Presence Of Coronary Calcification Research Articles

Association Between Coronary Calcium Detection on Chest Computed Tomography and Ischemic Cardiovascular Events and Mortality in Asymptomatic Chronic Obstructive Pulmonary Disease Patients. Systematic Review of the Literature

IntroductionLiterature suggests that there is a close relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular (CV) disease. The aim of this study was to assess whether the presence of coronary calcium (CC) on chest computed tomography (CT) in asymptomatic COPD patients is associated with an increased risk of CV events and mortality. Material and methodsA systematic review of the literature was performed following PRISMA recommendations. Studies published in the last 20 years in four databases (PubMed, Web of Science, Embase and MEDLINE) were included. ResultsThree hundred fifty articles were identified, eight of them met the selection criteria. The included studies, conducted between 2013 and 2024, were predominantly multicentre cohort studies. The meta-analysis showed that the presence of CC on chest CT of COPD patients is an independent predictor of CV events (hazard ratio 1.44, 95% CI 1.22–1.70) and associated with an increased mortality during the follow-up period (hazard ratio 1.57, 95% CI 1.35–1.83). ConclusionsOur analysis suggests that the identification of CC on chest CT scans of COPD patients may be useful in the early detection and treatment of CV disease in asymptomatic patients. Prospective, multicentre studies confirming our findings are needed to explore the potential impact of early detection and treatment of CV risk in COPD patients.

Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer: An NI-HEART Analysis

BackgroundRadiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients. ObjectivesThe aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying “high risk” patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT). MethodsThe medical records of patients who underwent definitive RT for non–small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death. ResultsAmong 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival. ConclusionsThe present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.

Circulating miR-6821-5p levels and coronary calcification in asymptomatic familial hypercholesterolemia patients

Background and aimsPremature atherosclerotic cardiovascular disease (CVD) is a clinic characteristic of familial hypercholesterolemia (FH). Coronary calcium score (CCS) is a highly used imaging modality to evidence atherosclerotic plaque burden. microRNAs (miRNAs) are non-coding RNAs that epigenetically regulate gene expression. Here, we investigated whether CCS associates with a specific miRNA-signature in FH-patients. MethodsPatients with genetic diagnosis of FH (N = 86) from the nationwide SAFEHEART-cohort were investigated by computed tomography angiography imaging and classified depending on the presence of coronary calcification in FH-CCS (+) and FH-CCS (−) groups by the Agatston score. Differential miRNA profiling was performed in two stages: first by Affymetrix microarray technology (high-throughput differential profiling-studies) and second by RT-PCR using TaqMan-technology (analytical RT-qPCR study) in plasma of the two patient groups. ResultsmiR-193a-5p, miR-30e-5p and miR-6821-5p levels were significantly higher in FH-CCS (+) compared to FH-CCS (−). miR-6821-5p was the best miRNA to discriminate FH-patients CCS(+), according to receiver operating characteristic (ROC) analysis (AUC: 0.70 ± 0.06, p = 0.006). High miR-6821-5p levels were associated with older age (p = 0.03) and high LDL-burden (p = 0.014) using a ROC-derived cut-off value. However, miR-6821-5p did not correlate with age in either the CCS- or CCS + group. Genes involved in calcification processes were identified by in silico analysis. The relation of cell-calcification and expression levels of miR-6821-5p, BMP2 and SPP1 was validated experimentally in human vascular smooth muscle cell cultures. ConclusionsUp-regulated levels of miR-6821-5p are found in the plasma of asymptomatic FH-patients with coronary calcified atherosclerotic plaques, as well as in isolated human vascular smooth muscle cells expressing the pro-calcification genes BMP2 and SPP1. These findings highlight the impact of epigenetic regulation on the development of subclinical atherosclerosis.

