Coronary Artery Calcium Screening Research Articles

SOCIODEMOGRAPHIC DISPARITIES IN CORONARY ARTERY CALCIUM SCREENING

ObjectivesThis study aimed to compare the demographic features and socioeconomic status of patients who underwent coronary artery calcium screening to that of their local population. BackgroundCoronary artery calcium scores provide important evidence of subclinical atherosclerosis. However, insurance often does not cover coronary artery calcium testing, which could exclude people of lower socioeconomic status. MethodsDemographic and occupational data were obtained for all patients referred for coronary artery calcium in a metropolitan area between October 2010 and August 2023. Household income and population reference information were taken from US Census Data and matched to zip code and regional metropolitan area. ResultsCoronary artery calcium tests were performed on 627 patients with a median age of 63 years and equal gender representation (52% female, 48% male). Patients were predominately White (77%) and English-speaking (98%), which is incongruent with local demographic data (p<0.001). Healthcare workers were the largest workforce (22%), followed by people involved in education (12%), which is higher than the local healthcare workforce of 10% (p<0.001). Those with graduate/professional degrees accounted for 32% of patients, significantly more than the local population (p<0.001). The average median annual income ($94,116) of patients who underwent CAC testing was greater than that of the metropolitan median income of $81,264 (p <0.001). ConclusionThe disproportionate distribution of coronary artery calcium screening favoring educated, affluent, White English speakers indicates that higher-income and healthcare personnel are more likely to receive testing. Disparities in coronary artery calcium testing, especially in minorities and non-English speaking individuals, should be further explored.

Behavioral, Clinical, and Coronary Artery Calcium Screening for Prevention and Treatment of Subclinical Atherosclerosis: Implications for Health Education

ABSTRACT Background In the USA, heart disease is the leading cause of death for women and men. Coronary artery disease (CAD) is the most common type of heart disease. Purpose To investigate the association between behavioral and non-behavioral risk factors associated with subclinical atherosclerosis. Methods Patients referred for a CT angiography completed a demographic/behavioral questionnaire and medical history interview for CAD risk factors. Risk factor data were correlated with CAD subclinical atherosclerosis scores for 521 participants. Results Frequency among four levels of CAD revealed: no disease 38%, mild atherosclerotic 20%, moderate atherosclerotic 30%, and severe atherosclerosis 12%. Significant (p ≤ .05) demographic variables were as follows: age, race, marital status, and employment status. Significant predictive behavioral variables were as follows: tobacco use, daily water intake, sodium consumption, exercise days per week, and junk food consumption. Risk factors significantly associated with subclinical CAD included hypertension, diabetes, sleep apnea, and abnormal coronary calcium score. Discussion Multi-slice CT angiography allows early reliable evaluation of subclinical atherosclerosis and correlation with behavioral/non-behavioral risk factors with level of CAD, instrumental to primary and secondary CAD prevention, limiting tertiary CAD treatment. Translation to Health Education Practice Study results have implications for Health Educators with regard to intervention research planning, implementation, and evaluation.

+Racial Inequities in Coronary Artery Calcium Screening and Follow-up

+Racial Inequities in Coronary Artery Calcium Screening and Follow-up

Epicardial adipose tissue attenuation on computed tomography in women with coronary microvascular dysfunction: A pilot, hypothesis generating study

