Coronary artery calcium clinical utilization: An update.

Progress in risk assessment and management: Forecasting updates across international cholesterol guidelines.

Impact of using the 2024 ESC guideline-recommended method to estimate the likelihood of obstructive coronary disease - a cardiac CT study.

Lung cancer screening (LCS) with low-dose CT offers a teachable moment for smoking cessation (SC), but the optimal way to implement SC within LCS is unclear. The Yorkshire Enhanced Stop Smoking (YESS) study assessed the efficacy of a personalised stop-smoking intervention delivered alongside LCS. Opt-out, co-located SC support, comprising nicotine replacement therapy/e-cigarettes/pharmacotherapy and behavioural support, was offered to all individuals who currently smoked attending for LCS. Four weeks later, participants were offered recruitment to a randomised controlled trial of continued standard best practice (SBP) versus a personalised SC support package, including a booklet containing CT images of participants' own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification and scripted communication delivered by a smoking cessation practitioner. 1003 people were recruited; 52.5% were allocated to the intervention group. Validated 7-day point prevalent (PP) abstinence rates were 33.6% and 30.0% in the intervention versus SBP groups, respectively (OR 1.17, 95% CI 0.90 to 1.54) at 3 months and 29.2% versus 28.6% (OR 1.03, 95% CI 0.78 to 1.36) at 12 months post-screening. Subgroup analyses indicated a significant increase in 7-day PP abstinence at 3 months with the intervention in women (33.9% intervention, 23.1% SBP, OR 1.70, 95% CI 1.15 to 2.53) but not in men (33.3% intervention, 37.8% SBP, OR 0.82, 95% CI 0.57 to 1.19). Around one-third of study participants were abstinent from smoking at 3 months post-screening irrespective of study arm, but adding the personalised intervention did not increase quit rates. Further research is needed exploring possible sex differences in efficacy of personalised SC support. The high overall quit rate reinforces the value of SC support delivered alongside LCS. ISRCRN 63825779 and NCT03750110.

Low-dose computed tomography (LDCT) lung cancer screening is recognized as a "teachable moment" for smoking cessation. However, evidence of its impact on smoking behavior is inconsistent, with limited research on incidental smoking-related findings, such as coronary artery calcification (CAC) or emphysema, and on sustained abstinence among former smokers. We comprehensively evaluated the effects of LDCT findings and physician counseling on smoking behaviors in both current and former smokers. A retrospective cohort study was conducted on 763 individuals who underwent national lung cancer screening at the Korean National Cancer Center between 2019 and 2021. Smoking status was assessed at a 2-year follow-up. Multivariable logistic regression was used to assess the association of CT findings and physician counseling with smoking cessation initiation (current smokers) and abstinence maintenance (former smokers). Among current smokers, higher Lung Imaging Reporting and Data System (Lung-RADS) categories (aOR = 18.84), moderate-to-severe CAC (aOR = 2.18), and emphysema (aOR = 1.95) were significantly associated with increased odds of quitting. Similarly, these findings significantly predicted sustained abstinence in former smokers, with CAC showing a particularly strong effect (aOR = 5.30). Physician counseling independently increased the odds of cessation in current smokers (odds ratio = 2.04) and abstinence maintenance in former smokers (odds ratio = 5.38). The effect of counseling did not significantly differ by the severity of low-dose computed tomography (LDCT) findings. Incidental smoking-related LDCT findings, particularly CAC and emphysema, are potent predictors of smoking behavior change. Physician counseling further enhances cessation outcomes, underscoring the value of integrating comprehensive counseling based on all relevant radiological findings into screening protocols. This study demonstrates that incidental smoking-related Low-dose computed tomography findings, such as coronary artery calcification and emphysema, strongly influence both smoking cessation in current smokers and sustained abstinence in former smokers, independent of malignant findings. Physician counseling significantly enhances these behavioral changes regardless of CT result severity. By highlighting the additive value of integrating structured smoking cessation counseling with interpretation of all salient radiological findings, the results support expanding lung cancer screening programs beyond cancer detection to serve as effective interventions for tobacco control, ultimately improving long-term health outcomes.

