Total Coronary Artery Calcium Research Articles

AI-based algorithm for assessing coronary artery calcium score on contrast-enhanced cardiac computed tomography scans

Abstract Introduction In cardiac computed tomography (CT) examinations, non-contrast scans are often performed in addition to contrast-enhanced scans to quantify the coronary artery calcification (CAC) score. These calcium score scans are associated with additional exposure to ionizing radiation. Purpose We sought to develop a fully automated artificial intelligence (AI)-based algorithm capable of determining CAC score based solely on contrast-enhanced CT scans, eliminating the need for additional non-contrast scans. Methods An automated CAC scoring algorithm on contrast-enhanced CT scans was developed and trained using a dataset of 297 cardiac CT studies. Coronary artery calcifications were manually segmented in contrast-enhanced scans using a threshold of 2 standard deviations above the mean attenuation value of the ascending aorta. On non-contrast scans, CAC was manually assessed using a standard threshold of ≥130 Hounsfield Units. A correction factor for calcium score results assessed on contrast-enhanced scans was determined using linear regression. The algorithm was tested on an independent set of 90 contrast-enhanced CT scans (four manufacturers, eight scanner models). We compared automated CAC scores to manual expert reader reference assessments on non-contrast CT scans. CAC scores were categorized into four risk categories following the Society of Cardiovascular Computed Tomography recommendations: 0, 1-100, 101-300, and >300 Agatston Units. Results In the assessment of 90 CT studies (mean age 61.0±11.4 years, 46.7% males), the AI-model detected CAC in 69 contrast-enhanced scans (76.7%), comparable to the human reader's detection rate of CAC in 71 non-contrast scans (78.9%) (p = 0.63). The CAC score was initially calculated using AI-based segmentation of coronary calcification on contrast-enhanced scans and then the result was multiplied by established linear correction factor of 1.97. There was an excellent correlation between AI-model and manual reference total CAC scores (Pearson’s r = 0.96, 95% CI 0.94–0.97, p < 0.001). The model correctly classified 77 patients (85.6%) into the same CAC risk category as the human reader (Figure 1). Among 19 patients (21.1%) with a CAC score of zero, only 1 patient (5.3%) was reclassified with a non-zero CAC score by the AI-model. Cohen’s kappa value for CAC score risk categorization was 0.80 (p < 0.001), indicating very good agreement (Figure 2). Bland–Altman analysis revealed minimal bias of -9.7 Agatston Unit with 95% limits of agreement ranging from -184.8 to 165.5 Agatston Unit. Conclusions CAC score can be accurately quantified on contrast-enhanced cardiac CT scans using an automated AI-based algorithm. This approach has the potential to eliminate the necessity for an additional non-contrast CT scan, thereby reducing the patient's exposure to ionizing radiation.

Photon-counting detector CT reduces the rate of referrals to invasive coronary angiography as compared to CT with whole heart coverage energy-integrating detector

BackgroundWe sought to compare the degree of maximal stenosis and the rate of invasive coronary angiography (ICA) recommendations in patients who underwent coronary CT angiography (CCTA) with photon-counting detector CT (PCD-CT) versus those who underwent CCTA with whole heart coverage energy-integrating detector CT (EID-CT). MethodsIn our retrospective single-center study, we included consecutive patients with suspected CAD who underwent CCTA performed with either PCD-CT or a 280-slice EID-CT. The degree of coronary stenosis was classified as no CAD, minimal (1–24 ​%), mild (25–49 ​%), moderate (50–69 ​%), severe stenosis (70–99 ​%), or occlusion. ResultsA total of 812 consecutive patients were included in the analysis, 401 patients scanned with EID-CT and 411 patients with PCD-CT (mean age: 58.4 ​± ​12.4 years, 45.4 ​% female). Despite the higher total coronary artery calcium score (CACS) in the PCD-CT group (10 [interquartile range (IQR) ​= ​0–152.8] vs 1 [IQR ​= ​0–94], p ​< ​0.001), obstructive CAD was more frequently reported in the EID-CT vs PCD-CT group (no CAD: 28.7 ​% vs 26.0 ​%, minimal: 23.2 ​% vs 30.9 ​%, mild: 19.7 ​% vs 23.4 ​%, moderate: 14.5 ​% vs 9.7 ​%, severe: 11.5 ​% vs 8.5 ​% and occlusion: 2.5 ​% vs 1.5 ​%, respectively, p ​= ​0.025). EID-CT was independently associated with downstream ICA (OR ​= ​2.76 [95%CI ​= ​1.58–4.97] p ​< ​0.001) in the overall patient population, in patients with CACS<400 (OR ​= ​2.18 [95%CI ​= ​1.13–4.39] p ​= ​0.024) and in patients with CACS≥400 (OR ​= ​3.83 [95%CI ​= ​1.42–11.05] p ​= ​0.010). ConclusionIn patients who underwent CCTA with PCD-CT the number of subsequent ICAs was lower as compared to patients who were scanned with EID-CT. This difference was greater in patients with extensive coronary calcification.

