High Calcium Score Research Articles

High Coronary Artery Calcium Score Is Associated with an Increased Risk of Death in Patients Evaluated for Kidney Transplant

High Coronary Artery Calcium Score Is Associated with an Increased Risk of Death in Patients Evaluated for Kidney Transplant

A Pilot Study on the Association between Cardiovascular Risk Factors and Coronary Artery Calcification in a Group of Patients Investigated via Cardiac Computed Tomography in a European Country with High Cardiovascular Risk.

(1) Background: Cardiovascular disease is the leading cause of mortality worldwide; the prevention and early detection of coronary artery disease are of critical importance; and the coronary artery calcium score is a powerful method in the assessment of coronary artery disease. Among European countries, Romania ranks as a country with a very high risk of cardiovascular diseases, but the data are limited in regard to the prevalence of the calcium score. (2) Methods: A retrospective study was conducted to establish the coronary calcium score in a group of patients investigated via cardiac CT and to determine the correlation with the presence of cardiovascular risk factors. (3) Results: According to the Agatston calcium score, 50% of the patients had a positive calcium score. High calcium scores above 400 UA were present in 12.6% of patients. Regarding the association between the presence of cardiovascular risk factors and the levels of coronary artery calcification, a mild level of calcification was associated with age over 50 years (X2 = 3.88, p = 0.04, OR = 3.25; 95% CI 0.94-11.14); a moderate level of calcification with the age of patients over 50 years (X2 = 6.54, p = 0.01, OR = 5.58; 95% CI 1.29-24.16), dyslipidemia (X2 = 7.28, p = 0.007, OR = 3.37; 95% CI 1.34-8.51), and arterial hypertension (X2 = 5.37, p = 0.02, OR = 2.88; 95% CI 1.14-7.27); a severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81); and a very severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81), smoking (X2 = 8.07, p = 0.004, OR = 4.44; 95% CI 1.47-13.44), and diabetes (X2 = 13.65, p = 0.001, OR = 6.59; 95% CI 2.5-20.18). (4) Conclusion: Half of the patients investigated by using cardiac CT had a calcium score of zero. Predictors for coronary calcium scores in relation to risk factors varied. For the very severe coronary calcification level, the strongest predictor was the presence of smoking and diabetes, which increased the odds for very severe calcification by 13.46 times. Patients who had multiple cardiovascular risk factors, hypertension, diabetes, and smoking were 9.18 times more likely to have very severe calcification.

Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach.

The most common minimally invasive approach for aortic valve replacement (AVR) is the partial upper mini-sternotomy. The aim of this study is to understand which preoperative computed tomography (CT) features are predictive of longer operations in terms of cardio-pulmonary bypass timesand cross-clamp times. From 2011 to 2022, we retrospectively selected 246 patients which underwent isolated AVR and had a preoperative ECG-gated CT scan. On these patients, we analysed the baseline anthropometric characteristics and the following CT scan parameters: aortic annular dimensions, valve calcium score, ascending aorta length, ascending aorta inclination and aorta-sternum distance. We identified augmented body surface area (>1.9 m2), augmented annular diameter (>23 mm), high calcium score (>2500 Agatson score) and increased aorta-sternum distance (>30 mm) as independent predictors of elongated operation times (more than two-fold). Identifying the preoperative predictive factors of longer operations can help surgeons select cases suitable for minimally invasive approaches, especially in a teaching context.

In 2023 invasive coronary angiography is preferred to PET myocardial perfusion imaging for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

In 2023 invasive coronary angiography is preferred to PET myocardial perfusion imaging for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

Distribution and determinants of coronary artery calcium score in asymptomatic patients with Type-2 diabetes: The French-CAC100 score

BackgroundCoronary artery calcium score (CACS) refines the cardiovascular disease (CVD) risk prediction in patients with Type-2 diabetes (T2D). We aimed to identify the determinants for high CACS in CVD-free patients with T2D. MethodsWe studied 796 patients with T2D with CACS measured in three centers: two in continental France and a third in the Reunion Island. To predict a CACS ≥ 100, we derived a risk score in patients in continental France, and validated it in those in the Reunion Island. ResultsThe distributions of CACS distributions were similar among patients in continental France and Reunion Island. The French-CAC100 score included 5 parameters (age, sex, diabetes duration, non-CV end-organ damage and presence of ≥ 2 other CVD risk factors), ranging from 0 to 22 points. Similar areas under the curves were found for the risk score in both settings (0.80 vs. 0.73, p = 0.10). A French-CAC100 score < 10 excluded the odds for CACS ≥ 100 and CACS ≥ 400 with negative predictive values of 90% and 97% respectively, avoiding 58% of CT-scans. ConclusionRegardless of the geographic area, patients with T2D share similar risk factors for high CACS. The French-CAC100 score allows the identification of those at higher risk of elevated CACS.

