Value Of Calcium Score Research Articles

The predictive value of coronary artery calcium score combined with traditional risk factors for obstructive coronary heart disease in young people

ObjectivesThis study attempts to compare the predictive effects of several prediction models on obstructive coronary artery disease (OCAD) in young patients (30–50 years old), with a view to providing a new evaluation tool for the prediction of premature coronary artery disease (PCAD).MethodsA total of 532 hospitalized patients aged 30–50 were included in the study.All of them underwent coronary computed tomography angiography (CCTA) for suspected symptoms of coronary heart disease.Coronary artery calcium score (CACS) combined with traditional risk factors and pre-test probability models are the prediction models to be compared in this study.The PTP model was selected from the upgraded Diamond-Forrester model (UDFM) and the Duke clinical score (DCS).ResultsAll patients included in the study were aged 30–50 years. Among them, women accounted for 24.4%, and 355 patients (66.7%) had a CACS of 0. OCAD was diagnosed in 43 patients (8.1%). The CACS combined with traditional risk factors to predict the OCAD area under the curve of receiver operating characteristic (ROC) (AUC = 0.794,p < 0.001) was greater than the PTP models (AUCUDFM=0.6977,p < 0.001;AUCDCS=0.6214,p < 0.001). By calculating the net reclassification index (NRI) and the integrated discrimination index (IDI), the ability to predict the risk of OCAD using the CACS combined with traditional risk factors was improved compared with the PTP models (NRI&IDI > 0,p < 0.05).ConclusionThe predictive value of CACS combined with traditional risk factors for OCAD in young patients is better than the PTP models.

ADVANCED CARDIAC IMAGING IN LIVER TRANSPLANTATION ECHOCARDIOGRAPHIC VENTRICULAR STRAIN AS PROGNOSTIC TOOLS

Abstract While cardiac involvement in the end–stage liver disease (ESLD) is a known condition, the characteristics of cardiac function in cirrhotic cardiomyopathy and their effects on candidates to liver transplant (LT) are still vague. The evaluation of right ventricular failure (RVF) in liver transplant candidates has been revolutionized by advanced cardiac imaging techniques, particularly echocardiography with global longitudinal strain (GLS) analysis. Aim of the present study is to evaluate RV function indexes in ESLD patients candidate to LT and the potential relationship with the liver disease status and cardiovascular major events on early post–LT phase Forty ESDL adult patients (age 46.8 ± 10 yrs, M/F 33/7) candidate to LT (19 for hepatic failure, 18 for hepatocarcinoma and 3 for other causes) were evaluate. All were submitted to transthoracic echocardiography and coronary CT angiography or coronary angiography. The Model for End–stage Liver Disease (MELD) score in the study population was 19±6.8. The higher values of the MELD score (i.e. the worst liver function condition) were directly correlated with the lower RV–GLS (p&amp;lt;0.02). Cardiac function indexes were LV–EF 62.8±4.5%, RV–GLS –22.9±4.5%, LV–GLS –19.5±4.6% and PAPs 31.8±6.6 mmHg. On 21 day follow–up, 4 patients died (2 with acute RV failure, 1 with Tako–Tsubo syndrome). On CT–angiography the value of calcium score was significantly different between the group of fatal events and the rest (0 vs 567±900), revealing that none of the died patient suffered from coronary atheromatic disease. Our findings identified that specific RV–GLS patterns on echocardiography, indicative of subclinical myocardial dysfunction, were strongly correlated with worst clinical hepatic conditions and reduced survival rates post–transplant. The study highlights the importance of advanced cardiac imaging in identifying liver transplant candidates at higher risk of post–transplant mortality due to RHF.

