Coronary artery calcium score: Current status of clinical application and how to handle the results

Chronic venous insufficiency as an independent risk factor for coronary artery disease: Evidence from coronary artery calcium score analysis

BackgroundPrevious research has indicated a correlation between chronic venous insufficiency (CVI) and cardiovascular disease. However, whether CVI is an independent risk factor for coronary artery disease (CAD) remains underexplored. This study aimed to investigate this relationship by utilizing coronary artery calcium score (CACS) assessment during CVI screening and comparing it with CACS in patients undergoing cardiac ablation treatment.Methodsand Subjects: A retrospective cohort study was conducted, approved by the ethical committee (IRB 2024012). From February to July 2023 Simultaneous non-contrast lower limb vein CT and CACS measurements were performed on CVI patients aged 50 and above and less than 90, excluding cases with history of heart failure, post-thrombotic syndrome, percutaneous coronary intervention (PCI), cardiac ablation, cardiac surgery, peripheral arterial disease, and renal failure. Parameters included coronary risk factors and CACS. Control group was composed of sex- and age-matched patients receiving cardiac ablation treatment from April 2020 to December 2023. A comparison between the two groups was made, and univariate and multivariate analyses were conducted. Statistical significance was set at p < .05.ResultsComparison between CVI group (n = 234) and cardiac ablation group (n = 234) were as follows: mean age (71 ± 9:71 ± 9, not significant (NS)), females (154:145, NS), body mass index (BMI) (23.6 ± 3.9:22.6 ± 3.5, p = .004), hypertension (103:121, NS), dyslipidemia (100:66, p = .001), diabetes (30:24, NS), Creatinine (0.76 ± 0.25:0.87 ± 0.64, p = .02), respectively. The total CACS was 214 ± 578 in the CVI group and 64.8 ± 233 in the cardiac ablation group (p < .001). The median CACS values were 14.8 (IQR: 0-178) and 0 (IQR: 0-16), respectively. CVI group included 35% with CACS >100 and the cardiac ablation group did 12%, respectively (p < .001). Univariate analysis identified age [beta 9.6 (95% CI 5.2 to 13.9), p < .001], hypertension [beta 142.4 (95% CI 62.5 to 222), diabetes [beta 179.1 (95% CI 53.5 to 305), p = .005], dyslipidemia [beta 164.5 (95% CI 81.2 to 248), p < .001],creatinine [beta 85.4 (95% CI 2.6 to 168), p = .04], and CVI [beta 149 (95% CI 69.4 to 229), p < .001], p = .001] as risk factors. Multivariate analysis revealed age [beta 7.1 (95% CI 2.7 to 11.5), p = .002], hypertension [beta 86.5 (95% CI 1.7 to 171), p = .046], dyslipidemia [beta87.5 (95% CI 1.4 to 174), p = .047], and CVI [beta 143.6 (95% CI 63.7 to 223), p < .001] as strong correlates of CACS.ConclusionsMultivariate analysis indicated that CVI is an independent risk factor for coronary artery disease, even after adjusting for age, hypertension, and dyslipidemia as confounding factors.

Ultralow dose coronary calcium scoring CT at reduced tube voltage and current by using deep learning image reconstruction

OBJECTIVE

To explore the potential of the deep learning reconstruction (DLR) for ultralow dose calcium scoring CT (CSCT) with simultaneously reduced tube voltage and current.

METHODS

In this prospective study, seventy-five patients (group A) undergoing routine dose CSCT (120kVp/30mAs) were followed by a low dose (120kVp/20mAs) scan and another 81 (group B) were followed by an ultralow dose (80kVp/20mAs) scan. The hybrid iterative reconstruction was used for the routine dose data while the DLR for data of reduced dose. The calcium score and risk categorization were compared, where the correlation was evaluated using the intraclass correlation coefficient (ICC). The noise suppression performance of DLR was characterized by the contrast-to-noise ratio (CNR) between coronary arteries and pericoronary fat.

RESULTS

The effective dose was 0.32 ± 0.03 vs. 0.48 ± 0.05 mSv for the two scans in group A and 0.09 ± 0.01 vs. 0.49 ± 0.05 mSv in group B. No significant difference was found on CACSs within either group (A: p = 0.10, ICC=0.99; B: p = 0.14, ICC=0.99), nor was it different on risk categorization (A: p = 0.32, ICC=0.99; B: p = 0.16, ICC=0.99). The DLR images exhibited higher CNR in both groups (A: p < 0.001; B: p = 0.001).