Predicting progression of white matter hyperintensity using coronary artery calcium score based on coronary CT angiography-feasibility and accuracy.

Coronary artery disease (CAD) usually coexists with subclinical cerebrovascular diseases given the systematic nature of atherosclerosis. In this study, our objective was to predict the progression of white matter hyperintensity (WMH) and find its risk factors in CAD patients using the coronary artery calcium (CAC) score. We also investigated the relationship between the CAC score and the WMH volume in different brain regions. We evaluated 137 CAD patients with WMH who underwent coronary computed tomography angiography (CCTA) and two magnetic resonance imaging (MRI) scans from March 2018 to February 2023. Patients were categorized into progressive (n = 66) and nonprogressive groups (n = 71) by the change in WMH volume from the first to the second MRI. We collected demographic, clinical, and imaging data for analysis. Independent risk factors for WMH progression were identified using logistic regression. Three models predicting WMH progression were developed and assessed. Finally, patients were divided into groups based on their total CAC score (0 to <100, 100 to 400, and > 400) to compare their WMH changes in nine brain regions. Alcohol abuse, maximum pericoronary fat attenuation index (pFAI), CT-fractional flow reserve (CT-FFR), and CAC risk grade independently predicted WMH progression (p < 0.05). The logistic regression model with all four variables performed best (training: AUC = 0.878, 95% CI: 0.790, 0.938; validation: AUC = 0.845, 95% CI: 0.734, 0.953). An increased CAC risk grade came with significantly higher WMH volume in the total brain, corpus callosum, and frontal, parietal and occipital lobes (p < 0.05). This study demonstrated the application of the CCTA-derived CAC score to predict WMH progression in elderly people (≥60 years) with CAD.

Severe periodontal disease is associated with a high-risk phenotype of coronary plaques and a higher severity of coronary atherosclerosis, as assessed by Coronary Computed Tomography Angiography

Abstract Introduction Although incompletely understood, the relationship between coronary heart disease (CHD) and periodontal disease (PD) is well known. A variety of indices can be used to identify periodontal disease. The lack of strict criteria in defining PD represents a challenge in studying the link with CHD. Data from the literature regarding the relationship between different periodontal indices and CHD are extremely limited. Purpose To investigate the link between the PD indices, coronary calcifications and plaque features in patients with CHD who underwent coronary computed tomography angiography (CCTA). Methods The study included 52 patients with PD in whom (CCTA) revealed CHD. All patients underwent a complex oral examination of the periodontal status and the following indices were assessed: gingival index (GI), plaque index (PqI), calculus index (CI), furcation defects (FI), papillary bleeding index (PBI), tooth mobility, clinical attachment loss (CAL) and probing pocket depth (PPD). The indices were determined for the tooth’s 1.6, 2.1, 2.4, 3.6, 4.1, 4.4 and the final score for each index was obtained by summing the values from the six teeth. The association between the periodontal indices and CCTA features (total coronary artery calcium and vulnerability markers) was evaluated using Graph Pad InStat 3.10 software. The p value was set at 0.05 for statistical significance. Results The mean age of the study population was 54.48 ± 12.83 years old with a male to female ratio of 2.46. At the CCTA examination, mean total coronary artery calcium score was 284.20 ± 418.00. An association between the total coronary artery calcium score and GI (r2=0.12, p=0.01), PqI (r2=0.07, p=0.04), CI (r2=0.10, p=0.01), PBI (r2=0.12, p=0.01), PPD (r2=0.08, p=0.03) was found. Assessment of CCTA features of vulnerability at the level of atherosclerotic plaques indicated a strong association between periodontal indexes and plaque vulnerability: p&amp;lt;0.01 for association between CAL and spotty calcification, positive remodeling and napkin ring sign, p=0.009 for association between PPD and spotty calcification, and p=0.01 for association between tooth mobility and positive remodeling. Conclusions In patients with concomitant PD and CHD, the severity of periodontal disease seems to be associated with severity of atherosclerotic disease, assessed by the total coronary artery calcium score. At the same time, severity of PD is associated with a more expressed vulnerability of coronary plaques, indicating a high-risk phenotype of atheromatous plaques in patients with concomitant PD, and systemic inflammation is most likely the link between the two conditions.