Efficacy of Coronary Calcium Score in Predicting Coronary Artery Morphology in Patients With Obstructive Coronary Artery Disease

BackgroundCoronary artery calcium score (CACS) is an established marker of coronary artery disease (CAD) and has been extensively used to stratify risk in asymptomatic individuals. However, the value of CACS in predicting plaque morphology in patients with advanced CAD is less established. The present analysis aims to assess the association between CACS and plaque characteristics detected by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) imaging in patients with obstructive CAD. MethodsSeventy patients with obstructive CAD underwent coronary computed tomography angiography (CTA) and 3-vessel NIRS-IVUS imaging were included in the present analysis. The CTA data were used to measure the CACS in the entire coronary tree and the segments assessed by NIRS-IVUS, and these estimations were associated with the NIRS-IVUS measurements at a patient and segment level. ResultsIn total, 65 patients (188 segments) completed the study protocol and were included in the analysis. A weak correlation was noted between the CACS, percent atheroma volume (r = 0.271, P = .002), and the calcific burden measured by NIRS-IVUS (r = 0.648, P < .001) at patient-level analysis. Conversely, there was no association between the CACS and the lipid content, or the incidence of high-risk plaques detected by NIRS. Linear regression analysis at the segment level demonstrated an association between the CACS and the total atheroma volume (coefficient, 0.087; 95% CI, 0.024-0.149; P = .008) and the calcific burden (coefficient, 0.117; 95% CI, 0.048-0.186; P = .001), but there was no association between the lipid content or the incidence of high-risk lesions. ConclusionsIn patients with obstructive CAD, the CACS is not associated with the lipid content or plaque phenotypes. These findings indicate that the CACS may have a limited value for screening or stratifying cardiovascular risk in symptomatic patients with a high probability of CAD.

The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score.

We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA. This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used. The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients. CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method.

Interplay Between Zero CAC, Quantitative Plaque Analysis, and Adverse Events in a Diverse Patient Cohort.

Coronary artery calcium scoring (CAC) has garnered attention in the diagnostic approach to chest pain patients. However, little is known about the interplay between zero CAC, sex, race, ethnicity, and quantitative coronary plaque analysis. We conducted a retrospective analysis from our computed tomography registry of patients with stable angina without prior myocardial infarction or revascularization undergoing coronary computed tomography angiography at Montefiore Healthcare System. Follow-up end points collected included invasive angiography, type-1 myocardial infarction, coronary revascularization, cardiovascular and all-cause death. A total of 2249 patients were included (66% female). The median follow-up was 5.5 years. The median age of those without CAC was 52 years (interquartile range, 44-59) and 60 years (interquartile range, 53-68) in those with CAC. Most patients were Hispanic (58%), and the rest were non-Hispanic Black (28%), non-Hispanic White (10%), and non-Hispanic Asian (5%). The majority had CAC=0 (55%). The negative predictive value of CAC=0 was 92.8%, 99.9%, and 99.9% for any plaque, obstructive coronary artery stenosis, and the composite outcome of all-cause death, myocardial infarction, or coronary revascularization, respectively. Among patients without CAC (n=1237), 89 patients (7%) had evidence of plaque on their coronary computed tomography angiography with a median low-attenuation noncalcified plaque burden of 4% (2-7). There were no significant differences in the negative predictive value for CAC=0 by sex, race, or ethnicity. Patients with ≥2 risk factors had higher odds of having plaque with zero CAC. In summary, no sex, race, or ethnicity differences were demonstrated in the negative predictive value of a zero CAC; however, patients with ≥2 risk factors had a higher prevalence of plaque. A small percentage (7%) of symptomatic patients undergoing coronary computed tomography angiography with zero CAC had noncalcified coronary plaque, with the implication that caution is needed for downscaling of preventive treatment in patients with zero CAC, chest pain, and multiple risk factors.

Coronary artery calcium score predicts outcome in patients with COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Aim Coronary artery calcium (CAC) score is a proven prognostic marker of cardiovascular risk. The aim of this study was to evaluate the prognostic value of CAC score on standard chest computed tomography (CT) in patients admitted with COVID-19. Methods We enrolled 144 consecutive patients (mean age 67± 13, 60.7% male) hospitalized with COVID-19, who on admission underwent chest CT to detect and assess pulmonary involvement. CAC score was calculated by two investigators blinded to patients clinical data. Patients were followed-up for 12 months after their admission. Results 106 patients had image quality sufficient for analysis. The median CAC score was 249 Agatston units (interquartile range 658). 33 deaths were recorded in the study group during the follow-up period. The median values of CAC of patients who died during the study period and of the survivors were 592 (interquartile range 1492) and 142 (interquartile range 400), respectively. The difference in CAC between these two subgroups was statistically significant (p = 0,0001). The area under the ROC curve for CAC score for predicting all-cause mortality was 0.738 (95% CI 0,644 to 0,819). The criterion with the highest prognostic accuracy was CAC score &amp;gt;143 Agatston units (positive and negative predictive values were 44,4% and 88,4%, respectively). The presence of this criterion was associated with 3,82 times higher relative risk of mortality (95%CI 1.60 – 9,11; p = 0.0025). Conclusion CAC score measurement based on standard chest CT performed on admission in patients with COVID-19 to detect pulmonary involvement is a prognostic marker of increased mortality during the 12-month follow-up.

