Coronary Artery Calcified Plaque Research Articles

Type 2 diabetes mellitus aggravates coronary atherosclerosis in hypertensive individuals based on coronary CT angiography: a retrospective propensity score-based study.

The effect of type 2 diabetes mellitus (T2DM) on coronary atherosclerosis detected on coronary computed tomography angiography (CCTA) in hypertensive patients has attracted increasing attention. This study investigated the relationships of T2DM with coronary artery plaque characteristics and semiquantitative CCTA scores in hypertensive patients. In this single-center study, 1,700 hypertensive patients, including 850 T2DM [HT(T2DM+)] and 850 non-T2DM [HT(T2DM-)] individuals, were retrospectively analyzed after propensity matching. Plaque type, extent, coronary stenosis, segment involvement score (SIS), segment stenosis score (SSS), and CT-based Leaman score (CT-LeSc) based on CCTA were assessed and compared between the two groups. HT(T2DM+) patients had more coronary segments with calcified plaque (2.08 ± 2.20 vs. 1.40 ± 1.91), mixed plaque (2.90 ± 2.87 vs. 2.50 ± 2.66), nonobstructive stenosis (4.23 ± 2.44 vs. 3.62 ± 2.42), and obstructive stenosis (1.22 ± 2.18 vs. 0.78 ± 1.51), a lower proportion of 1-vessel disease (15.3% vs. 25.5%), a higher proportion of 3-vessel disease (59.6% vs. 46.7%), and higher SIS (5.5 ± 3.1 vs. 4.4 ± 3.0), SSS (10.3 ± 8.5 vs. 7.7 ± 7.1), and CT-LeSc (9.4 ± 5.6 vs. 7.9 ± 5.2) than HT(T2DM-) patients (all P-values <0.05). Multivariable analysis revealed that T2DM was an independent risk factor for calcified plaque [odds ratio (OR) = 2.213], obstructive coronary artery disease (CAD) (OR = 1.271), multivessel disease (OR = 1.838), SIS > 4 (OR = 1.910), SSS > 6 (OR = 1.718), and CT-LeSc > 5 (OR = 1.584) in hypertension population (all P-values <0.05). T2DM was independently associated with the presence of calcified coronary artery plaque and increased the risk of obstructive CAD, multivessel disease, and CT-LeSc > 5 in hypertensive patients. More attention should be given to the assessment and management for coronary atherosclerosis in hypertensive patients with T2DM, as this population may have a higher risk of cardiovascular events.

Virtual calcium removal in calcified coronary arteries with photon-counting detector CT-first in-vivo experience.

To evaluate the feasibility and accuracy of quantification of calcified coronary stenoses using virtual non-calcium (VNCa) images in coronary CT angiography (CCTA) with photon-counting detector (PCD) CT compared with quantitative coronary angiography (QCA). This retrospective, institutional-review board approved study included consecutive patients with calcified coronary artery plaques undergoing CCTA with PCD-CT and invasive coronary angiography between July and December 2022. Virtual monoenergetic images (VMI) and VNCa images were reconstructed. Diameter stenoses were quantified on VMI and VNCa images by two readers. 3D-QCA served as the standard of reference. Measurements were compared using Bland-Altman analyses, Wilcoxon tests, and intraclass correlation coefficients (ICC). Thirty patients [mean age, 64 years ± 8 (standard deviation); 26 men] with 81 coronary stenoses from calcified plaques were included. Ten of the 81 stenoses (12%) had to be excluded because of erroneous plaque subtraction on VNCa images. Median diameter stenosis determined on 3D-QCA was 22% (interquartile range, 11%-35%; total range, 4%-88%). As compared with 3D-QCA, VMI overestimated diameter stenoses (mean differences -10%, p < .001, ICC: .87 and -7%, p < .001, ICC: .84 for reader 1 and 2, respectively), whereas VNCa images showed similar diameter stenoses (mean differences 0%, p = .68, ICC: .94 and 1%, p = .07, ICC: .93 for reader 1 and 2, respectively). First experience in mainly minimal to moderate stenoses suggests that virtual calcium removal in CCTA with PCD-CT, when feasible, has the potential to improve the quantification of calcified stenoses.

