Coronary Artery Calcium Score Groups Research Articles

Prognostic value of coronary artery calcium scoring in patients with non-small cell lung cancer using initial staging computed tomography

BackgroundLung cancer is a leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) comprising 85% of cases. Due to the lack of early clinical signs, metastasis often occurs before diagnosis, impacting treatment and prognosis. Cardiovascular disease (CVD) is a common comorbidity in lung cancer patients, with shared risk factors exacerbating outcomes.MethodsThis study investigates the association between coronary artery calcium (CAC) scores, major adverse cardiovascular events (MACE), and survival outcomes in NSCLC patients, utilizing positron emission tomography-computed tomography (PET-CT) for CAC scoring. A retrospective cohort study of 154 NSCLC patients (mean age 66.3 years, 52% women) at the University of Utah (2005–2022) was conducted. Baseline PET-CT or CT imaging was used to quantify CAC scores, categorized into five risk levels. Cox proportional hazards and logistic regression analyses assessed the impact of CAC scores on survival and cardiovascular events, adjusting for confounders such as age, gender, and smoking status.ResultsHigher CAC scores were significantly associated with increased MACE, acute myocardial infarction (MI), and poorer overall survival. The severe risk CAC score group had significantly lower survival (p = 0.022). Logistic regression revealed a strong association between higher CAC scores and MI incidence (moderate: OR = 13.8, severe: OR = 21.2) and MACE (severe: OR = 10.2). Smoking history was a significant predictor of overall survival (p = 0.006).ConclusionCAC scoring via PET-CT provides valuable prognostic insights in NSCLC patients, highlighting the need for integrated cardiovascular risk management in this population. Further research and advanced technologies like machine learning could enhance CAC scoring application in clinical practice.Trial registrationRetrospectively registered.

The Impact of the Coronary Artery Calcium Score on the Clinical Outcomes in Patients with Acute Myocardial Infarction.

Background: It is essential to identify the risk factors for poor clinical outcomes in patients with acute myocardial infarction (AMI). The coronary artery calcium score (CACS) is gathering attention as a predictor for future cardiovascular events. This study aimed to (1) measure CACSs in patients with AMI by non-ECG-gated computed tomography (CT), (2) compare clinical outcomes between patients with a high CACS and a low-intermediate CACS and (3) to elucidate the association between high CACS and clinical outcomes. Methods: We defined the high CACS group as the highest quantile of CACS (Q4) and defined the low-intermediate CACS group as the other quantiles of CACS (Q1-Q3). The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, non-fatal MI and target vessel revascularization. We included 548 patients with AMI who underwent non-ECG-gated CT and divided them into the high CACS group (CACS ≥ 5346.5, n = 137) and the low-intermediate CACS group (CACS ≤ 5329.3, n = 411). Results: During the median follow-up duration of 535 days, 150 MACE were observed. The Kaplan-Meier curves showed that MACE occurred more frequently in the high CACS group than in the low-intermediate CACS group (p < 0.001). Multivariable Cox hazard analysis revealed that a high CACS was significantly associated with MACE (hazard ratio 1.597, 95% confidence interval 1.081-2.358, p = 0.019) after controlling for multiple confounding factors. Conclusions: Clinical outcomes were worse in AMI patients with a high CACS than in those with a low-intermediate CACS. A high CACS was significantly associated with MACE in multivariate analysis.

(053) ASSOCIATIONS BETWEEN CORONARY ARTERY CALCIUM SCORES AND ERECTILE DYSFUNCTION PRESENT: INITIAL RESULTS FROM MONTAGE DATA POOL