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

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

The value of calcium scoring in hypertensive patients as a referral criterion for the prediction of coronary artery disease detected on computed tomography coronary angiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The current national guidelines do not address the inequity between the increasing demand of Computed Tomography Coronary Angiography (CTCA) and the contrasting constrained imaging capacity. In a previous study we showed hypertension to be the strongest independent predictor of Coronary Artery Disease (CAD) detected on CTCA. In this study, the use of Coronary Calcium Scoring (CCS) for CTCA referrals is reviewed to identify the main parameters upon which CTCA referrals for the investigation of CAD, should be based. Methods After excluding TAVI and graft assessment patients, the individual electronic health records of 420 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age 59.1 years. Risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate and severe disease, as seen on CTCA reports. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared in regard to the number of coronary arteries affected and the severity of CAD in each artery. Results Out of the total cohort, 247 (50.9%) patients were hypertensive. 249 (59.3%) CCS were interpreted in the very low risk category, 57 (13.6%) low risk, 58 (13.8%) moderate risk, 23 (5.48%) moderately high risk and 33 (7.86%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate and severe CAD (P = 0.015 and P &amp;lt; 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (P = 0.013). Further comparison of CCS between hypertensives with chest pain and hypertensives without chest pain was non-significant. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensives and non-hypertensives for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries. Conclusions Hypertensive patients with a high CCS were associated with higher incidence of severe CAD. Further, in those with hypertension, additional symptoms appear to have no effect on CCS. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography, may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension and stable chest pain, in the progress of angiographic coronary disease.

1046 DIAGNOSTIC PERFORMANCE OF CALCIUM SCORE ASSESSMENT IN ATRIOVENTRICULAR CONDUCTION DETERIORATION AFTER TAVI: A SINGLE CENTRE PILOT STUDY

Abstract Background The risk of cardiac conduction system defects (CCD) after transcatheter aortic valve implantation (TAVI) remains high and requiring permanent pacemaker implantation (PPI) in 20% of the patients. Numerous studies have suggested that up to half of patients who underwent PPI within 30 days after TAVI do not depend on their PM at one year. The micro-calcific deposits of the atrioventricular node cannot be detected by standard echocardiography, while CT scan can reliably identify them. While pacemaker implantation was recommended according to clinical status and current guideline, in this small retrospective analysis, pre-procedural CT scan calcium quantification was considered an anatomical predictor of AV conduction prolongation until advanced disorder and cardiac block. We assume that differential calcium localization into the AV node might contribute to progression of conduction disorders until complete heart block. Aims The objective of this pilot study is to evaluate the impact of calcium score assessment as a predictor of the development of CCD after TAVI. The goal is to evaluate the interaction between PM dependency and the value of calcium score at the CT scan pre-TAVI. the data collected in this single-center cohort analysis AIMS TO help identify patients at higher risk of permanent pacemaker implantation after TAVI pacemaker insertion and pacemaker-dependent patients at one year through CT calcium scoring. Methods From January 2020 to September 2021, we retrospectively collected data from our institute. One-hundred and thirty patients without prior PM underwent TAVI in our institution. Overall mean age was 79,7 years old with 57,1% of females, with a pre-procedural diagnosis of aortic stenosis and a mean gradient of 47,4 mmHg. At 30 days, PPI was reported in 21 patients (16,1%). Out of twenty-one patients 47,6% developed complete atrioventricular block, 19% developed atrioventricular block II grade type 2 and 33,3% other conduction defects. The dependency at the implantation was 51,1%. With a dedicated software at the CT scan, we assessed the calcium score located in three regions near the atrioventricular node: aortic valve, left ventricular outflow tract (LVOT) and anterior mitral annular (Figure 1). Two patients were excluded for the diagnosis of severe aortic stenosis low-flow low-gradient. The Primary endpoint was to identify patients who had higher risk of PPI after TAVI pacemaker insertion. Results At 12 months follow-up, 23,8% of patients died (n=5). All the remaining patients, 28,5% had a high rate of ventricular pacing (Vp) at implantation (n=6). One year later at the follow up, three of these patients restored intrinsic rhythm and had a low Vp rate. The rate of patients found pacemaker-dependent at one year of follow-up was 76,2%. Conclusions Among 21 patients who requiring PPI after TAVI, at 12 months 14,2% restored intrinsic rhythm. The methodology of calcium scoring outside the coronary arteries is still an active area of study. In the coming months, the collected data will be analyzed to assess the association between PM dependence at follow-up and calcium score on CT scan before TAVI.