CONCLUSIONS

The DLR allowed reliable calcium scoring in not only low dose CSCT with reduced tube current but ultralow dose CSCT with simultaneously reduced tube voltage and current, showing feasibility to be adopted in routine applications.

Relationship of Thyroid Volume and Function with Ankle-Brachial Index, Toe-Brachial Index, and Toe Pressure in Euthyroid People Aged 18-65

Background and Objectives: The interrelationship between thyroid function and the state of the cardiovascular system has been investigated both in preclinical and human studies. However, it remains unclear whether there is any association between thyroid hormones and features of subclinical cardiovascular dysfunction in euthyroid patients. Material and Methods: This study involved 45 people (females: 57.8%) with no thyroid disease who, during planned hospitalization, underwent thyroid ultrasound, determination of biochemical parameters of thyroid function, and measurement of ankle-brachial index (ABI) and toe-brachial index (TBI). People with signs of acute illness or a deterioration of their health were excluded. Results: Significant correlations were found between free triiodothyronine (FT3) and several parameters of both ABI (R = 0.347; p = 0.019 for the mean ABI taken from right side and left side values) and TBI (R = 0.396; p = 0.007 for the mean TBI taken from right side and left side values), as well as the maximal toe pressure (TP) taken from right side and left side values (R = 0.304; p = 0.045). Thyrotropin (TSH) was shown to be significantly correlated only with the maximal TBI value (taken from right side and left side values) (R = 0.318; p = 0.033), whereas free thyroxin (FT4) was shown to be significantly correlated only with the minimal TBI value (taken from right side and left side values) (R = 0.381; p = 0.01). Thyroid volume (TV) was shown to be correlated with TP (R = 0.4; p = 0.008 for the mean TP taken from right side and left side values) and some parameters of TBI value (R = 0.332; p = 0.028 for the mean TBI taken from right side and left side values), but no significant correlations were found between TVand ABI parameters. Patients with a mean ABI value ≤ 1.0 or a mean TBI value ≤ 0.75 have lower TSH, FT3, FT4, and TV than the rest of the study population, but the difference was statistically significant only for FT3. Conclusions: Even in a population of euthyroid patients with no diagnosed thyroid disease, there are some significant correlations between the volume and function of the thyroid gland and the selected features of subclinical cardiovascular dysfunction such as ABI and TBI.

Associations of plasma proteomics and age-related outcomes with brain age in a diverse cohort

Machine learning models are increasingly being used to estimate "brain age" from neuroimaging data. The gap between chronological age and the estimated brain age gap (BAG) is potentially a measure of accelerated and resilient brain aging. Brain age calculated in this fashion has been shown to be associated with mortality, measures of physical function, health, and disease. Here, we estimate the BAG using a voxel-based elastic net regression approach, and then, we investigate its associations with mortality, cognitive status, and measures of health and disease in participants from Atherosclerosis Risk in Communities (ARIC) study who had a brain MRI at visit 5 of the study. Finally, we used the SOMAscan assay containing 4877 proteins to examine the proteomic associations with the MRI-defined BAG. Among N = 1849 participants (age, 76.4 (SD 5.6)), we found that increased values of BAG were strongly associated with increased mortality and increased severity of the cognitive status. Strong associations with mortality persisted when the analyses were performed in cognitively normal participants. In addition, it was strongly associated with BMI, diabetes, measures of physical function, hypertension, prevalent heart disease, and stroke. Finally, we found 33 proteins associated with BAG after a correction for multiple comparisons. The top proteins with positive associations to brain age were growth/differentiation factor 15 (GDF-15), Sushi, von Willebrand factor type A, EGF, and pentraxin domain-containing protein 1 (SEVP 1), matrilysin (MMP7), ADAMTS-like protein 2 (ADAMTS), and heat shock 70 kDa protein 1B (HSPA1B) while EGF-receptor (EGFR), mast/stem-cell-growth-factor-receptor (KIT), coagulation-factor-VII, and cGMP-dependent-protein-kinase-1 (PRKG1) were negatively associated to brain age. Several of these proteins were previously associated with dementia in ARIC. These results suggest that circulating proteins implicated in biological aging, cellular senescence, angiogenesis, and coagulation are associated with a neuroimaging measure of brain aging.