BackgroundPatients with myocardial ischemia without obstructive coronary artery disease often have coronary microvascular dysfunction (CMD) and associated increased risk of cardiovascular (CV) events and anginal hospitalizations. Epicardial adipose tissue (EAT) covers much of the myocardium and coronary arteries and when dysfunctional, secretes proinflammatory cytokines and is associated with CV events. While oxidative stress and systemic inflammation are associated with CMD, the relationship between EAT and CMD in women is not well known. MethodsWomen diagnosed with CMD (n = 21) who underwent coronary computed tomography with coronary artery calcium (CAC) scoring were compared to a reference group (RG) of women referred for CAC screening for preventive risk assessment (n = 181). EAT attenuation (Hounsfield units (HU)) was measured adjacent to the proximal right coronary artery, along with subcutaneous adipose tissue (SCAT). Two-sample t-tests with unequal variances were utilized. ResultsMean age of the CMD group was 56 ± 8 years and body mass index (BMI) was 31.6 ± 6.8 kg/m2. CV risk factors in the CMD group were prevalent: 67 % hypertension, 44 % hyperlipidemia, and 33 % diabetes. Both CMD and RG had similar CAC score (25.86 ± 59.54 vs. 24.17 ± 104.6; p = 0.21. In the CMD group, 67 % had a CAC of 0. Minimal atherosclerosis (CAD-RADS 1) was present in 76 % of women with CMD. The CMD group had lower EAT attenuation than RG (−103.3 ± 6.33 HU vs. −97.9 ± 8.3 HU, p = 0.009, respectively). There were no differences in SCAT attenuation. Hypertension, smoking history, age, BMI, and CAC score did not correlate with EAT in either of the groups. ConclusionsWomen with CMD have decreased EAT attenuation compared to RG women. EAT-mediated inflammation and changes in vascular tone may be a mechanistic contributor to abnormal microvascular reactivity. Clinical trials testing therapeutic strategies to decrease EAT may be warranted in the management of CMD.

Does coronary artery calcium screening help cardiovascular risk stratification in asymptomatic young patients with diabetes mellitus? A knowledge gap.

Does coronary artery calcium screening help cardiovascular risk stratification in asymptomatic young patients with diabetes mellitus? A knowledge gap.

Coronary Artery Calcium Screening—Data First

Coronary Artery Calcium Screening—Data First

The potential impact of computed tomography coronary calcium score screening on patients with dyslipidemia

Background Coronary artery calcium (CAC) scoring helps determine whether patients with known coronary artery disease (CAD) should initiate medical management by predicting future cardiac event risk. CAC scoring is underutilized because many insurance companies consider it experimental. This study aimed to determine whether CAC screening of patients at risk for CAD is associated with decreased risk of myocardial infarction and improved survival. Methods The TriNetX research network was used for this study. Two cohorts of 86,574 patients aged 40 to 70 years were created. All patients were diagnosed with dyslipidemia and without CAD, and the cohorts were matched for demographics, comorbidities, and statin use. One cohort had been screened with CAC scoring while the other had not. The primary outcomes of this study were myocardial infarction and overall survival at 5 years. Results Screened patients had 44% fewer myocardial infarction events at 5 years with a 76% lower risk of death. Conclusion CAC scoring is associated with reduced risk of myocardial infarction and death in asymptomatic dyslipidemia patients and should be considered as a screening tool in these patients. The presumed mechanism for improved outcomes is that early identification of CAD results in earlier or more intensive treatment, reducing future cardiac event risk.

Prognostic value of coronary artery calcium score for the prediction of atherosclerotic cardiovascular disease in participants with suspected nonalcoholic hepatic steatosis: Results from the multi-ethnic study of atherosclerosis

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events; thus, a diagnostic approach to help identify NAFLD patients at high risk is needed. In this study, we hypothesized that coronary artery calcium (CAC) screening could help stratify the risk of ASCVD events in participants with suspected nonalcoholic hepatic steatosis. A total of 713 participants with suspected nonalcoholic hepatic steatosis without previous cardiovascular events from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for the occurrence of incident ASCVD. Nonalcoholic hepatic steatosis was defined using nonenhanced computed tomography and liver/spleen attenuation ratio <1. Cox proportional hazards regression models were used to estimate hazard ratios (HR). C-statistics and areas under the time-dependent receiver operating characteristic curves (tAUC) were used to compare incremental contributions of CAC score when added to the clinical risk factors. In multivariable analyses, CAC score was found to be independently associated with incident ASCVD (HR=1.33, 95% CI=1.22-1.44, P < .001). The addition of CAC score to clinical risk factors increased the C-statistic from 0.677 to 0.739 (P < .001) and tAUC at 10 years from 0.668 to 0.771, respectively. In subgroup analyses, the incremental prognostic value of CAC score was more significant in participants with low/borderline- (<7.5%) and intermediate- (7.5%-20%) 10-year ASCVD risk scores. The inclusion of CAC score in global risk assessment was found to significantly improve the classification of incident ASCVD events in participants with suspected nonalcoholic hepatic steatosis, indicating a potential role for CAC screening in risk assessment.