Abstract 16044: Coronary Artery Calcium Score, a Superior Predictor of Cardiac Revascularization Risk Than Framingham

Introduction: The coronary artery calcium (CAC) score is a powerful independent screening tool for coronary artery disease (CAD). Elevated CAC score has been significantly associated with increased rates of revascularization, however the Framingham Risk Score remains the most used method of predicting patients’ risk for future revascularization. Hypothesis: The CAC score is a superior predictor of adverse cardiac events than the traditionally accepted Framingham Risk Score. Methods: Data was analyzed retrospectively of patients who underwent calcium score scans between August 2011 and April 2021 as part of the Sanford Cardiovascular Prevention Program and were categorized into low (&lt;100), moderate (100-399), or high (≥400) CAC groups. The accuracy of revascularization prediction between subjects with CAC score and those without CAC score were evaluated by a ROC curve. Results: A total of 28,187 patients were screened for CAC score. 46% were females and the mean age was 61.4 ± 9.9 years. ROC predictive accuracy of patients with CAC scores (0.76) compared against those with no CAC score (0.71) was found to be statistically significant (Z = -6.27, P&lt;0.01). Furthermore, total CAC was found to a significant predictor (b=.001, p&lt;0.01) of revascularization above and beyond the additional risk factors with the pseudo R2 increasing from .08 for starting risk factors to .15 when total CAC was added for a pseudo R2 change of .07 Conclusions: In our study, CAC scoring was not only able to better predict the need for future revascularization compared to Framingham components but also able to improve the specificity of revascularization prediction when added to the Framingham components.

Fully automated coronary artery calcium quantification on electrocardiogram-gated non-contrast cardiac computed tomography using deep-learning with novel Heart-labelling method.

To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) images. Retrospectively, 560 gated CCT images (including 60 synthetic images) performed at our institution were used to train AI-model, which can automatically divide heart region into five areas belonging to left main (LM), left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), and another. Total and vessel-specific CAC score (CACS) in each scan were manually evaluated. AI-model was trained with novel Heart-labelling method via DL according to the manual-derived results. Then, another 409 gated CCT images obtained in our institution were used for model validation. The performance of present AI-model was tested using another external cohort of 400 gated CCT images of Stanford Center for Artificial Intelligence of Medical Imaging by comparing with the ground truth. The overall accuracy of the AI-model for total CACS classification was excellent with Cohen's kappa of k = 0.89 and 0.95 (validation and test, respectively), which surpasses previous research of k = 0.89. Bland-Altman analysis showed little difference in individual total and vessel-specific CACS between AI-derived CACS and ground truth in test cohort (mean difference [95% confidence interval] were 1.5 [-42.6, 45.6], -1.5 [-100.5, 97.5], 6.6 [-60.2, 73.5], 0.96 [-59.2, 61.1], and 7.6 [-134.1, 149.2] for LM, LAD, LCX, RCA, and total CACS, respectively). Present Heart-labelling method provides a further improvement in fully automated, total, and vessel-specific CAC quantification on gated CCT.

THU600 Coronary Calcium Scores In Medical Group Versus Individualized Dietitian-led Visits Group In An Inner-city Setting

Abstract Disclosure: T.C. Friedman: None. P. Duran: None. M.J. Budoff: None. M. Shaheen: None. Obesity is highly prevalent in the U.S., particularly among ethnic minority groups. The purpose was using a randomized trial of 12-months to evaluate if coronary artery calcium (CAC) scores will decline in the medical arm compared to the dietitian-led arm and the control arm. Adult patients were recruited from LAC-DHS and randomized to medical group visit (n=58), dietitian individual visit (n=18) and control (n=50) groups. We measured the total CAC score and left anterior descending [LAD] scores using cardiac computed tomography to quantify CAC. We analyzed data for the change from baseline in the CAC scores between groups using the Kruskal Wallis test. We categorized the total CAC scores into 0-100 (no/mild risk); 101-400 (moderate risk); and &amp;gt; 400 (severe risk) and the LAD score into 0-99 (no/mild risk); 100-300 (moderate risk); and &amp;gt;300 (severe risk) and compared the groups using chi square or fisher exact test. P-value &amp;lt;0.05 was statistically significant. No statistical difference was found between the study groups in the change of the total CAC score. The mean, median and IQR of the change in total CAC score were -26.4, 0.0,3.0 in the dietitian group; 21.6, 0.0, 10.0 in the medical group; 44.6, 3.0, 23.0 in the control group (p=0.10). At baseline and post-intervention, no significant differences were found between the study groups in the total CAC risk (p=0.22). The mean, median and inter-quartile range (IQR) of the change in LAD score were -23.6, 0.0, 2.0 in the dietitian group; 4.7, 0.0, 2.0 in the medical group; 12.5, 1.0, 9.8 in the control group (p=0.036). Significant improvements were found between the dietitian group and control group (p=0.039) and the medical group and control group (p=0.027). For LAD risk groups at baseline, 10%, 11.1% and 10.3% of the control, dietitian, and medical groups, respectively, had moderate risk; and 10.0%, 5.6%, and 1.7%, respectively, had severe risk (p=0.069). Post intervention, there was a reduction in the percent with moderate risk in the dietitian (-5.5%) and the medical (-1.7%) groups relative to control group (2.0%). For the severe risk, there was a reduction of 5.6% in the dietitian group, with no change in the medical group relative to 2% increase in the control group (p=0.013). Our study showed significant improvement in the LAD score and its risk groups in the dietitian group relative to the control and medical groups indicating that the dietitian intervention was able to attenuate the progression of atherosclerosis. The implications of our study is that lifestyle obesity interventions have the potential to reduce cardiovascular disease. Presentation: Thursday, June 15, 2023