Microcatheter-versus wire-based measurement of the fractional flow reserve

Background Fractional flow reserve (FFR) guided-percutaneous interventions is nowadays the gold standard for optimal coronary artery revascularization. While multiple pressure guidewires have been validated, the use of microcatheter for FFR measurements is still a matter of debate. Objective The aim of this study was to investigate the crossing profile characteristics of the NAVVUS® microcatheter as compared with the COMETTM pressure wire. At the same time, we compared non-hyperaemic pressure ratio (NHPR) and FFR measurements of both systems. Method/materials In this retrospective study, all angiographically intermediate coronary artery stenoses each month were assessed, using either the NAVVUS® or the COMETTM pressure system, to receive coronary artery physiology assessment with NHPR and FFR measurements. The crossing profile of both systems was compared regarding objective coronary artery lesion characteristics using quantitative coronary analysis evaluation. Results Over a period of 4.5 years, we evaluated 213 coronary artery stenoses using one of the two coronary tools. We found a 9.2% crossing profile failure rate using the microcatheter, compared to 0.7% in the pressure wire group (p < .001). The crossing failure was significantly correlated with the presence of coronary artery calcifications and angulation (p = .042, p = .049, respectively). FFR values were comparable be- tween the two groups and were significantly lower in the presence of coronary calcifications and proportional to the degree of stenosis (p = .036, p = .010). Pressure drift was comparable. Conclusion Our observations are in line with other studies reporting the poor crossing profile of the NAVVUS® microcatheter. NHPR and FFR measures of both systems were well correlated.

Cardiac Incidental Findings on Abdominopelvic Computed Tomography: Prevalence and Association with Subsequent Cardiovascular Events

The aim of this study was to assess the prevalence of reportable cardiac findings detected on abdominopelvic CTs and the association with subsequent cardiovascular events. We performed a retrospective search of electronic medical record of patients who underwent abdominopelvic CT between November 2006 and November 2011 with a clinical history of upper abdominal pain. A radiologist blinded to the original CT report reviewed all 222 cases for the presence of pertinent reportable cardiac findings. The original CT report was also evaluated for documentation of pertinent reportable cardiac findings. The following findings were recorded on all CTs: presence of coronary calcification, fatty metaplasia, ventricle wall thinning and thickening, valve calcification or prosthesis, heart/chamber enlargement, aneurysm, mass, thrombus, device, air within ventricles, abnormal pericardium, prior sternotomy, and adhesions if prior sternotomy. Medical records were reviewed to identify cardiovascular events on follow-up in patients with the presence or absence of cardiac findings. We compared the distribution findings in patients with and without cardiac events using the Wilcoxon test (for continuous variables) and the Pearson's chi-squared test (for categorical variables). Eighty-five of 222 (38.3%) patients (52.7% females, median age 52.5 years) had at least one pertinent reportable cardiac finding on the abdominopelvic CT, with a total of 140 findings in this group. From the total 140 findings, 100 (71.4%) were not reported. The most common findings seen on abdominal CTs were: coronary artery calcification (66 patients), heart or chamber enlargement (25), valve abnormality (19), sternotomy and surgery signs (9), LV wall thickening (7), device (5), LV wall thinning (2), pericardial effusion (5), and others (3). After a mean follow-up of 43.9 months, 19 cardiovascular events were found in the cohort (transient ischemic attack, cerebrovascular accident, myocardial infarction, cardiac arrest, acute arrhythmia, palpitation, syncope and acute chest pain). Only 1 event occurred in the group of patients with no incidental pertinent reportable cardiac findings (1/137=0.73%). All other 18 events occurred in patients with incidental pertinent reportable cardiac findings (18/85=21.2%), which was significantly different (p < 0.0001). One out of the total 19 events in the overall group (5.24%) occurred in a patient with no incidental pertinent reportable cardiac findings while 18 of 19 total events (94.74%) occurred with patients with incidental pertinent reportable cardiac findings, which was also significantly different (p < 0.001). Fifteen of the total events (79%) occurred in patients in whom the incidental pertinent reportable cardiac findings were not reported, which was significantly different (p < 0.001) from the four events that occurred in patients in whom the incidental pertinent reportable cardiac findings were reported or had no findings. Incidental pertinent reportable cardiac findings are common on abdominal CTs and are frequently not reported by radiologists. These findings are of clinical relevance since patients with pertinent reportable cardiac findings have a significantly higher incidence of cardiovascular events on follow-up.