Atherosclerosis is a chronic inflammatory, immune-mediated disease that is a leading cause of global mortality and disability. Coronary artery calcification (CAC) is a key predictor of the severity of coronary artery disease (CAD). Interleukin-38 (IL-38), a newly identified anti-inflammatory cytokine, may modulate inflammation and prevent atherosclerosis progression. This study aimed to evaluate the association between serum IL-38 levels and CAC severity among patients referred to the CT angiography unit at Razieh Firooz Hospital in Kerman City. In this cross-sectional study, 151 patients aged 50-70 years were evaluated. The mean age of the participants was 60.1 ± 6.9 years. CAC severity was determined using the Agatston scoring method and multi-detector CT scanners. Serum IL-38 levels were measured via enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed using an independent T-test and multivariable logistic regression. Comparing serum IL-38 levels across CAC severity categories showed a statistically significant difference (P = 0.039). Mean serum IL-38 in patients with non-severe and severe calcification were 16.8 ± 5.5 pg/mL and 19.4 ± 4.9 pg/mL, respectively. However, in the multivariable regression analysis, adjusted for major risk factors including sex, age, diabetes, hypertension, and smoking, the association between serum IL-38 levels and CAC severity was not significant (P>0.05). In subgroup analyses, the significant association between IL-38 and CAC severity was observed only in older participants and in patients with established cardiovascular risk factors. Although serum IL-38 levels were higher in patients with severe CAC, this association did not remain significant after adjustment for major cardiovascular risk factors. Therefore, the observed elevation may reflect age- or risk-related inflammatory changes rather than a direct role of IL-38 in calcification. So, this relationship remains unclear. Further investigation is needed to clarify the potential context-dependent function of IL-38 in atherosclerosis progression.

Abdominal arterial calcification is a well-established predictor of cardiovascular events and mortality in kidney failure. Autosomal dominant polycystic kidney disease (ADPKD), a common genetic cause of kidney failure, presents with a distinct vascular profile. However, the burden of abdominal arterial calcification in ADPKD remains inadequately characterized. Clarifying these differences may improve cardiovascular risk stratification and transplant timing. We conducted a retrospective cohort study of 4088 adult patients listed for kidney transplant at three Mayo Clinic sites (2005-2024). Patients were categorized by kidney failure cause: ADPKD vs. non-ADPKD. Abdominal arterial calcification was quantified on non-contrast computed tomography (CT) scans using a modified Agatston scoring method. Propensity score matching (1:1) adjusted for age, sex, race, lipid levels, left ventricular ejection fraction, dialysis exposure, coronary artery disease, neurovascular disease, and smoking history, was performed. Abdominal arterial calcification scores were compared between matched groups, and subgroup analyses evaluated abdominal arterial calcification severity across dialysis durations in ADPKD patients. After matching, 309 patients with ADPKD were compared with 309 non-ADPKD chronic kidney disease (CKD) controls. Abdominal arterial calcification scores were significantly lower in the ADPKD group (median: 425.3; IQR: 0.0-2033.5) than in the non-ADPKD group (median: 1256.8; IQR: 96.5-5033.8). Among ADPKD patients, abdominal arterial calcification scores increased with dialysis duration (P < .001). ADPKD patients exhibit lower abdominal arterial calcification scores than their non-ADPKD counterparts after adjusting for clinical variables. Abdominal arterial calcification progression with dialysis highlights the importance of early transplant evaluation. This study introduces a novel adaptation of coronary calcium scoring software for quantifying abdominal calcification, offering a standardized approach to vascular risk assessment in kidney transplant candidates.

