To validate the accuracy of coronary artery calcium score (CACS) using photon-counting detector (PCD) CT under various scanning settings and explore the optimized scanning settings considering both the accuracy and the radiation dose. A CACS phantom containing six hollow cylindrical hydroxyapatite calcifications of two sizes with three densities and 12 patients underwent CACS scans. For PCD-CT, two scanning modes (sequence and flash [high-pitch spiral mode]) and five tube voltages (90kV, 120kV, 140kV, Sn100kV, and Sn140kV) at different image quality (IQ) levels were set for phantom, and patients were scanned with 120kV at IQ19 using flash mode. All acquisitions from PCD-CT were reconstructed at 70keV. Acquisitions in sequence mode at 120kV on an energy-integrating detector CT (EID-CT) was used as the reference. Agatston, mass, and volume scores were calculated. The CACS from PCD-CT exhibited excellent agreements with the reference (all intraclass correlation coefficient [ICC] > 0.99). The root mean square error (RMSE) between the Agatston score acquired from PCD-CT and the reference (5.4-11.5) was small. A radiation dose reduction (16-75%) from PCD-CT compared with the reference was obtained in all protocols using flash mode, albeit with IQ20 only at sequence mode (22-44%). For the patients, ICC ( all ICC > 0.98) and Bland-Altman analysis of CACS all showed high agreements between PCD-CT and the reference, without reclassifying CACS categories(P = 0.317). PCD-CT yields repeatable and accurate CACS across diverse scanning protocols according to our pilot study. Sn100kV, 90kV, and 120kV using flash mode at IQ20 are recommended for clinical applications considering both accuracy and radiation dose.

UNASSIGNED: Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined.
UNASSIGNED: To investigate the association between CAC score and in-hospital mortality of COVID-19 patients.
UNASSIGNED: This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes.
UNASSIGNED: The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70-10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13-1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47-2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79-18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18-40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001).
UNASSIGNED: Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.

UNASSIGNED: From the Fukuoka University Coronary Computed Tomography Angiography (FU-CCTA) registry, we present major adverse cardiovascular events (MACEs) in hypertensive patients who have undergone CCTA, and the association between MACEs and the Gensini score of coronary arteries or the coronary artery calcification (CAC) score.
UNASSIGNED: Of the patients who underwent CCTA for coronary artery disease (CAD) screening at Fukuoka University Hospital, 318 hypertensive patients who had at least one cardiovascular risk factor or suspected CAD were enrolled. The patients were divided into two groups: MACEs and non-MACEs groups. The severity of atherosclerosis of coronary arteries was assessed by the Gensini score. The CAC score was also defined by computed tomography (CT) images at the time of CCTA. A primary endpoint was MACEs (all-cause death, ischemic stroke, acute myocardial infarction, coronary revascularization). The patients were followed for up to 5 years.
UNASSIGNED: The patients were 68 ± 10 years, and 50% were males. The percentages of smoking, dyslipidemia, diabetes, and chronic kidney disease were 39%, 70%, 26% and 37%, respectively. The %males, %smoking, CAC score and Gensini score in the MACEs group were significantly higher than those in the non-MACEs group. On the other hand, the differences in age, dyslipidemia, diabetes, or chronic kidney disease between the groups were not seen. A multivariate analysis was performed regarding the presence or absence of MACE by logistic regression analysis of the CAC score or Gensini score in addition to conventional risk factors as independent variables. A Cox regression analysis revealed significant relationships for both the CAC score (P = 0.043) and the Gensini score (P = 0.008).
UNASSIGNED: The CAC score and the Gensini score could predict MACEs in hypertensive patients who have undergone CCTA.

We investigated the predictive value of clinical factors combined with coronary artery calcium (CAC) score based on a machine learning method for obstructive coronary heart disease (CAD) on coronary computed tomography angiography (CCTA) in individuals with atypical chest pain.
The study included data from 1,906 individuals undergoing CCTA and CAC scanning because of atypical chest pain and without evidence for the previous CAD. A total of 63 variables including traditional cardiovascular risk factors, CAC score, laboratory results, and imaging parameters were used to build the Random forests (RF) model. Among all the participants, 70% were randomly selected to train the models on which fivefold cross-validation was done and the remaining 30% were regarded as a validation set. The prediction performance of the RF model was compared with two traditional logistic regression (LR) models.
The incidence of obstructive CAD was 16.4%. The area under the receiver operator characteristic (ROC) for obstructive CAD of the RF model was 0.841 (95% CI 0.820-0.860), the CACS model was 0.746 (95% CI 0.722-0.769), and the clinical model was 0.810 (95% CI 0.788-0.831). The RF model was significantly superior to the other two models (p < 0.05). Furthermore, the calibration curve and Hosmer-Lemeshow test showed that the RF model had good classification performance (p = 0.556). CAC score, age, glucose, homocysteine, and neutrophil were the top five important variables in the RF model.
RF model was superior to the traditional models in the prediction of obstructive CAD. In clinical practice, the RF model may improve risk stratification and optimize individual management.

Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) are anatomically close to the myocardium and may influence cardiovascular pathology. Thus, in this study, we aim to assess whether EAT and PAT volumes were associated with coronary artery calcification score (CCS) in patients with suspected coronary artery disease (CAD), especially in overweight and obese individuals.We included consecutive patients with suspected CAD in whom EAT volume, PAT volume, and CCS were measured via computed tomography between September 2015 and June 2017 at the Affiliated Hospital of Chengde Medical University, China. Logistic regression models were applied to analyze the risk factors for CCS ≥ 100 Agatston units (AU) and in different body mass index (BMI) subgroups.EAT and PAT volumes were noted to be higher in people with BMI ≥ 24 kg/m2, BMI ≥ 28 kg/m2, hyperlipidemia, hypertension, diabetes, stroke, and CCS ≥ 100 AU (P < 0.05). After adjusting for the traditional CAD factors, we found that EAT and PAT volumes were independent risk factors for CCS ≥ 100 AU (odds ratio, 3.001; 95% confidence interval, 1.900-4.740, P < 0.001). In patients with CCS ≥ 100 AU, the EAT and PAT volumes were noted to be greater in the BMI ≥ 24 kg/m2 and BMI ≥ 28 kg/m2 subgroups than in the BMI < 24 kg/m2 and BMI < 28 kg/m2 subgroups, respectively (P < 0.05).Our results indicate that EAT and PAT volumes may be clinical predictors for a CCS ≥ 100 AU, especially in overweight and obese individuals.

BACKGROUND: Multivessel coronary disease (MVCD) is the common type of coronary artery disease in acute coronary syndrome (ACS). Coronary artery calcification (CAC) has been confirmed the strong predictor of major adverse cardiovascular events (MACEs). Several studies have validated that triglyceride glucose (TyG) index can reflect the degree of coronary calcification or predict MACEs. However, no evidence to date has elucidated and compared the predictive intensity of TyG index or/and coronary artery calcification score (CACS) on multi-vascular disease and MACEs in ACS patients.
METHODS: A total of 935 patients, diagnosed with ACS and experienced coronary computed tomography angiography (CCTA) from August 2015 to March 2022 in the Second Hospital of Shandong University, were selected for retrospective analysis. The subjects were divided into TyG index quartile 1-4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multivessel coronary disease (MVCD) groups, respectively. The general data, past medical or medication history, laboratory indicators, cardiac color Doppler ultrasound, CACS, and TyG indexes were respectively compared among these groups. The ROC curve preliminarily calculated and analyzed the diagnostic value of TyG index, CACS, and the combination of the two indicators for MVCD. Univariate and multivariate logistic regression analysis discriminated the independent hazard factors for forecasting MVCD.
RESULTS: Compared with the lower TyG index and non-MVCD groups, the higher TyG index and MVCD groups had higher values of age, smoking history, waist circumference, systolic blood pressure, low-density lipoprotein cholesterol(LDL-C), fasting blood glucose and glycosylated hemoglobin, and CACS, but lower values of high-density lipoprotein cholesterol(HDL-C) (all P < 0.01). Coronary artery calcification is more common in the left anterior descending artery. Compared with non-MVCD, each unit increase in TyG index was associated with a 1.213-fold increased risk of MVCD. Logistic regression analysis adjusted for potential confounders indicated that TyG index is an independent risk factor for MVCD. With the increase of TyG index, the incidence of MACEs, apart from all-cause death, cardiac death, unexpected re-hospitalization of heart failure, recurrent ACS or unplanned revascularization, and non-fatal stroke in coronary artery increased (P log-rank < 0.001).
CONCLUSIONS: TyG index could completely substitute for CACS as a reliable, practical, and independent indicator for predicting the severity and prognosis of MVCD in patients with ACS.