Is coronary artery calcium an independent risk factor for white matter hyperintensity?

BackgroundCardiovascular diseases have been considered the primary cause of disability and death worldwide. Coronary artery calcium (CAC) is an important indicator of the severity of coronary atherosclerosis. This study is aimed to investigate the relationship between CAC and white matter hyperintensity (WMH) in the context of diagnostic utility.MethodsA retrospective analysis was conducted on 342 patients with a diagnosis of WMH on magnetic resonance images (MRI) who also underwent chest computed tomography (CT) scans. WMH volumes were automatically measured using a lesion prediction algorithm. Subjects were divided into four groups based on the CAC score obtained from chest CT scans. A multilevel mixed-effects linear regression model considering conventional vascular risk factors assessed the association between total WMH volume and CAC score.ResultsOverall, participants with coronary artery calcium (CAC score > 0) had larger WMH volumes than those without calcium (CAC score = 0), and WMH volumes were statistically different between the four CAC score groups, with increasing CAC scores, the volume of WMH significantly increased. In the linear regression model 1 of the high CAC score group, for every 1% increase in CAC score, the WMH volume increases by 2.96%. After including other covariates in model 2 and model 3, the β coefficient in the high CAC group remains higher than in the low and medium CAC score groups.ConclusionIn elderly adults, the presence and severity of CAC is related to an increase in WMH volume. Our findings suggest an association between two different vascular bed diseases in addition to traditional vascular risk factors, possibly indicating a comorbid mechanism.

#2531 AGATSTON INDEX AS A PREDICTOR OF PREDICTION OF THE DEGREE OF HEART VASCULAR DAMAGE IN STAGE 5 CKD PATIENTS RECEIVING PROGRAM HEMODIALYSIS

Abstract Background and Aims Cardiovascular events (CVEs) are the leading cause of death in patients with chronic kidney disease (CKD). A retrospective analysis of the causes of death of a large group of nephrological patients shows that the mortality of patients from cardiovascular events is more than 4.1 higher than the number of deaths from all kidney diseases, including end-stage chronic kidney disease [1]. Aim of the study: to evaluate the possibility of CI for predicting the degree of damage to the coronary arteries of the heart in patients with CKD. Method In a prospective study for MSCT, 60 patients were selected (30 patients each from groups 1 and 2 (15 patients in subgroups) with CKD stage 5 of various etiologies receiving PG. The results of multispiral CT-coronary angiography in 60 consecutive patients/clients of a multidisciplinary clinic were analyzed. Among them were: 41 men (68.3%) and 19 women (31.6), the age ranged from 28 to 74 years (mean age - 53.4 ± 11.89 years). The mean age of the woman was 55.05 ± 11.92 years; men 52.63 ± 11.61 years old, there were no statistically significant differences between the age, heart rate, SBP and DBP of women and men, which indicates the representativeness of the groups. Results To assess coronary calcification, MSCT of the chest was performed to determine the mass and volume of coronary calcium. When compared in group 1 patients, in relation to group 2 patients in all coronary basins, there is a significant increase in the content of coronary calcium (p&amp;lt;0.05 for all indicators). The Agatston index in the examined patients ranged from 0 to 790 units (units). Patients with CI ranging from 101 to 400 units. were older - from 34 to 54 years (mean age 42.77 years). Among them, males clearly predominated. In 50% of patients, there was a multivascular lesion of the coronary arteries with significant stenosis in the anterior interventricular branch (LAD) and the right coronary artery (RCA), and without significant stenosis in the circumflex branch of the left coronary artery. With CI over 400 units. all 30 examined patients had multiple coronary artery stenoses, the maximum of which exceeded 70%. At the same time, 5 patients (8.3%) had 4 stenoses of the coronary arteries of the heart. This is consistent with evidence that increased cardiovascular risk is associated with total coronary artery calcium load. Taking into account the fact that according to the results of the study it was found that in many patients with coronary artery stenosis from 20 to 49%, belonging to the group of patients with high cardiovascular risk and with stenosis of more than 50%, to the group of very high risk, having an increased CI, then this indicator can be used as an additional indicator for cardiovascular risk stratification to predict cardiovascular events. Conclusion The Agatston index or CI, determined using multislice CT, can be used as a screening method for detecting coronary artery atherosclerosis and determining cardiovascular risk. With CI over 100 units. the vast majority of the surveyed revealed multiple stenoses of the coronary arteries, with an indicator of more than 400 units. hemodynamically significant arterial damage is expected. Such patients should undergo an additional examination: functional tests (bicycle ergometry, treadmill test, daily ECG monitoring) or contrast coronary angiography to verify the main diagnosis and to decide on further tactics for managing patients.