The novel H2VK-65 clinical risk assessment tool predicts high coronary artery calcium score in symptomatic patients referred for coronary computed tomography angiography.

Coronary computed tomographic angiography (CCTA) has emerged as a powerful imaging modality for the detection and prognostication of individuals with suspected coronary artery disease (CAD). High amounts of coronary artery calcium (CAC) significantly obscure the interpretation of CCTA. Clinical risk assessment tools and data specific to predictors of high CAC in symptomatic patients are limited. Consecutive patients who underwent CAC scan and CCTA to diagnose CAD during 2016-2020 were included. A high CAC score was defined as >400 by Agatston method. Univariate and multivariate analyses were performed to determine the predictors of high CAC. The clinical risk score was derived from factors independently associated with high CAC. The derivation cohort was composed of 465 patients; this score was validated in 98 patients. The mean age was 63 ± 11 years, 53% were female, and 15.9% had high CAC scores. The independent predictors of high CAC scores were age >65 years (odds ratio [OR] 3.02, 95% confidence interval (95%CI) 1.56-5.85, p = 0.001), chronic kidney disease (CKD) (OR 11.09, 95%CI 3.38-36.38, p < 0.001), heart failure (OR 6.52, 95%CI 2.23-19.09, p = 0.001), hypertension (OR 26.44, 95%CI 9.02-77.44, p < 0.001), and vascular diseases, including ischemic stroke/transient ischemic attack and peripheral arterial disease (OR 20.96, 95%CI 4.19-104.86, p < 0.001). The H2VK-65 (Hypertension, Heart failure, Vascular diseases, CKD, and Age > 65) score allocates 1 point for age >65, 2 points for CKD or heart failure, and 3 points for hypertension or vascular diseases. Using a threshold of ≥4 points, the sensitivity and specificity to detect high CAC was 81% and 80%, respectively. The area under the curve was 0.88 and 0.85 in the derivation and validation cohorts, respectively. The novel H2VK-65 score demonstrated good performance for predicting high CAC scores in symptomatic patients referred for CCTA.

Correlations between coronary calcium score, FAI index of epicardial fat inflammation and regional distribution of pericoronary inflammation - insights from the IntelFAT study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Introduction Coronary calcium score (CCS) is a well-established coronary CT angiography (CCTA) feature associated with the future risk of cardiovascular events. At the same time, coronary inflammation, which can be measured by the recently developed FAI technology at the level of epicardial fat using CCTA, has been proved to be associated with increased plaque-associated risk. However, the correlation between these 2 CT features, both associated with cardiovascular risk, has not been established so far. The aim of the study was to assess the correlation between CCS, as a measure of coronary calcification, and FAI index of coronary inflammation, as a measure of associated inflammation in the coronary tree. Methods In total, 169 patients who underwent CCTA were enrolled in the study and divided into two groups according to their calculated CCS: group 1: 54 patients with CCS &amp;lt; 130, and group 2: 115 patients with CCS &amp;gt; 130. In all patients, FAI index of coronary inflammation and associated FAI score centiles were calculated for each coronary artery. The global CT-derived cardiovascular risk was calculated according to both Duke score and CariHeart score, a risk score derived from the FAI index of coronary inflammation and CT phenotype of the coronary plaques. Results Patients with high CCS had a higher FAI score (mean FAI score 12.37 +/- 8.33 in group 2 vs 11.65 +/- 7.84 in group 1, p = 0.7). The presence of a high CCS was not significantly associated with the CT-derived Duke score of lesion severity (3.02 +/- 1.38 in group 2 vs 3.09 +/- 1.29 in group 1, p = ns), however the CaRI Heart Risk was significantly higher in the group with high Calcium score (22.88 +/- 19.05 vs 15.95 +/- 11.87, p = 0.0004). At the same time, mapping of inflammation scores along the coronary tree identified that in the group with high CCS, lesions located in the right coronary artery (RCA) had a significantly higher score of inflammation than those in the left coronary artery (Mean FAI score 17.95 +/- 14.56 for RCA versus 11.47 +/- 7.03 for LCA, p = 0.002), while this difference was not significant in patients with lower CCS (p&amp;gt;0.05). Conclusions A high level of coronary calcification, as expressed by a high CCS, is associated with an increased level of inflammation at the level of pericoronary fat. At the same time, patients with high CCS present regional differences in distribution of coronary inflammation, showing increased inflammatory reactions especially at the level of the right coronary circulation. This suggests the potential role of geometric and hemorheologic alterations in the complex process of plaque progression.