Association Between Coronary Artery Calcium Score and Bone Mineral Density in Type 2 Diabetes Mellitus with Different Visceral Fat Area.

The relationship between coronary artery calcification and bone mineral density (BMD) in T2DM is still unclear. The aim of this study is to analyze the association between coronary artery calcium score (CACs) and BMD in T2DM with different visceral fat area (VFA), and further to explore the clinical significance of CACs in predicting osteoporosis in T2DM patients. A total of 479 T2DM patients aged ≥50 years were included. Agatston was applied to calculate CACs to evaluate the degree of coronary artery calcification. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD. According to VFA, all subjects were divided into VFA <100cm2 and VFA ≥100cm2 group. Adjusted regression analysis was performed to analyze the association between CACs and BMD. ROC curve was used to analyze the optimal cut-off value of CACs for screening osteoporosis. The baseline showed that in VFA ≥100cm2 group, CACs increased significantly than that in VFA <100cm2 group (212.1±195.9 vs 139.3±141.8, p<0.001) and total hip BMD decreased obviously (0.968±0.19 vs 1.021±0.184, p=0.01). After multivariable adjustment, CACs was not significantly associated with BMD in all patients (p>0.05). However, CACs was negatively associated with BMD of total hip and lumbar spine in patients with VFA ≥100cm2 (total hip β=-0.087 p=0.01; lumbar spine β=-0.052 p=0.005), but not VFA <100cm2. ROC curve analysis showed that the optimal cut-off value of CACs for screening osteoporosis was 191.505. The present study implied that associations between CACs and BMD varied by the visceral fat deposition. It is critical to evaluate the condition of visceral fat accumulation for exploring the complex interplay of coronary artery calcification and BMD in T2DM patients. It may be of some clinical value for CACs in predicting osteoporosis in T2DM with visceral obesity.

Abstract 11009: Aortic Valve Calcium Score and Mortality Risk Following Transcatheter Aortic Valve Replacement

Background: Transcatheter aortic valve replacement (TAVR) is an approved alternative to surgical aortic valve replacement. However, as the clinical indication and adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to study the impact of aortic valve calcium score on long term mortality following TAVR in a large patient population. Methods: We included consecutive patients who successfully underwent TAVR from June 2010 – June 2019 across all Mayo Clinic sites. Patients were followed through February 2021. Aortic valve calcium scores were obtained from preoperative computed tomography angiography of the chest. Additional data was abstracted from medical records. Cox-proportional hazard regression models were employed to evaluate the independent effect of aortic valve calcium score on mortality. Results: A total of 1988 patients were evaluated in the final analysis. Forty-two percent were women, median age was 83 years (Q1: 77, Q3: 87), 16% received a permanent pacemaker following TAVR and 83% received an Edwards Sapien valve. We demonstrate an incremental increase in mortality risk as aortic valve calcium score values increased after adjusting for age, gender, pacemaker implantation, left bundle branch block, and Charlson Comorbidity Index. Selected calcium score cut-points with adjusted hazard ratios (aHR) are displayed: 1200 AU (aHR: 1.13, 95% CI 1.06, 1.20); 2000 AU (aHR: 1.22, 95% CI 1.09, 1.35); 3000 AU (aHR: 1.34, 95% CI: 1.14, 1.58). Conclusion: This study demonstrates an association between aortic valve calcium score and long-term mortality in a large patient population. This highlights the potential predictive value of the calcium score in preoperative planning and may provide clinicians with an additional measure for risk stratification prior to TAVR.