Long-axial field-of-view PET/CT for the assessment of inflammation in calcified coronary artery plaques with [68 Ga]Ga-DOTA-TOC

PurposeInflamed, prone-to-rupture coronary plaques are an important cause of myocardial infarction and their early identification is crucial. Atherosclerotic plaques are characterized by overexpression of the type-2 somatostatin receptor (SST2) in activated macrophages. SST2 ligand imaging (e.g. with [68 Ga]Ga-DOTA-TOC) has shown promise in detecting and quantifying the inflammatory activity within atherosclerotic plaques. However, the sensitivity of standard axial field of view (SAFOV) PET scanners may be suboptimal for imaging coronary arteries. Long-axial field of view (LAFOV) PET/CT scanners may help overcome this limitation. We aim to assess the ability of [68 Ga]Ga-DOTA-TOC LAFOV-PET/CT in detecting calcified, SST2 overexpressing coronary artery plaques.MethodsIn this retrospective study, 108 oncological patients underwent [68 Ga]Ga-DOTA-TOC PET/CT on a LAFOV system. [68 Ga]Ga-DOTA-TOC uptake and calcifications in the coronary arteries were evaluated visually and semi-quantitatively. Data on patients’ cardiac risk factors and coronary artery calcium score were also collected. Patients were followed up for 21.5 ± 3.4 months.ResultsA total of 66 patients (61.1%) presented with calcified coronary artery plaques. Of these, 32 patients had increased [68 Ga]Ga-DOTA-TOC uptake in at least one coronary vessel (TBR: 1.65 ± 0.53). Patients with single-vessel calcifications showed statistically significantly lower uptake (SUVmax 1.10 ± 0.28) compared to patients with two- (SUVmax 1.31 ± 0.29, p < 0.01) or three-vessel calcifications (SUVmax 1.24 ± 0.33, p < 0.01). There was a correlation between coronary artery calcium score (CACS) and [68 Ga]Ga-DOTA-TOC uptake, especially in the LAD (p = 0.02). Stroke and all-cause death occurred more frequently in patients with increased [68 Ga]Ga-DOTA-TOC uptake (15.63% vs. 0%; p:0.001 and 21.88% vs. 6.58%; p: 0.04, respectively) during the follow-up period.Conclusion[68 Ga]Ga-DOTA-TOC as a marker for the macrophage activity can reveal unknown cases of inflamed calcified coronary artery plaques using a LAFOV PET system. [68 Ga]Ga-DOTA-TOC uptake increased with the degree of calcification and correlated with higher risk of stroke and all-cause death. [68 Ga]Ga-DOTA-TOC LAFOV PET/CT may be useful to assess patients’ cardiovascular risk.

Effects of coronary artery calcified plaque and stent on severity and survival of COVID-19 patients: a decision tree model study.

We aimed to investigate the relationship between the presence of calcified plaques and stents in coronary arteries as evaluated by the chest computed tomography severity score (CT-SS) and mortality rates in patients with COVID-19. A single-center retrospective analysis was conducted of 492 patients (≥18 yrs) who were hospitalized between March and June 2020. All included patients had RT-PCR tests positive for COVID-19. A radiologist recorded pulmonary imaging findings and the presence of coronary calcified plaque and / or stent, sternotomy wires, and cardiac valve replacement on initial non-contrast chest CT. Also, cardiothoracic ratios (CTR) were calculated on chest CTs. Data were analyzed using univariate and multivariate analyses and a chi-squared automatic interaction detection (CHAID) tree analysis, which was developed as a predictive model for survival of COVID-19 patients according to chest CT findings. The mean CT-SS value of the patients with coronary plaque was 11.88±7.88, and a significant relationship was found between CT-SS with coronary calcified plaque (p&lt;0.001). No statistical difference was found between CT-SS and coronary stent (p=0.296). In multivariate analysis, older age was associated with 1.69‑fold (p&lt; 0.001), the presence of coronary calcified plaque 1.943‑fold (p=0.034) and higher CT-SS 1.038‑fold (p=0.042) higher risk of mortality. In the CHAID tree analysis, the highest mortality rate was seen in patients with coronary plaque and CTR&gt;0.57. The presence of coronary artery calcified plaque and cardiomegaly were high risks for severe prognosis and mortality in COVID-19 patients and may help to predict the survival of patients.