Cardiovascular disease, particularly myocardial infarction, is the leading cause of death of rheumatoid arthritis (RA) patients. The usefulness of the coronary artery calcification score (CACS), determined using cardiac computed-tomography (CT)-scan images, was assessed as a part of a cardiovascular work-up of RA patients at low or intermediate cardiovascular disease risk. This descriptive, cross-sectional, single-center study was conducted on patients with stable RA or that which is in remission. Each patient’s work-up included a collection of cardiovascular risk factors, laboratory analyses, an electrocardiogram, a supra-aortic trunks (SATs) echo-Doppler test and a cardiac CT scan. The primary endpoint was to determine the frequency of patients with a CACS > 100, indicating notable atherosclerosis. Fifty patients were analyzed: mean ± standard deviation age was 53.7 ± 7.5 years, 82% women. The CACS exceeded 100 in 12 (24%) patients (11 were at intermediate risk) and 2 of them underwent angioplasty for silent myocardial ischemia. Cardiovascular risk was reclassified from intermediate to high for 5 patients. Age according to sex and smoking status were significantly associated with that increase; no association was found with RA characteristics or treatments.

OBJECTIVE: To investigate the relationship among coronary artery calcification score (CACS), the number of calcification vessels, SYNTAX score and GRACE score in patients with coronary atherosclerotic heart disease (CHD).
METHODS: The CACS, calcification vessel number, SYNTAX score, and GRACE score were collected or calculated from 214 CHD patients admitted in Haikou People\'s Hospital from January 2014 to April 2019. Patients were assigned into several groups according to the CACS and calcification vessel number, and then to compare the differences in SYNTAX and GRACE scores between groups. Spearman correlation coefficient was used to analyze the correlation between CACS or calcification vessel number and SYTAX score or GRACE score. Regression of binary logistic was used to analyze independent risk factors for coronary calcification. The diagnostic values of the CACS and calcification vessel number for predicting CHD, and SYNTAX score and GRACE score high-risk group were evaluated by the receiver operator characteristic (ROC) curve.
RESULTS: Spearman correlation analysis showed that CACS was positively correlated with SYTAX score (r=0.505, P<0.01) or GRACE score (r=0.195, P<0.01). The number of calcified vessels was positively correlated with the SYNTAX score (r=0.533, P<0.01), but not with the GRACE score (r=-0.14, P=0.899). Regression of binary logistic showed that male and SYTAX scores were independent risk factors for coronary artery calcification (P<0.05). The analysis of ROC curve showed that the CACS was of good value in the diagnosis of CHD (AUC=0.756, P<0.01) and SYNTAX score high-risk group (AUC=0.781, P<0.01), while it was of lower value in the diagnostic of the GRACE score high-risk group (AUC=0.698, P<0.01). The value of calcification vessel number in the diagnosis of CHD (AUC=0.763, P<0.01) and the SYNTAX score high-risk group (AUC=0.868, P<0.01) was good, but that in the diagnosis of the GRACE score high-risk group (AUC=0.601, P=0.07) was not statistically significant.
CONCLUSIONS: In patients with suspected CHD, CACS and calcification vessel number can predict the severity of CHD and the risk of future cardiovascular events. Measuring the CACS and the number of calcification vessels before coronary angiography has certain clinical significance for predicting the severity of coronary lesion and formulating the treatment plan.
目的: 探讨拟诊冠状动脉粥样硬化性心脏病(以下简称冠心病)患者冠状动脉钙化积分、钙化支数与评估冠状动脉病变严重程度的SYNTAX评分、评估未来心血管事件危险分层的GRACE评分之间的关系。方法: 回顾性收集2014年1月至2019年4月在海口市人民医院住院的214名拟诊冠心病患者的冠状动脉钙化积分、钙化支数、SYNTAX评分及GRACE评分等资料。根据冠状动脉钙化积分及钙化支数进行分组，比较各组间SYNTAX评分和GRACE评分的差异。采用Spearman相关系数分析冠状动脉钙化积分、钙化支数与SYNTAX评分、GRACE评分的相关性，二项logistic回归分析冠状动脉钙化的危险因素，受试者操作特征(receiver operator characteristic，ROC)曲线分析冠状动脉钙化积分、钙化支数预测冠心病及SYNTAX评分、GRACE评分高危组的价值。结果: Spearman相关分析显示冠状动脉钙化积分与SYNTAX评分(r=0.505，P<0.01)、GRACE评分(r=0.195，P<0.01)呈正相关。钙化支数与SYNTAX评分(r=0.533，P<0.01)呈正相关，与GRACE评分无关(r=0.124，P>0.05)。二项logistic回归显示男性和SYNTAX评分是冠状动脉发生钙化的独立危险因素(P<0.05)。ROC曲线分析显示冠状动脉钙化积分预测冠心病(AUC=0.756，P<0.01)和SYNTAX评分高危组(AUC=0.781，P<0.01)的价值良好，而预测GRACE评分高危组的价值较低(AUC=0.698，P<0.01)。钙化支数预测冠心病(AUC=0.763，P<0.01)和SYNTAX评分高危组(AUC=0.868，P<0.01)的价值良好，而在预测GRACE评分高危组上无统计学意义(AUC=0.601，P=0.07)。结论: 在临床拟诊冠心病患者中，冠状动脉钙化积分、钙化支数对冠状动脉病变严重程度及未来心血管事件发生风险有较好的预测作用。冠状动脉造影术前测量冠状动脉钙化积分、钙化支数对预测冠状动脉病变严重程度及制订治疗方案有一定的临床意义。.