Background: Cardiovascular disease (CVD) remains a major global health concern and the leading cause of mortality and disability. Early detection and prevention strategies rely heavily on evaluating coronary artery calcification, traditionally assessed using the coronary artery calcium score (CACS). However, CACS is limited by its dependence on strictly fixed tube voltage and slice thickness, sensitivity to changes in scanning parameters, and the need for an additional dedicated coronary calcium scan that increases radiation exposure. Methods: To address these challenges, we developed a novel two-compartment coronary artery calcium score system (TACS) for quantitative calcium assessment. TACS was established and validated using a QRM Thorax phantom scanned on a GE Revolution CT at 70-140 kVp. Volumetric calcium density (VCD) derived from TACS was compared with conventional CACS under varying slice thickness, pitch, and iterative reconstruction algorithms. Additionally, coronary artery calcium scans from 15 patients were retrospectively analyzed to assess correlations between TACS and CACS. Results: TACS demonstrated stable performance across tube voltages, with VCD errors ranging from 3.8% to -19.0% and maintained consistency under different slice thicknesses (23.9% to -2.3%) and reconstruction algorithms, showing near-zero residual percentages. Patient analyses revealed a strong correlation between TACS and CACS (r = 0.932). Conclusions: These findings suggest that TACS provides robust and reliable quantification of coronary calcium, supporting its potential use for opportunistic coronary artery disease screening, particularly in routine CT imaging. Further studies with larger cohorts are warranted to confirm its clinical applicability.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Current guidelines recommend algorithms to estimate 10-year cardiovascular diseases (CVD) risk in apparently healthy individuals, but their precision remains limited. Whether the integration of imaging and genetic information can improve individual risk stratification remains uncertain. : The CVRISK-IT trial is a multicentre, open-label, randomised controlled study designed to enhance CVD prevention through precision-based risk assessment and targeted communication strategies. A total of 30,000 adults aged 40-80 years without previous CVD or diabetes are recruited across Italy. In Phase I, participants undergo a baseline assessment including clinical examination, blood sampling, and calculation of CVD risk. Approximately 12,000 eligible enter Phase II and are randomised equally into four intervention arms: (i) standard care (control), (ii) imaging-based risk refinement (coronary artery calcium score or carotid ultrasound), (iii) polygenic risk score (PRS), or (iv) combination of imaging and PRS. The co-primary endpoints are differences in estimated 10-year CVD risk at 12 months and the incidence of major CVD events, CVD mortality, and all-cause mortality at 5 years. Secondary endpoints include differences in CVD risk factors, prescription and adherence to preventive drug adherence, and behavioural or psychological measures. By prospectively evaluating the feasibility and impact of incorporating genetic and imaging information in CVD risk stratification, CVRISK-IT will generate robust evidence to inform its integration into routine screening practices and public health policy. ClinicalTrials.gov Identifier NCT06832644.

Objective This study was designed to test if multidetector computed tomography-derived epicardial fat parameters like epicardial fat volume, thickness, and attenuation can predict obstructive coronary artery disease in a South Indian Population. Methods All 60 patients underwent a coronary angiogram using 128-slice multidetector computed tomography. Computed tomography coronary angiogram studies were evaluated for coronary artery calcium score, presence of plaque, type of plaque, epicardial fat volume, and degree of coronary stenosis. Results 60 patients had a mean age of 51.7 ± 11.4 years. Obstructive coronary artery disease (≥50% luminal narrowing) was found in 91.7% of males. Various risk factors for coronary artery disease were diabetes mellitus (40%), hypertension (55%), hyperlipidemia (58.33%), smoking (15%), and body mass index &gt;25 (41.67%). These risk factors were higher in the “obstructive coronary artery disease” group than in the “no/non-obstructive coronary artery disease” group, with a statistically significant correlation. Mean epicardial fat volume for the studied population was found to be 114.26 ± 45.68 cm 3 with values ranging from 38.55 cm 3 to 270.08 cm 3 . The mean epicardial fat volume of “obstructive coronary artery disease” group was found to be higher, that is, 137.69 ± 29.44 cm 3 compared to “no/non-obstructive coronary artery disease” group, which was 108.4 ± 47 cm 3 , showing a statistically significant correlation ( P = .046). Multiple variables showed a positive correlation of epicardial fat volume with the increasing degree of coronary artery stenosis. Epicardial fat volume demonstrated a statistically significant correlation with age ( P = .007), hypertension ( P = .001), hyperlipidemia ( P = .034), smoking ( P = .002), and body mass index ( P &lt; .001). Epicardial fat volume also showed a statistically significant correlation with the epicardial mesenteric fat area ( P &lt; .001), calcium score ( P = .048), and epicardial fat thickness ( P &lt; .001). An increase in epicardial fat volume was observed with higher calcium score categories, showing a statistically significant correlation ( P = .02). Based on the receiver operating characteristic curve, an optimal cutoff value of &gt;110.48 cm 3 was obtained, which shows a sensitivity and specificity of 91.67% and 60.42%, respectively. Epicardial fat volume (multidetector computed tomography) is a significant imaging biomarker for predicting obstructive coronary artery disease with a cutoff value of &gt;110.48 cm³ for differentiating.

Vessel-specific perivascular fat attenuation index derived from AI-CCTA and its association with impaired coronary flow reserve in patients with INOCA

Associations of cigarette smoking with coronary artery and extra-coronary calcification in older adults: The Atherosclerosis Risk in Communities study.