The association of epicardial adipose tissue volume and density with coronary calcium in HIV-positive and HIV-negative patients

We sought to assess and compare the association of epicardial adipose tissue (EAT) with cardiovascular disease (CVD) in HIV-positive and HIV-negative groups METHODS AND RESULTS: Using existing clinical databases we analysed 700 patients (195 HIV-positive, 505 HIV-negative). CVD was quantified by the presence of coronary calcification from both dedicated cardiac computed tomography (CT) and non-dedicated CT of the thorax. Epicardial adipose tissue (EAT) was quantified using dedicated software. The HIV-positive group had lower mean age (49.2 versus 57.8, p<0.005), higher proportion of male sex (75.9% versus 48.1%, p<0.005) and lower rates of coronary calcification (29.2% versus 58.2%, p<0.005). Mean EAT volume was also lower in the HIV-positive group (68mm3 versus 118.3mm3, p<0.005). Multiple linear regression demonstrated EAT volume was associated hepatosteatosis (HS) in the HIV-positive group but no the HIV-negative group after adjustment for BMI (p<0.005 versus p=0.066). In the multivariate analysis, after adjustment for CVD risk factors, age, sex, statin use and body mass index (BMI), EAT volume and hepatosteatosis were significantly associated with coronary calcification (odds ratio [OR] 1.14, p<0.005 and OR 3.17, p<0.005 respectively). In the HIV-negative group the only significant association with EAT volume after adjustment was total cholesterol (OR 0.75, p=0.012). We demonstrated a strong and significant independent association of EAT volume and coronary calcium, after adjustment, in HIV-positive group but not in the HIV-negative group. This result hints at differences in the mechanistic drivers of atherosclerosis between HIV-positive and HIV-negative groups.

Coronary calcification is independently associated with major adverse cardiovascular events in men with recurrent prostate cancer while aortic calcification is not

Abstract Background Cardiovascular disease is an important cause of morbidity and mortality in men with prostate cancer. Coronary and aortic calcification have been associated with major adverse cardiovascular events (MACE) in the general population, and are readily seen on staging cancer positron emission tomography (PET)/computed tomography (CT) scans. The utility of vascular calcification on non-gated CT for cardiovascular risk assessment in men with prostate cancer is not known. Purpose We determined the association between coronary and aortic calcification on non-gated CT imaging and MACE in men with prostate cancer. Methods We studied 354 men who underwent indium-111 capromab pendetide PET/CT for recurrent prostate cancer at our institution between 2012–2016. Clinical data were obtained from the medical record. Coronary and aortic calcification were qualitatively assessed using a standardized scoring system. The primary outcome of MACE included myocardial infarction, stroke, coronary and/or peripheral revascularization, heart failure hospitalization, and all-cause mortality. Results Over 5 years of follow-up, 63 patients (18%) met the primary outcome. Vascular calcification was common in this cohort (median 68 years of age), with 214 patients (60%) having coronary calcification and 296 patients (84%) having aortic calcification. Older patients had greater coronary and aortic calcification, and also higher rate of MACE. In adjusted models for age and diabetes, coronary calcification was associated with higher rate of MACE (hazard ratio [HR] 2.1, interquartile range [IQR] 1.1–4.0, p=0.02) while aortic calcification was not (HR 2.7, IQR 0.8–9.0, p=0.12). Undifferentiated vascular calcification was not associated with MACE (p=0.24). Conclusions Coronary calcification on non-gated CT scan is independently associated with MACE in men with recurrent prostate cancer while aortic calcification is not. The presence of coronary calcification should be included in staging PET/CT reports, and this information should prompt implementation of cardiovascular risk modification strategies. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): This study was supported by the Mentors in Medicine Program, Department of Internal Medicine, Washington University School of Medicine.