Transient left bundle branch block associated with very high coronary artery calcium: a case report.

Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 diabetes, and hyperlipidemia presenting with dyspnea. Initial electrocardiogram (ECG) demonstrated normal conduction with a heart rate of 76 beats/min, but new T-wave inversions in V1-V4 and a high-sensitivity troponin-I (hsTnI) value of 6 ng/L (normal < 6 ng/L). Repeat ECG in the emergency department showed normal sinus rhythm (heart rate of 80 beats/min); however, it subsequently demonstrated a left bundle branch block (LBBB) with a repeat hsTnI of 7 ng/L. Stress testing with pharmacologic single-photon emission computerized tomography did not show scintigraphic evidence of ischemia but noted extensive CAC and a concern for balanced ischemia. Subsequent coronary computed tomography angiography (CCTA) showed nonobstructive disease and a total Agatston CAC score of 1262. Invasive evaluation with left heart catheterization was deferred given the patient's unchanged symptoms and CCTA findings. Statin therapy was intensified and aspirin, metoprolol succinate, and antihypertension therapies were continued. Initiation of glucose-lowering therapy and lipoprotein(a) testing was strongly recommended on follow-up. Our case suggests that CAC ⩾ 1000 may be incidentally associated with transient LBBB during the workup of coronary artery disease. Here, we specifically show that functional testing that incorporates measurement of CAC burden can help to improve ASCVD-preventive pharmacotherapy initiation and intensification beyond the identification of obstructive disease alone.

Automated total and vessel-specific coronary artery calcium (CAC) quantification on chest CT: direct comparison with CAC scoring on non-contrast cardiac CT

BackgroundThis study aimed to evaluate the artificial intelligence (AI)-based coronary artery calcium (CAC) quantification and regional distribution of CAC on non-gated chest CT, using standard electrocardiograph (ECG)-gated CAC scoring as the reference.MethodsIn this retrospective study, a total of 405 patients underwent non-gated chest CT and standard ECG-gated cardiac CT. An AI-based algorithm was used for automated CAC scoring on chest CT, and Agatston score on cardiac CT was manually quantified. Bland-Altman plots were used to evaluate the agreement of absolute Agatston score between the two scans at the patient and vessel levels. Linearly weighted kappa (κ) was calculated to assess the reliability of AI-based CAC risk categorization and the number of involved vessels on chest CT.ResultsThe AI-based algorithm showed moderate reliability for the number of involved vessels in comparison to measures on cardiac CT (κ = 0.75, 95% CI 0.70–0.79, P < 0.001) and an assignment agreement of 76%. Considerable coronary arteries with CAC were not identified with a per-vessel false-negative rate of 59.3%, 17.8%, 34.9%, and 34.7% for LM, LAD, CX, and RCA on chest CT. The leading causes for false negatives of LM were motion artifact (56.3%, 18/32) and segmentation error (43.8%, 14/32). The motion artifact was almost the only cause for false negatives of LAD (96.6%, 28/29), CX (96.7%, 29/30), and RCA (100%, 34/34). Absolute Agatston scores on chest CT were underestimated either for the patient and individual vessels except for LAD (median difference: − 12.5, − 11.3, − 5.6, − 18.6 for total, LM, CX, and RCA, all P < 0.01; − 2.5 for LAD, P = 0.18). AI-based total Agatston score yielded good reliability for risk categorization (weighted κ 0.86, P < 0.001) and an assignment agreement of 86.7% on chest CT, with a per-patient false-negative rate of 15.2% (28/184) and false-positive rate of 0.5% (1/221) respectively.ConclusionsAI-based per-patient CAC quantification on non-gated chest CT achieved a good agreement with dedicated ECG-gated CAC scoring overall and highly reliable CVD risk categorization, despite a slight but significant underestimation. However, it is challenging to evaluate the regional distribution of CAC without ECG-synchronization.

