Coronary Calcium Score In Patients Research Articles

Relation of JAK2 V617F allele burden and coronary calcium score in patients with essential thrombocythemia.

JAK2 V617F (JAK2) mutation is associated with clonal hemopoiesis in myeloproliferative neoplasms as well as with faster progression of cardiovascular diseases. Little is known about the relationship between allele burden and the degree of atherosclerotic alteration of coronary vasculature. We previously reported that carotid artery stiffness progressed faster in patients with JAK2 positive essential thromocythemia (ET) patients. After a four-year follow-up we investigated whether mutation burden of a JAK2 allele correlates with a higher coronary calcium score. Thirty-six patients with JAK2 positive ET and 38 healthy matched control subjects were examined twice within four years. At each visit clinical baseline characteristics and laboratory testing were performed, JAK2 mutation burden was determined, and coronary calcium was measured. JAK2 allele burden decreased in 19 patients, did not change in 5 patients, and increased in 4 patients. The coronary calcium Agatston score increased slightly in both groups. Overall, there was no correlation between JAK2 allele burden and calcium burden of coronary arteries. However, in patients with the JAK2 mutation burden increase, the coronary calcium score increased as well. The average JAK2 allele burden decreased in our patients with high-risk ET during the four-year period. However, in the small subgroup whose JAK2 mutation burden increased the Agatston coronary calcium score increased as well. This finding, which should be interpreted with caution and validated in a larger group, is in line with emerging evidence that JAK2 mutation accelerates atherosclerosis and can be regarded as a non-classical risk factor for cardiovascular disease.

Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health

Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9%female; 32.4%with OSA). In covariate-adjusted analyses (n= 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95%CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95%CI, 1.30-2.12; P= .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n= 319) showed a positive association for both OSA (β= 1.084; 95%CI, 0.032-2.136; P= .043) and OSA with EDS (β= 1.651; 95%CI, 0.208-3.094; P= .025). OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.

The Diagnostic and Prognostic Value of Coronary Calcium Scoring inStable Chest Pain Patients: A Narrative Review.

Background Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints. Method PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n = 38 137 patients) focused on diagnostic value and 23 articles (n = 44 683 patients) on prognostic value of CCS. Of these, 10 articles (n = 21 208 patients) focused on both the diagnostic and prognostic value of CCS. Results Between 22 and 10 037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43 % and 51 % patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD (OCAD, defined as a luminal stenosis of ≥ 50 % in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4 % (n = 703/16 074) with a range of 0–26 % in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0 % to 2.1 % during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98 % and 100 % in CCS 0 patients. At increasing CCS, the OCAD probability and MACE risk increased. OCAD was present in 58.3 % (n = 617/1058) of CCS > 400 patients with percentages ranging from 20 % to 94 % and MACE occurred in 16.7 % (n = 175/1048) of these patients with percentages ranging from 6.9 % to 50 %. Conclusion Accumulating evidence shows that OCAD is unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCAD and risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting. Key Points: A CCS of zero makes OCAD in patients at low-intermediate PTP unlikelyA CCS of zero is related to a very low risk of MACECategories of increasing CCS are related to increasing rates of OCAD and MACEFuture studies should focus on the diagnostic and prognostic value of CCS in symptomatic women and the role in primary care Citation Format Koopman MY, Willemsen RT, van der Harst P et al. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. Fortschr Röntgenstr 2022; 194: 257 – 265

PO-1201 Importance of coronary calcium score in patients with locally advanced non-small cell lung cancer

PO-1201 Importance of coronary calcium score in patients with locally advanced non-small cell lung cancer

Predicting the change in the coronary calcium score in patients with diabetes

Abstract Background The rate of increase of coronary arterial calcification score (CCS) on serial CT-scans years apart is a potent marker of cardiovascular risk but identifies risk only after irreversible damage has occurred. Molecular imaging may assist in identifying patients who are at risk of developing severe arterial calcification. Purpose To determine if 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) can predict and anatomically locate the progression of CCS over 2 years. Methods Subjects with diabetes mellitus underwent a baseline 18F-NaF PET scan and a CT CCS. The CT CCS was repeated after 2 years. 18F-NaF PET tracer uptake was measured as the maximum tissue to background ratio (TBRmax) and using a pre-defined cut-off for positivity, arteries were dichotomised into 18F-NaF positive and negative. We compared the change in the CCS between coronary arteries that were positive and negative for 18F-NaF uptake. Results In forty-one participants (mean age 65.0±7.1, male: 63.4%) a total of 163 coronary arteries were included in the analysis. Fifty-two (31.9%) coronary arteries were 18F-NaF positive at baseline and 111 (68.1%) were negative. After 2.8 [2.4–3.2] years follow-up, the TBRmax at baseline correlated with the time-standardised change in the CCS (Spearmans' rho 0.33, p<0.001). The time-standardised change in the CCS was higher in coronary arteries that were 18F-NaF positive compared to negative (48.9 [13.6–119.7] v 3.3 [0–27.9], p<0.001). The time-standardised change in coronary calcium score increased across patients with increasing number of 18F-NaF positive arteries at baseline (p=0.006) (Figure 1). Conclusions 18F-NaF PET activity at baseline is associated with new co-localised calcifications 2.8 years later Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Royal Perth Hospital Research Foundation