Abstract Introduction Erectile dysfunction (ED) is a multifactorial condition impacting adult men and is associated with an increased risk of cardiovascular disease (CVD). Existing studies have identified shared risk factors among ED and CVD including hypertension, diabetes, dyslipidemia, obesity, aging, and smoking. Furthermore, literature suggests a bidirectional predictive relationship between CVD and ED, even when controlling for confounding factors. In accordance with the updated Princeton IV guidelines, which recommend coronary artery calcium (CAC) score testing in low-risk men with vasculogenic ED, our study sought to investigate the link between CAC scores and the prevalence of ED within historical cohorts. Objective This study aims to evaluate the association between CAC scores and ED diagnosis and treatment. Methods Using Montage software, data were collected from 108 men who underwent CAC score evaluation at a tertiary referral center between January to March 2019. Retrospective chart reviews were conducted to identify patients with ED pre- and post CAC score. Based on validated cut-offs for CVD risk, patients were divided into three groups for analysis: low-risk (CAC score 0), moderate-risk (CAC score 1-100) and high-risk (CAC score &amp;gt; 100). Multivariate logistic regression was performed using JMP17. Results Of the 108 patients, 103 had complete data available for evaluation (mean age (±SD): 54 years (±11)). 71% were White, 4% were Asian, 3% were African American and only 4% were Hispanic or Latino. Across the three CAC score groups, 45 patients (44%) were low-risk, 32 (31%) moderate-risk, and 26 (25%) high-risk. Mean age (±SD) was 47 (±10), 55 (±8), and 63 (±8) years, respectively. The prevalence of ED was 18% in low-risk, 28% in moderate-risk, and 58% in high-risk groups. 32 patients had ED – 69% had ED prior to CAC testing and remainder developing after CAC, with a median time lapse of 981 days (SD ± 507) between CAC and diagnosis. Factors such as CAD, HTN, and alcohol use were more prevalent in patients with ED (p = 0.023, p = 0.009, and p = 0.044, respectively), while smoking, BMI, and diabetes did not show significant differences. On univariate analysis, the likelihood of ED was found to be significantly higher in men with high-risk CAC scores (OR = 6.31, p = 0.001). However, on multivariate analysis, the effect of high-risk CAC score on likelihood of ED was not significant (OR 2.82, p = 0.123) while age remained a significant predictor (OR 1.06, p = 0.048). Conclusions In a predominantly white patient cohort, CAC score &amp;gt; 100 was strongly correlated with ED; however, on multi-variate analysis much of this associated was explained by the older age of the high-risk cohort. Given the small sample size of this preliminary analysis, future efforts are ongoing to access and study a larger historical cohort. Deepening our understanding of the relationship between CAC and ED could enhance cardiovascular risk management and has the potential to improve efforts to help men engage in preventative care. Disclosure No.

A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score.

The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS). We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95% CI 0.87-0.92) vs. 0.32 (95% CI 0.28-0.36); per-vessel, 0.92 (95% CI 0.89-0.94) vs. 0.66 (95% CI 0.62-0.7); both p < 0.001), CACS ≥ 100 (per-patient, 0.86 (95% CI 0.82-0.88) vs. 0.44 (95% CI 0.4-0.48); per-vessel, 0.88 (95% CI 0.85-0.9) vs. 0.51 (95% CI 0.46-0.55); both p < 0.001), and CACS < 400 (per-patient, 0.9 (95% CI 0.87-0.93) vs. 0.74 (95% CI 0.7-0.78), p < 0.001; per-vessel, 0.8 (95% CI 0.76-0.83) vs. 0.74 (95% CI 0.7-0.78); p = 0.02)). CT-FFR demonstrates superior diagnostic performance in low CACS groups (CACS < 400) than CCTA in detecting hemodynamic stenoses in patients with coronary artery disease (CAD). Computed tomography-derived fractional flow reserve might be utilized to determine the necessity of invasive coronary angiography in coronary artery disease patients with coronary artery calcium score < 400. • There is a lack of meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of calcification. • Computed tomography-derived fractional flow reserve only has a better diagnostic performance than coronary computed tomography angiography with low amounts of coronary calcium. • For the low coronary artery calcium score group, computed tomography-derived fractional flow reserve might be a good non-invasive method to detect hemodynamic stenoses in coronary artery disease patients.

Visual Ordinal Coronary Artery Calcium Score from Non-Gated Chest CT Predicts Mortality After Severe Chronic Obstructive Pulmonary Disease Exacerbation.