502 Distribution Of Coronary Artery Calcium In Diabetes Versus Non-diabetes Population: Multiethnic Study Of Atherosclerosis (mesa)

Introduction: Total coronary artery calcium (CAC) score is an effective predictor of cardiovascular events in individuals with and without diabetes. Diabetes patients have a greater rate of CVD events, which we hypothesize is related to their greater development of diffuse atherosclerosis. The main goal of this study is to determine the pattern of atherosclerosis distribution in individuals with and without diabetes mellitus (DM) utilizing a novel 10 segment model.

Association of Coronary Events with Burden and Distribution of Coronary Artery Calcification: Results from the Multi-Ethnic Study of Atherosclerosis

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Coronary artery calcium (CAC), even when mild, is associated with increased risk for coronary heart disease (CHD) events. <h3>Objective/Purpose</h3> We sought to characterize the association between number of vessels with CAC and specific artery involvement with incident CHD. <h3>Methods</h3> We evaluated participants with baseline CAC >0, free of cardiovascular disease (CVD), and follow-up from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam 1 visit until adjudicated CHD, death, or censoring date of December 31st, 2018. We used Cox proportional hazard regression analyses to characterize incident CHD by number of vessels with CAC and specific artery involvement with sequential multivariable models adjusting for ASCVD risk score, body mass index, and log-transformed total calcification volume. <h3>Results</h3> There were 3,290 participants (mean age, 66 years; 42% female) with baseline CAC >0. Among these, 33% had CAC >0 in only 1 artery, 25% in 2 arteries, 30% in 3 arteries, and 12% in all 4 coronary arteries. Of those with single-vessel involvement, CAC was most frequently in the left anterior descending artery (LAD) (75%), followed by the right coronary artery (RCA) (12%), left circumflex (LCx) (10%), and left main (LM) (3%). Over follow-up of 18.5 years, 589 participants (18%) developed CHD with a mean time to event of 12.6 years. In the multivariable- adjusted Cox model, CHD risk was 1.7x higher for 3- vs 1- (95% CI 1.2-2.3, p=0.002) and 1.6x higher for 3- vs 2-vessel involvement (95% CI 1.2-2.0, p=0.0004), though similar for 1- vs 2- (p=0.7) and 3- vs 4 (p=0.8) [Figure]. Single-vessel CAC in the LAD conferred a similar risk for CHD when compared to single-vessel CAC in the LM (p=0.66), LCx (p=0.83), and RCA (p=0.31). <h3>Conclusions</h3> Subclinical coronary artery disease was most commonly in 1, 2, and 3 number of arteries, and most frequently included the LAD. Compared with having CAC in only 1 to 2 arteries, those with CAC in 3 to 4 arteries had a 60-70% higher risk of incident CHD. In the context of the multivariable-adjusted model accounting for total CAC volume, no specific artery conferred a higher CHD risk than others. Number of vessels with CAC but not specific artery distribution were important characteristics for individualized risk stratification.

THE DIAGNOSTIC PERFORMANCE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY COMPARED WITH INVASIVE CORONARY ANGIOGRAPHY IN SYMPTOMATIC PATIENTS: LONG–TERM PROGNOSTIC IMPLICATIONS

Objective: We aimed to investigate the diagnostic accuracy of 64-multidetector coronary computed tomographic angiography (CCTA) for stable symptomatic patients and evaluate the relationship between severity of coronary artery disease (CAD), cardiovascular risk scores, and coronary artery calcium (CAC) scores. We also assessed the possible predictors of all-cause mortality at a median of 10 years of follow-up. Materials and Methods: This retrospective, observational study included 45 patients with suspected CAD who had undergone CCTA and invasive coronary angiography within the previous two weeks (67% male, mean age 62.1±10.72 years). Using CCTA, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated on a segment and patient basis analysis. The total CAC (Agatston units [AU]) and systematic coronary risk evaluation (SCORE) scores were calculated for each patient. Results: The CCTA NPV and PPV for the segment- and patient-based analyses were 97% and 100%, and 94% and 88%, respectively. CAC scores &gt;100 AU reflected a higher incidence of significant CAD (OR=4.88, 95% CI 1.62–14.68 p&lt;0.001), and CAC scores were significantly correlated with SCORE risk values (r=0.669, p&lt;0.001). Ultimately, 6 patients (13.3%) died. Combined CAC and SCORE value and age significantly improved the prediction of all-cause mortality at a median of 10 years of follow-up (AUC=0.833, 95% CI 0.693–0.974, p=0.009). Conclusion: 64-multidetector CCTA has high diagnostic accuracy for detecting or excluding significant CAD. Moreover, CAC and SCORE risk score may provide valuable prognostic information for predicting long-term mortality and improving preventive therapies.

Coronary artery calcium score is a prognostic factor for mortality in idiopathic pulmonary fibrosis.

