Significant Coronary Artery Calcification Research Articles

Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review

ObjectivesTo determine whether bisphosphonates and NF-κB ligand (RANKL) inhibitors delay coronary artery calcification (CAC).DesignA systematic review was conducted.Data sourcesMEDLINE, EMBASE and CENTRAL.Eligibility criteriaLongitudinal studies investigating CAC progression in adults (>18...

Coronary calcification on invasive angiography and the Agatston score—a single-center experience

Aim: The pattern and severity of coronary artery calcification (CAC) can influence prognosis and outcome in percutaneous coronary intervention. An objective assessment of CAC during invasive angiography may provide additional prognostic information. This study aimed to assess the correlation between the angiographic Birmingham calcium score (BCS) and the Agatston coronary calcium score (CCS) performed as part of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Methods: In this retrospective observational study, patients undergoing SPECT-MPI and invasive coronary angiography as part of their routine management were included. BCS was calculated by reviewing angiography images in retrospect by an observer blinded to the SPECT-MPI calcium score. Spearman’s correlation was used to analyze the correlation between BCS and SPECT-MPI. Receiver operating characteristic curve was used to detect cut-off for BCS that would detect clinically significant CAC [> 400 Agatston units (AU)]. Kaplan-Meier was used to report on outcomes at 5 years follow-up. Results: In this cohort of 151 patients, there was a positive correlation between BCS and CCS [Spearman correlation coefficient (r) = 0.558, P < 0.001]. Cumulative BCS of 1 was able to identify clinically significant CAC [area under the curve 0.788, 95% confidence interval (CI) 0.714–0.863]. Cumulative BCS ≥ 3 was associated with major adverse outcomes at 5 years follow-up (log rank P = 0.013). Conclusion: BCS correlates well with established higher CCS. Application of BCS during invasive coronary angiography will aid risk stratification, management, and follow-up with no extra patient involvement, radiation, or costs.

Cerebral white matter hyperintensities indicate severity and progression of coronary artery calcification

Cerebral white matter hyperintensities (WMH) have been associated with subclinical atherosclerosis including coronary artery calcification (CAC). However, previous studies on this association are limited by only cross-sectional analysis. We aimed to explore the relationship between WMH and CAC in elderly individuals both cross-sectionally and longitudinally. The study population consisted of elderly stroke- and dementia-free participants from the community-based Austrian Stroke Prevention Family Study (ASPFS). WMH volume and CAC levels (via Agatston score) were analyzed at baseline and after a 6-year follow-up period. Of 324 study participants (median age: 68 years), 115 underwent follow-up. Baseline WMH volume (median: 4.1 cm3) positively correlated with baseline CAC levels in multivariable analysis correcting for common vascular risk factors (p = 0.010). While baseline CAC levels were not predictive for WMH progression (p = 0.447), baseline WMH volume was associated CAC progression (median Agatston score progression: 27) in multivariable analysis (ß = 66.3 ± 22.3 [per cm3], p = 0.004). Ten of 11 participants (91%) with severe WMH (Fazekas Scale: 3) at baseline showed significant CAC progression > 100 during follow-up. In this community-based cohort of elderly individuals, WMH were associated with CAC and predictive of its progression over a 6-year follow-up. Screening for coronary artery disease might be considered in people with more severe WMH.

Chest Computed Tomography for Lymphoma Staging: A Wasted Opportunity for Cardiovascular Risk Stratification?