The diagnostic accuracy of aortic valve calcium score in patients with low gradient and high gradient aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The gold standard imaging modality for diagnosing aortic stenosis (AS) is echocardiography (echo); the definition of severe AS is based on the transvalvular mean gradient (AMG) (&amp;gt;40 mmHg) and aortic valve area (AVA) (&amp;lt;1 cm2). However, in around one quarter of the cases echo provides discordant findings (AVA&amp;lt;1 cm2, despite of an AMG &amp;lt;40 mmHg), complicating clinical decision making. Computed tomography aortic valve calcium scoring (CT-AVC) offers an alternative diagnostic method. In cases with discordant echo measurements current guidelines recommend CT-AVC to decide on severity. Purpose Our aim was to validate the sensitivity of the recommended calcium score (CAS) thresholds within our patient population, as well as to identify any factors associated with below cut-off CAS values despite confirmed severe AS (CAS false negativity). Methods Our retrospective study included 332 consecutive patients with severe AS (AVA ≤1 cm2), who underwent CT angiography (CTA) for transcatheter aortic valve implantation (TAVI) planning. Based on the AMG the patients were classified into high gradient (HG: AMG ≥ 40 mmHg) and low gradient (LG: AMG &amp;lt;40 mmHg) groups. In the LG group AS severity was assessed by a multiparametric algorithm. To specify the predictors of CAS false negativity among patients with HG-AS, logistic regression analysis was used. The patients were followed for 50 months. Cox proportional hazard model was used to assess the risk of death from any cause. Results The HG-AS group consisted of 244 and the LG-AS cohort of 88 patients. In the HG-AS population the sensitivity of CAS to diagnose severe AS was 89%. Within the HG severe AS group, logistic regression analysis revealed an association between CAS false negativity and the AMG (OR 0.89, CI 0.83 – 0.95, p &amp;lt;0,001), whereas none of the other tested factors (age, sex, hypertension, diabetes, left ventricle function, renal function) showed a predictive value. In the LG-AS group, contrary to the HG-AS patients, the sensitivity of CAS to define severe LG AS was limited (53% in males and 67% in females). Over a median follow-up of 50 months, the prognosis of HG AS patients with low CAS (false negative group) was more favourable than that of the high CAS patient population (HR 0.41; CI 017 – 097; p = 0.04). Conclusions Our results confirmed that among patients with HG AS, the recommended CAS thresholds provide a good diagnostic sensitivity for severe AS. Nonetheless, the number of severe AS patients with low CAS is not negligible, especially within the LG-AS population, where the diagnosis is the most challenging. Our findings underline that in patients with discordant echocardiographic findings, a personalized, multiparametric diagnostic approach is needed, instead basing the final diagnosis exclusively on CAS.