One-step integrated coronary–carotid–cerebral computed tomography angiography to evaluate cardiovascular and cerebrovascular atherosclerosis

PurposeThis study aims to develop a low-radiation dose, one-step integrated coronary–carotid–cerebral computed tomography angiography (ICCC-CTA) technique to analyze the relationship between cardiovascular and cerebrovascular atherosclerosis and evaluate the risk factors of plaque to provide an early-stage treatment to patients and reduce vascular events.MethodsA total of 300 consecutive asymptomatic patients with cardiovascular risk factors who underwent ICCC-CTA were enrolled in this prospective study. The association between coronary and carotid-cerebrovascular atherosclerosis was assessed. The primary cardiovascular risk factors for various plaque types in cardiovascular or cerebrovascular disease were evaluated using multivariate analysis.ResultsAmong 300 patients, 189 (63%) had plaques in their coronary and cerebral arteries. The presence of calcified and mixed plaques in the carotid-cerebral and coronary arteries was strongly correlated (χ2 = 20.71, P = 0.001; χ2 = 8.96, P = 0.003, respectively). Multivariate logistic regression analysis revealed that abnormal blood glucose [OR = 1.44, 95% CI 0.12–0.62, P = 0.01] and abnormal total cholesterol [OR = 1.28, 95% CI 0.07–0.46, P = 0.01] are risk factors in all the models in the coronary artery, non-calcified plaque group. Abnormal blood glucose [OR = 1.43, 95% CI 0.11–0.61, P = 0.01] and abnormal systolic blood pressure [OR = 1.02, 95% CI 0.01–0.04, P = 0.02] are risk factors in all the models in the coronary artery calcified plaque group. Abnormal blood glucose level [OR = 1.44, 95% CI = 0.12–0.62, P = 0.01] was only a risk factor in the non-calcified plaque carotid–cerebral artery group.ConclusionsWe confirm that elevated blood glucose and total cholesterol levels are associated with coronary and carotid-cerebrovascular plaques using the novel one-step low dose cerebral-carotid-cardiac CTA technique. These findings will provide insights for further studies focusing on developing low-radiation dose one-step ICCC-CTA to screen cardiovascular/cerebrovascular plaques in general population with cardiovascular risk factors.Advances in knowledgeWe developed a low–radiation dose, one-step ICCC-CTA technique to detect cardiovascular and cerebrovascular atherosclerosis. We evaluated the risk factors for plaque burden for the early treatment and reduction of vascular events. These findings supported the development of low–radiation dose one-step ICCC-CTA to screen for cardiovascular/cerebrovascular disease in general population with cardiovascular risk factors.

LPE-Unet: An Improved UNet Network Based on Perceptual Enhancement

In Computed Tomography (CT) images of the coronary arteries, the segmentation of calcified plaques is extremely important for the examination, diagnosis, and treatment of coronary heart disease. However, one characteristic of the lesion is that it has a small size, which brings two difficulties. One is the class imbalance when computing loss function and the other is that small-scale targets are prone to losing details in the continuous downsampling process, and the blurred boundary makes the segmentation accuracy less satisfactory. Therefore, the segmentation of calcified plaques is a very challenging task. To address the above problems, in this paper, we design a framework named LPE-UNet, which adopts an encoder–decoder structure similar to UNet. The framework includes two powerful modules named the low-rank perception enhancement module and the noise filtering module. The low-rank perception enhancement module extracts multi-scale context features by increasing the receptive field size to aid target detection and then uses an attention mechanism to filter out redundant features. The noise filtering module suppresses noise interference in shallow features to high-level features in the process of multi-scale feature fusion. It computes a pixel-wise weight map of low-level features and filters out useless and harmful information. To alleviate the problem of class imbalance caused by small-sized lesions, we use a weighted cross-entropy loss function and Dice loss to perform mixed supervised training on the network. The proposed method was evaluated on the calcified plaque segmentation dataset, achieving a high F1 score of 0.941, IoU of 0.895, and Dice of 0.944. This result verifies the effectiveness and superiority of our approach for accurately segmenting calcified plaques. As there is currently no authoritative publicly available calcified plaque segmentation dataset, we have constructed a new dataset for coronary artery calcified plaque segmentation (Calcified Plaque Segmentation Dataset, CPS Dataset).