Patients with a lymphoma diagnosis undergo non-gated chest computed tomography (CT) scans as part of cancer diagnosis or staging. Although coronary artery calcification (CAC) is traditionally evaluated on dedicated cardiac CT, CAC can also be detected on standard chest CT. This exploratory study aimed to determine the prognostic value of CAC detected on non-gated chest CT and to report its use on clinical practice. Consecutive patients with a lymphoma diagnosis who performed non-contrasted non-gated chest CT for cancer diagnosis or staging were included and retrospectively evaluated. Coronary artery calcification was evaluated by quantitative (Agatston score) and qualitative (visual) assessment. Fifty-seven patients were included in this study (mean age 61±15 years; 58% male). Coronary artery calcification was identified in 22 patients (39%), most of them with multi-vessel involvement. Coronary artery calcification was qualitatively classified as mild, moderate and severe in 11%, 19% and 9% patients, respectively. This study suggested that moderate or severe CAC was an independent predictor of all-cause mortality (odds ratio 3, 95% confidence interval 2-11; p=0.04) after adjusting for cardiovascular risk factors and lymphoma staging. Regarding quantitative evaluation, a higher CAC score was also associated with higher mortality. While significant CAC was identified in 22 patients, it was only reported in four patients. The preliminary findings of this hypothesis-generating study support the investigation of CAC identified by chest CT for diagnosis/staging of cancer as a risk modifier in the global risk assessment of patients with lymphoma. The unrecognition and underreporting of this finding may represent a wasted opportunity to detect subclinical coronary atherosclerosis in these patients and may help in guiding preventive cardiology care.

Eveningness is associated with coronary artery calcification in a middle-aged Swedish population

Coronary artery calcification (CAC) is an established imaging biomarker of subclinical atherosclerosis, but its relationship to diurnal preference is not well studied. We investigated the association between chronotype and CAC in the Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot cohort. Participants aged 50–64 years were randomly recruited and underwent extensive examination including imaging and accelerometry-assessed physical activity. 771 participants (47.3 % male, 57.6 ± 4.4 years) were included in this cross-sectional analysis. CAC was assessed by non-contrast computed tomography, and a CAC score > 10 was considered significant calcification. Self-assessed chronotype was classified as extreme morning, moderate morning, intermediate, moderate evening, or extreme evening. 10-year risk of first-onset cardiovascular disease was estimated by the Systemic Coronary Risk Evaluation 2 (SCORE2). Significant CAC was present in 29 % of the cohort. CAC prevalence increased from extreme morning to extreme evening type (22 %, 28 %, 29 %, 27 %, 41 % respectively, p = 0.018). In a multivariate logistic regression model controlling for confounders, extreme evening chronotype was independently associated with increased CAC prevalence compared to extreme morning type (OR 1.90, [95%CI 1.04–3.46], p = 0.037). When stratified by SCORE2 risk category (low: <5 %; moderate: 5 to <10 %; high: ≥10 %), significant CAC was most prevalent among extreme evening chronotypes in the low and moderate-risk groups, while chronotype seemed less important in the high-risk group (p = 0.011, p = 0.023, p = 0.86, respectively). Our findings suggest circadian factors may play an important role in atherosclerosis and should be considered in early cardiovascular prevention.

Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care

Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.

Association of silent myocardial infarction on electrocardiogram and coronary artery calcium: The Multi-Ethnic Study of Atherosclerosis.

Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood. Characterize the relationship between SMI on ECG and CAC. Eligible participants from the Multi-Ethnic Study of Atherosclerosis study had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression. Among 6705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0-261.7] vs. 0 [0-81.5]; p < .0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48-3.20, p < .0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06-2.16, p = .02). An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.

Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease

IntroductionPrevious studies have shown that the population attributable risk of low forced expiratory volume in one second (FEV1) for coronary artery disease (CAD) is substantial. FEV1 can be low either because of airflow obstruction or ventilatory restriction. It is not known if low FEV1 arising from spirometric obstruction or restriction are differently associated with CAD. MethodsWe analyzed high resolution computed tomography (CT) scans acquired at full inspiration in lifetime non-smoker adults with no lung disease (controls) and those with chronic obstructive pulmonary disease enrolled in the Genetic Epidemiology of COPD (COPDGene) study. We also analyzed CT scans of adults with idiopathic pulmonary fibrosis (IPF) from a cohort of patients attending a quaternary referral clinic. Participants with IPF were matched 1:1 by FEV1 %predicted to adults with COPD and 1:1 by age to lifetime non-smokers.Coronary artery calcium (CAC), a surrogate for CAD, was measured by visual quantification on CT using the Weston score. Significant CAC was defined as Weston score ≥7. Multivariable regression models were used to test the association of the presence of COPD or IPF with CAC, with adjustment for age, sex, body-mass-index, smoking status, hypertension, diabetes mellitus, and hyperlipidemia. ResultsWe included 732 subjects in the study; 244 with IPF, 244 with COPD, and 244 lifetime non-smokers. The mean (SD) age was 72.6 (8.1), 62.6 (7.4), and 67.3 (6.6) years, and median (IQR) CAC was 6 (6), 2 (6), and 1 (4), in IPF, COPD, and non-smokers, respectively. On multivariable analyses, the presence of COPD was associated with higher CAC compared to non-smokers (adjusted regression coefficient, β = 1.10 ± SE0.51; P = 0.031). The presence of IPF was also associated with higher CAC compared to non-smokers (β = 03.43 ± SE0.41; P < 0.001). The adjusted odds ratio for having significant CAC was 1.3, 95% CI 0.6 to 2.8; P = 0.53 in COPD and 5.6, 95% CI 2.9 to 10.9; P < 0.001 in IPF, compared to non-smokers. In sex stratified analyses, these associations were mainly noted in women. ConclusionAdults with IPF displayed higher coronary artery calcium than those with COPD after accounting for age and lung function impairment.