Correlation between osteoprotegerin and coronary artery calcification in diabetic subjects: a systematic review of observational studies

Coronary artery calcification (CAC) is one of the critical cardiovascular complications that lead to elevated morbidity and mortality among patients with type 2 diabetes (T2M). The association between osteoprotegerin (OPG) and CAC could potentially provide a reasonable chance for preventive therapy in type 2 diabetic patients and benefit the rate of mortality. Since measurement of CAC score is relatively expensive and requires radiation exposure, the current systematic review aims to provide clinical evidence for evaluating the prognostic role of OPG in determining CAC risk among subjects with T2M. Web of Science, PubMed, Embase, and Scopus, were investigated until July 2022. We assessed human studies investigating the association of OPG with CAC in type 2 diabetic patients. Quality assessment was performed by Newcastle–Ottawa quality assessment scales (NOS). Out of 459 records, 7 studies remained eligible to be included. Observational studies that provided odds ratio (OR) estimates with 95% confidence intervals (CIs) for the association between OPG and the risk of CAC were analyzed by random-effects model. In order to provide a visual summary of our findings, the estimation of pooled OR from cross-sectional studies was reported as 2.86 [95% CI 1.49–5.49], which is consistent with the findings of the cohort study. Results revealed that the association between OPG and CAC was significant among diabetic patients. OPG is hypothesized to be a potential marker in predicting the presence of high coronary calcium score among subjects with T2M that could be recognized as a novel target for further pharmacological investigations.

Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes

BackgroundThe 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy) or high coronary artery calcium (CAC) score. This study aimed to test the validity of this strategy.MethodsIn this retrospective study, we included 385 asymptomatic patients with diabetes and no history of coronary disease but with TOD or ≥ 3 risk factors in addition to diabetes. CAC score was measured using computed tomography scan and a stress myocardial scintigraphy was performed to detect silent myocardial ischemia (SMI), with subsequent coronary angiography in those with SMI. Various strategies to select patients to be screened for SMI were tested.ResultsCAC score was ≥ 100 Agatston units (AU) in 175 patients (45.5%). SMI was present in 39 patients (10.1%) and among the 30 patients who underwent angiography, 15 had coronary stenoses and 12 had a revascularization procedure. The most effective strategy consisted in performing myocardial scintigraphy in the 146 patients with severe TOD and, among the 239 other patients without severe TOD, in those with CAC ≥ 100 AU: this strategy provided 82% sensitivity for SMI diagnosis, and identified all the patients with stenoses.ConclusionThe ESC-EASD guidelines suggesting SMI screening in asymptomatic patients with very high risk assessed by severe TOD or high CAC score appears effective and could identify all the patients with stenoses eligible for revascularization.

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.

Association between Brachial Flow-Mediated Dilation and Calcium Score in Patients with Symptomatic CAD.

Endothelial function plays an important role in the protection of vessels from atherosclerosis. Detection of endothelial dysfunction by non-invasive methods (flow-mediated dilation) and its association with other imaging modalities (calcium score in coronary computed tomography [CT] angiography) is still controversial. In this study, we aim to investigate the association between endothelial function evaluated by flow-mediated dilation (FMD) and calcium score evaluated by coronary CT. In this cross-sectional study, 124 patients with known coronary artery disease (CAD, positive calcium score) were enrolled. FMD as an indicator of endothelial function was evaluated in these participants. FMD less than 7.1%was considered abnormal. Correlation between calcium score and severity of calcification(calcium score above 100 considered as the cutoff point of the high score) and glow-mediated dilation was obtained using the linear regression model. The association between calcium score and FMD was strongly significant (P < 0.001). Among individuals with low calcium scores, only 15 (18.1%) had abnormal FMD findings, but the majority of individuals with high calcium scores (95.1%) had abnormal FMD findings. Our findings provide strong evidence of association between FMD, a marker of vascular endothelial dysfunction, and intensity of coronary atherosclerosis, as assessed by the calcium score on the CCTA.

High prevalence of coronary artery calcification and increased risk for coronary artery disease in patients with Sheehan syndrome-A case-control study.

Patients with Sheehan syndrome (SS) are predisposed to coronary artery disease (CAD) due to risk factors like abdominal obesity, dyslipidemia and chronic inflammation. In addition to estimate CAD risk enhancers like high sensitive C reactive protein (hsCRP), apolipoprotein B (ApoB) and lipoprotein A [Lp(a)], this study applies Framingham risk score (FRS) and coronary artery calcium (CAC) score to compute a 10-year probability of cardiovascular (CV) events in SS patients. Case-control study Sixty-three SSpatients, on a stable hormonal replacement treatment except for growth hormone and 65age, body mass index and parity-matched controls. Measurement of serum hsCRP, ApoB and Lp(a) and estimation of CAC with 16-row multislice computed tomography scanner. The concentrations of hsCRP, ApoBand Lp(a) were significantly higher in SS patients than in controls (p < .01). After calculating FRS, 95.2% of SS patients were classified as low risk, 4.8% as intermediate risk and all controls were classified as low risk for probable CV events. CAC was detected in 50.7% SS patients and 7.6% controls (p = .006). According to the CAC score, 26.9% SS patients were classified as at risk (CAC > 10) for incident CV events as against 1.6% controls. The mean Multi-Ethnic Study of Atherosclerosis (MESA) score was significantly higher in patients with SS than controls. CAC corelated significantly with fasting blood glucose (r = .316), ApoB (r = .549), LP(a) (r = .310) and FRS(r = .294). Significant number of asymptomatic SS patients have high coronary artery calcium score and are classified at risk for CAD.