Diagnostic Ability of Manual Calcification Length Assessment on Non-Electrocardiographically Gated Computed Tomography for Estimating the Presence of Coronary Artery Disease

Background: Coronary artery calcification score (CACS) on electrocardiography (ECG)-gated computed tomography (CT) is used for risk stratification of atherosclerotic cardiovascular disease, which requires dedicated analytic software. In this study, we evaluated the diagnostic ability of manual calcification length assessment on non-ECG-gated CT for epicardial coronary artery disease (CAD). Methods: A total of 100 patients undergoing both non-ECG-gated plain CT scans with a slice interval of 1.25 mm and invasive coronary angiography were retrospectively included. We manually measured the length of the longest calcified lesions of coronary arteries on each branch. The relationship between the number of coronary arteries with the length of coronary calcium > 5, 10, or 15 mm and the presence of epicardial CAD on invasive angiography was evaluated. Standard CACS was also evaluated using established software. Results: Of 100 patients, 49 (49.0%) had significant epicardial CAD on angiography. The median standard CACS was 346 [7, 1965]. In both manual calcium assessment and standard CACS, the increase in calcium burden was progressively associated with the presence of epicardial CAD on angiography. The receiver operating characteristic curve analysis showed similar diagnostic abilities of the two diagnostic methods. The best cut-off values for CAD were 2, 1, and 1 for the number of vessels with calcium > 5, 10, and 15 mm, respectively. Overall, the diagnostic ability of manual calcium assessment was similar to that of standard CACS > 400. Conclusions: Manual assessment of coronary calcium length on non-ECG-gated plain CT provided similar diagnostic ability for the presence of significant epicardial CAD on invasive angiography, as compared to standard CACS.

Effect of dapagliflozin on epicardial fat volume in patients with acute coronary syndrome assessed by computed tomography

BACKGROUND AND AIM

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular outcomes; one of the target organs is epicardial adipose tissue, achieving a 10-20% change in patients with diabetes but excluding acute coronary syndrome (ACS), Therefore, the aim was to evaluate the effect of dapagliflozin on epicardial fat in patients with ACS assessed by non-contrast cardiac tomography (CT) and its association with major adverse cardiovascular events (MACE).

METHODS AND RESULTS

This cohort nested case-control study included 52 patients with type 2 diabetes (T2D) and acute myocardial infarction with and without ST-segment elevation. Cases were defined as all patients assigned to dapagliflozin 10 mg, and controls were patients assigned to placebo. Treatment was initiated in-hospital and after percutaneous coronary intervention, and non-contrasted CT was performed at baseline and after 12 months of treatment. In the dapagliflozin group, 4 MACE occurred and 10 in the placebo group (p=0.027), with an odds ratio (OR) of 0.317 (95% CI 0.114-0.882) for the dapagliflozin. Basal epicardial fat volume (EFV) was 117.20 ± 42.65 cm3 in the dapagliflozin group and 123.84 ± 46.9 cm3 in the placebo group, p= 0.596, with an OR of 1.016 (95% CI 0.999-1.033) for MACE. Final EFV was 128.30 ± 37.53 cm3 in the dapagliflozin group and 137.05 ± 50.59 cm3 in the placebo group, p= 0.520.

CONCLUSIONS

Epicardial fat is a risk factor for MACE and increased after 12 months of follow-up in patients with ACS and there was no effect on volume change with the use of dapagliflozin. (ClinicalTrials.gov NCT05998525).

Calcium-Phosphorus Product Is Associated with Adverse Prognosis in Hospitalized Patients with Heart Failure and Chronic Kidney Disease

It has been reported that high levels of calcium-phosphorus (Ca-P) product are an indicator of coronary calcification and mortality risk in patients undergoing chronic hemodialysis. In the present study, we aimed to evaluate the significance of Ca-P product to predict the prognosis of patients with heart failure (HF) and chronic kidney disease (CKD). We conducted a prospective observational study of 793 patients with decompensated HF and CKD, and measured the value of Ca-P product. The cut-off value was obtained from the survival classification and regression tree (CART) analysis to predict post-discharge all-cause mortality and/or worsening HF, and the patients were divided into 2 groups: a high group (Ca-P product > 28, n = 594) and a low group (Ca-P product ≤ 28, n = 199). We compared the patient baseline characteristics and post-discharge prognosis between the 2 groups. The age as well as the prevalence of male sex, ischemic etiology, and anemia were significantly higher in the low group than in the high group. In contrast, there was no difference in echocardiographic parameters between the 2 groups. In the Kaplan-Meier analysis (mean follow-up 1089 days), all-cause mortality and/or worsening HF event rates were higher in the low group than in the high group (log-rank P = 0.001). In the multivariable Cox proportional hazard analysis, lower Ca-P product was found to be an independent predictor of all-cause mortality and/or worsening HF (hazard ratio 0.981, P = 0.031). Lower Ca-P product predicts adverse prognosis in patients with HF and CKD.