Relationship between epicardial adipose tissue attenuation and coronary artery disease in type 2 diabetes mellitus patients.

High epicardial adipose tissue (EAT) attenuation is a key characteristic of adipose tissue dysfunction and associated with coronary artery disease (CAD). As little is known about the modulation of EAT attenuation by metabolic disorders, we investigated the association between EAT attenuation and CAD risk factors, CAD presence and CAD severity in type 2 diabetes mellitus (T2DM) patients. We included 276 inpatients with T2DM and 305 control patients with normal glucose metabolism (NGM), who underwent cardiac computed tomography angiography (CCTA) and coronary artery calcium (CAC) scoring. EAT attenuation and volume were evaluated by contrast-enhanced CCTA image analysis. Furthermore, segment stenosis scores (SSSs) of the left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCX), right coronary artery (RCA), diagonal/intermediate branch (D/I) and obtuse marginal branch (OM) were calculated to assess CAD severity. T2DM patients showed higher significant CAC scores, coronary plaque prevalence, total SSSs and LMCA-SSSs, LAD-SSSs, LCX-SSSs, RCA-SSSs and D/I-SSSs compared with NGM controls. In contrast to NGM controls, EAT volume was significantly increased in T2DM patients, whereas EAT attenuation was similar. In T2DM patients, EAT attenuation was associated with discrete CAD risk factors, the presence of coronary and triple-vessel plaques, as well as LAD-SSSs, LCX-SSSs, RCA-SSSs and total SSSs. In addition, EAT attenuation was only associated with the total SSS of calcified plaques, but not with noncalcified plaques. In T2DM patients, high EAT attenuation is associated with the presence and severity of CAD in general and with coronary stenosis caused by calcified plaques in particular.

Coronary artery disease and its vascular associates in patients with chronic nonsurgical hypoparathyroidism.

Patients with chronic hypoparathyroidism (cHypoPT) are prone to intracranial-calcification, cataractand nephrocalcinosis. In this study, we systematically investigated the possibility of increased coronary artery calcification (CAC) and coronary artery disease (CAD) in them. Cross-sectional. Ninety-fournonsurgical cHypoPT (M:F = 50:44; age = 45 ± 15 years) with 18.6 ± 9.3 years of illness were assessed. Those with dyspnoea, angina, syncope, abnormal electrocardiogram, echocardiographyor significant CAC underwent coronary angiography or myocardial-perfusion-stress imaging. Their lipid parameters andhigh-sensitivity C-reactive protein (hsCRP)were compared with age-matched healthy controls (Group A, n = 101). The prevalence of CAC in cHypoPT was compared with that of subjects referred from cardiology-clinics (Group B, n = 148, age = 52 ± 11 years). One of 94 cHypoPT had known CAD. On screening, 17 cHypoPT required evaluation for CAD. Two of 17 had severe coronary stenosis, and 12 showed subclinicalCAD. CAC and aortic-valve calcification occurred in 21.5% and 11.8%. Clinical and subclinical CAD, CACand aortic-valve calcification in cHypoPT ≥50 years of age was 8.1%, 27.0%, 52.8%and 27.8%, respectively. Frequency of age-adjusted CAC was comparable between cHypoPT and control Group B (30.2% vs. 30.7%, p = .93). Elevated hsCRP was higher in cHypoPT than in controls A (52% vs. 32%, p < .01). Factors associated with CAD in cHypoPT were CAC and hypertension. However, CAD and CAC showed no association with long-term calcemic or phosphatemic control and intracranial-calcification in cHypoPT. Clinical and subclinical CAD was observed in 3.2% and 12.8% of cHypoPT patients. The increased prevalence of CAD, CAC and aortic-valve calcification in cHypoPT above 50 years of age suggested their careful cardiac evaluation during follow-up.

Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study.

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events.Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated.Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100.Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.

Abstract P072: Elevated Coronary Artery Calcification In Highly Active Men: Role Of Exercise Intensity Versus Duration

Introduction: While living a physically active lifestyle is associated with many health benefits, recent evidence suggests that high volume physical activity (PA) may contribute to coronary artery calcification (CAC). Whether exercise intensity or duration contributes more to CAC elevation is unknown. Hypothesis: Higher PA intensity, but not duration, predicts elevated CAC. Methods: We studied 25,801 apparently healthy men who completed a self-report PA questionnaire and underwent EBT or MDCT scans as part of a preventive physical examination. Participants were categorized into two CAC groups (≥100 or &lt;100 Agatston units (AU)) and three PA groups (≥3000, 1500 – 2999, and &lt;1500 MET-minutes/week (MET-min/wk)). An exploratory classification tree model identified maximum intensity of activity as the second most important predictor of CAC≥100 AU after age. As such, maximal intensity of activity ≥8 METs was entered as a predictor in subsequent logistic regression models that were adjusted for age, current smoking status, body mass index, glucose, total cholesterol, and systolic blood pressure. We also included categories of PA duration ≥5 or &lt;5 hours/week, the current PA Guidelines recommendation for increased performance. Results: The mean age was 52 years, and 6,075 men had CAC≥100 AU. Regardless of CAC category, the ≥3000 MET-min/wk group had more favorable glucose and lipid profiles compared to the &lt;1500 group. The average PA volume reported in the most highly active group (≥3000 MET-min/wk) was 4626 MET-min/wk with all participants reporting ≥5 hours of PA/week. In the fully adjusted model, maximum exercise intensity ≥8 METs was associated with lower risk of CAC≥100 AU (Relative risk (RR): 0.93, 95% Confidence interval (CI): 0.88 – 0.98, p = 0.004), while total duration of ≥5 hours/week trended in the opposite direction yet without significance (RR: 1.07, CI 95%: 0.98 – 1.17, p = 0.14). Prevalence of CAC≥100 AU was highest among those engaging only in activities &lt;8 METs and for a total duration ≥5 hours/week. Conversely, the lowest prevalence of CAC≥100 AU was found in the higher intensity, lower duration group (≥8 METs, &lt;5 hours/week). Jointly, maximum intensity ≥8 METs was associated with a lower risk of CAC≥100 AU (RR: 0.92, CI 95%: 0.88 – 0.97, p =0.003) only among those with a total duration &lt;5 hours/week. Conclusions: Exercise intensity ≥8 METs was associated with a lower likelihood of men patients presenting with clinically significant CAC while exercise duration of ≥5 hours/week trended in the opposite direction. These novel findings should be considered by clinicians when counseling highly active men with elevated CAC on their exercise prescriptions.

Evaluation of Asymptomatic Carotid Artery Stenosis Prior to Coronary Artery Bypass Grafting - A Prospective Observational Study in North Indian Population.