Impact of Hypertension Duration on Coronary Coronary Calcium Score in Patients With Low To Intermediate Pretest Probability for Coronary Artery Disease

Impact of Hypertension Duration on Coronary Coronary Calcium Score in Patients With Low To Intermediate Pretest Probability for Coronary Artery Disease

Rheumatoid arthritis patients have higher prevalence and burden of asymptomatic coronary artery disease assessed by coronary computed tomography: A systematic literature review and meta-analysis

BackgroundRheumatoid arthritis (RA) is associated with increased risk of coronary artery disease (CAD) and studies with coronary computed tomography have suggested increased rates of asymptomatic CAD determined by the coronary calcium score (CCS) in these patients. To synthesize the evidence on this topic, we conducted a systematic review and meta-analysis of the literature. MethodsA systematic review was performed of data comparing the prevalence and burden of asymptomatic CAD in RA and controls using CCS with or without coronary computed tomographic angiography (CCTA). For the meta-analysis, pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in patients with RA compared to controls. ResultsThe search revealed 1841 results of which 1083 were screened and 26 full text papers were evaluated. Eight studies were included with data on 788 patients with RA and 1641 controls. Patients with RA had significantly increased risk of CAD (RR = 1.26 [95% CI 1.04–1.52]; p = .021) and increased weighted mean differences for CCS (48.25 [95% CI 26.97–69.53]; p < .001) compared to controls. Limited evidence suggested that patients with RA had a higher prevalence of moderate-severe (CCS > 100) CAD and more multivessel CAD, and RA duration and disease activity were associated with higher CCS, RA disease activity was linked with presence of high risk (non-calcified or mixed) coronary plaques, and treatment with methotrexate was tied to absence of CAD, respectively. ConclusionsIn patients with RA, asymptomatic CAD is more prevalent, with higher mean CCS, more multivessel disease, and more high-risk plaques compared to controls.

Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1.

Objective:Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS) in individuals with bipolar disorder type 1.Methods:Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0) or positive (CCS > 0). Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations.Results:Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001) and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04) when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001).Conclusion:Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

Evaluation of coronary calcium score in patients with normocalcemic primary hyperparathyroidism.

RationaleGiven that the diagnosis of primary hyperparathyroidism (PHPT) is given at an increasingly less-symptomatic phase, and the literature data on the cardiovascular risk of patients with normocalcemic primary hyperparathyroidism (NPHPT) are controversial, the coronary calcium score (CCS), which is correlated with coronary artery disease, may be useful for clarifying the association between cardiovascular risk and NPHPT.ObjectiveThis research aims to describe the CCS and the clinical and laboratory variables of patients with NPHPT compared with a control group and to verify the presence of an association between NPHPT and CCS.Study population and methodsA questionnaire on anthropometric data (weight, height, waist circumference, and blood pressure) was used, laboratory examinations (estimations of glucose, glycated hemoglobin [HbA1c], total cholesterol [TC] and its fractions, triglycerides, creatinine, calcium, parathyroid hormone, and 25-OH vitamin D) were conducted, and computerized tomography was carried out to measure the CCS in 13 patients diagnosed with NPHPT and 16 controls.ResultsThere was no association between NPHPT and altered CCS (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.05–1.26; p=0.095). Differences between the case and control groups were found in terms of body mass index (BMI) (26.97 kg/m2 vs 31.53 kg/m2, respectively; p=0.044), HbA1c (5.59% vs 6.62%; p=0.000), and TC (188.07 mg/dL vs 220.64 mg/dL; p=0.088). After adjustment for potential confounders, no statistical significance was observed for the association between changes in CCS and presence of NPHPT (adjusted OR: 1.64; 95% CI: 0.1–26.43; p=0.726).ConclusionNo association was found between the CCS and the presence of NPHPT.