Sodium Chloride Physiological Saline Solution Versus Water Preparations Injectable in the Use of Shockwave Intravascular Lithotripsy: A Single-Center Experience

Shockwave intravascular lithotripsy (IVL) coronary system is a very useful new technology for de novo severely calcified coronary artery plaques before percutaneous coronary intervention (PCI). The device uses a semi-compliant low-pressure balloon, integrated into a sterile catheter, to deliver by vaporizing fluid an expanding bubble that generates high-pressure ultrasonic energy by waves that create multiplane longitudinal micro-macro fractures in calcified plaques, which facilitate optimal stent placement and expansion, and luminal gain. The use of Shockwave IVL coronary system in our cardiac catheterization laboratory (Cath lab) at the "Clinique Saint-Hilaire" in Rouen, France, started in March 2019, with 42 procedures performed since this date: two patients in 2019, two patients in 2020, seven patients in 2021, 23 patients in 2022, and eight patients since the beginning of 2023. We had experienced problems at the beginning of our activity for the first 11 patients (two patients in 2019, two patients in 2020, and seven patients in 2021): after less than five pulses, the shock therapy stopped. We used initially for Shockwave IVL semi-compliant low-pressure integrated balloons a mixture of 50% contrast and 50% water preparations injectable (PPI). After changing water PPI by sodium chloride physiological saline solution, we never encountered this problem again for the following 31 patients (23 patients in 2022, and eight patients since the beginning of 2023). In fact, the proper functioning of Shockwave IVL system requires ions in balloon mixture in addition to the contrast. It is thanks to the ions contained in sodium chloride physiological saline solution that the spark necessary for shocks delivery after balloon inflation is produced. Water PPI or sodium chloride physiological saline solution is used in angioplasty balloons in a lot of Cath labs worldwide. It is therefore essential to disseminate in the worldwide Cath lab the obligation to put in Shockwave IVL semi-compliant low-pressure integrated balloons sodium chloride physiological saline solution, rather than water PPI for optimal performance, and the importance of Shockwave Medical reporting this to interventional cardiologists.

Electroplating a miniature diamond wheel for grinding of the calcified plaque inside arteries

A miniature grinding wheel (0.85mm diameter) was fabricated by nickel (Ni)-diamond electroplating on a thin (0.65mm outer diameter) flexible hollow stainless steel drive shaft to remove the calcified plaque in coronary and peripheral arteries by atherectomy procedure. To coat electrically nonconductive diamond grits, the drive shaft was submerged in a pile of diamond grit during Ni electroplating. The electroplating current density and temperature were investigated for better surface finishing and Faraday efficiency. The electroplating time to obtain the designed coating thickness was modeled based on Faraday's law of electrolysis and the geometry of drive shaft, wheel, and diamond grit. To validate the miniature wheel performance in atherectomy, grinding experiments were conducted on an atherectomy cardiovascular simulator with a calcified plaque surrogate. The wheel motion, material removal rate, and wheel surface wear were studied via high-speed camera imaging and laser confocal microscopy. The grinding wheel with 80,000rpm rotational speed had an orbital speed of 14,300rpm around the 1.5mm diameter plaque surrogate lumen. After grinding for 120s, the plaque surrogate inner diameter was enlarged to 3.03mm, and no wear or loss of diamond abrasive was observed on the grinding wheel. This study demonstrated that the proposed electroplating process for fabricating miniature grinding wheels could effectively remove the calcified plaque surrogate. This research could lead to a more effective and safer atherectomy device with sub-mm miniature diamond wheels to treat lesions deep in coronary and peripheral arteries.

Abstract 15552: Optimal Virtual Monoenergetic Settings in Spectral Ct With a Dual Layer Detector: Breakthrough in Achieving Best Contrast Between Non Calcified and Calcified Plaques and Lumen in Coronary Arteries