The cost-effectiveness of coronary calcium score-guided statin therapy initiation for Australians with family histories of premature coronary artery disease.

To compare the cost-effectiveness of coronary artery calcium (CAC) score-guided statin therapy criteria and American College of Cardiology/American Heart Association (ACC/AHA) guidelines (10-year pooled cohort equation [PCE] risk ≥ 7.5%) with selection according to Australian guidelines (5-year absolute cardiovascular disease risk [ACVDR] ≥ 10%), for people with family histories of premature coronary artery disease. Markov microsimulation state transition model based on data from the Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD) trial and transition probabilities derived from published statin prescribing and adherence outcomes and clinical data. 1083 people with family histories of premature coronary artery disease but no symptomatic cardiovascular disease. Relative cost-effectiveness over fifteen years, from the perspective of the Australian health care system, compared with usual care (Australian guidelines), assessed as incremental cost-effectiveness ratios (ICERs), with a notional willingness-to-pay threshold of $50 000 per quality-adjusted life-year (QALY) gained. Applying the Australian guidelines, 77 people were eligible for statin therapy (7.1%); with ACVDR 5-year risk ≥ 2% and CAC score > 0, 496 people (46%); with ACVDR 5-year risk ≥ 2% and CAC score ≥ 100, 155 people (14%); and with the ACC/AHA guidelines, 256 people (24%). The ICERs for CAC-guided selection were $33 108 (CAC ≥ 100) and $53 028 per QALY gained (CAC > 0); the ACC/AHA guidelines approach (ICER, $909 241 per QALY gained) was not cost-effective. CAC score-guided selection (CAC ≥ 100) was cost-effective for people with 5-year ACVDR of at least 5%. Expanding the number of people at low to intermediate CVD risk eligible for statin therapy should selectively target people with subclinical atherosclerosis identified by CAC screening. This approach can be more cost-effective than simply lowering treatment eligibility thresholds.

Opportunistic AI-enabled automated bone mineral density measurements in lung cancer screening and coronary calcium scoring CT scans are equivalent

Rationale and objectivesWe previously reported a novel manual method for measuring bone mineral density (BMD) in coronary artery calcium (CAC) scans and validated our method against Dual X-Ray Absorptiometry (DEXA). Furthermore, we have developed and validated an artificial intelligence (AI) based automated BMD (AutoBMD) measurement as an opportunistic add-on to CAC scans that recently received FDA approval. In this report, we present evidence of equivalency between AutoBMD measurements in cardiac vs lung CT scans. Materials and methodsAI models were trained using 132 cases with 7649 (3 mm) slices for CAC, and 37 cases with 21918 (0.5 mm) slices for lung scans. To validate AutoBMD against manual measurements, we used 6776 cases of BMD measured manually on CAC scans in the Multi-Ethnic Study of Atherosclerosis (MESA). We then used 165 additional cases from Harbor UCLA Lundquist Institute to compare AutoBMD in patients who underwent both cardiac and lung scans on the same day. ResultsMean±SD for age was 69 ± 9.4 years with 52.4% male. AutoBMD in lung and cardiac scans, and manual BMD in cardiac scans were 153.7 ± 43.9, 155.1 ± 44.4, and 163.6 ± 45.3 g/cm3, respectively (p = 0.09). Bland-Altman agreement analysis between AutoBMD lung and cardiac scans resulted in 1.37 g/cm3 mean differences. Pearson correlation coefficient between lung and cardiac AutoBMD was R2 = 0.95 (p < 0.0001). ConclusionOpportunistic BMD measurement using AutoBMD in CAC and lung cancer screening scans is promising and yields similar results. No extra radiation plus the high prevalence of asymptomatic osteoporosis makes AutoBMD an ideal screening tool for osteopenia and osteoporosis in CT scans done for other reasons.