Development of vascular calcification is accelerated in patients with end-stage renal disease. In addition to traditional risk factors of cardiovascular disease (CVD) abnormal bone and mineral metabolism together with many other factors contribute to the excess cardiovascular burden in patients on dialysis. Aortic calcification score and coronary calcification score are predictive of CVD and mortality. The aim of this study was to evaluate the possible relationship between arterial calcification and bone metabolism.
Thirty two patients on dialysis were included. All patients underwent a bone biopsy to assess bone histomorphometry and a 18F-NaF PET scan. Fluoride activity was measured in the lumbar spine (L1 - L4) and at the anterior iliac crest. Arterial calcification scores were assessed by computerized tomography for quantification of coronary artery calcification score and lateral lumbar radiography for aortic calcification score.
This study group showed high prevalence of arterial calcification and 59% had verified CVD. Both CAC and AAC were significantly higher in patients with verified CVD. Only 22% had low turnover bone disease. There was a weak association between fluoride activity, which reflects bone turnover, measured in the lumbar spine, and CAC and between PTH and CAC. There was also a weak association between erosion surfaces and AAC. No significant association was found between calcification score and any other parameter measured.
The results in this study highlight the complexity, when evaluating the link between bone remodeling and vascular calcification in patients with multiple comorbidities and extensive atherosclerosis. Several studies suggest an impact of bone turnover on development of arterial calcification and there is some evidence of reduced progression of vascular calcification with improvement in bone status. The present study indicates an association between vascular calcification and bone turnover, even though many parameters of bone turnover failed to show significance. In the presence of multiple other factors contributing to the development of calcification, the impact of bone remodeling might be diminished.
The study is registered in ClinicalTrials.gov protocol registration and result system, ID is NCT02967042 . Date of registration is 17/11/2016.

BACKGROUND: Dyslipidemia is a well-known risk factor for cardiovascular disease (CVD). Recently, atherogenic index of plasma (AIP) has been proposed as a novel predictive marker for CVD, and few cross sectional studies have demonstrated a relationship between AIP and coronary artery disease. The present study investigated the association between AIP and the progression of coronary artery calcification (CAC) in Korean adults without CVD.
METHODS: A total of 1124 participants who had undergone CAC measurement at least twice by multi-detector computed tomography (CT) at a health check-up center were enrolled. Their anthropometric measurements and various cardiovascular risk factors were assessed. AIP was defined as the base 10 logarithm of the ratio of the concentration of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C). CAC progression was defined as either incident CAC in a CAC-free population at baseline, or an increase of ≥2.5 units between the square roots of the baseline and follow-up coronary artery calcium scores (CACS) in subjects with detectable CAC at baseline.
RESULTS: CAC progression was observed in 290 subjects (25.8%) during the mean follow-up of 4.2 years. All subjects were stratified into three groups according to AIP. There were significant differences in cardiovascular parameters among groups at baseline. The follow-up CAC and the incidence of CAC progression increased gradually with rising AIP tertiles. In logistic regression analysis, the odds ratio for CAC progression was 2.27 when comparing the highest to the lowest tertile of AIP (95% CI: 1.61-3.19; P for trend < 0.01). However, this association was attenuated after adjustment for multiple risk factors (P for trend = 0.67).
CONCLUSIONS: There is a significant correlation between AIP and the progression of CAC in subjects without CVD. Although AIP was not an independent predictor of CAC progression, AIP should be considered when estimating the current as well as future CVD risk, along with other traditional risk factors.