Background:Carotid artery stenosis (CAS) is an established risk factor for peri-operative neurological complications in patients following coronary artery bypass grafting (CABG). However, routine pre-surgical screening for CAS is still a matter of debate. This study was conducted to study the prevalence of asymptomatic carotid artery disease in patients undergoing CABG and to determine the predictors of significant carotid stenosis in them.Methods:In this prospective observational study, 112 patients, who were planned for CABG, were enrolled, and their demographic details, risk factor profile, and coronary angiogram parameters were analyzed.Results:Carotid stenosis was observed in 75.0% of the study population with 11.6% having unilateral and 63.4% having bilateral carotid stenosis. A total of 56.2% of the patients had mild, 14.3% had moderate, and 4.5% had severe carotid stenosis. The presence of significant carotid stenosis showed a correlation with chronic stable angina (P = 0.009), significant left main (LM) disease (P = 0.001), chronic total occlusion (P = 0.043), and coronary vessel calcification (P = 0.004). Multivariate analysis of all the predictor variables in a regression model showed that significant LM disease (Odds ratio (OR):6.5, P = 0.002) and coronary artery calcification (OR: 4.3, P = 0.024) were the only independent predictors of significant CAS in the study population.Conclusion:The presence of significant carotid vessel stenosis in patients undergoing CABG in the Indian population has a stronger association with the chronicity of the coronary artery disease rather than the coronary atheroma load (as determined by the modified Gensini score). The presence of significant LM disease and coronary artery calcification may be useful in detecting high-risk patients for significant CAS during the pre-surgical workup.

Is Drinking Water Hardness Associated With Elevated Coronary Artery Calcium Scores? A Comparison Between Sydney Water and Mudgee Water Drinkers

Coronary artery calcium (CAC) is a marker of atherosclerosis and predicts the risk of future cardiac events. It is often higher in rural populations compared to metropolitan ones. We hypothesise that rural patients may have higher CAC scores than city dwellers due to increased calcium intake from drinking water. 126 patients were included in the study (Sydney water n=51, Mudgee bore water n=37, Mudgee tank water n=38). Patients must have consumed this water for >10 years and received a CAC score in the allocated timeframe (April 2021–December 2021, inclusive). Cardiovascular risk data and CAC data were collected from hard copy patient records and retrospectively analysed. The mean cardiovascular risk score was 4%, 10%, and 5.5% respectively for Sydney, bore water, and tank water groups. Sydney water drinkers had the highest proportion of ‘zero’ CAC scores; 39.2% versus 27.0%, and 21.1% in bore and tank water drinkers, respectively (see Figure 1). Among non-zero scores, Sydney water drinkers had a statistically significant lower average CAC score [192.5, 95%CI 95.8 - 289.1], compared to Mudgee groups (p<0.05). There was no statistically significant difference in average non-zero CAC scores between the Mudgee bore water [745.6, 95%CI 442.4 - 1048.8] and tank water [635.3, 95%CI 371.6 - 899.0] groups (p=0.11). Mudgee patients have higher CAC and cardiovascular risk scores than Sydney patients. After adjusting for cardiovascular risk factors, however, there is not sufficient evidence to suggest an association between drinking water hardness and CAC scores.

Abstract 9305: Association of Silent Myocardial Infarction on Electrocardiogram and Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis

Introduction: Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood. Hypothesis: SMI on ECG is predictive of elevated CAC. Methods: Eligible participants from the Multi-Ethnic Study of Atherosclerosis (MESA) had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression. Results: Among 6,705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0 - 261.7] vs. 0 [0 - 81.5]; p &lt; 0.0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48 - 3.20, p &lt; 0.0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06 - 2.16, p = 0.02). Conclusions: An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk-stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.

Shockwave intravascular lithotripsy facilitated percutaneous coronary intervention in patients with calcified coronary artery disease: a systematic review and meta-analysis of observational studies