Abstract 12604: Coronary Artery Calcium Score Determined From Pre-Ablation Pulmonary Vein Computed Tomography Allows for Diagnosis of Coronary Artery Disease and Improved Atherosclerotic Cardiovascular Disease Risk Prediction

Objective: Coronary artery calcification (CAC) is a useful adjunct for atherosclerotic cardiovascular disease (ASCVD) risk stratification and can influence preventive strategies. However, CAC screening is infrequently done, even among cardiology patients. Ancillary imaging, for example pulmonary vein CT (CTPV) performed prior to atrial arrhythmia ablation, may allow for CAC quantification. Our goal was to assess CAC prevalence on pre-ablation CTPVs and to assess how this information could influence risk stratification. Methods: Patients undergoing atrial arrhythmia ablation at NYU from 4/1/18 to 4/30/19 were identified and all available medical records reviewed. CTPVs were reviewed and CAC graded semi-quantitatively (0, 1-9, 10-99, 100-399, 400-999, 1000+). 10-yr ASCVD and MESA scores were calculated for patients without known ASCVD. Results: 739 patients underwent ablations and 660 had CTPV available for assessment. Mean age was 63.4 ± 11.4 years, 33.9% were female, and 17.1% had a history of ASCVD (prior MI, CVA/TIA, CAD, PAD). CAC was present in 62% of patients, including 57.2% without ASCVD history (22.3% of these had CAC ≥100). Complete data for the calculation of 10-year AHA/ACC and MESA risk scores were present in 27.9% and 32.4%, respectively. MESA CHD risk score allows for the incorporation of CAC for improved predictive capacity. Median MESA risk was 6.5% without and 6.7% with median CAC included. Incorporating CAC into MESA risk decreased risk in 110 patients (79 of these had CAC &lt;10), and increased risk in 102 patients (101 had CAC ≥10) ( Figure ). AHA/ACC ASCVD risk distribution is displayed in Figure. Guidelines recommend consideration of statins in those with ASCVD risk &lt;7.5% and non-zero CAC. 52.4% of patients with ASCVD risk &lt;7.5 had non-zero CAC ( Figure ) with 18.2% on a statin at the time of their procedure. Conclusion: Quantification of CAC on CTPV can provide a means to diagnose CAD, improve risk stratification and impact primary preventive treatment.

Abstract 11172: Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: Multi-Ethnic Study of Atherosclerosis

Introduction: Coronary artery calcium (CAC) has been widely recognized as an important predictor of cardiovascular disease (CVD). Given the finite resources, it is important to identify individuals who would receive the most benefit from detecting positive CAC by screening. However, the evidence is limited as to whether the burden of positive CAC on CVD differs by multi-dimensional individual characteristics. We aimed to investigate the heterogeneity in the association between positive CAC and incident CVD. Methods: This longitudinal cohort study included adults aged ≥45 years free of cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA). After propensity score matching in a 1:1 ratio, we applied a machine-learning causal forest model to (i) evaluate the heterogeneity in the association between positive CAC and incident CVD and (ii) predict the increase in CVD risk at 10-year when CAC&gt;0 (vs. CAC=0) at the individual level. We then compared the estimated increase in CVD risk when CAC&gt;0 to the 10-year atherosclerotic CVD (ASCVD) risk calculated by the 2013 ACC/AHA pooled cohort equations. Results: Across 3,348 adults in our propensity score-matched analysis, our causal forest model showed heterogeneity in the association between CAC&gt;0 and incident CVD. We found a dose-response relationship of the estimated increase in CVD risk when CAC&gt;0 with higher calculated 10-year ASCVD risk ( Figure ). Even among 1,413 adults with low/borderline ASCVD risk, 689 (49.4%) showed ≥7.5% increase in CVD risk when CAC&gt;0; these individuals were more likely to be male, non-Hispanic Black or Hispanic, less educated, never smokers, and have unfavorable CVD risk factors than others. Conclusion: The increases in CVD risk when CAC&gt;0 were heterogeneous across individuals, and nearly half of people with low/borderline calculated ASCVD risk showed a large increase in CVD risk when CAC&gt;0, highlighting the need for CAC screening among such low-risk individuals.

Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: A Machine-Learning Approach in the MESA Study.

Coronary artery calcium (CAC) has been widely recognized as an important predictor of cardiovascular disease (CVD). Given the finite resources, it is important to identify individuals who would receive the most benefit from detecting positive CAC by screening. However, the evidence is limited as to whether the burden of positive CAC on CVD differs by multidimensional individual characteristics. We sought to investigate the heterogeneity in the association between positive CAC and incident CVD. This cohort study included adults from MESA (Multi-Ethnic Study of Atherosclerosis) ages ≥45 years and free of cardiovascular disease. After propensity score matching in a 1:1 ratio, we applied a machine learning causal forest model to (1) evaluate the heterogeneity in the association between positive CAC and incident CVD, and (2) predict the increase in CVD risk at 10-years when CAC>0 (versus CAC=0) at the individual level. We then compared the estimated increase in CVD risk when CAC>0 to the absolute 10-year atherosclerotic CVD (ASCVD) risk calculated by the 2013 American College of Cardiology/American Heart Association pooled cohort equations. Across 3328 adults in our propensity score-matched analysis, our causal forest model showed the heterogeneity in the association between CAC>0 and incident CVD. We found a dose-response relationship of the estimated increase in CVD risk when CAC>0 with higher 10-year ASCVD risk. Almost all individuals (2293 of 2428 [94.4%]) with borderline risk of ASCVD or higher showed ≥2.5% increase in CVD risk when CAC>0. Even among 900 adults with low ASCVD risk, 689 (69.2%) showed ≥2.5% increase in CVD risk when CAC>0; these individuals were more likely to be male, Hispanic, and have unfavorable CVD risk factors than others. The expected increases in CVD risk when CAC>0 were heterogeneous across individuals. Moreover, nearly 70% of people with low ASCVD risk showed a large increase in CVD risk when CAC>0, highlighting the need for CAC screening among such low-risk individuals. Future studies are needed to assess whether targeting individuals for CAC measurements based on not only the absolute ASCVD risk but also the expected increase in CVD risk when CAC>0 improves cardiovascular outcomes.

Early identification and treatment of women's cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers.

Cardiovascular diseases (CVD) including heart attacks, strokes, heart failure, and uncontrolled hypertension are leading causes of death among women of all ages. Despite efforts to increase awareness about CVD among women, over the past decade there has been stagnation in the reduction of CVD in women, and CVD among younger women and women of color has in fact increased. We recommend taking action using policy levers to address CVD in women including: (1)Promoting periodic screening for risk factors including blood pressure, lipids/cholesterol, diabetes for all women starting at 18-21 years, with calculated atherosclerotic CVD (ASCVD) risk score use among women 40 years or older. (2)Considering coronary artery calcium (CAC) screening for those with intermediate risk per current guidelines. (3)Enhancing Obstetrics and Gynecologyand primary care physician education on reproductive age CVD risk markers, and that follow-up is needed, including extended postpartum follow-up. (4)Offering Health Coaching/motivational Interviewing to support behavior change. (5)Funding demonstration projects using different care models. (6)Creating a Stop High Blood Pressure consult line (for providers and patients) and providing other support resources with actions consumers can take, modeled after the California tobacco quit line. And (7)Requiring inclusion of adverse pregnancy outcomes in all Electronic Health Records, with reminder systems to follow-up on hypertension post-partum.