Introduction: Non calcified plaque (NCP) in coronary arteries on CT is correlated with occurrence of acute coronary syndromes and coronary artery calcification (CAC) may occasionally be co-existed. CAC induces a blooming artifact, which magnifies the calcification versus its actual size. The CT values of NCP and CAC are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using a new spectral CT, we can determine the optimal VMS settings for achieving best contrast between NCP, CAC and the lumen in coronary arteries. Methods: We performed enhanced 128 slice Spectral CT 7500 scans using a dual-layer detector in 42 patients with NCP and CAC on CT (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of NCP and CAC, lumen in left main artery (LMA), and fat tissue around coronary arteries within a 1.0 mm2 circle in the axial images at each keV in early phase with a contrast. Results: Lower keV values were linked to only slightly increased mean CT values of NCP, but markedly increased mean CT values of CAC. The CT values of the lumen in the LMA were markedly increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between NCP and the LMA were observed at 40 keV. However, considering blooming artifact of CAC at 40 keV, the optimal keV for achieving the best contrast between the CT values of NCP and the lumen in the LMA was influenced by age, male sex. Conclusions: The NCP in coronary arteries, CAC, lumen of the LMA, and fat tissue exhibit unique characteristics. When conventional CT rather than spectral CT is used to evaluate the occurrence of NCP, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient, CAC, and lumen of the LMA.

Predicting coronary artery calcified plaques using perivascular fat CT radiomics features and clinical risk factors

ObjectiveThe purpose of this study was to develop a combined radiomics model to predict coronary plaque texture using perivascular fat CT radiomics features combined with clinical risk factors.MethodsThe data of 200 patients with coronary plaques were retrospectively analyzed and randomly divided into a training group and a validation group at a ratio of 7:3. In the training group, The best feature set was selected by using the maximum correlation minimum redundancy method and the least absolute shrinkage and selection operator. Radiomics models were built based on different machine learning algorithms. The clinical risk factors were then screened using univariate logistic regression analysis. and finally a combined radiomics model was developed using multivariate logistic regression analysis to combine the best performing radiomics model with clinical risk factors and validated in the validation group. The efficacy of the model was assessed by a receiver operating characteristic curve, the consistency of the nomogram was assessed using calibration curves, and the clinical usefulness of the nomogram was assessed using decision curve analysis.ResultsTwelve radiomics features were used by different machine learning algorithms to construct the radiomics model. Finally, the random forest algorithm built the best radiomics model in terms of efficacy, and this was combined with age to construct a combined radiomics model. The area under curve for the training and validation group were 0.98 (95% confidence interval, 0.95–1.00) and 0.97 (95% confidence interval, 0.92–1.00) with sensitivities of 0.92 and 0.86 and specificities of 0.99 and 1, respectively. The calibration curve demonstrated that the nomogram had good consistency, and the decision curve analysis demonstrated that the nomogram had high clinical utility.ConclusionsThe combined radiomics model established based on CT radiomics features and clinical risk factors has high value in predicting coronary artery calcified plaque and can provide a reference for clinical decision-making.

Density of Calcified Coronary Artery Plaque and Risk of Incident Atrial Fibrillation (from the Multiethnic Study of Atherosclerosis)

Elevated coronary artery calcium (CAC) score, as assessed by the Agatston method, is associated with incident atrial fibrillation (AF). We aimed to evaluate the associations of CAC volume and density with incident AF. Participants from the Multiethnic Study of Atherosclerosis without baseline AF and CAC &amp;amp;gt;0 were included. The associations between baseline and progression (average annual change) of CAC measures and incident AF were evaluated using Cox proportional hazards models. CAC volume and Agatston scores were natural log (ln)-transformed, and hazard ratios (HRs) were calculated per standard deviation increment. The baseline analysis included 3,332 participants; 2,643 were included in the progression analysis. In multivariable models adjusted for cardiovascular risk factors, volume (HR 1.24, 95% confidence interval [CI] 1.14 to 1.36), density (HR 1.14, 95% CI 1.05 to 1.25), and Agatston score (HR 1.24, 95% CI 1.14 to 1.35) were associated with increased risk of incident AF. In models including both volume and density, the magnitude of association between volume and incident AF was unchanged, whereas the density association was eliminated (HR 0.99, 95% CI 0.89 to 1.11). Median time to follow-up CAC assessment was 1.9 (interquartile range 1.3, 3.0) years. Similar results were observed for the association of incident AF with annual change in volume and Agatston score. CAC volume, but not density, is associated with risk for incident AF when adjusting for both. In conclusion, our findings suggest that, although CAC may be a risk marker for AF, the association between CAC and AF appears to be independent of plaque density.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Guidelines for the Prevention of Symptomatic Cardiovascular Disease, Based upon the Presence of Coronary Artery Calcified Plaque—Provided by the Society for the Prevention of Symptomatic Heart Disease

