and FABP4 with EAT volume and coronary artery calcium score within this cohort. We recruited 186 consecutive patients with chronic schizophrenia and utilized enzyme-linked immunosorbent assay to assess plasma concentrations of RBP4, FABP3, and FABP4. Cardiac multislice computed tomography measured EAT volume and coronary artery calcium scores. Significantly higher EAT volume in patients with chronic schizophrenia compared to controls. RBP4 associated positively with metabolic factors and EAT volumes, while FABP3 associated positively with creatinine and coronary atherosclerosis markers. FABP4 showed positive associations with metabolic factors, hypertension, and EAT volumes, but negative associations with HDL-C and eGFR. Logistic regression identified RBP4 and FABP4 as independent factors associated with increased EAT volumes, even after adjusting for known biomarkers. Both RBP4 and FABP4 were significantly associated with metabolic syndrome components and EAT volume. This study elucidates the association between chronic schizophrenia and augmented EAT volume, suggesting plausible correlations with CAD-related health complications through RBP4 and FABP4 pathways.

PET/CT-derived coronary calcium score may predict cardiac complications in anthracycline-treated patients with lymphoma

AbstractAnthracycline-mediated cardiotoxicity is a common concern after lymphoma therapy, particularly in patients with high cardiovascular risk (CVR). In noncancer populations, coronary artery calcium scoring (CACS) effectively identifies individuals who may benefit from aggressive CVR modification to lower the risk of cardiovascular events. Emerging evidence suggests that CACS can also predict cancer therapy-related cardiotoxicity, potentially identifying candidates for cardioprotective strategies. Our study aimed to evaluate whether CACS obtained from pretreatment positron emission tomography (PET)/computed tomography (CT) scans could stratify cardiac event risk in patients with lymphoma receiving anthracycline-based chemotherapy. We enrolled 358 consecutive patients with lymphoma treated between 2012 and 2022, calculating the CACS from their pretreatment PET/CT. We reviewed medical records to identify pre-existing cardiac conditions, CVR, and posttreatment cardiac events, including coronary events, heart failure (HF), and arrhythmias. Logistic and Cox regression models were used to assess associations between CVR, CACS categories (CACS = 0, CACS 1-400, CACS >400), and new cardiac events. At a median follow-up of 27 months (95% confidence interval [CI], 22.3-31.7) in patients without cardiac history, 10% experienced posttreatment cardiac events (HF, 14; arrhythmias, 9; coronary event, 1; combination, 8). Patients with a CACS >0 had more events (21 total, 20% vs 11 total, 5.4% for CACS = 0; P < .001). Elevated CACS was independently associated with HF (CACS 1-400: odds ratio [OR], 3.73; 95% CI, 1.21-11.43; P = .022; CACS >400: OR, 5.43; 95% CI, 1.47-20.03; P = .011) and any cardiac event (CACS 1-400: OR, 2.48; 95% CI, 1.02-6.04; P = .045; CACS >400: OR, 3.28; 95% CI, 0.91-10.68; P = .029). CACS may effectively stratify patients with lymphoma at risk of cardiac complications, thereby identifying a group poised to benefit from targeted preventive strategies.

Association of serum HIF-1α levels with coronary artery calcification in patients of non-dialysis chronic kidney disease

Vascular calcification is the main cause of death in patients with chronic kidney disease (CKD). The study aims to investigate the risk factor affecting coronary artery calcification (CAC), and the relationship between serum hypoxia-inducible factor-1α (HIF-1α) levels and CAC in non-dialysis CKD patients. One hundred and twenty-three patients were selected in the final analysis. Spearman rank correlation analysis assessed the correlation between HIF-1α levels and CAC scores. Logistic regression analysis was utilized to assess potential risk variables associated with CAC. A ROC curve was drawn to analyze the diagnostic value of HIF-1α in non-dialysis CKD patients with CAC. Compared to the non-CAC group, the CAC group was older age, with a higher proportion of males, smokers, hypertension and diabetes, lower eGFR and HDL-C, and higher SBP and HIF-1α levels. As the HIF-1α levels went up, the proportion of patients with VC increased, as well as Agatston scores. Spearman rank correlation analysis showed that HIF-1α levels were positively correlated with VC and Agatston scores. Logistic regression analysis indicated that being male (OR = 0.242, P = 0.036), older age (OR = 1.093, P < 0.001), and increased HIF-1α levels (OR = 1.002, P = 0.025) were risk factors for the occurrence of CAC. Furthermore, ROC curve analysis determined that a HIF-1α cutoff value of 451.177 pg·mL-1 provided the best diagnostic value for non-dialysis CAC, with a sensitivity of 65.8% and a specificity of 80.9%. The prevalence of CAC is high in non-dialysis CKD patients, with old age and male gender being traditional risk factors for CAC occurrence. HIF-1α positively correlate with both CAC and VC, which can provide certain diagnostic values for non-dialysis CAC.

Prognostic value of coronary calcification detected via non-electrocardiogram-gated computed tomography in patients with cardiovascular disease: A retrospective cohort study

BackgroundThe correlation between coronary artery calcification (CAC) detected via electrocardiogram-gated computed tomography (ECG-gated CT) and future cardiovascular events has been well-established. Non-ECG-gated CT is simple and widely used, making it suitable for screening. However, the correlation between CAC observed via non-ECG-gated CT and cardiovascular and non-cardiovascular events remains unclear. Therefore, we examined the association between coronary calcification detected via non-ECG-gated CT and prognosis. MethodsThis non-randomized, retrospective cohort study included 353 consecutive patients with cardiovascular diseases (male/female 229/124; mean age, 68.6 ± 12.7 years) who underwent non-ECG-gated CT between October 1, 2017 and May 31, 2021. Correlations between the Agatston score and cardiovascular and non-cardiovascular events were evaluated. The Agatston scores were divided into three tertiles (low, intermediate, and high) and compared. The primary endpoint was composite cardiovascular events, including cardiac death, myocardial infarction, hospitalization for congestive heart failure, stroke, and unplanned cardiac surgery. The secondary endpoint was composite non-cardiovascular events, including non-cardiovascular death, cancer development, and hospitalization for a non-cardiovascular worsening event. ResultsDuring the median follow-up period of 16.9 (interquartile range, 2.2–38.6) months, 83 patients reached the primary endpoint, while 81 patients reached the secondary endpoint. Kaplan–Meier analysis indicated that patients with high Agatston scores had a significantly higher incidence of cardiovascular and non-cardiovascular events than those with low Agatston scores (p < 0.001). ConclusionsIn this study, the Agatston score obtained using non-ECG-gated CT predicted cardiovascular and non-cardiovascular events. Non-ECG-gated CT can be easily performed, aiding early detection in patients with high event rates.

Longitudinal assessment of serum albumin levels with the risk of coronary artery calcification progression in an asymptomatic population of Korean adults: an observational cohort study

ObjectivesThis study evaluated the association between serum albumin levels and coronary artery calcification (CAC) progression in asymptomatic adults without hypoalbuminaemia at baseline.DesignObservational cohort study.SettingData from the Korea Initiatives on Coronary...