Cardiovascular diseases are frequent in idiopathic pulmonary fibrosis (IPF) and impact on survival. We investigated the association of coronary artery calcium (CAC) score at IPF diagnosis and during mid-term follow-up, with adverse cardiovascular events and all-cause mortality. Consecutive patients with IPF were retrospectively analyzed. Demographic data, smoking history, comorbidities and pulmonary function tests (PFTs) were recorded. All patients had at least two chest high resolution computed tomography (HRCT) performed 2 years apart. The total CAC score and visual fibrotic score were calculated, and all clinically significant cardiovascular events and deaths were reported. The population consisted of 79 patients (57 males, mean age: 74.4±7.6 years); 67% of patients had a history of smoking, 48% of hypertension, 37% of dyslipidemia and 22.8% of diabetes. The visual score was 21.28±7.99% at T0 and 26.54±9.34% at T1, respectively (T1-T0 5.26±6.13%, P<0.001). CAC score at T0 and at T1 was 537.93±839.94 and 759.98±1027.6, respectively (T1-T0 224.66±406.87, P<0.001). Mean follow-up time was 2.47±1.1 years. On multivariate analysis, male sex (HR=3.58, 95% CI: 1.14-11.2) and CAC score at T0 (HR=1.04, 95% CI: 1.01-1.07) correlated with mortality and cardiovascular events. CAC score at T0≥405 showed 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events. IPF patients with a CAC score at diagnosis ≥405 have a poor prognosis over a mid-term follow-up. A higher CAC score is associated with mortality and cardiovascular events.

MO750: Dialysate Magnesium Impact on Progression of Coronary Artery Calcification

Abstract BACKGROUND AND AIMS The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg. METHOD This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up. RESULTS Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P &amp;lt; 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P &amp;lt; 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P &amp;lt; 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P &amp;lt;0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P &amp;lt; 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22; P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively. CONCLUSION Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.

Relationship between genomic risk scores (GRS) and coronary artery calcium (CAC) score: A pilot study.

Coronary artery disease (CAD) genomic risk scores (GRS), as FDR202, GRS46K, 1.7M, and MetaGRS, help in assessing cardiovascular related morbidity and mortality. Interventions to adhere to a healthy lifestyle as a means of prevention based on the GRS have a potential to greatly reduce incident CAD event rates. We performed a prospective observational study to see the relationship between GRS and coronary artery calcium (CAC) scoring in individuals who are at risk. 104 subjects with mean age 55.1±8.8 years were enrolled and consented and all the participants underwent CAC scoring. 55 (53%) were male. CAC score was measured using the Agatston method. Spearman correlation analysis assessed relationships between GRS scores and CAC scores, in the entire sample and in subjects with CAC score greater than zero. Multivariable linear regression analyzed associations while adjusting potential confounding variables. Mean±SD CAC score of the study population was 49.0±130. A significant negative correlation was noted between FDR202 Prevalence and total CAC Score in 39 subjects with CAC >0, r=-0.35, p=0.02. Multivariable analysis shows a significant association between FDR202 prevalence and log adjusted CAC score in subjects with CAC >0 while adjusting age, gender, hypertension and hyperlipidemia (β=-0.2, SE=0.1, p=0.04). No significant correlations were found between GRS46K, 1.7M, and MetaGRS with CAC score. Additional research is necessary in a larger population to evaluate the potential role ofGRS for the detection of CAD. This allows the individuals to adopt a healthy lifestyle modificationtominimize the cardiovascular risk and delays the onset of most diseases of old age to prolong the life.

SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta.