The Effect Of Calcium Score On Aortic Regurgitation Post Transcatheter Aortic Valve Replacement

Introduction: As transcatheter aortic valve replacements (TAVR) becomes more common in lower risk populations, the importance of even mild post-procedural paravalvular aortic regurgitation (AR) becomes more important. A very high Agatson calcium score (CS) of the aortic valve has been shown to be an independent prognostic factor for ≥ moderate aortic regurgitation post TAVR, however, the predictive value of CS for mild AR is not known. Furthermore, the evidence mainly refers to older TAVR valve models; new TAVR valve models have much lower rates of AR, and the evidence of calcium scoring to predict AR in these devices is limited. Our aim was to study the relationship of valve calcium and paravalvular AR in the current generation of devices.

Cutaneous and Vascular Deposits of 18F-NaF by PET/CT in the Follow-Up of Patients with Pseudoxanthoma Elasticum.

Active microcalcification of elastic fibers is a hallmark of pseudoxanthoma elasticum and it can be measured with the assessment of deposition of 18F-NaF using a PET/CT scan at the skin and vascular levels. It is not known whether this deposition changes over time in absence of specific therapy. We repeated in two years a PET/CT scan using 18F-NaF as a radiopharmaceutical in patients with the disease and compared the deposition at skin and vessel. Furthermore, calcium score values at the vessel wall were also assessed. Main results indicate in the vessel walls that calcification progressed in each patient; by contrast, the active microcalcification, measured and target-to-background ratio showed reduced active deposition. By contrast, at skin levels (neck and axillae) the uptake of the pharmaceutical remains unchanged. In conclusion, because calcification in the arterial wall is not specific for pseudoxanthoma elasticum condition, the measurement of the deposition of 18F-NaF in the neck might be potentially used as a surrogate marker in future trials for the disease.

Usefulness of skin advanced glycation end products to predict coronary artery calcium score in patients with type 2 diabetes.

The early identification of type 2 diabetic (T2D) patients at risk of developing coronary artery disease (CAD) remains a challenge. The coronary artery calcium score (CACs) is considered the most sensitive tool for assessing CAD risk in diabetic population, and the identification of a more targeted population in which the CACs would be more cost-efficient seems warranted. The accumulation of advanced glycation end products plays an important role in the pathogenesis of cardiovascular disease (CVD) in patients with diabetes. The aim of this study was to evaluate whether the assessment of skin autofluorescence (SAF) could be useful tool to identify those diabetic patients in whom CACs assessment should be prioritized. Prospective case-control study, comprising 156 subjects with T2D with no history of clinical CVD and 52 non-diabetic subjects matched by age. A value of CACs ≥ 400 Agatston Units (AU) was considered as "high CVD risk." Logistic regression analysis to predict a CACs ≥ 400 AU was performed. Sensibility and specificity were calculated using the optimal cutoff point based on ROC curve. T2D patients had higher value of SAF compared to controls (p = 0.011). Among subjects with diabetes, 122 presented CACs < 400 AU and 35 CACs ≥ 400 AU. SAF values were significantly higher among the group with CACs ≥ 400AU compared to patients with CACs < 400 (2.96 ± 0.86 vs. 2.59 ± 0.57; p = 0.0035). The logistic regression analysis showed that age, HDL-cholesterol and SAF values were independently related to CACs ≥ 400UA. Our finding suggests that SAF could be useful in selecting T2D patients in whom the screening for CAD by means of CACs assessment would be more cost-effective.