Relationship between the coronary artery calcium quantification and gut microbiota composition in subjects without previous cardiovascular disease: A pilot study

AimsTo investigate the relationship between gut microbiota composition and the presence of coronary atherosclerosis assessed by coronary artery calcium (CAC) quantification in individuals without previous cardiovascular disease (CVD). MethodsWe included 20 patients over 18 years of age with no history of CVD who underwent multiple detector-computed tomography (MDCT). From each patient, a stool sample was obtained to characterize gut microbiota composition by sequencing bacterial 16S ribosomal RNA gene. In addition, circulating levels of TNF-α and IL-1β, as well as trimethylamine N-oxide (TMAO) were determined in plasma samples by automated ELISA and capillary gas chromatography-mass spectrometry, respectively. ResultsThe mean age of patients was 63.5 years and 60% were women. Half of patients had CAC > 100 (Agatston score), and were characterized by a higher abundance of the phylum Proteobacteria, mainly of bacteria belonging to the families Enterobacteriaceae, Pasteurellaceae, Erwiniaceae, Vibrionaceae and Morganellaceae, than patients with a CAC ≤ 100. Moreover, bacterial genera identified as biomarkers, such as Enterobacter, Escherichia/Shigella y Klebsiella, were positively associated with inflammation levels and with TMAO production. ConclusionsOur data shows a gut microbiota profile associated with the presence of coronary calcium in patients without previous CVD. Although there are no strategies to decrease the amount of coronary calcium, gut microbiota is highly malleable by several factors. The possibility of preventing and even intervening CVD progression through strategies targeted gut microbiota is a very attractive idea that deserves further studies.

Osteoprotegerin Gene Polymorphisms Are Associated with Subclinical Atherosclerosis in the Mexican Mestizo Population.

Subclinical atherosclerosis (SA) is the presence of coronary calcification in the absence of cardiovascular symptoms, and it usually progresses to atherosclerotic disease. Studies have shown an association of osteoprotegerin gene (OPG) variants with calcification process in cardiovascular diseases; however, to this day there are no studies that evaluate individuals in the asymptomatic stage of atherosclerotic disease. Therefore, the purpose of this study was to analyze the association of four genetic variants and haplotypes of the OPG gene with the development of SA, through TaqMan genotyping assays. We also aimed to identify potential response elements for transcription factors in these genetic variants. The study included 1413 asymptomatic participants (1041 were controls and 372 were individuals with SA). The rs3102735 polymorphism appeared as a protective marker (OR = 0.693; 95% CI = 0.493–0.974; pheterozygote = 0.035; OR = 0.699; 95% CI = 0.496–0.985; pcodominant 1 = 0.040) and two haplotypes were associated with SA, one as a decreased risk: GACC (OR = 0.641, 95% CI = 0.414–0.990, p = 0.045) and another as an increased risk: GACT (OR = 1.208, 95% CI = 1.020–1.431, p = 0.029). Our data suggest a lower risk of SA in rs3102735 C carriers in a representative sample of Mexican mestizo population.

Assessment of Post-Dilatation Strategies for Optimal Stent Expansion in Calcified Coronary Lesions: Ex Vivo Analysis With Optical Coherence Tomography

IntroductionInterventional cardiologists make adjustments in the presence of coronary calcifications known to limit stent expansion, but proper balloon sizing, plaque-modification approaches, and high-pressure regimens are not well established. Intravascular optical coherence tomography (IVOCT) provides high-resolution images of coronary tissues, including detailed imaging of calcifications, and accurate measurements of stent deployment, providing a means for detailed study of stent deployment. ObjectiveEvaluate stent expansion in an ex vivo model of calcified coronary arteries as a function of balloon size and high-pressure, post-dilatation strategies. MethodsWe conducted experiments on cadaver hearts with calcified coronary lesions. We assessed stent expansion as a function of size and pressure of non-compliant (NC) balloons (i.e., nominal, 0.5, 1.0, and 1.5 mm balloons at 10, 20 and 30 atm). IVOCT images were acquired pre-stent, post-stent, and at all post-dilatations. Stent expansion was calculated using minimum expansion index (MEI). ResultsWe analyzed 134 IVOCT pullbacks from ten ex-vivo experiments. The mean distal and proximal reference lumen diameters were 2.2 ± 0.5 mm and 2.5 ± 0.7 mm, respectively, 80% of times using a 3.0 mm diameter stent. Overall, based on stent sizing, a good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at 20 atm, and expansion > 100% was reached using the 1:1 NC balloon at 30 atm. In the subgroup analysis, comparing low-calcified and high-calcified lesions, good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at nominal pressure (10 atm) versus using 1:1 NC balloon at 30 atm, respectively. Significant vessel rupture was identified in all the vessels mainly upon post-dilatation with larger balloons, and 60% of the experiments (6 vessels, 3 in each calcium subgroup) presented rupture with the +1.0 mm NC balloon at 20 atm. ConclusionWhen treating calcified lesions, good stent expansion was reached using smaller balloons at higher pressures without coronary injuries, whereas bigger balloons yielded unpredictable expansion even at lower pressures and demonstrated potential harmful damages to the vessels. As these findings could help physicians with appropriate planning of stent post-dilatation for calcified lesions, it will be important to clinically evaluate the recommended protocol.