Prevalence of thoracic aortic aneurysm in patients referred for no/low-charge coronary artery calcium scoring: Insights from the CLARIFY registry

ObjectiveLow-dose cardiac-gated chest CTs allow for simultaneous evaluation of coronary artery calcification and aortic size. We sought to evaluate the prevalence of thoracic aortic dilation (TAD) and thoracic aortic aneurysm (TAA) in a large cohort of patients undergoing coronary artery calcium (CAC) screening. MethodsWe reviewed all patients from a large, prospective no-charge CAC screening program (CLARIFY, Clinicaltrials.gov NCT04075162) for whom measurements of the ascending aorta were available. TAD was defined as an ascending aortic diameter ≥4.0cm, while TAA was defined as ascending aortic diameter ≥ 4.5cm. We explored associations between patient characteristics, CAC, and the prevalence of TAD/TAA. ResultsA total of 36,356 patients enrolled in the CLARIFY program underwent analysis for TAD/TAA. 3,130 patients (8.6%) had TAD and 237 (0.7%) had TAA. Patients with TAA were older (63±8 vs 59±10 years, p < 0.001), more likely to be male (87% vs 49%, p < 0.001), have higher BMI (32 vs 30 kg/m2, p < 0.001), and 10-year atherosclerotic cardiovascular disease estimated risk (18% vs 12%, p < 0.001). Similar differences were observed for individuals with TAD compared to individuals without TAD with respect to age (63 vs 59 years, p < 0.001), percent male (76% vs 46%, p < 0.001), BMI (32 vs 30 kg/m2, p < 0.001), and 10-year predicted risk (17% vs 11%, p < 0.001). CAC score was associated with prevalence of TAD (4.9% in those with CAC 0 to 16.5% in those with CAC≥400) and TAA (0.3% in those with CAC of 0 to 1.5% in those with CAC ≥400). ConclusionIn this large, prospective study of patients undergoing no-charge CAC screening, 8.6% had TAD (≥4.0cm) and 0.7% had TAA (≥4.5cm). Our results highlight a high yield of TAD/TAA diagnosis in this targeted cohort with cardiovascular risk factors and supports the role of no-charge CAC as a population-level strategy.

Estimating the accuracy of dual energy chest radiography for coronary calcium detection with lateral or anteroposterior orientations.

Coronary artery calcium (CAC) scoring with CT has been studied as a risk stratification tool for cardiovascular disease. However, concerns remain from the radiation dose, economic expense, and incidental findings associated with this exam. Dual energy chest X-ray (DE CXR) has been proposed as an alternative, but validation of this technique remains limited. The purpose of this work was twofold: first, to estimate the sensitivity and specificity of DE CXR using simulation of patient datasets in a CAC screening cohort; second, to assess if sensitivity and specificity could be improved using a lateral instead of an anteroposterior (AP) orientation. We started from a cohort of 73 CAC scoring CT exams after exclusions for metal wires, data truncation, or with age outside 40-75 years. The fraction of CT CAC scores in the validation set of 0, 1-99, 100-299, and 300+ were 36, 25, 14, and 26%, respectively. CT datasets were decomposed on a voxel-by-voxel basis into mixtures of water and calcium according to CT number. DE CXR images were simulated using polyenergetic forward projection with scatter estimated from Monte Carlo. We assumed a technique of 60 and 120kVp for the dual energy acquisition. The tube current was scaled such that the estimated radiation dose from DE CXR was 10 times less than CAC scoring CT. Patient motion was not simulated. Two readers read the validation set in a blinded, randomized fashion, and estimated the amount of CAC in each DE CXR image using a semiquantitative 4-point scale. Although patients present on a spectrum of CAC severity, in the primary analysis, sensitivity and specificity were calculated by dichotomizing patients into two categories of CT CAC (Agatston) scores of either 0-99 or 100+. From the lateral orientation, average sensitivity between two readers was 69% (range, 69-69%), specificity was 85% (range, 84-86%), and area under the curve (AUC) was 0.81 (range, 0.80-0.81). From the AP orientation, average sensitivity was 35% (range, 31-38%), average specificity was 70% (range, 66-73%), and AUC was 0.54 (range, 0.53-0.55). Reader DE CXR scores agreed within 1 point of the 4-point scale on 97% of ratings from the lateral orientation and 80% from the AP orientation. From the lateral orientation, AUC increased when considering higher CT CAC score thresholds as disease positive; for thresholds of 1+, 300+, and 1000+, average AUC was 0.72, 0.81, and 0.92, respectively. From the AP orientation, AUC was 0.57, 0.55, and 0.61, respectively. DE CXR for CAC scoring may have higher diagnostic accuracy when acquired from the lateral orientation. The sensitivity and specificity of lateral DE CXR, when combined with its modest cost and radiation dose, suggest a possible role for this technique in screening coronary calcium in lower risk individuals. These estimates of diagnostic accuracy are derived from simulation of patient datasets and have not been corroborated with experimental or clinical images.