Incidence and Predictors of Increased Coronary Calcium Scores in Liver Transplant Recipients

BackgroundCardiovascular complications in liver transplant recipients are common. A coronary calcium score >400 determined by coronary computed tomographic angiography (coronary CT) provides useful information for predicting postoperative cardiovascular complications in liver transplant recipients. However, little is known about the association between risk factors and increased coronary calcium scores in coronary CT preformed as a preoperative cardiovascular evaluation before liver transplantation. We evaluated the incidence and cardiovascular risk factors of a coronary calcium score >400 in liver transplant recipients. MethodsBetween 2013 and 2014, 548 liver transplant recipients were analyzed retrospectively. Preoperative cardiovascular assessments and laboratory data were collected with coronary calcium scores. Univariate and multivariate logistic regression analyses were performed to evaluate cardiovascular risk factors of a coronary calcium score >400 in coronary CT. ResultsThe total mean coronary calcium score was 103 ± 358. Of the 548 recipients, 41 (7.5%) had a coronary calcium score >400. The mean coronary calcium score in patients with a coronary calcium score >400 was 999.7 ± 892.1, and the mean coronary calcium score in patients with a coronary calcium score ≤400 was 30.1 ± 70.9. In multivariate logistic regression analysis, predictors of a coronary calcium score >400 in liver transplant recipients were age (odds ratio [OR] = 1.05, P = .029), male sex (OR = 14.42, P = .009), and diabetes mellitus (OR = 2.04, P = .040). ConclusionsWe found that old age, male sex, and diabetes mellitus were predictors of a coronary calcium score >400, which is associated with cardiovascular complications after liver transplantation. This study can provide useful information for preoperative cardiovascular evaluation in liver transplant recipients.

Association between platelet/lymphocyte ratio and coronary calcium score in patients with stable coronary disease

Association between platelet/lymphocyte ratio and coronary calcium score in patients with stable coronary disease

Correlation of serum apelin level with coronary calcium score in patients with suspected coronary artery disease

Introduction A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High resolution non contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results Forty three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c and WBCs count than subjects without detectable CAC (p 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Comparison of arterial stiffness parameters, epicardial fat volume and coronary calcium score in patients with coronary artery disease

Comparison of arterial stiffness parameters, epicardial fat volume and coronary calcium score in patients with coronary artery disease

Prediction of cardiac events based on coronary calcium score in patients with symptoms suggestive of coronary artery disease

Objective: To determine predictive value of coronary artery calcium score (CACS) for major adverse cardiovascular events (MACE) in symptomatic patients with atypical chest pain and suspected coronary artery disease (CAD) using a 64-row multislice computed tomography (MSCT). Background: In asymptomatic patients, positive CACS is an established marker of coronary plaque burden and it is associated with higher risk of MACE. Zero CACS has been associated with low risk of MACE. In symptomatic patients without previous diagnosis of CAD, prognostic significance of CACS is less well established. Methods: 588 consecutive symptomatic subjects (376 women, 212 men; age 61±10 years) with atypical chest pain were included in the study. CACS was determined in each subject using 64-row MSCT. CT angiography was not performed to avoid treatment bias. Patients were observed for occurrence of combined MACE (death, myocardial infarction, myocardial revascularization). Results: For all patients median CACS was 11 Agatston Units (AU; range 0 to 5927). Zero CACS was present in 239 patients while CS>0 was present in 349 patients. During the follow-up of 638±261 days MACE occured only in patients with a positive CACS (P<0.0001; logrank). Absence of coronary calcium defined a low risk group of patients (HR=0.17, CI 0.03-0.39; Figure 1). CS<92 AU was the optimal cut-off point for definition of the low risk group (ROC; P<0.001, sensitivity 90.1, specificity 82.6; AUC 0.93). Figure 1.MACE free survival in CS groups Conclusions: CACS assessment may be a useful tool for risk stratification in symptomatic patients with atypical chest pain. Absence of coronary calcium defines a low risk group in these subjects. Larger multicentre observational studies are warranted to determine prognostic CACS

Advanced age and apnea-hypopnea index predict subclinical atherosclerosis in patients with obstructive sleep apnea syndrome

Background: Both obstructive sleep apnea syndrome (OSAS) and coronary artery calcification (CAC) are considered to be related with the presence of coronary artery disease (CAD). In this study we evaluate the association between OSAS and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in patients who had OSAS but no history of known CAD. Methods: Seventy-three patients who were asymptomatic for CAD and had suspected OSAS were referred to overnight attended polysomnography. Patients were classified into 4 groups according to the Apnea-Hypopnea Index (AHI). All patients underwent computed tomographic examination for tomographic coronary calcification scoring. Physical examination, sleep study recordings, complete blood count and serum biochemistry were obtained from all patients. Results: In the whole group, AHI levels were weakly correlated with coronary calcium score (r = 0.342, p = 0.003) and body mass index (r = 0.337, p = 0.004), moderately correlated with basal oxygen saturation (r = −0.734, p &lt; 0.001), and strongly correlated with oxygen desaturation index (r = 0.844, p &lt; 0.001). In an univariate analysis, age, AHI, basal oxygen saturation, and oxygen desaturation index were associated with CAC in patients with OSAS. In a multiple logistic regression model, age (OR 1.108,%95 CI 1.031-1.191, p = 0.005) and AHI (OR 1.036,% 95 CI 1.003-1.070, p = 0.033) were only independent predictors of CAC in patients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of 54.3% and 56.5% respectively. Conclusions: Our findings suggest that in patients with moderate or severe OSAS and advanced age, physicians should be alert for the presence of subclinical atherosclerosis.