Introduction: The epidemic of atherosclerotic cardiovascular disease in the Western World accounts for the majority of morbidity and mortality in adults. This disease is on the increase, and previous recommendations using “risk equations” to prescribe preventive treatment have not been successful in reducing the prevalence of cardiovascular disease. Furthermore, compliance with statin medication has been limited, with approximately 50% of individuals being non-compliant within five years. This situation is unacceptable since atherosclerosis is both preventable and reversible. Methods: The guidelines presented in this article utilize coronary artery calcium scanning as the basis for preventative therapeutic decisions and identifying the presence of asymptomatic cardiovascular disease. This radiographic technique is superior to “risk equations” in predicting future cardiovascular events. It provides a comprehensive assessment of the lifelong insults to the coronary artery vascular endothelium and the resulting inflammation. Coronary artery calcium scanning is widely available, inexpensive, safe, and reproducible. It has the major advantage of increasing treatment compliance in patients with positive coronary artery calcium scores. Results: All suggested guidelines are supported by published scientific data. Citations are provided to allow the reader to obtain further information. The authors are available for further consultation. Each guideline provides specific recommendations that the primary caregiver can discuss with the patient. Patient involvement in decision-making is strongly recommended. Both treatment costs and adverse effects are minimal. Conclusion: It is anticipated that the early identification of asymptomatic cardiovascular disease and its aggressive treatment will result in regression of subclinical atherosclerosis. Adoption of these guidelines will stop the epidemic of symptomatic heart disease and result in healthier and more satisfied patients.

Intravascular Lithotripsy in Calcified Subclavian and Innominate Peripheral Artery Disease: A Single-Centre Experience

BackgroundIntravascular lithotripsy (IVL) is a novel tool for the treatment of calcified vascular stenosis. Recently, IVL has been successfully used for modification of calcified plaque in coronary and lower extremity peripheral arteries with promising results. However, experience in subclavian and innominate peripheral arterial disease is limited. This study aims to report our initial experience of IVL use in calcified subclavian and innominate vasculature. MethodsThis was a retrospective review of all the cases of IVL performed in subclavian and innominate arteries at the Miriam Hospital, Providence, between January 2019 and May 2020. Data on the baseline and procedural characteristics were collected. The primary endpoint was procedural success defined as residual stenosis of <20% after stenting. Other endpoints of interest were; 1) procedural complications, including dissections, perforations, abrupt closure, slow or no-reflow, thrombosis, and distal embolization; 2) in-hospital major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, or stroke/transient ischemic attack. ResultsA total of 7 patients with 13 lesions undergoing IVL were included. Of these, 5 (71%) were women, the mean age was 74.6 ± 12.9, and the mean BMI was 25.1 ± 6.7. IVL was successfully delivered to all the target lesions with a mean 252.9 ± 54.4 pulses delivered per patient. Procedural success was achieved in 100% of the treated lesions. No procedure-related complications or in-hospital MACE occurred in any of the patients. ConclusionsIn this single-center retrospective analysis, IVL facilitated acute procedural success without any procedural complications in severely calcified stenoses of the subclavian and innominate vasculature. Larger studies with an active comparator and longer follow-up are needed to establish the relative efficacy and safety of IVL use in this vascular bed.

Higher levels of serum phosphorus are associated with coronary calcification post heart transplantation