Prevalence and distribution of coronary artery calcium in a southeast asian cohort

Abstract Funding Acknowledgements Type of funding sources: None. Background The coronary artery calcium score (CACS) independently predicts the risk of cardiovascular disease and major adverse cardiovascular events. While previous studies have demonstrated regional and ethnic differences in coronary calcification, the distribution of CACS in Southeast Asian (SEA) adults has not been investigated. Purpose The aim of this study was to determine CACS distribution in a SEA cohort living in Singapore. Methods This study involved 4945 asymptomatic patients who underwent CT coronary angiography and calcium scoring as part of screening for cardiovascular disease. Similar to the MESA study, patients with diabetes were analyzed separately due an increased prevalence of coronary calcification. A nonparametric analytical approach was used to determine CACS distribution stratified by age, gender and ethnicity. Results A positive CACS was seen in 43.7% of the overall SEA cohort with a higher prevalence in males (45.2%) than females (36.7%). The onset and burden of coronary calcification was also earlier and more severe in male subjects. There were no significant differences in CACS distribution amongst the three major ethnic groups in our study (p = 0.177). The presence of coronary calcification (CACS &amp;gt;0) was associated with increasing age, male gender and hypertension. Ethnicity, dyslipidemia, smoking and a family history of coronary artery disease did not significantly affect the presence of CACS. Conclusions This study provides a reference CACS distribution in an asymptomatic SEA population. There were no significant differences in CACS distribution amongst the three major ethnic groups living in Singapore.

Relación entre la cuantificación de calcio coronario y la composición de la microbiota intestinal en sujetos sin enfermedad cardiovascular previa: estudio piloto

AimTo investigate the relationship between gut microbiota composition and the presence of coronary atherosclerosis assessed by coronary artery calcium (CAC) quantification in individuals without previous cardiovascular disease (CVD). MethodsWe included 20 patients over 18 years of age with no history of CVD who underwent multiple detector-computed tomography. From each patient, a stool sample was obtained to characterize gut microbiota composition by sequencing bacterial 16S ribosomal RNA gene. In addition, circulating levels of TNF-α and IL-1β, as well as trimethylamine N-oxide (TMAO) were determined in plasma samples by automated ELISA and capillary gas chromatography-mass spectrometry, respectively. ResultsThe mean age of patients was 63.5 years and 60% were women. Half of patients had CAC >100 (Agatston score), and were characterized by a higher abundance of the phylum Proteobacteria, mainly of bacteria belonging to the families Enterobacteriaceae and than patients with a CAC ≤ 100. Moreover, bacterial genera identified as biomarkers, such as Enterobacter, Escherichia/Shigella y Klebsiella, were positively associated with inflammation levels and with TMAO production. ConclusionOur data shows a gut microbiota profile associated with the presence of coronary calcium in patients without previous CVD. Although there are no strategies to decrease the amount of coronary calcium, gut microbiota is highly malleable by several factors. The possibility of preventing and even intervening CVD progression through strategies targeted gut microbiota is a very attractive idea that deserves further studies.

Contemporary tools and devices for coronary calcium modification.

With the aging population, up to a third of patients referred for percutaneous coronary intervention (PCI) have moderate or severe calcified lesions assessed by coronary angiography. The presence of coronary calcium is associated with difficult device delivery, sub-optimal stent deployment, and prolonged procedures, with more complications. Furthermore, it is known that sub-optimal stent expansion is associated with poor clinical outcomes. In this manuscript we describe how to quantify the severity of coronary calcium, review the armamentarium of contemporary devices available for calcium modification, and provide a systematic approach to device selection, assessment of successful calcium modification, and stent optimization.