Relationship between Calcium Score and Conventional Risk Factors in the Diagnosis of Atherosclerosis.

Background: The coronary artery calcium score has been established as a highly specific feature of coronary atherosclerosis. The present study aimed to assess the possible association of coronary artery risk factors involving atherosclerosis with the coronary artery calcification (CAC) scores using coronary computed tomographic angiography (CCTA). Methods: The present cross-sectional study, performed on 252 patients in need of CCTA during April 2019 and September 2019 at Farshchian hospital in Hamadan, Iran. The demographic information and risk factors were acquired from the files of patients. Furthermore, the CACs of patients were calculated and expressed as the Agatston score. Based on the Agatston scale, participants were divided into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399), and severe (CAC ≥400). The association between possible coronary artery disease (CAD) risk variables and the CAC score was investigated using multinomial logistic regression. Results: Of 252 participants, approximately 40% of studied patients had a positive CAC score (CAC > 0). CAC significantly shifts toward higher scores in smokers, patients with diabetes, hypertension, and older patients. Mild (CAC = 1-99) and moderate CAC (100-399) were significantly associated with diabetes (odds ratio [OR], 3.26; 95% CI, 1.48-7.17) and (OR, 12; 95% CI, 4.40-32.71) for mild and moderate CAC, respectively. However, the strongest predictor for severe CAC was diabetes (OR, 7.72; 95% CI, 2.10-28.35). Conclusion: Coronary artery calcium scoring is a marker for risk factors associated with atherosclerosis. In this study, more than half of patients in CAC screening had CAC = 0. The strongest predictor of severe CAC>0 was smoking and diabetes. Regarding this association between health condition and CAC, determining the CAC can prevent major coronary heart disease events in these patients.

Abstract 10633: Deep Learning Model Accurately Quantifies LA Volumes on Routine Non-Contrast Chest CTs and Predicts Adverse Outcomes

Introduction/Hypothesis: To develop and validate a deep learning model to automatically segment and measure left atrial (LA) volumes from routine noncontrast chest CTs and evaluate for outcomes prognosis. Methods: A prototype AI algorithm, with a conditional variational auto-encoder architecture, was initially developed and trained using training data from 1313 patients (paired CTA and non-contrasted exams; “training group”). Left atrium contours from contrasted cases were used to train the model on corresponding non-contrasted dataset. We then retrospectively evaluated 274 patients (mean age 67.9 years, 54.6% male, 57.2% caucasian) who underwent a routine non ECG-gated, noncontrast chest CT for coronary artery calcium or lung cancer screening for validation of the AI model (“validation group”). Outcomes included heart failure (HF) hospitalization and new-onset atrial fibrillation within 5 years. Simple logistic regressions with appropriate univariate statistics were used for modelling outcomes. Results: In the validation group, there was excellent correlation between AI and expert results with a LA volume index (LAVi) intraclass correlation coefficient of 0.950 (0.936-0.960). Bland-Altman plot demonstrated that the AI underestimated LAVi by a mean 5.86 mL/m2. AI-LAVi independently predicted new-onset atrial fibrillation (AUC = 0.855, OR = 1.12, 95% CI 1.08 - 1.18; p&lt;0.0001). AI-LAVi was independently associated with HF hospitalization (AUC = 0.903, OR = 1.08, 95% CI 1.04 - 1.13, p = 0.0009). Conclusion: In this large validation cohort, AI for automated measurement of LA volume on routine noncontrast chest CTs had excellent agreement with manual quantification. AI-LAVi is independently predictive for new-onset atrial fibrillation and HF hospitalization within 5 years.