Advanced age and apnea-hypopnea index predict subclinical atherosclerosis in patients with obstructive sleep apnea syndrome.

BackgroundBoth obstructive sleep apnea syndrome (OSAS) and coronary artery calcification (CAC) are considered to be related with the presence of coronary artery disease (CAD). In this study we evaluate the association between OSAS and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in patients who had OSAS but no history of known CAD.MethodsSeventy-three patients who were asymptomatic for CAD and had suspected OSAS were referred to overnight attended polysomnography. Patients were classified into 4 groups according to the Apnea-Hypopnea Index (AHI). All patients underwent computed tomographic examination for tomographic coronary calcification scoring. Physical examination, sleep study recordings, complete blood count and serum biochemistry were obtained from all patients.ResultsIn the whole group, AHI levels were weakly correlated with coronary calcium score (r = 0.342, p = 0.003) and body mass index (r = 0.337, p = 0.004), moderately correlated with basal oxygen saturation (r = −0.734, p < 0.001), and strongly correlated with oxygen desaturation index (r = 0.844, p < 0.001). In an univariate analysis, age, AHI, basal oxygen saturation, and oxygen desaturation index were associated with CAC in patients with OSAS. In a multiple logistic regression model, age (OR 1.108,%95 CI 1.031-1.191, p = 0.005) and AHI (OR 1.036,% 95 CI 1.003-1.070, p = 0.033) were only independent predictors of CAC in patients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of 54.3% and 56.5% respectively.ConclusionsOur findings suggest that in patients with moderate or severe OSAS and advanced age, physicians should be alert for the presence of subclinical atherosclerosis.

Coronary Calcium Score in Renal Transplant Recipients

Background: Coronary calcium score (CCS) is established as an index for the risk of coronary heart disease (CHD). The aim of this prospective study was to assess changes in CCS in patients 1 year after kidney transplantation (KTx). Method: A total of 221 consecutive renal transplant recipients were enrolled in our prospective study (140 males/81 females). CCS was analyzed by spiral multidetector CT at baseline and 1 year after KTx. Bone mineral density (BMD) was measured in the lumbar spine (L-BMD) and femur (F-BMD). Results: The mean CCS was 539 ± 1,033 at baseline. 33% of the patients had a CCS of 0, and 33% of patients had a CCS of >401. A negative correlation was found between F-BMD and CCS, but no correlation was found between L-BMD and CCS. Using CCS, a positive correlation was found between total cholesterol and the age of patients, but no correlation of CCS was found with other biochemical markers of bone and lipid metabolism. One year after transplantation, the mean CCS was 703 ± 1,253; in 75% of patients the CCS was the same and 25% had a higher CCS. Conclusion: A high risk of CHD was found in 33% of renal graft recipients. No improvement in CCS was found 1 year after KTx.

A pilot study of subclinical coronary atherosclerosis in systemic sclerosis: Coronary artery calcification in cases and controls

Systemic sclerosis (SSc) is associated with vasculopathy and endothelial cell injury, which could potentially increase the risk of coronary atherosclerosis. Multidetector computed tomography, a noninvasive procedure, generates a coronary calcium score (CCS) as a marker for coronary atherosclerosis. Serum proinflammatory high-density lipoprotein (piHDL) is a potential novel marker of atherosclerotic risk. The objective of the pilot study was to determine 1) the prevalence of subclinical coronary atherosclerosis in SSc and 2) serum piHDL levels as a potential novel marker of atherosclerotic risk in SSc. A cross-sectional study of 17 patients with SSc and 17 age-, sex-, and race-matched healthy controls in Cincinnati, Ohio, was conducted. Measurements included CCS; body mass index; lipid profile; and serum levels of high-sensitivity C-reactive protein, homocysteine, and piHDL. Patients with SSc were slightly older (mean 52.8 years) than control subjects (mean 50.6 years; P = 0.01). Coronary calcium was found in 12 participants (9 with SSc, 3 controls; P = 0.03). The mean +/- SD CCS in patients with SSc was significantly greater than the controls (126.6 +/- 251.0 versus 14.7 +/- 52.2; P = 0.003). Five patients with SSc (29%), but no controls, had detectable levels of piHDL (P = 0.06). Prevalence of subclinical coronary atherosclerosis is greater in patients with SSc compared with healthy controls. These findings should be confirmed in a larger study.