There is no study about the relationship between the complexity of coronary artery disease (SYNTAX SCORE; SS), and coronary artery calcium (CAC) score, accompanied with aortic calcium score (ACS) levels. The objective of this study was to investigate the relationship between the preoperative SS and CAC scores accompanying ACS in isolated CABG patients and their postoperative clinical results. This study included 130 consecutive CABG patients. The mean age of the patients was 62.3 ± 8.62 years (range: 47-84 years). SS was measured using coronary angiography by an experienced cardiologist. We investigated the ACS accompanied with CAC scores using a multidetector computed tomography (MDCT) in the same session, preoperatively. Measurements of the CAC score and ACS were measured by an experienced radiologist, who was unaware of the study in the same session. In order to investigate aortic wall pathology in patients with positive aortic calcification, we provided aortic tissue samples prior to the proximal anastomosis of bypass grafts using No:11 scalpel. Overall median SS was 39 ± 7.2 (range: 15-41). CAC score was zero in 34 patients (26.1%). For the patients with a CAC score of zero, the median SS was 32 ± 9.4. There was no evidence of aortic calcification or plaque formation in 62 patients (47.6%). In these patients, the median SS was 35.6 ± 11.3. No significant difference was found when both groups were compared and for those patients with a calcific score of zero (P = .85). The median CAC score and ACS were 238 ± 122 AU (range: 0-1238 AU) and 112 ± 40 AU (range: 0-730 AU), respectively (P = .0033). For patients with a CAC score and ACS ≥400 AU, the mean SYNTAX score was ≥ 37. SS was correlated with CAC score (R:0.585; P < .0001). SYNTAX was correlated with ACS (R:0.557; P < .001). In multivariate analysis of SS (OR 1.053, 95% CI: 1.003-1.106, P = .039), gender (OR 0.189, 95% CI: 0.053-0.678, P = 0.011), age (OR 1.454, 95% CI: 1.256-1.632, P = .012), and diabetes mellitus (OR 0.341, 95% CI: 1.006-1.124, P = .014) were independent predictors for CAC score and aortic calcification. CAC score and ACS are strongly correlated with the complexity of coronary arteries in CABG patients. The total CAC score (≥ 400 AU) was independently associated with the degree of SS (>37). To prevent MACCE and mortality in CABG patients, we suggest the measurement of CAC score accompanied with ACS using MDCT as a non-invasive method. Highlight points: • Atherosclerotic plaque formation in aorta and coronary arteries are the main risk factors for stroke and infarction in CABG operations. •SYNTAX score value and aortic atherosclerosis levels are directly correlated. •SYNTAX score may predict the complications due to atherosclerosis during heart surgery.

Deep learning for vessel-specific coronary artery calcium scoring: validation on a multi-centre dataset.

To present and validate a fully automated, deep learning (DL)-based branch-wise coronary artery calcium (CAC) scoring algorithm on a multi-centre dataset. We retrospectively included 1171 patients referred for a CAC computed tomography examination. Total CAC scores for each case were manually evaluated by a human reader. Next, each dataset was fully automatically evaluated by the DL-based software solution with output of the total CAC score and sub-scores per coronary artery (CA) branch [right coronary artery (RCA), left main (LM), left anterior descending (LAD), and circumflex (CX)]. Three readers independently manually scored the CAC for all CA branches for 300 cases from a single centre and formed the consensus using a majority vote rule, serving as the reference standard. Established CAC cut-offs for the total Agatston score were used for risk group assignments. The performance of the algorithm was evaluated using metrics for risk class assignment based on total Agatston score, and unweighted Cohen's Kappa for branch label assignment. The DL-based software solution yielded a class accuracy of 93% (1085/1171) with a sensitivity, specificity, and accuracy of detecting non-zero coronary calcium being 97%, 93%, and 95%. The overall accuracy of the algorithm for branch label classification was 94% (LM: 89%, LAD: 91%, CX: 93%, RCA: 100%) with a Cohen's kappa of k = 0.91. Our results demonstrate that fully automated total and vessel-specific CAC scoring is feasible using a DL-based algorithm. There was a high agreement with the manually assessed total CAC from a multi-centre dataset and the vessel-specific scoring demonstrated consistent and reproducible results.

Coronary calcium scoring potential of large field-of-view spectral photon-counting CT: a phantom study

ObjectiveThe aim of the current study was, first, to assess the coronary artery calcium (CAC) scoring potential of spectral photon-counting CT (SPCCT) in comparison with computed tomography (CT) for routine clinical protocols. Second, improved CAC detection and quantification at reduced slice thickness were assessed.MethodsRaw data was acquired and reconstructed with several combinations of reduced slice thickness and increasing strengths of iterative reconstruction (IR) for both CT systems with routine clinical CAC protocols for CT. Two CAC-containing cylindrical inserts, consisting of CAC of different densities and sizes, were placed in an anthropomorphic phantom. A specific CAC was detectable when 3 or more connected voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). For all reconstructions, total CAC detectability was compared between both CT systems. Significant differences in CAC quantification (Agatston and volume scores) were assessed with Mann-Whitney U tests. Furthermore, volume scores were compared with the known CAC physical.ResultsCAC scores for routine clinical protocols were comparable between SPCCT and CT. SPCCT showed 34% and 4% higher detectability of CAC for the small and large phantom, respectively. At reduced slice thickness, CAC detection increased by 142% and 169% for CT and SPCCT, respectively. In comparison with CT, volume scores from SPCCT were more comparable with the physical volume of the CAC.ConclusionCAC scores using routine clinical protocols are comparable between conventional CT and SPCCT. The increased spatial resolution of SPCCT allows for increased detectability and more accurate CAC volume estimation.Key Points• Coronary artery calcium scores using routine clinical protocols are comparable between conventional CT and spectral photon-counting CT.• In comparison with conventional CT, increased coronary artery calcium detectability was shown for spectral photon-counting CT due to increased spatial resolution.• Volumes scores were more accurately determined with spectral photon-counting CT.