600.01 Effects of Trem2 R47h Mutation on Coronary Artery Calcification and Cardiac Function

Cardiovascular Events in COPD: Complementary Role of Cardiac Risk and Coronary Artery Calcium Scores.

This is a summary of a few of the recent innovations in cardiology that affect our practice. In the area of cardiac intensive care, recent developments included the use of AI algorithms to improve multi-modality monitoring, thus improving patient safety. The use of robots in Coronary Care Units (CCUs) and the extensive use of mechanical support are also some of the major breakthroughs in intensive care cardiology. The area of cardiac interventions is characterized by procedures performed in octogenarians and nonagenarians, including coronary interventions in heavily calcified coronary arteries, and valvular interventions of various kinds. In the field of arrhythmia, there was a recent entrance of new energies for ablation, especially the pulsed field ablation, based on non-thermal electroporation, that is less destructive to the surrounding tissue and is therefore safer to the patient. Another breakthrough is the wide adoption of conduction system pacing which paces the heart in a physiological mode that decreases the long-term damage of pacing to the function of the heart. Another new trend in pacing is the use of small leadless pacemakers that are implanted directly into the heart by an interventional technique via the femoral vein. Innovations in imaging include the increased use of 3-dimensional echocardiography as well as strain echocardiography that increases sensitivity to specific conditions such as drug effects and cardiomyopathy. The new photon counting CT technology improved the quality of CT imaging considerably. Heart failure treatment has improved significantly over recent years, with special emphasis on the use of mechanical support for bridging and destination treatments. This is just a partial list of the great advances that have happened in the field of cardiology.

Cardiovascular disease (CVD) remains theleading cause of mortality worldwide. Despite the release of the updated Australian Cardiovascular Disease (AusCVD) Risk calculator, many general practitioners (GPs) have raised concerns regarding the calculator's ability to be 'personalised' to the patient. As a result, inappropriate investigations are ordered in an attempt to individualise cardiovascular disease risk. The aim of this paper was to summarise the indications and pros and cons of different CVD screening tests to support GPs in managing a patient's CVD risk. We recommend that everyone above the age of 45 is screened with the AusCVD Risk calculator. If the patient's CVD risk is in doubt, a coronary artery calcium score may assist in sharpening the diagnosis. For those at high-risk, an exercise stress test, myocardial perfusion scan or computed tomography (CT) coronary angiography may be useful (provided they are conducted in safe environments) to determine the patients who require referral for specialist assessment.

Aortic valve calcification is a key determinant of aortic stenosis severity. Whether AI-derived thoracic aortic calcium volume reflects valvular calcification remains unclear. This study examined the association between aortic valve calcification quantified using Agatston, volume and mass scores, and total aortic calcium volume measured with an automated AI tool. This retrospective single-center study included 32 patients undergoing computed tomography (CT) for transcatheter aortic valve implantation planning. Aortic valve calcification was quantified on noncontrast CT using Agatston, volume and mass scores. Total aortic calcium volume was derived from contrast-enhanced CT using the AI-Rad Companion Chest CT. Correlation analyses and simple linear regression assessed associations between aortic and valvular calcification metrics. Mean total aortic calcium volume was 4.38 ml. Mean aortic valve Agatston score was 3307 units and mean valve calcium volume was 2727 mm3. Correlation between total aortic calcium and aortic valve Agatston score was weak and nonsignificant (Pearson r=0.213, p=0.259). Correlation with valve calcium volume was similarly weak (Pearson r=0.219, p=0.244). Regression models showed minimal explained variance (R2≈4-5 percent), and slopes were not statistically significant. No clinically relevant association between thoracic aortic calcium burden and aortic valve calcification was identified. AI-derived thoracic aortic calcium volume did not correlate with aortic valve calcification. Valvular calcification appears to progress independently of thoracic aortic wall calcification. Automated aortic calcium measurements cannot substitute for direct quantification of aortic valve calcification in preprocedural assessment.