Nonalcoholic fatty liver disease is associated with myocardial ischemia by CT myocardial perfusion imaging, independent of clinical and coronary CT angiography characteristics.

The aim of this study was to evaluate whether patients with nonalcoholic fatty liver disease (NAFLD) have more myocardial malperfusion on CT myocardial perfusion imaging (CT-MPI), as well as to further assess if NAFLD is a predictor of myocardial ischemia independently. A total of 310 consecutive patients were included for analysis. All patients were divided into two groups according to the presence or absence of NAFLD, which was diagnosed by noncontrast cardiac CT partially covered liver and spleen. Clinical characteristics as well as imaging features including coronary artery calcium score, CCTA, and CT-MPI findings were analyzed. Univariable and multivariable logistic regression analyses were used to find out the relationship between NAFLD and myocardial ischemia. NAFLD (unadjusted hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.2 to 4.4, p = 0.008), male (HR: 2.6, 95% CI: 1.5 to 4.5, p = 0.001), obstructive CAD (HR: 2.3, 95% CI: 1.3 to 4.2, p = 0.004), and FAI ≥ -70.1 HU (HR: 3.1, 95% CI: 1.8 to 5.5, p < 0.001) were associated with myocardial ischemia in univariable analysis. After adjusting for traditional CAD risk factors and CT characteristics in the multivariable regression analysis, NAFLD (HR: 2.3, 95% CI: 1.2 to 4.4, p = 0.016) was an independent predictor of myocardial ischemia. Our data suggest that myocardial ischemia was more prevalent in patients with NAFLD, and NAFLD is a predictor of myocardial ischemia independent of traditional cardiovascular risk factors and CCTA characteristics. • NAFLD patients had higher calcium score, incidence of obstructive coronary artery disease, grade of CAD-RADS, quantitative plaque characteristics, and incidence of fat attenuation index ≥ -70.1 HU. • NAFLD patients had a higher incidence of myocardial ischemia, myocardial hypoperfusion, and hypoperfusion myocardial segments ratio. • NAFLD was a predictor of myocardial ischemia, independent of traditional cardiovascular risk factors, and CCTA characteristics.

Hepatic fat as a novel marker for high-risk coronary atherosclerotic plaque features in familial hypercholesterolaemia

Background & aimsHepatic steatosis has been associated with increased risk of coronary artery disease. Individuals with familial hypercholesterolaemia have accelerated but variable progression of coronary artery disease. We investigated whether hepatic steatosis is associated with novel coronary atherosclerosis biomarkers in adults with heterozygous familial hypercholesterolaemia, using comprehensive coronary computed tomographic angiography. MethodsWe conducted a cross-sectional study of 213 asymptomatic patients with familial hypercholesterolaemia (median age 54.0 years, 59 % female) who underwent coronary computed tomographic angiography for cardiovascular risk assessment in an outpatient clinic. High-risk plaque features, plaque volume and pericoronary adipose tissue attenuation were assessed. From concurrently captured upper abdominal images, severity of hepatic steatosis was computed, as liver minus spleen computed tomography attenuation and stratified into quartiles. ResultsOf 213 familial hypercholesterolaemia patients, 59 % had coronary artery calcium, 36 % obstructive coronary artery disease (≥50 % stenosis) and 77 % high-risk plaque features. Increasing hepatic steatosis was associated with higher calcium scores, more high-risk plaque features and presence of obstructive coronary artery disease. Hepatic steatosis was associated with the presence of high-risk plaque features (OR: 1.48; 95 % CI: 1.09–2.00; p = 0.01), particularly in the proximal coronary segments (OR: 1.52; 95 % CI: 1.18–1.96; p = 0.001). Associations persisted on multivariable logistic regression analysis adjusting for cardiometabolic factors, obstructive coronary artery disease and calcium score. Hepatic steatosis was associated with higher plaque volumes (Q4: 499 mm3 vs Q1: 414 mm3, p = 0.02), involving mainly low attenuation and noncalcified plaques (both p = 0.03). No differences in pericoronary adipose tissue attenuation were observed. ConclusionsHepatic steatosis is associated with multiple indices of advanced coronary atherosclerosis in familial hypercholesterolaemia patients, particularly high-risk plaque features, independent of conventional cardiovascular risk factors and markers. This may involve specific mechanisms related to hepatic steatosis.Clinical trial number: N/A.