Abstract 13946: Subclinical Atherosclerosis and Peri-Operative Cardiac Events in Patients Undergoing Peripheral Bypass Surgery

Introduction: Coronary artery disease (CAD) is associated with a higher risk of peri-operative adverse events after vascular surgery. Subclinical CAD, defined as presence of coronary calcium, has not been established as a risk factor for adverse events after vascular surgery. Hypothesis: We sought to describe the epidemiology and peri-operative outcomes in patients with subclinical coronary atherosclerosis (SCA) undergoing supra- and infra-inguinal peripheral bypass. Methods: Using the Vascular Quality Initiative, we identified patients at a single institution undergoing supra- and infra-inguinal peripheral bypass surgery (2009-2020). Retrospective chart review was performed to identify chest computed tomography (CT) within one year prior to revascularization; imaging was reviewed for presence of coronary calcifications, a marker of SCA. Individuals were stratified by: no atherosclerosis, SCA, and CAD. Comorbidities and peri-operative outcomes were compared among groups with the chi-square or ANOVA, as appropriate. Results: Of 1018 patients undergoing peripheral bypass surgery, 199 (20%) had a CT available. SCA was noted in 96 patients (48%) while 72 (36%) had known CAD. Patients with SCA had similar comorbidities to patients with CAD (Table) but were less likely to be on a pre-operative beta-blocker or P2Y12 inhibitor. The incidence of postoperative myocardial infarction and congestive heart failure was similar in patients with SCA (13% and 9%, respectively) as those with CAD (10%, 6% respectively), compared to those without atherosclerosis (3% and 0, respectively). Conclusions: SCA is common in patients undergoing peripheral bypass surgery and is associated with a risk of peri-operative myocardial infarction or congestive heart failure similar to occult CAD. Aggressive secondary prevention measures should be considered in patients with polyvascular disease, including subclinical CAD.

Myocardial uptake of 68Ga-DOTATATE: correlation with cardiac disease and risk factors.

Myocardial uptake on 68Ga-DOTATATE PET/CT is often observed and its clinical relevance is poorly understood. To detect any correlation between myocardial uptake of 68Ga-DOTATATE and presence of cardiac disease or risk factors. In this institutional review board-approved retrospective study, we reviewed 68Ga-DOTATATE PET/CT scans in our institution between 1 May 2018 and 30 September 2018. A semi-quantitative score (MUS) for myocardial uptake of 68Ga-DOTATATE was developed by measuring mean standardized uptake value (SUV) in five myocardial regions, corrected by blood pool activity, and MUS was validated between two readers. We investigated the relationship between MUS and presence of cardiac disease or risk factors, including Framingham score and coronary calcification. A total of 145 scans were included (79 women; mean age = 56.9 ± 13.7 years). Inter-reader agreement was excellent with intraclass correlation coefficient (r) = 0.964 (95% confidence interval [CI] = 0.903-0.987; P < 0.001). There was a weak but significant positive correlation between MUS and presence of coronary calcifications (Spearman rho = 0.20; P = 0.016). MUS was higher in patients with heart disease or risk factors (n = 83, mean MUS 2.03, 95% CI = 1.85-2.21) compared to those without (n = 23, mean MUS 1.40, 95% CI = 1.17-1.62; P < 0.001), although the cardiac disease group was older with a higher percentage of men (62.0 years, 57.8% men compared to 47.6 years, 13.0% men; P value <0.0001 for both comparisons). For patients undergoing 68Ga-DOTATATE PET/CT scan, an elevated MUS might indicate an underlying heart disease.

Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

Abstract Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. Funding Acknowledgement Type of funding sources: None. Table 1

The detection rate of non-invasive markers of subclinical atherosclerosis of brachyocephalic and coronary arteries with an assessment of their relationship in patients with arterial hypertension

Abstract Introduction Atherosclerosis is a chronic, progressive, inflammatory disease, which is characterized by an undulating course and multifocal nature of the lesion. Arterial hypertension (AH) is widespread in the population, and also contributes to the development and progression of atherosclerosis. Non-invasive imaging techniques make it possible to diagnose atherosclerosis, also at its subclinical stage. The detection of coronary calcification, atheromatous plaques in the brachiocephalic arteries (BCA), and the detection of the ankle-brachial index (ABI) are referred to as non-invasive markers of atherosclerosis. Estimation of the strength of the relationship between the detection rate of non-invasive markers of atherosclerosis in AH is on the front burner. Purpose To estimate the presence and degree of relationship between non-invasive markers of subclinical atherosclerosis in patients with AH. Methods 99 patients were studied with an proven diagnosis of AH, without anamnesis of symptomatic diseases of atherosclerotic genesis. Median age is 58 years, of them 37 are men. To detect subclinical atherosclerotic lesions of the coronary arteries (CA), all persons included in the study, after obtaining informed consent, were performed the multispiral computed tomography of CA on a 64-slice computed tomography Optima CT 660 (General Electric Co, USA) with the calculation of the cardiac calcium score (CCS) according to the Agatston score. Duplex ultrasound of BCA and determination of ABI value was performed using a supersonic diagnostic apparatus Vivid E9 (General Electric Co, USA) according to the standard procedure. Statistical data processing was performed using the Statistica for Windows ver 10.0 software (StatSoft, Inc., USA). To describe the relationship between the parameters under study, the Kendall's rank correlation coefficient was used (at a statistical significance p&amp;lt;0.05). Results Subclinical atherosclerotic lesions of CA (CCS &amp;gt;0) was detected in 53 persons (53.5%), and BCA (presence of atheromatous plaque) – in 52 persons (52.5%). In 13 patients (13.1%), a decrease in ABI &amp;lt;0.9 was recorded. Correlation analysis revealed the presence of a direct correlation of average strength between subclinical lesions of the BCA (presence of atheromatous plaque) and CA (CCS &amp;gt;0), τb=0.33 (95% CI: 0.14; 0.49), p&amp;lt;0.001). Besides, atherosclerotic lesions of BCA had a negative correlation weak strength with subclinical peripheral arterial lesion (ABI &amp;lt;0.9) τb=−0.19 (95% CI: −0.37; 0.01), p=0.005. We have not detected a correlation between the ABI decrease and the presence of coronary calcification. Conclusion Subclinical lesions of CA and BCA were more often detected in persons with AH (in 53.5% and 52.5%, respectively). Correlation analysis showed that in persons with AH, subclinical BCA lesion is positively associated with the presence of coronary calcification and has a weak negative relationship with a decrease value of ABI. Funding Acknowledgement Type of funding sources: None.

Associations of Hepatosteatosis With Cardiovascular Disease in HIV-Positive and HIV-Negative Patients: The Liverpool HIV-Heart Project.

Hepatosteatosis (HS) has been associated with cardiovascular disorders in the general population. We sought to investigate whether HS is a marker of cardiovascular disease (CVD) risk in HIV-positive individuals, given that metabolic syndrome is implicated in the increasing CVD burden in this population. To investigate the association of HS with CVD in HIV-positive and HIV-negative individuals. We analyzed computed tomography (CT) images of 1306 subjects of whom 209 (16%) were HIV-positive and 1097 (84%) HIV-negative. CVD was quantified by the presence of coronary calcification from both dedicated cardiac CT and nondedicated thorax CT. HS was diagnosed from CT data sets in those with noncontrast dedicated cardiac CT and those with venous phase liver CT using previously validated techniques. Previous liver ultrasound was also assessed for the presence of HS. The HIV-positive group had lower mean age (P < 0.005), higher proportions of male sex (P < 0.005), and more current smokers (P < 0.005). The HIV-negative group had higher proportions of hypertension (P < 0.005), type II diabetes (P = 0.032), dyslipidemia (P < 0.005), statin use (P = 0.008), and HS (P = 0.018). The prevalence of coronary calcification was not significantly different between the groups. Logistic regression (LR) demonstrated that in the HIV-positive group, increasing age [odds ratio (OR): 1.15, P < 0.005], male sex (OR 3.37, P = 0.022), and HS (OR 3.13, P = 0.005) were independently associated with CVD. In the HIV-negative group, increasing age (OR: 1.11, P < 0.005), male sex (OR 2.97, P < 0.005), current smoking (OR 1.96, P < 0.005), and dyslipidemia (OR 1.66, P = 0.03) were independently associated with CVD. Using a machine learning random forest algorithm to assess the variables of importance, the top 3 variables of importance in the HIV-positive group were age, HS, and male sex. In the HIV-negative group, the top 3 variables were age, hypertension and male sex. The LR models predicted CVD well, with the mean area under the receiver operator curve (AUC) for the HIV-positive and HIV-negative cohorts being 0.831 [95% confidence interval (CI): 0.713 to 0.928] and 0.786 (95% CI: 0.735 to 0.836), respectively. The random forest models outperformed LR models, with a mean AUC in HIV-positive and HIV-negative populations of 0.877 (95% CI: 0.775 to 0.959) and 0.828 (95% CI: 0.780 to 0.873) respectively, with differences between both methods being statistically significant. In contrast to the general population, HS is a strong and independent predictor of CVD in HIV-positive individuals. This suggests that metabolic dysfunction may be attributable to the excess CVD risk seen with these patient groups. Assessment of HS may help accurate quantification of CVD risk in HIV-positive patients.