Severe coronary artery calcification (CAC) remains a major challenge in percutaneous coronary intervention (PCI), driving stent under-expansion and higher rates of restenosis and adverse events. Balloon-based calcium modification remains central to lesion preparation, with the available tools ranging from high-pressure non-compliant balloons and ultra-high-pressure balloons to cutting, scoring, and intravascular lithotripsy (IVL) balloons. While traditional IVL has advanced the field by permitting circumferential fracture of deep calcium through acoustic shockwaves, important drawbacks persist, including problems in deliverability, energy distribution, and questionable efficacy in nodular or eccentric calcium. This review examines all contemporary balloon-based modification strategies and introduces the novel Hertz-contact IVL (HC-IVL), a new technology designed to transmit mechanical energy through direct contact rather than shockwave propagation. Based on Hertzian mechanics, this device may facilitate more focused energy delivery, improved lesion crossing, and enhanced calcium fracture in complex morphologies. A detailed comparison between HC-IVL and standard IVL is provided, along with a proposed algorithm for device selection. Taking into consideration the limitations of current tools, HC-IVL represents a promising mechanistic innovation in balloon-based calcium modification, warranting further validation in randomized, imaging-guided clinical studies.

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;ABSTRACT&amp;lt;/strong&amp;gt;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;/strong&amp;gt;To examine the association between metabolic parameters and novel cardiometabolic indices with the coronary artery calcium score (CACS).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods: &amp;lt;/strong&amp;gt;This retrospective cross-sectional study included 130 patients who underwent coronary computed tomography angiography (CCTA) at the Radiology Clinic of the Clinical Centre of the University of Sarajevo between January and June 2024.&amp;lt;strong&amp;gt; &amp;lt;/strong&amp;gt;Patients were classified into two groups: those with CACS &amp;amp;le;100 and those with CACS &amp;amp;gt;100.&amp;lt;strong&amp;gt; &amp;lt;/strong&amp;gt;Platelet count, mean platelet volume (MPV), estimated glomerular filtration rate (eGFR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), uric acid (UA), and novel cardiometabolic indices, including Castelli risk index I and II (CRI-I and CRI-II), non-high-density lipoprotein cholesterol (non-HDL-C), were compared between the groups.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results &amp;lt;/strong&amp;gt;Patients with CACS &amp;amp;gt;100 had significantly higher MPV, TC, LDL-C, UA, non-HDL-C, CRI-I, CRI-II, and the UA/eGFR ratio. Older age, increased platelet activity, dyslipidemia, hyperuricemia, and the higher UA/eGFR ratio correlated positively with CACS, whereas eGFR correlated negatively. In multivariate regression analysis, the UA/eGFR ratio emerged as an independent predictor of higher CACS (OR = 2.37; 95% CI 1.18&amp;amp;ndash;4.78; p=0.017).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion &amp;lt;/strong&amp;gt;Elevated UA levels and adverse cardiometabolic indices are associated with greater coronary artery calcification. The UA/eGFR ratio independently predicts higher CACS, highlighting its potential prognostic value.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Keywords: &amp;lt;/strong&amp;gt;coronary angiography, glomerular filtration rate, uric acid, vascular calcification&amp;lt;/p&amp;gt;

BackgroundThe prognostic significance of incidental cardiovascular calcifications-including coronary artery calcification (CAC), thoracic aortic calcification (TAC), aortic valve calcification (AVC), and mitral annular calcification (MAC)-detected on non-gated, non-contrast low-dose chest computed tomography (LDCT) remains unclear.PurposeTo evaluate the long-term prognostic significance of incidental cardiovascular calcifications detected on screening LDCT.Material and MethodsThis retrospective cohort study included individuals who underwent LDCT at a single health promotion center between 2007 and 2013. A cardiovascular radiologist quantified CAC, TAC, AVC, and MAC using dedicated software. Multivariable Cox proportional hazards regression was used to assess associations with all-cause mortality (ACM) and major adverse cardiovascular events (MACE), defined as revascularization, myocardial infarction, stroke, or cardiovascular death. Incremental prognostic performance was evaluated using Harrell's concordance index (C-index).ResultsAmong the 2434 included individuals (1863 men; median age = 54.2 years), CAC, TAC, AVC, and MAC were identified in 506 (20.8%), 1215 (49.9%), 159 (6.5%), and 49 (2.0%), respectively. The highest TAC category (≥1000) showed the strongest association with ACM (hazard ratio [HR] = 3.11, 95% confidence interval [CI] = 1.57-6.16; P = 0.001). The highest CAC category (≥400) showed the strongest association with MACE (HR = 8.67, 95% CI = 4.46-16.88; P <0.001). However, a combined model incorporating CAC, TAC, AVC, and MAC did not provide significant incremental prognostic value beyond CAC alone for ACM or MACE.ConclusionIncidental TAC was associated with increased long-term risk of ACM, while CAC was associated with MACE. However, their combined incorporation did not provide significant incremental prognostic value.