Abstract 11225: Comparison of Coronary Artery Calcium Scores in South Asians and Other Racial-Ethnic Groups

Introduction and Hypothesis: There is a disproportionately higher incidence of atherosclerotic cardiovascular disease (ASCVD) and associated adverse outcomes in South Asians (SA), compared to other races. SA ancestry has been identified as a risk enhancer in the US cholesterol guidelines. Coronary artery calcium (CAC), a validated marker of sub clinical atherosclerosis offers a robust assessment of CVD risk. We sought to compare the distribution of CAC scores as a marker of CVD risk, across various age groups in SA and other races/ethnicities. Methods: Our analyses included 33,663 individuals (517 SA, 24,060 whites, 1,509 African Americans (AA), 3,759 Hispanics, 3,818 Asians), who underwent CAC scoring at our center. CAC scores were stratified by age, across various races/ethnic sub-groups. Age groups were classified into quartiles as follows: &lt;51 years, 51-59 years, 59-67 years and &gt;67 years of age. Differences in median CAC across races/ethnicities were tested with the Kruskal-Wallis Test, by age quartiles as described. Results: Mean (SD) age was 59 (11.6) years and 63% were men in the entire cohort. SA over 67 years of age, had significantly higher median CAC score 354.0, Interquartile Range (IQR) 36 - 1476, compared to other race/ethnicities (Median CAC (IQR): whites, 195, (21-762), Hispanics 167.5, (19-779), Asians 144, (14-642), AA 159 (8.5-676) (P=0.0019). In age groups from 50-67 years of age, median CAC scores were not significantly different between these groups (Figure 1). Conclusions: In older age groups, SA have higher median CAC scores compared to whites and other racial/ethnic groups including AAs, Hispanics and other Asians. The observed differences in atherosclerotic burden provide mechanistic insights to higher CVD risk, in the vulnerable SA groups. Future studies should explore the effects of CAC screening on treatment strategies, such as initiation of statins and prognosis in SA.

Abstract 12277: Concordance of High Polygenic CAD Risk Score With High Coronary Artery Calcium Score &amp; Low Polygenic CAD Risk Score With Low Coronary Artery Calcium Score: A Real World Experience

Introduction: Genetic predisposition for CAD is well established. Polygenic risk scores are emerging as tools which attempt to quantify the genomic component of an individual’s risk for CAD. However, clinical utility for individual risk stratification is unclear. Hypothesis: 180 SNPs previously identified in Caucasian Genome Wide-Association Studies for CAD were used to construct a weighted restricted polygenic risk score (PRS; normalized range 11.18 -17.58). This study hypothesizes that high PRS (&gt;=85th percentile) is associated with high (&gt;400) coronary artery calcium (CAC) score, &amp; a low PRS(&lt; 85th percentile) is associated with low (&lt;100) CAC. Methods: Between January 2018 and March 2020, 21,784 patients underwent CAC screening and/or PRS testing. Caucasian patients with both PRS and CAC scores were reviewed. Patients with CAC 100-400 were excluded. Fisher’s exact test for high/low PRS and high/low CAC was utilized. Results: 2,752 patients were identified to have low (&lt;100) or high (&gt;400) CAC; 306 (11.1%) had a high CAC (table 1). Odds ratio of high PRS associated with high CAC and low PRS associated with low CAC was 1.54 (95% CI: 1.07-2.19; p=0.017). Conclusion: Our real-world experience in a Caucasian cohort shows that high PRS is associated with a high CAC, as is a low PRS with low CAC. Concordance between PRS and CAC lends support for incorporating PRS in the clinical setting, especially for early identification of individuals at high risk for CAD. Larger, ethnically diverse studies are needed.