Feasibility of Subtraction Coronary Computed Tomographic Angiography and Influencing Factor Analysis: a Retrospective Study.

To investigate the feasibility of subtraction coronary computed tomographic (CT) angiography (SubCCTA) to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA. A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography (CCTA) and SubCCTA. Coronary stenoses were blindly evaluated by two experienced radiologists, which were compared with invasive coronary angiography (ICA). Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses. The diagnosable rate of SubCCTA was 67.2% (n=197), and the non-diagnosable rate was 32.8% (n=97). Using SubCCTA, the false positive rate decreased from 56.5% to 17.4%, and the corresponding diagnostic accuracy was increased from 83.6% to 92.9%. Univariate logistic regression analysis showed that height (OR=1.029, 95% CI=1.001-1.058), weight (OR=1.025, 95% CI=1.004-1.046), left ventricular size (OR=1.018, 95% CI=1.007-1.030), cardiothoracic ratio (OR=39.917, 95% CI=1.244-1281.098), the average heart rate (OR=0.866, 95% CI=0.836-0.896) and heart rate range (OR=0.882, 95% CI=0.853-0.912) might be the factors influencing SubCCTA. This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques. Moreover, several factors were discovered for the first time to possibly influence SubCCTA, which will be helpful in improving the subtracted image quality.

Liver fibrosis scores and coronary atherosclerosis: novel findings in patients with stable coronary artery disease

Although non-invasive liver fibrosis scores (LFSs) have already been considered as effective tools for estimating cardiovascular risk, their roles in predicting disease severity and cardiovascular event (CVEs) in patients with stable coronary artery disease (CAD) are not comprehensively evaluated. The aim of the present study was to investigate whether non-alcoholic fatty liver disease fibrosis score (NAFLD-FS) and fibrosis-4 (FIB-4) are associated with CVEs in a large cohort with long-term follow-up. A cohort of 5143 patients with angiography-proven stable CAD were consecutively enrolled and followed up for CVEs. The degree of coronary severity was assessed using the number of diseased vessels, Gensini, Syntax, and Jeopardy scores. The predictive values of NAFLD-FS and FIB-4 scores to coronary severity, coronary calcification (CAC), and CVEs were assessed, respectively. During a median follow-up of 7years, 435 CVEs were recorded. Both NAFLD-FS and FIB-4 were predictors for the presence of CAC. The degree of coronary stenosis was significantly higher in high NAFLD-FS categories while FIB-4 was only positively associated with the number of diseased vessels and Gensini score. In Kaplan-Meier analysis, the patients with intermediate and high NAFLD-FS and FIB-4 had higher risk of CVEs and cardiovascular mortality. In multivariate Cox regression analysis, NAFLD-FS and FIB-4 were independently associated with CVEs [hazard ratio (95% confidence interval): 1.150 (1.063-1.244), p < 0.001 and 1.128 (1.026-1.240), p = 0.012]. The current data first indicated that both NAFLD-FS and FIB-4 scores were not only significantly related to coronary severity but also associated with CAC and CVEs. None.