Chronic obstructive pulmonary disease (COPD) patients often undergo chest CT for various indications. Coronary artery calcium (CAC) can be quantified visually on ungated chest CT using an ordinal score that has been shown to correlate well with traditional Agatston CAC scoring. The prognostic role of CAC was studied mainly in stable COPD patients. We aim to study the association between ordinal CAC and mortality amongst patients admitted for acute exacerbation of COPD (AECOPD). Retrospective study of AECOPD cases with no previous coronary revascularization admitted between 1st January 2016 to 30th June 2017 with a chest CT performed during admission or within 365 days prior. Ordinal CAC scoring (scale of 0-12) was performed by an experienced CT cardiologist blinded to patient data and outcomes. Patient demographics and future clinical events were retrieved from electronic medical records. There were 93 patients included (87.1% male, mean age 75 years) with the majority (59.1%) in GOLD Stage III. There were 21 (22.6%) patients with no CAC as well as 39 (41.9%) and 33 (35.5%) with ordinal CAC of 1-3 and 4-12, respectively. There were no significant differences in Charlson Comorbidity Index (CCI) and the proportion of patients with traditional cardiovascular risk factors (namely hypertension, dyslipidaemia, diabetes and smoking status) between the ordinal CAC score groups. Over a median follow-up period of 2.9 (1.1-3.9) years, there were 51 (54.8%) deaths. An ordinal CAC score of 4-12 was the only significant predictor of mortality after multivariate Cox-regression analysis adjustment for age, gender, body mass index, prior exacerbations, FEV1, cardiovascular risk factors and CCI [HR 3.944, (95% confidence interval 1.647-9.433, p = 0.002)]. Ordinal CAC measured from a current or recent ungated chest CT is an independent predictor of all-cause mortality in admitted AECOPD patients with no previous coronary revascularization.

Is coronary artery calcium an independent risk factor for white matter hyperintensity?

BackgroundCardiovascular diseases have been considered the primary cause of disability and death worldwide. Coronary artery calcium (CAC) is an important indicator of the severity of coronary atherosclerosis. This study is aimed to investigate the relationship between CAC and white matter hyperintensity (WMH) in the context of diagnostic utility.MethodsA retrospective analysis was conducted on 342 patients with a diagnosis of WMH on magnetic resonance images (MRI) who also underwent chest computed tomography (CT) scans. WMH volumes were automatically measured using a lesion prediction algorithm. Subjects were divided into four groups based on the CAC score obtained from chest CT scans. A multilevel mixed-effects linear regression model considering conventional vascular risk factors assessed the association between total WMH volume and CAC score.ResultsOverall, participants with coronary artery calcium (CAC score > 0) had larger WMH volumes than those without calcium (CAC score = 0), and WMH volumes were statistically different between the four CAC score groups, with increasing CAC scores, the volume of WMH significantly increased. In the linear regression model 1 of the high CAC score group, for every 1% increase in CAC score, the WMH volume increases by 2.96%. After including other covariates in model 2 and model 3, the β coefficient in the high CAC group remains higher than in the low and medium CAC score groups.ConclusionIn elderly adults, the presence and severity of CAC is related to an increase in WMH volume. Our findings suggest an association between two different vascular bed diseases in addition to traditional vascular risk factors, possibly indicating a comorbid mechanism.

High Coronary Artery Calcium Score Is Associated With Increased Major Adverse Cardiac Events After Liver Transplantation.

Patients who underwent LT between January 2010 and June 2019 with a pretransplant CAC score were included in this study. Patients were divided by CAC score into 4 groups (CAC score 0, CAC score 1-100, CAC score 101-400, CAC score >400). Major adverse cardiovascular events (MACEs) were defined as myocardial infarction, stroke, revascularization, heart failure, atrial fibrillation, and cardiovascular death. Associations between CAC score and MACE or all-cause mortality within the 5-y post-LT follow-up period were analyzed using Cox regression. Statistical significance was defined as P < 0.05. During the study period, 773 adult patients underwent their first LT, and 227 patients met our study criteria. The median follow-up time was 3.4 (interquartile range 1.9, 5.3) y. After 5 y, death occurred in 47 patients (20.7%) and MACE in 47 patients (20.7%). In multivariable analysis, there was no difference in death between CAC score groups. There was significantly higher risk of MACE in the CAC score >400 group, with a hazard ratio 2.58 (95% confidence interval 1.05, 6.29). CAC score was not associated with all-cause mortality. Patients with CAC score >400 had an increase in MACEs within the 5-y follow-up period compared with patients with a CAC score = 0. Further research with larger cohorts is needed to examine cardiac risk stratification in this vulnerable patient population.