Abstract Background Percutaneous coronary intervention (PCI) outcomes for patients with significant coronary artery calcification (CAC) have been consistently inferior compared to patients without significant CAC. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion modification of severely calcified plaques but supporting evidence on safety and efficacy of this technology is narrow. The aim of this study is to assess S-IVL safety and efficacy in patients with severe CAC undergoing PCI. Methods We systematically searched MEDLINE, ClinicalTrials.gov and the Cochrane Library to identify studies assessing the efficacy and safety of S-IVL in adult patients with calcified coronary artery disease undergoing PCI. We excluded those studies assessing the effect of S-IVL in patients with under-expanded coronary stents and/or in-stent restenosis. Results The largest meta-analysis to date was performed. All studies were observational since no relevant randomized controlled trials have been published so far. Nine studies were included in our qualitative synthesis, while 7 of them, in a total of 794 enrolled patients, were used in the quantitative synthesis. Frequency of peri-procedural outcomes of interest was low: a) coronary dissection: 2.52%, b) coronary perforation: 3.0%, c) MI: 3.51%. Relative frequency of 1-month MACE was 5.59% and cardiovascular death 1.01%. S-IVL resulted in a significant increase in the in-stent post-IVL minimum lumen diameter by 1.67 mm, a significant decrease in the in-stent post-IVL vessel diameter stenosis by 53.60%, and a significant increase in the in-stent post-IVL acute gain by 1.68 mm. OCT analysis confirmed a significant decrease in area stenosis post-IVL by 19.71% and calcium angle by 22.14o and a significant increase in lumen area by 1.62 mm2, without however affecting maximum calcium thickness. When we compared post-stent post-IVL vs. pre-stent post-IVL OCT results, we demonstrated a further significant decrease in area stenosis by 35.89% and in calcium angle by 20.33o, a significant increase in lumen area by 2.74 mm2 and a neutral effect on maximum calcium thickness. Conclusion Shockwave Intravascular lithotripsy offers a significant improvement in coronary lumen to facilitate stent delivery and deployment in severely calcified coronary arteries. Although S-IVL appears to be associated with a low incidence of complications and MACE based on our present findings, further evidence from RCTs and longer-term follow-up is required to advocate its routine use in patients with severe CAC. Funding Acknowledgement Type of funding sources: None.

MANAGEMENT OF CORONARY ARTERY CALCIFICATION IN PATIENTS ENROLLED IN A LOW-DOSE COMPUTERIZED TOMOGRAPHY LUNG CANCER SCREENING PROGRAM

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: The most common incidental finding in Griffin Hospital’s Lung Cancer Screening Program is coronary artery calcification (CAC), which serves as a sign of Coronary Artery Disease and a predictor of adverse cardiac events. We sought to assess how incidental findings of CAC are managed in patients at high risk for lung cancer. METHODS: We performed a single-center retrospective chart review of patients enrolled in a low-dose computerized tomography (LDCT) Lung Cancer Screening Program and a telephone survey including demographic characteristics, medical history, and patient perceptions of their disease and treatment. Patients were included if their initial scan showed moderate or severe CAC and if their scans were performed at least three months prior to the survey date to ensure that they were able to meet with their physicians and take any necessary actions. RESULTS: 35 of 78 patients who met inclusion criteria agreed to participate in the study. Actions directed at incidental findings of CAC were performed in only 60% (N=21) of these patients – 48% underwent coronary stress testing, 33% were prescribed aspirin and/or a statin, 24% quit or reduced smoking, 14% made modifications to their diet and exercise regimens, and 5% underwent stenting of a coronary artery; one patient had recently (< 1 year) undergone cardiac workup. The remaining 40% (N=14) of patients had no identifiable action or treatment to address CAC findings. 50% of these patients (N=7) were instructed by their physicians to make lifestyle changes but denied making those changes. The remaining 50% (N=7) deny ever discussing CAC with their physicians. Finally, when asked about their level of concern regarding CAC on a scale of 1-10 (with 10 being the greatest concern), the mean patient response was 4.9. CONCLUSIONS: Actions addressing incidental CAC were only performed in 60% of patients. 20% of patients disregarded instructions from their physicians to make lifestyle changes. Although the Lung Cancer Screening Program emphasizes the importance of incidental CAC to patients and their physicians, the remaining 20% of patients report never discussing CAC with their physicians. This apparent breakdown in communication may be a significant driver of the inaction in response to significant findings. Patients are only moderately concerned about CAC. CLINICAL IMPLICATIONS: Although LDCT screening for lung cancer often returns significant incidental CAC, these findings do not lead to changes in a large subset of patients. DISCLOSURES: No relevant relationships by Riley Kermanian, source=Web Response No relevant relationships by Jo-Ann Persson, source=Web Response No relevant relationships by Richard Salzano, source=Web Response

Association between the Severity of Nonalcoholic Fatty Liver Disease and the Risk of Coronary Artery Calcification.