CT Coronary Angiography: Technical Approach and Atherosclerotic Plaque Characterization

Coronary computed tomography angiography (CCTA) currently represents a robust imaging technique for the detection, quantification and characterization of coronary atherosclerosis. However, CCTA remains a challenging task requiring both high spatial and temporal resolution to provide motion-free images of the coronary arteries. Several CCTA features, such as low attenuation, positive remodeling, spotty calcification, napkin-ring and high pericoronary fat attenuation index have been proved as associated to high-risk plaques. This review aims to explore the role of CCTA in the characterization of high-risk atherosclerotic plaque and the recent advancements in CCTA technologies with a focus on radiomics plaque analysis.

Correlation Between Coronary Artery Calcium Score and Triglyceride-Glucose Index in Post-menopausal Women

INTRODUCTION

To clarify the correlation between coronary artery calcium score (CACS) and triglyceride-glucose (TyG) index in post-menopausal women.

METHODS

Post-menopausal women who underwent computed tomography angiography with the suspicion of acute coronary syndrome were included in the study. Patients were categorized into three groups (CACS < 100 as group 1, CACS = 100-300 as group 2, and CACS > 300 as group 3). Groups were compared with regard to demographic characteristics, laboratory test outcomes, electrocardiogram findings, and the TyG index.

RESULTS

The study was conducted by examining the data of 228 patients. Median TyG index was 9.0 and median CACS was 79.5. The median age was significantly lower in group 1 (p = 0.001). Diabetes mellitus rate and smoking rate were higher in group 3 compared to the other groups (p = 0.037 and p = 0.032). The glucose level was significantly higher for group 3 (p = 0.001). Additionally, the TyG index was 9.3 in group 3 and was statistically significantly higher than the values in group 1 and group 2 (8.9 and 9.1, respectively) (p = 0.005). There was a moderate correlation between CACS and age (correlation coefficient (CC): 0.241, p = 0.001). Also, there was a significant correlation between glucose level and CACS (CC: 0.307, p = 0.001). A high correlation was found between the TyG index and CACS (CC: 0.424, p = 0.001).

CONCLUSION

Our study demonstrated for the first time that there was a strong correlation between the TyG index and CACS in post-menopausal patients. In addition, patients with increased age, patients with higher glucose levels, and diabetic patients had significantly higher CACS.

Association between psoriasis and coronary artery calcification: A systematic review and meta-analysis

Background

Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a hallmark of atherosclerosis and a predictor of poor cardiovascular prognosis, remains to be determined. We performed a systematic review and meta-analysis to comprehensively evaluate the association between these related inflammatory conditions.

Methods

Observational studies evaluating the relationship between psoriasis and CAC were retrieved by searching PubMed, Cochrane's Library, and Embase databases. Presence of CAC was confirmed according to an Agatston's Score >0 upon computed tomography examination. A random-effect model incorporating between-study heterogeneity was used to pool the results.

Results

Sixteen studies involving 3,039 patients with psoriasis and 46,191 controls without psoriasis were included in the meta-analysis. All participants were without previously known cardiovascular diseases. Pooled results showed that psoriasis was associated with overall CAC [odds ratio (OR): 1.54, 95% confidence interval: 1.23-1.91, p < 0.001; I 2 = 57%], after matching or adjusting the conventional cardiovascular risk factors. Subgroup analyses showed that study country, comorbidity of psoriatic arthritis, baseline Psoriasis Area and Severity Index, and duration of psoriasis (p for subgroup difference all >0.05) did not significantly affect the association of psoriasis and CAC. However, a stronger association was observed in younger patients (mean age <50 years, OR: 2.63, p < 0.001) compared to older patients (≥50 years, OR: 1.24, p = 0.02; p for subgroup difference <0.001).

Conclusion

Psoriasis is associated with CAC, and the association may be stronger in younger patients.