PS-C15-3: CORRELATIONS BETWEEN CORONARY ARTERY DISEASE, CORONARY ARTERY CALCIUM SCORE, AND LIPOPROTEIN(A) LEVEL IN KOREA

Background: Lipoprotein(a) levels are associated with coronary artery disease (CAD) and aortic valve calcification. This study aimed to determine the correlation between Lp(a) levels and coronary artery calcium (CAC) scores in patients who underwent coronary computed tomography angiography (CCTA). Methods: This was a single-center observational study. The patients had not been previously diagnosed with CAD and underwent CCTA and Lp(a) measurement within a three-month interval. Coronary angiography and further management were performed according to the physicians decision. Among 252 patients, 81 and 171 patients underwent coronary revascularization and received medical treatment, respectively. To examine the relationship between Lp(a) and CAC score and between Lp(a) and CAD, we divided the patients by Lp(a) level (50 mg/dL) and CAC score (400). Results: No relationship was observed between Lp(a) and CAD and other risk factors for that. There were no differences in the ratio of patients who underwent coronary revascularization and the CAC score according to an Lp(a) level of 50 ml/dL. There was no difference in Lp(a) level at a CAC level of 400. The proportion of patients who underwent coronary intervention was high in the high CAC score group (50.6% vs. 23.7%, p = 0.000). No association was observed between Lp(a) and CAC in the Pearson correlation (0.000, p &lt; 0.998). Conclusion: Correlations between Lp(a) and CAC and between Lp(a) and CAD were not observed in Korean patients. However, a high CAC score was correlated with coronary revascularization.

The association between cardiovascular risk factors and coronary CT angiography findings for predicting obstructive coronary artery disease in Korean patients with stable chest pain

Abstract Background/Introduction The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Purpose The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS). Methods The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient. Results Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p&amp;lt;0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively). Conclusion This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain. Funding Acknowledgement Type of funding sources: None.

Correlations Between Coronary Artery Disease, Coronary Artery Calcium Score, and Lipoprotein(a) Level in Korea.

BackgroundLipoprotein(a) (Lp(a)) levels are associated with coronary artery disease (CAD) and aortic valve calcification. This study aimed to determine the correlation between Lp(a) levels and coronary artery calcium (CAC) scores in patients who underwent coronary computed tomography angiography (CCTA).MethodsThis was a single-center observational study. The patients had not been previously diagnosed with CAD and underwent CCTA and Lp(a) measurement in a three-month timeframe. Coronary angiography and further management were performed according to the physician’s decision. Of the 252 patients, 81 and 171 patients underwent coronary revascularization and received medical treatment only, respectively. To examine the relationship between Lp(a) and CAC score and between Lp(a) and CAD, we divided the patients by Lp(a) level (50 mg/dL) and CAC score (400).ResultsNo relationship was observed between Lp(a) and CAD or other risk factors for CAD. There were no differences in the ratio of patients who underwent coronary revascularization or in the CAC score according to an Lp(a) level of 50 mg/dL. There was no difference in Lp(a) level at a CAC score of 400. The proportion of patients who underwent coronary revascularization was high in the high CAC score group (50.6% vs 23.7%, p = 0.000). No association was observed between Lp(a) level and CAC score in the Spearman correlation (0.000, p < 0.998).ConclusionCorrelations between Lp(a) level and CAC score and between Lp(a) and CAD were not observed in this Korean cohort study. However, a high CAC score was correlated with coronary revascularization.