The prognostic impact of coronary calcium score in low risk patients presenting with chest pain; a 6-year follow-up single center study

Abstract Background Evaluation and risk stratification of patients with chest pain is a frequent task in cardiology. Coronary artery calcium is an established risk marker and is in wide clinical use. However, less is known about the long-term prognostic implications of coronary calcium score values in low risk individuals. Purpose We wanted to investigate the long-term outcome related to coronary artery calcium score (CAC). Methods We included patients who were examined with coronary CT angiography or GT SPECT from August 2011 to August 2015. The coronary calcium score percentile was calculated using the MESA Coronary Artery Calcium (CAC) Score Reference Values web tool. We excluded patients already stratified as high risk due to previous myocardial infarction or coronary revascularization. The primary endpoint was a composite of 5 point MACE (death, myocardial infarction, PCI, CABG and stroke) and was extracted from the electronic medical records. We censored follow up on the 31st December 2018. Results We included 1975 patients (958 (48.5%) male, age 60.3±12.0). The average CAC was 288±701. After median follow up of 6.0 (5.3–6.5 IQR) years, 372 patients fulfilled a primary endpoint. Event rate increased significantly with higher percentiles of CAC score (log rank 0.001, Figure 1). A total of 687 patients had a CAC score of 0. In this group we observed only 21 events during 6 years follow up, giving an annual event rate of 0.6%. Annual event rate in the patients with CAC percentile 1–75 was 3.2% and in the patients with CAC percentile 75–99 annual event rate was 5.6%. Death occurred in 10% of patients in the two upper percentiles compared to only 2% in the lowest percentile (p&amp;lt;0.001) Conclusion Our findings support that CAC is a powerful predictor of coronary artery events. Furthermore, our study confirms excellent long term prognosis regarding cardiac events in patients with 0 CAC, which is helpful in risk stratification of patients with chest pain. Figure 1 Funding Acknowledgement Type of funding source: None

1172 Predictive value of coronary artery calcium score for myocardial ischaemia in positron emission tomography

Abstract Funding Acknowledgements This study received no funding. Introduction Coronary artery calcium score (CACS) is an excellent predictor of long-term adverse cardiac events. However, little is known about its value and thresholds for immediate prediction of myocardial ischaemia. Purpose We tested the ability of CACS to predict myocardial ischaemia in patients with positron emission tomography (PET). In particular, we assessed the negative predictive value (NPV) of low CACS and the positive predictive value (PPV) of high CACS for myocardial ischaemia. Methods All consecutive patients undergoing 82Rb PET myocardial perfusion imaging with CACS from October 2016 to January 2019 at our centre were enrolled. Patients with known coronary artery disease (CAD) were excluded. Ischaemia was defined as a summed difference score (SDS) ≥4 in PET, and severe ischaemia as SDS ≥8 or transient ischaemic dilation. CACS was measured from low-dose computed tomography (CT) scans using the Agatston method. Receiver operating characteristic (ROC) analysis was used to calculate areas under the curves (AUC, with 95% confidence interval) and to assess sensitivity, specificity, PPV and NPV of CACS for ischaemia at pre-specified cut-offs (0, 100, 400, and 1000 Agatston units [AU]). Multivariate logistic regression was used to assess the predictive ability of CACS with clinical and ECG data, using odds ratios (OR, with 95% confidence interval). Prediction models were generated with propensity scores for CACS and clinical data with ECG, and compared using AUC. Results Of 1833 patients, 927 were included, all with CACS and 82Rb PET, without known CAD. Mean age was 64.3 ±11.1 years and median CACS was 55 AU (interquartile range 359). In PET, 179 patients (19.3%) had ischaemia and 87 (9.4%) severe ischaemia. To predict ischaemia, CACS had an AUC of 0.82 (0.79-0.84) and was superior to the clinical and ECG data model (AUC 0.68 [0.65-0.71], P &amp;lt; 0.0001 vs. CACS, Figure 1). For ischaemia, CACS 0 AU had 97% sensitivity and 98% NPV, and CACS 100 AU 81% sensitivity and 94% NPV. But CACS 1000 AU had 94% specificity and 60% PPV. Results were similar for severe ischaemia, with an AUC of 0.81 for CACS (0.79-0.84) and superiority over the clinical and ECG data model (AUC 0.74 [0.71-0.77], P = 0.018 vs. CACS). For severe ischaemia, CACS 0 AU had 98% sensitivity and 99% NPV, and CACS 100 AU 85% sensitivity and 98% NPV. But CACS 1000 AU had 90% specificity and 30% PPV. In multivariate analysis, CACS was the strongest predictor of ischaemia (OR 1.14 [1.11-1.17] by 100 AU, P &amp;lt; 0.0001) and made all clinical and ECG data nonsignificant. Conclusion CACS is a valuable predictor of myocardial ischaemia in PET. In particular, CACS ≤100 AU has an excellent NPV and CACS ≥1000 a good PPV for myocardial ischaemia. These findings can be useful to assess the need for additional cardiac testing after a chest CT showing coronary calcifications and to support the interpretation of borderline myocardial perfusion results. Abstract 1172 Figure 1: Prediction of ischaemia