Validation of a Three-Dimensional Computed Tomography Reconstruction Tool for Aortic Valve Calcium Quantification

BackgroundAortic valve calcification correlates with the severity of aortic valve stenosis and a high calcium score is associated with conduction disturbances and paravalvular leakage after transcatheter aortic valve replacement. The 3mensio Structural Heart is a semiautomated software package to facilitate aortic root analysis by multislice computed tomography.The aim of the contemporary study is to validate a semiautomated calcium quantification scoring tool with a conventional manual calcium quantification tool. MethodsFifty randomly selected patients who underwent multislice computed tomography for preprocedural planning were retrospectively selected to compare the semiautomated aortic valve Agatston calcium score by 3mensio with the manually obtained score using IntelliSpace Portal as standard reference. ResultsPatients had a mean age of 76.7 ± 7.4 years and 60% were male. The median Agatston score was 3390 [interquartile range 1877-4509] with 3mensio and 3434 [interquartile range 1839-4620] with IntelliSpace.The mean difference was -0.18 [95% confidence interval (CI) −53.8 to 53.4]. The intraclass correlation coefficient between the Agatston scores using IntelliSpace and 3mensio showed an excellent correlation of 0.995 [95% CI 0.992-0.997], p ≤ 0.001. The interobserver and intraobserver variability was 0.993 ([95% CI 0.961-0.998], p ≤ 0.001) and 0.995([95%CI 0.981-0.999], p = <0.001), respectively. ConclusionsThe semiautomated calcium quantification module in 3mensio Structural Heart highly correlated with a conventional manual calcium scoring tool.

The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain.

Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to patients with stable chest pain (SCP). Since it is known that ACP differs in many ways from SCP, the aim of this study was to compare the predictive value of a high CACS for the diagnosis of severe CAD between ACP and SCP patients. This single center observational retrospective study included consecutive patients who underwent cardiac CT for chest pain and were found to have a CACS of &gt;200 Agatston units. Patients were divided into two groups, ACP and SCP. Severe CAD was defined as ≥70% stenosis on coronary CT angiography or invasive coronary angiography. Baseline characteristics and final diagnosis of severe CAD were compared. The cohort included 220 patients, 106 with ACP and 114 with SCP. ACP patients had higher severe CAD rates (60.4% vs. 36.8%; p &lt; 0.001). On multivariate analysis including cardiac risk factors, CACS &gt; 400 au (OR = 2.34 95% CI [1.32-4.15]; p = 0.004) and ACP (OR = 2.54 95% CI [1.45-4.45]; p = 0.001) were independent predictors of severe CAD. The addition of the clinical setting of ACP added significant incremental predictive value for severe stenosis. A high CACS is more associated with severe CAD in patients presenting with ACP than SCP. The findings suggest that the CACS could impact the management of patients during the scan.

Abstract 14708: Cardiovascular Calcium Scoring by Deep Learning is Predictive of Mortality in Emergency Department Patients

Introduction: Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common incidental findings that may herald clinical or subclinical cardiovascular disease. Hypothesis: We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients. Methods: We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression. Results: The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure. Conclusions: High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.