Background and Objectives: There are limited data on the association between severity of non-alcoholic fatty liver disease (NAFLD) and coronary artery calcification. This study investigated sonographic diagnosed NAFLD and coronary artery calcium score (CAC) as detected by cardiac multidetector computed tomography in general populations. Materials and Methods: A total of 545 patients were enrolled in this study. NAFLD was diagnosed by ultrasonography examination and CAC score were evaluated by cardiac multidetector computed tomography. The association between NAFLD and artery calcium score stage was determined by logistic regression analysis and Spearman correlation coefficient analysis. Results: Of all the participants, 437 (80.2%) had ultrasonography-diagnosed NAFLD and 242 (44%) had coronary artery calcification (CAC > 0). After adjustment for cardiovascular risk factors, the risk of developing coronary artery calcification was 1.36-fold greater in the patients with different severity of NAFLD compared to those without NAFLD (OR = 1.36, 95% CI = 1.07–1.77, p = 0.016). The highest OR for separate coronary artery calcification was 1.98 (OR = 1.98, 95% CI = 1.37–2.87, p < 0.001) in the left main artery, and the risk was still 1.71-fold greater after adjustments (OR = 1.71, 95% CI = 1.16–2.54, p = 0.007). Conclusions: This cross-sectional study demonstrated that the severity of NAFLD was associated with the presence of significant coronary artery calcification, especially in the left main coronary artery, suggesting increasing the cardiovascular risk.

Evaluating the Independent Impact of Renal Function Decline on Coronary Artery Calcification in Patients Undergone Cardiac CT Scan

Background: Cardiovascular events are the leading global cause of death. Calcification of coronary arteries is a common complication of renal failure and the leading cause of death in this population. However, its multifactorial mechanism is not fully understood. Objectives: The current study aimed to, firstly, investigate the association between renal dysfunction and the calcification of coronary arteries in patients with severe and milder stages of renal failure and, secondly, to determine the role of this variable by eliminating the effect of established confounding factors. Methods: Following a retrospective design, 261 patients with cardiovascular risk factors or atypical symptoms were investigated. Estimated GFR (glomerular filtration rate) was calculated using both Cockcroft-Gault and MDRD equations. An ECG-gated multidetector CT scan was performed to calculate CACS (coronary artery calcification score) using the Agatston method. The presence of significant CAC (coronary artery calcification) was defined as CACS &gt; 100. Univariate and multivariate analyses were performed using binary logistic regression. Results: A total of 134 cases were diagnosed with CAC, and the mean CACS was 83.4 ± 18. According to univariate analysis, older age, male gender, systolic and diastolic blood pressure, and higher TG levels were correlated with the degree of CAC. HbA1C showed a weak correlation with CACS (P-value = 0.04). Renal insufficiency resulted in increased CAC, and lower eGFR (calculated with both Cockgraft-Gault and MDRD equations) was associated with higher calcification (P-value &lt; 0.01). Our analysis shows that serum Ca, P, LDL, and HDL levels do not have a significant influence on calcification changes. After adjusting for confounding factors, male sex, age, triglyceride level, and eGFR were recognized as independent risk factors for CACS ≥ 100, a marker of coronary artery atherosclerosis. However, HbA1C and systolic and diastolic blood pressure were no longer considered as factors that contribute to the risk of CAC. Conclusions: We observed a gradual and independent association between lower eGFR and higher CAC scores.

Managing Calcified Coronaries: the Bugaboo of Percutaneous Coronary Intervention

Background Percutaneous coronary intervention (PCI) of lesions with heavily coronary artery calcium (CAC) still represents a challenge for interventionists, with increased risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. In this focused review, we provide the summary of principles, technique and contemporary evidence for various existing and emergent plaque modifying strategies. Main text PCI of lesions with heavy CAC still poses a challenge for the interventionists due to an increased risk of incomplete lesion preparation with subsequent suboptimal stent deployment and higher rates of acute and chronic stent failure. With the emergence of many novel devices and technologies, the treatment of lesions with heavy CAC has become increasingly feasible, safe and predictable. It seems likely that combining enhanced intravascular imaging modalities with traditional or new dedicated tools for the treatment of such lesions grant better lesion preparation. This optimizes delivery and deployment of drug-eluting stents translating into improved patient outcome. Conclusion The lesions with significant CAC are likely to surge due to aging population and increased rates of diabetes and chronic renal disease. The optimal therapy for such lesions is multi-adjunctive and requires the availability of several modalities including intracoronary imaging which could impact the clinical outcome favourably.