436 Prognostic value of calcium scoring in changes of echogenicity in carotid plaques

Abstract Background Atherosclerosis is a dynamic process, in which the characteristics of the plaques evaluated by imaging methods could represent the degree of inflamatory activity of the disease. Purpose Assess the value of the coronary calcium score in the changes of echogenicity of carotid plaques in a population with low-intermediate cardiovascular risk. Methods Patients with no cardiovascular history and low and intermediate Framingham risk score were evaluated. Patients attended at our institute for a preventive cardiovascular control between January 2012 and April 2013, and then a subsequent follow-up was made until January 2019. They were screened for coronary calcium scoring (CCS) and carotid plaque by ultrasound at first visit. Then the changes of carotid atherosclerotic disease were evaluated through new carotid ultrasound exam at follow up. A carotid artery plaque was defined as a localized protrusion of the vessel wall, which 1) extended into the lumen ≥ 1.5 mm, or 2) had a thickness exceeding the intima-media thickness (IMT) of the adjacent portion of the vessel wall by &amp;gt;50%. Plaque morphology was defined in terms of its echogenicity. Results 121 patients that have carotid atherosclerotic disease at first carotid ultrasound exam were included. The mean age was 61 ± 9 years, 72 (59%) male patients. Cardiovascular risk factors: hypertension: 68 (56%), dyslipidemia: 46 (38%), sedentary lifestyle: 24 (20%), overweight: 17 (14%), smoking: 29 (24%) and diabetes: 15 (12%). Median distribution of CCS was 192 (percentile distribution 25-75%: 8 – 224) Agatston units. Medium follow-up: 5 ± 1 year. At first ultrasonography study, 47 patients (39%) presented hypoechoic plaques, 61 patients (50%) isoechoic plaques and hyperechoic plaques in 13 patients (11%). After the follow-up, the distribution of the plates according to their sonographic characteristics was: hypoechoic plaques in 23 patients (19%), isoechoic plaques in 55 patients (45%) and hyperechoic plaques in 42 patients (36%). The incidence of the progression of sonographic changes of the carotid plaques varies according to CCS: 0-100:29%, 101-400: 54%, &amp;gt;401:53% (p &amp;lt; 0,001) Figure 1. The value of CCS was associated with the progression of carotid atherosclerotic plaque regardless of the use of statins and angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers (Cox model p &amp;lt;0.001). Conclusions This study shows that there is an association between coronary calcium score and progression of carotid disease. Even in populations with low and intermediate cardiovascular risk, the higher the severity of the calcium score, the greater changes in the structure of the carotid plaque manifested in our work as changes in the echogenicity; regardless of the use of statins. These findings could be useful to assess the progression of atherosclerotic disease at a median follow up. Abstract 436 Figure. folow up

The diagnostic value of low-dose chest computed tomography for calcium score determining compared with the standard method and the results of computed tomography and selective coronary angiography

Aim. Coronary artery calcification is a characteristic of coronary atherosclerosis, which is often detected by chest computed tomography (CT). The aim of this study is to assess the efficiency of low-dose chest CT in calcium score (CS) determining and to compare it with conventional method and results of CT and selective coronary angiography.Material and methods. A total of 251 patients underwent a low-dose chest CT and a CS determining. Coincidence between the two methods was evaluated by the absolute CS values and by stratification of patients into five risk categories (“zero” CS values were excluded from the analysis). Eighty patients underwent CT or selective coronary angiography and the results were divided into two groups according to the degree of coronary stenosis — ˂50% and ≥50%. The CS values determined by chest CT are compared with the results of coronary angiography. Results. In 79 patients (31%), the CS was 0 and they were excluded from further analysis. The absolute CS values comparability between the two scanning methods in other 172 patients was very high (r=0,978, p&lt;0,05). The coincidence in stratification of patients by risk groups was also high (contingency coefficient k=0,846). The CS specificity compared with coronary angiography was 97,5%, but with a low sensitivity of 43,6%, if the CS value is set to 400, above which coronary stenosis will considered significant. In comparing CS values with results of CT, the relationship of high CS values with coronary stenosis, were statistically proved: in 17 patients from 18 with CS &gt;400 significant coronary stenosis was detected, in comparison with 22 patients from 52 patients with a CS more than 400 (p&lt;0,05). Conclusion. The research showed that low-dose chest CT can be used to determine CS. Studied values correlate with the results of coronary angiography.