Gender Specific Coronary Artery Diameters in CT Coronary Angiogram: A Comparative Study in Female and Male Population

Objectives: Women show significant in-hospital morbidity and mortality with greater extent of symptoms, poorer post-revascularization outcome with increased restenosis and repeat revascularization after angioplasty, than men. Smaller sized coronary arteries in females can be attributable for this differential outcome, which is also similar in case of Indians, compared to Caucasians. Our aim is to assess the gender-specific difference in coronary arteries using noninvasive Multidetector Computed-Tomography Coronary-Angiogram(CT-CAG) and comparing the same with other racial database. Materials and Methods: With Ethics committee approval, present retrospective comparative study conducted in 128CT-CAG scans in 18-45years aged 100 women and 89 men with no atherosclerotic burden excluding pathological coronaries and high calcium score&gt;100. Diameter measurements of proximal (≤10mm) segments of right coronary artery(RCA), left main coronary artery(LMCA), left anterior descending(LAD) and circumflex(LCx) arteries were taken, averaged and compared using 2-sample z-test. Considering the obtained mean diameters of total sample as South-Indian dataset which is then compared with Caucasians dataset taken from previous study. Results: Women showed smaller coronary artery diameters compared to men in all the arteries, with greater gender-specific age-adjusted difference in LMCA, followed by LAD, RCA and least in LCX. South-Indians showed statistically significant smaller diameters of all the coronary arteries compared to Caucasians. Conclusion: Gender-specific difference among the coronary arteries does exist, with females having smaller dimensions; South-Indians also show smaller diameters. This warrants a clinician for gender-specific approaches during the interventions because of technical difficulties.

Associations of segment-specific pulse wave velocity with vascular calcification: the Atherosclerosis Risk in Communities (ARIC) Study

Abstract Background Pulse wave velocity (PWV) is a non-invasive measure of arterial stiffness and a predictor of cardiovascular disease (CVD). Vascular calcification, especially coronary artery calcium (CAC) measured by computed tomography (CT), is one of the strongest predictors of CVD but requires radiation for measurement. PWV may be helpful to identify persons with vascular calcification who may benefit from formal assessment of vascular calcification with CT. However, the associations between PWV and vascular calcification across different vascular beds have not been fully investigated. Purpose The aims of this study were to quantify the association between PWV and calcification at different segments and to explore whether PWV can identify individuals with vascular calcification beyond traditional risk factors. Methods Among 1486 ARIC Study participants (mean age 79.3 [SD 4.2] years), we measured PWV by OMRON VP1000plus at the following segments: heart-carotid (hcPWV), heart-femoral (hfPWV), carotid-femoral (cfPWV), heart-ankle (haPWV), brachial-ankle (baPWV) and femoral-ankle (faPWV). Participants were stratified into four groups based on quartiles of each PWV measure. Dependent (i.e., outcome) variables were high calcium score (≥75th percentile of Agatston score by CT) of the following vascular beds (including valves): coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta. We ran multivariable logistic regression models and assessed c-statistics as a measure of prediction discrimination. Results Only cfPWV was significantly positively associated with high CAC (adjusted odds ratio [OR] for the highest vs. lowest quartile: 1.73 [95% CI: 1.17–2.55]) (green dot in figure). The associations were overall most evident for descending aorta calcification, with significantly positive results for hfPWV (gold dot in figure), cfPWV (green dot), haPWV (emerald dot), and baPWV (blue dot). For example, adjusted OR for the highest vs. lowest quartile of cfPWV was 4.08 (2.70–6.24). hfPWV and cfPWV were significantly associated with mitral valve calcification as well. In contrast, faPWV (purple dots) was inversely associated with calcification of aortic valve ring, ascending aorta, and descending aorta. For descending aorta calcification, even the second highest quartile of the following measures demonstrated significant adjusted OR: hfPWV (3.21 [2.11–4.95]), cfPWV (2.11 [1.40–3.20]), and baPWV (1.75 [1.14–2.69]). Simultaneously adding cfPWV and hfPWV improved c-statistic for CAC (Δc-statistic 0.011 [0.0007–0.022]) and descending aorta calcification (0.035 [0.017–0.053]). Conclusions The associations of PWV with vascular calcification varied substantially across segments, with descending aorta calcification most closely linked to PWV measures and cfPWV most robustly associated with calcification of multiple vascular beds. cfPWV and hfPWV, together, improved discrimination of high CAC beyond traditional risk factors. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Heart, Lung, and Blood Institute, National Institutes of Health