Abstract Background A higher serum phosphorus level, although within the normal range has been linked to coronary artery and aortic calcification in the non-transplant population. Coronary calcification is mostly associated with donor-derived lesions, and is uncommon within the first years after heart transplantation. Purpose We aimed to investigate the association of phosphorus levels with plaque calcification after heart transplantation. Methods A total of 156 patients who underwent virtual histology intravascular ultrasound (VH-IVUS) studies for cardiac allograft vasculopathy (CAV) surveillance and had fasting serum phosphorus levels &amp;lt;4.5 mg/dL, were included in the analyses. IVUS analyses were performed in the proximal left anterior descending artery, and plaque composition of dense calcium (DC) was evaluated using VH-IVUS, and presented as percent DC of total plaque volume. The patients were separated into 3 groups according to tertiles of serum phosphorus levels. Results Mean recipient and donor ages were 54±13 and 31±14 years, respectively. Mean serum phosphorus in recipients was 3.5±0.6 mg/dL, with median time after transplantation at the IVUS studies of 6 (3,10) years. There were no significant differences in %DC between phosphorus tertiles in patients who underwent IVUS within 6 years after transplantation (p=0.11, Fig. 1A). However, beyond 6 years after transplantation, we observed an incremental association between phosphorus levels and the extent of calcification (p=0.02, Fig. 1B). In this group, serum phosphorus levels significantly correlated with %DC (standardized β=0.29, P=0.008), and this correlation remained significant after adjustment for donor age, recipient age, and eGFR (standardized β=0.26, P=0.001). Conclusion Higher serum phosphorus levels were associated with a level-dependent increase in calcified coronary artery plaque in patients starting 6 years post heart transplant. Long-term exposure to higher serum phosphorus, even within the normal range, might promote plaque calcification after heart transplantation. Funding Acknowledgement Type of funding sources: None.

Medical Prior Knowledge Guided Automatic Detection of Coronary Arteries Calcified Plaque with Cardiac CT

Calcified plaque in coronary arteries is one major cause and prediction of future coronary artery disease risk. Therefore, the detection of calcified plaque in coronary arteries is exceptionally significant in clinical for slowing coronary artery disease progression. At present, the Convolutional Neural Network (CNN) is exceedingly popular in natural images’ object detection field. Therefore, CNN in the object detection field of medical images also has a wide range of applications. However, many current calcified plaque detection methods in medical images are based on improving the CNN model algorithm, not on the characteristics of medical images. In response, we propose an automatic calcified plaque detection method in non-contrast-enhanced cardiac CT by adding medical prior knowledge. The training data merging with medical prior knowledge through data augmentation makes the object detection algorithm achieve a better detection result. In terms of algorithm, we employ a deep learning tool knows as Faster R-CNN in our method for locating calcified plaque in coronary arteries. To reduce the generation of redundant anchor boxes, Region Proposal Networks is replaced with guided anchoring. Experimental results show that the proposed method achieved a decent detection performance.

The Influence of Calcification Factors and Endothelial-Dysfunction Factors on the Development of Unstable Atherosclerotic Plaques.

Background: This study aimed to evaluate changes in markers of calcification and of endothelial dysfunction during the development of calcification and instability of atherosclerotic plaques and to identify associations of calcification factors with the formation of unstable plaques. Methods: We analyzed 44 male patients with coronary atherosclerosis who underwent endarterectomy in coronary arteries during coronary bypass surgery. The endarterectomy material (intima/media) was examined using histological and biochemical methods, and the stability and calcification degree of atherosclerotic plaques were assessed. In homogenates of the tissue samples and in blood, concentrations of osteoprotegerin, osteocalcin, osteopontin, osteonectin, monocyte-chemoattractant protein type 1 (MCP-1), soluble vascular cell adhesion molecule 1 (sVCAM-1), and E-selectin were determined by enzyme immunoassays. Results: Unstable atherosclerotic plaques proved to be calcified more frequently (80.4% of plaques) than stable ones (45.0%). Osteonectin, E-selectin, and sVCAM-1 levels were lower in unstable plaques and plaques with large calcification deposits. Osteocalcin content increased with the increasing size of the calcification deposits in plaque. Blood osteocalcin concentration directly correlated with osteocalcin concentration in atherosclerotic plaques and was higher in the blood of patients with calcified plaques in coronary arteries. Conclusions: The results provide the basis for further research on the suitability of osteocalcin as a potential biomarker of an unstable calcified atherosclerotic plaque in a coronary artery.

Early Detection of Coronary Artery Disease by Micro-RNA Analysis in Asymptomatic Patients Stratified by Coronary CT Angiography.