The Impact of Femoropopliteal Artery Calcium Score after Endovascular Treatment

The coronary artery calcium score is a widely known independent predictor of cardiac events. Tibial artery calcification had been reported as an amputation risk, but the femoropopliteal artery calcium score is rarely known. A retrospective analysis was performed using the data collected from the patients who underwent endovascular treatment for the femoropopliteal artery between January 2010 and December 2017. The femoropopliteal artery calcium scores on preprocedural computed tomography were calculated according to the Agatston definition. The mean value of total of femoropopliteal artery calcium scores was used to divide the scores into two groups. The prognostic value of the calcium score was analyzed based on primary patency, clinically driven target lesion revascularization, major amputation, and all-cause death. In total, 132 consecutive limbs that underwent successful endovascular intervention were analyzed in this study; 44 and 88 limbs were assigned to the high and low calcium score groups, respectively. There were no significant differences between the two groups in terms of patient and lesion characteristics, except for chronic kidney disease (7% vs. 25%, P<0.01), hemodialysis (80% vs. 25%, P<0.01), and coronary artery disease (73% vs. 53%, P=0.03). Compared with the low calcium score group, the high calcium score group had a significantly higher rate of loss of primary patency and clinically driven target lesion revascularization at one year, based on the Kaplan-Meier curve (55% vs. 81%, 44% vs. 8%, both P<0.01). There were no significant differences between the two groups in terms of major amputation and death. Multivariate analysis revealed that hemodialysis [hazard ratio (HR): 1.9; 95% confidence interval (CI): 1.01-5.28; P=0.04] runoff grade 0 (HR: 2.9; 95% CI: 1.02-10.9; P=0.04), lesion length>200mm (HR: 3.9; 95% CI: 1.1-13.7; P=0.03), and calcium score per 100 increase (HR: 1.05; 95% CI: 1.02-1.08; P<0.01) were predictors of clinically driven target lesion revascularization. As per receiver operating characteristic analysis, the best cutoff value of target lesion calcium score for target lesion revascularization was206. A high femoropopliteal artery calcium score might increase loss of patency and the risk for clinically driven target lesion revascularization.

P2242Prognostic impact of CT derived quantified coronary artery plaque volume: A 10 year follow-up study

Abstract Background Automated plaque quantification derived from coronary CT angiogragphy (CCTA) datasets provides exact and reliable assessment of coronary atherosclerosis burden. Purpose To investigate the long-term predictive value of quantified coronary plaque volume (PV) in comparison to Calcium Score (CACS). Methods Dedicated software was used to quantify PV in 1577 patients. A combination of cardiac death and acute coronary syndrome was used as endpoint. Incremental prognostic value was tested with c-statistics and continuous net reclassification improvement (NRI). The Morise Score was used to summarize patients clinical risk profile. Results Patients were followed for 10.4 years. The combined endpoint occurred in 59 patients, of whom 36 suffered from cardiac death, 18 had non-fatal myocardial infarction and 5 presented with unstable angina requiring revascularisation. The additive predictive value of PV and CACS was tested against a baseline model (c-index 0.741) including clinical risk and the number of diseased coronary segments (segment-Involvement score). While PV provided additive prognostic value (rise in c-index to 0.763, p=0.01 and NRI 0.247, p=0.03), CACS did not (c-index 0.749, p=0.2 and NRI 0.162, p=0.12). A threshold of 110.5 mm3, which was established by a previous analysis of our group, provided excellent separation of patients into low (no PV), intermediate (PV &lt;110.5 mm3) and high (PV &gt;110.5 mm3) risk categories based upon quantified PV (see attached Figure). Conclusion Quantification of PV from CCTA datasets provides excellent prognostic information on long-term follow-up.