A Simple Approach to the Identification of Guideline-Based Coronary Artery Calcium Score Percentiles (From the Multi-Ethnic Study of Atherosclerosis)

Absolute coronary artery calcium (CAC) scores and CAC percentiles can identify different patient groups, which could be confusing in clinical practice. We aimed to create a simple "rule of thumb" for identifying the American College of Cardiology/American Heart Association endorsed 75th CAC percentile based on age, gender, and the absolute CAC score. Using the Multi-Ethnic Study of Atherosclerosis, we calculated the age and gender-specific percent likelihood that a guideline-based absolute CAC score group (1 to 100, 100 to 300, &gt;300) will place a patient above the 75th percentile. Also, we derived gender-specific age cutoffs by which 95% of participants with any (&gt;0), moderate (≥100), or severe (≥300) CAC score would be over the 75th percentile. We repeated the analysis using the 90th percentile threshold and also conducted sensitivity analyses stratified by race. Any CAC &gt;0 places 95% of women younger than 60 years and over 90% of men younger than 50 years over the 75th percentile. Moderate absolute CAC scores (&gt;100) place nearly all men &lt;60 years and all women &lt;70 years over the 75th percentile. Confirmatory analysis for age cutoffs was consistent with primary analysis, with cutoffs of 48 years for men and 59 years for women indicating a 95% likelihood that any CAC would place patients over the 75th percentile. In conclusion, our study provides a simple rule of thumb (men &lt;50 years and women &lt;60 years with any CAC, men &lt;60 years and women &lt;70 years with CAC &gt;100) for identifying CAC &gt;75th percentile that might be readily adopted in clinical practice.

Abstract 10256: Presence, but Not Severity, of Coronary Artery Calcium Predicts Covid-19 Mortality

Introduction: Coronary artery calcium score (CACS) is a known predictor of cardiac events, however its association with inpatient mortality in COVID-19 infection remains unknown. Hypothesis: We hypothesized that elevated CACS is associated with increased mortality in inpatient patients with COVID-19. Methods: Inpatients with COVID-19 between March and May, 2020 at a single center were identified. All patients had a non-contrast chest CT during admission, and CACS and Multi-Ethnic Study of Atherosclerosis (MESA) percentile were retrospectively measured. Patients were grouped in quartiles: no CACS (0 AU), mild CACS (1-99 AU), moderate CACS (100-399 AU), and severe ( &gt; 400 AU). Inpatient mortality was compared between groups using logistic regression adjusted for age and troponin level. Results: One hundred thirty-nine patients were included with 107 (80%) surviving to discharge. Eighty-two patients self-identified as black or African American (59%) and 66 were female sex at birth (47%). The mean CACS for the survivors was 319 AU and 406 AU for non-survivors (p = 0.02). The mean MESA percentile for survivors and non-survivors was 41% and 60%, respectively (p = 0.03). Fifty-nine patients had no CACS, 19 had mild CACS, 28 had moderate CACS, and 33 had severe CACS. Fifty-three of the no CACS group survived (89%), 13 of the mild group survived (68%), 17 of the moderate group survived (60%), and 24 of the severe group survived (73%). After adjustment for age and troponin level, CACS &gt; 0 AU versus those with CACS of 0 AU had 4-fold higher odds of mortality (OR 4.0, 95%CI 1.3 - 12, p= 0.02). However, there was no significant increased odds of death within higher quartiles of CACS (OR 1.4, 95%CI 1.0 - 2.1, p=0.08). Conclusion: The presence of coronary artery calcium positively correlates with inpatient COVID-19 mortality, even after accounting for age and myocardial injury. Severity of CACS, however, is not associated with mortality.

Association of coronary artery calcium score groups with qualitative and quantitatively assessed adverse plaque

Abstract Introduction Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes on coronary computed tomography (CT) angiography (CCTA) is unknown. Methods In this post-hoc analysis, CT images and clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1 to 9AU), low (10 to 99AU), moderate (100 to 399AU), high (400 to 999AU) and very high (≥1000AU). Adverse plaques were investigated with qualitative (visual categorisation of positive remodelling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation and total plaque burden) methods. Results Images of 1769 patients were assessed (mean age 58±9 years, 56% male, median Agatston score 21 [interquartile range 0 to 230] AU). Of these 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high and 8% very high CACS. Amongst patients with a zero CACS, 14% had nonobstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques and 13% had quantitative low-attenuation plaque (LAP) burden &amp;gt;4% (Figure 1). Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal and low CACS (p&amp;lt;0.001), but there was no difference between those with medium, high and very high CACS. Over a median follow-up of 4.8 [4.1 to 5.7] years, fatal or non-fatal myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS ≥1000AU (Hazard ratio (HR) 4.55 [1.20 to 17.3], p=0.026) and low-attenuation plaque burden (HR 1.74 [1.19 to 2.54], p=0.004) were the only predictors of myocardial infarction, independent of obstructive disease and cardiovascular risk score. Figure 2 shows example CCTA images in a patient with zero CACS, non-calcified plaque (red), low attenuation plaque (orange) burden &amp;gt;4% and obstructive disease in the left anterior descending coronary artery. Conclusions In patients with stable chest pain, a zero CACS is associated with a good prognosis, but 1 in 6 have coronary artery disease, including the presence of adverse plaques. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute

CORONARY ARTERY CALCIUM SCORE AND HOME BLOOD PRESSURE VARIABILITY IN A MIDDLE-AGED SAMPLE OF THE SWEDISH POPULATION

Objective: The aim of this study was to explore associations between coronary artery calcium (CAC) score and home blood pressure variability (HBPV) in a Swedish population sample. Design and method: In this cross-sectional study, we analysed data from a Swedish population-based cohort (n = 5057). We included all participants (n = 4262) who as part of the baseline examination had undergone a CAC scoring, and who also during a seven-day period had performed systolic home blood pressure measurements thirteen times (each in triplicate). Mean home systolic blood pressure (HSBP) was calculated, and its standard deviation (SD) and coefficient of variation (CV = 100 X SD / HSBP) were used as measures of HBPV. Participants were divided in four groups: group 1 had CAC score zero (n = 2578), group 2 had CAC score 1–99 (n = 1180), group 3 had CAC score 100–399 (n = 352) and group 4 had CAC score &gt; = 400 (n = 152). One-way analysis of variance was used to test for statistically significant between-group differences. Post-hoc pairwise comparisons were adjusted for multiple comparisons as described by Bonferroni. Results: Overall, there were significant associations between CAC score groups and SD, CV and HSBP, (P &lt; 0.001 for all comparisons). Average SD in group 1 (7.0 ± 2.4 mmHg) was significantly lower than in group 2 (7.3 ± 2.6 mmHg), group 3 (8.1 ± 3.0 mmHg) and group 4 (8.4 ± 3.3 mmHg), P for pairwise comparisons: 0.006, &lt;0.001 and &lt;0.001, respectively. Average CV in group 1 (5.9 ± 1.9) was not significantly different from group 2 (6.0 ± 2.0, P = 1.00) but was significantly lower than in group 3 (6.3 ± 2.1, P = 0.005) and group 4 (6.5 ± 2.4, P = 0.003). Average HSBP in group 1 (117.9 ± 13.6 mmHg) was significantly lower than in group 2 (122.6 ± 13.0 mmHg), group 3 (127.3 ± 12.5) and group 4 (129.1 ± 12.2 mmHg), P for all pairwise comparisons &lt;0.001. Conclusions: In this middle-aged sample of the Swedish population, CAC score was modestly but significantly associated with HBPV. The prognostic performance of HBPV remains to be determined in this cohort.

Abstract 17236: Coronary Artery Calcification Scoring Stratifies Risk of Sudden Cardiac Death: The CAC Consortium

Introduction: Sudden cardiac death (SCD) commonly presents as the initial manifestation of coronary heart disease in the general population. Coronary artery calcium (CAC), a sub-clinical marker of atherosclerosis, is a strong predictor of cardiovascular events. We assessed the ability of CAC to stratify risk of SCD. Methods: We studied 66,636 adults from the CAC Consortium, a large multi-center cohort of asymptomatic patients free of clinical CVD at baseline. We categorized participants into 4 CAC score groups—CAC=0, CAC 1-99, CAC 100-399, and CAC≥400. The primary outcome was defined by identifying accepted International Classification of Diseases codes for SCD on official death certificates obtained for all deaths from the National Death Index. Predictive value of CAC for SCD was assessed using Cox proportional hazards regression models adjusted for age, sex and traditional risk factors. We performed standard area under receiver operating curve (AUC) analyses from fully adjusted logistic regression models, with and without CAC. All analyses were also repeated among participants aged 45-75 years. Results: Mean age of the study population was 54.4 years, and 33% were females and 89% were Whites. Over a mean follow up of 12.3±3.9 years, there were 211 SCD events. Participants with CAC=0 had lower absolute SCD rates compared to those with CAC≥400 (0.05 vs 1.28 per 1000 person-years, respectively). Increasing CAC scores (reference CAC=0) were associated with increasing SCD risk [CAC 100-399: HR (95% CI) 2.8(1.6-5.0), CAC≥400: 4.3(2.4-7.7)]. Addition of CAC to the fully adjusted model (vs without CAC) improved AUC for SCD among the whole study population (0.88 vs 0.86, P &lt;0.001) and more so among 45-75 year-olds (0.82 vs 0.76, P &lt;0.001). Conclusions: We demonstrate the predictive value of CAC for SCD. CAC could be a cost-effective risk-stratification tool that can be used to help identify individuals at high risk of SCD who could undergo additional screening and management.