Early detection of asymptomatic coronary artery disease (CAD) is essential but underdeveloped. The aim of this study was to assess micro-RNA (miRNA) expression profiles in patients with or without CAD as selected by coronary CT angiography (CTA) and stratified by risk of CAD as determined by Framingham Risk Score (FRS). In this pilot study, patients were divided into two groups based on the presence or absence of CAD. Disease status was determined by Coronary CTA by identification of atherosclerosis and/or calcified plaque in coronary arteries. There were 16 control subjects and 16 subjects with documented CAD. Groups were then subdivided based on FRS. Pathway-specific microarray profiling of 86 genes using miRNAs isolated from whole peripheral blood was analyzed. MiRNA were differentially expressed in patients with and without CAD and who were stratified on the basis of FRS with miRNA associated with endothelial function, cardiomyocyte protection and inflammatory response (hsa-miR-17-5p, hsa-miR-21-5p, hsa-miR-210-3p, hsa-miR-29b-3p, hsa-miR-7-5p and hsa-miR-99a-5p) consistently upregulated by greater than twofold in groups with CAD. The present study reveals that miRNA expression patterns in whole blood as selected on the basis of coronary CTA and risk scores vary significantly depending on the subject phenotype. Thus, profiling miRNA may improve early detection of CAD.

S0983 Coronary Artery Calcium Score and All-Cause Mortality in Liver Transplant Recipients: A Retrospective Analysis

INTRODUCTION: Cardiovascular disease is a major cause of death after liver transplantation. Pre-transplant cardiac risk stratification generally involves pharmacologic stress testing, as well as coronary artery angiography in high-risk patients. Coronary artery calcium (CAC) score is a non-invasive estimation of total calcified plaque in coronary arteries. CAC score has been shown to be associated with 1-month post-transplant mortality; however, it has not been studied as a predictor of long-term outcomes in liver transplant recipients. METHODS: We retrospectively studied patients who underwent liver transplantation at Johns Hopkins Hospital between 1/1/2015 and 12/31/2018 who had a pre-transplant CAC score measured. Patients were divided into 3 groups: CAC score 0 (group 1), CAC score 1–400 (group 2) and CAC score >400 (group 3). All-cause mortality in the 3 groups was compared using Kaplan-Meier curves and the log-rank test, with statistical significance defined as P < 0.05. RESULTS: A total of 412 adult patients underwent liver transplantation, of which 155 patients had a CAC score measured as part of pre-transplant cardiovascular evaluation. CAC group 1, 2, and 3 and 37, 82, and 36 patients, respectively. The median age was 60, median body mass index (BMI) was 28.6, and median model for end-stage liver disease (MELD) score was 19, with no significant difference between groups (Table 1). The cohort was 38.1% female, with significantly lower proportion of females in higher CAC score groups (P = 004). At 1 year, death occurred in 3 (8.1%), 7 (8.5%) and 2 (5.6%) patients in groups 1, 2, and 3, respectively (Table 2). At 2 years, there were 5 (15.2%), 12 (16.9%), and 6 (20.7%) deaths in the three groups, respectively. At 3 years, there were 6 (23.1%), 13 (24.5%), and 8 (32.0%) deaths in the 3 groups, respectively. There was no significant difference in all-cause mortality between CAC score groups (Figure 1). CONCLUSION: CAC score may be useful in cardiac risk stratification prior to liver transplantation. In this study, there was no significant difference in 1-, 2-, or 3-year all-cause mortality between CAC score groups. However, there was a non-significant trend towards increased all-cause mortality with higher calcium scores at 2 and 3 years of follow up. Further research is needed with a larger sample size and examination of cardiac risk factors to better evaluate the prognostic utility of CAC score in this population.Table 1.: Baseline characteristics by coronary artery calcium score groups. Continuous variables in this table were assumed to be skewed in the population, thus nonparametric k-test for equality of medians was used to compare medians between groups. Fisher’s exact test was used to compare categorical variables. a. body mass index (BMI) b. model for end-stage liver disease (MELD) c. coronary artery calcium (CAC)Table 2.: All-cause mortality at 1, 2, and 3 years after liver transplant, stratified by coronary artery calcium score groups. a. coronary artery calcium (CAC)Figure 1.: Three-year Kaplan-Meier survival curves stratified by coronary artery calcium score groups. No significant difference between groups (P = 0.71). Abbreviations: coronary artery calcium (CAC).

SHOCKWAVE INTRAVASCULAR LITHOTRIPSY IN THE MANAGEMENT OF CALCIFIED CORONARY ARTERY STENOSIS

A severely calcified coronary artery plaque is among the numerous challenges encountered in Percutaneous Coronary Intervention (PCI). Calcified plaques limit stent expansion, disrupt the polymers that coat drug-eluting stents, and increase the likelihood of restenosis. To overcome this, a technique