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).

The Future of Concurrent Automated Coronary Artery Calcium Scoring on Screening Low-Dose Computed Tomography.

Low-dose computed tomography (LDCT) has been extensively validated for lung cancer screening in selected patient populations. Additionally, the use of gated cardiac CT to assess coronary artery calcium (CAC) burden has been validated to determine a patient's risk for major cardiovascular adverse events. This is typically performed by calculating an Agatston score based on density and overall burden of calcified plaque within the coronary arteries. Patients that qualify for LDCT for lung cancer screening commonly share major risk factors for coronary artery disease and would frequently benefit from an additional gated cardiac CT for the assessment of CAC. Given the widespread use of LDCT for lung cancer screening, we evaluated current literature regarding the use of non-gated chest CT, specifically LDCT, for the detection and grading of coronary artery calcifications. Additionally, given the evolving and increasing use of artificial intelligence (AI) in the interpretation of radiologic studies, current literature for the use of AI in CAC assessment was reviewed. We reviewed primary scientific literature dating up to April 2020 using Pubmed and Google Scholar, with the search terms low dose CT, lung cancer screening, coronary artery calcium, EKG/cardiac gated CT, deep learning, machine learning, and AI. These publications were then independently evaluated by each member of our team. Overall, there was a consensus within these papers that LDCT for lung cancer screening plays a role in the evaluation of CAC. Most studies note the inherent problems with the evaluation of the density of coronary calcifications on LDCT to give an accurate numeric calcium or Agatston score. The current method of evaluating CAC on LDCT involves using a qualitative categorical system (none, mild, moderate, or severe). When performed by cardiac imaging experts, this method broadly correlates with traditional CAC score groups (0, 1 to 100, 101 to 400, and > 400). Furthermore, given the high sensitivity of a properly protocolled LDCT for coronary calcium, a negative study for CAC precludes the need for a dedicated gated CT assessment. However, qualitative methods are not as accurate or reproducible when performed by general radiologists. The implementation of AI in the LDCT screening process has the potential to give a quantifiable and reproducible numeric value to the calcium score, based on whole heart volume scoring of calcium. This more closely aligns with the Agatston score and serves as a better guide for treatment and risk assessment using current guidelines.We conclude that CAC should be assessed on all LDCT performed for lung cancer screening and that a qualitative categorical scoring system should be provided in the impression for each patient. Early studies involving AI for the assessment of CAC are promising, but more extensive studies are needed before a final recommendation for its use can be given. The implementation of an accurate, automated AI CAC assessment tool would improve radiologist compliance and ease of overall workflow. Ultimately, the potential end result would be improved turnaround time, better patient outcomes, and reduced healthcare costs by maximizing preventative care in this high-risk population.

Sex Differences in the Association Between Bone Mineral Density and Coronary Artery Disease in Patients Referred for Cardiac Computed Tomography

Atherosclerosis and osteoporosis are both common and preventable diseases. Evidence supports a link between coronary artery disease (CAD) and low bone mineral density (BMD). This study aimed to assess the association between thoracic spine BMD and CAD in men and women with symptoms suggestive of CAD.This cross-sectional study included 1487 (mean age 57 years (range 40-80), 47% men) patients referred for cardiac computed tomography (CT). Agatston coronary artery calcium score (CACS), CAD severity (no, mild, moderate, and severe), vessel involvement (no, 1-, 2-, and 3/left main disease), and invasive measurements were evaluated. BMD of three thoracic vertebrae was measured using quantitative CT. We used the American college of radiology cut-off values for lumbar spine BMD to categorize patients into very low (<80 mg/cm3), low (80-120 mg/cm3), or normal BMD (>120 mg/cm3). BMD as a continuous variable was included in the linear regression analyses to assess associations between CACS (CACS=0, CACS 1- 399, and CACS ≥ 400) and BMD, and CAD severity and BMD.Significant lower BMD was present with increasing CACS and stenosis degree unadjusted. Multivariate linear regression analyses in women revealed a significant correlation between BMD and CACS groups (β = −4.06, p<0.05), but no correlation between BMD and CAD severity (β = −1.59, p = 0.14). No association was found between BMD and CACS (β = −1.50, p = 0.36) and CAD severity (β = 0.07, p = 0.94) in men.BMD is significantly correlated to CACS after adjusting for confounders in women, but not in men, suggesting a possible sex difference in pathophysiology.

Characteristics of Intracranial Aneurysms According to Levels of Coronary Artery Calcium.

Background and Purpose- Several vascular risk factors are known to be associated with the occurrence of intracranial aneurysms (IAs). Coronary artery calcium (CAC), which reflects the atherosclerotic burden of the coronary arteries, is a known predictor of cardiovascular events and stroke. We investigated the relationship between IA and CAC. Methods- We retrospectively enrolled Korean subjects at a single university hospital who had both brain magnetic resonance angiography and cardiac computed tomography as part of health examinations from January 2010 to July 2017. Subjects were categorized into 4 groups according to CAC score as assessed by cardiac computed tomography: zero (0), low (1-99), intermediate (100-399), or high (≥400). Then, the prevalence of IA in each CAC score group was assessed. We also performed subgroup analysis by age, sex, and location of IA. Results- A total of 4934 subjects (mean age, 54.1±9.8 years; %women, 42.2%) were included for analysis. IAs were detected in 258 subjects (5.23%). The prevalence of IA significantly increased as the CAC score increased (4.8%, 5.4%, 6.4%, and 11.1%, respectively; P for trend, 0.004). In subjects over the age of 50 years, this correlation was more prominent in women than in men (7.1% versus 3.7%, 8.8% versus 4.4%, 8.6% versus 6.3%, and 21.1% versus 10.0%, respectively). Subgroup analysis for the aneurysm location showed that nonbifurcation aneurysm was associated with a high CAC score but bifurcation aneurysm was not. Multivariate logistic regression showed high CAC score was an independent risk factor for the presence of IA compared with zero CAC score (adjusted odds ratio, 2.16; 95% CI, 1.18-3.95). Conclusions- A high CAC score was associated with the presence of IA. This relationship was more prominent in females and nonbifurcation aneurysms.

Coronary calcium score influences referral for invasive coronary angiography after normal myocardial perfusion SPECT

BackgroundIn patients with normal SPECT but persistent complaints, invasive angiography may exclude obstructive coronary disease. We assessed whether high coronary artery calcium (CAC) scores are associated with increased referral for invasive angiography following normal SPECT. Methods and results2286 consecutive patients (mean age 60 ± 12, 39% male) with normal SPECT were assessed. All patients underwent simultaneous CAC scoring. Patients were categorized into four groups based on their CAC score: CAC = 0 (n = 694), CAC 1 to 100 (n = 891), CAC 101 to 400 (n = 368), and CAC >400 (n = 333). The decision to perform angiography was left to the discretion of treating physician. Follow-up angiography was confined to the first 60 days after SPECT. Occurrence of MACE (late revascularization, myocardial infarction or death) was recorded. Overall, 100 patients (4.4%) underwent early angiography with increasing rates in higher CAC score groups (1.0%, 2.6%, 8.4%, and 11.7%), respectively, P < .001). A CAC score >400 (OR 3.56, 95% CI 2.19 to 5.77, P < .001) was independently associated with referral to angiography. Similarly, CAC score >400 was an independent predictor for MACE (HR 9.26, 95% CI 5.06 to 16.93). Early angiography did not influence prognosis (HR 1.57, 95% CI 0.91 to 2.73). ConclusionsCAC scoring impacts clinical decision-making and increases referral rates for invasive angiography after normal SPECT.