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Background: Coronary angiography (CAG) remains the gold standard to diagnose coronary artery disease (CAD). However, it is associated with multiple risks and its utility is not well defined in the liver transplant population. Alternatives to evaluate for CAD such as coronary artery calcium score (CACS) are being increasingly investigated. Hypothesis: To determine if the absence of coronary arterial calcium (CACS=0) on non-contrast, non-ECG gated chest CT scan can exclude obstructive CAD in liver transplant patients. Methods: We performed a retrospective analysis of data collected from liver transplant recipients. We included patients who had a CT chest without contrast and CAG less than one year apart. Agatston score was derived from non-IV contrast, non-ECG gated chest CT’s utilizing the syngo.via platform (Siemens Healthcare). CACS was compared against CAG. Patients with coronary stents were excluded. We determined NPV, PPV, sensitivity and specificity of using CACS = 0 as predictor of the absence of obstructive CAD. Results: Mean age at date of transplant was 59.03 and males accounted for 68.8% of our population. The negative predictive value for CACS=0 as a predictor of non-obstructive CAD was 100%. Positive predictive value for CACS≥1 was 6.8%. Sensitivity and specificity for the correlation between CACS and CAD were 100% and 33% respectively (Figure 1). CACS was stratified into four subgroups based severity, and we found that all patients with obstructive CAD had scores >400 (Figure 2). Conclusion: The absence of coronary arterial calcium (CACS=0) on non-contrast, non ECG gated chest CT has a high negative predictive value and can exclude the presence of obstructive CAD.

Background: Annual or biannual coronary angiography is recommended after heart transplantation. This is associated with radiation and contrast exposure in addition to being invasive. Absence of coronary calcium on CT in non-transplanted patients has a high negative predictive value (NPV) to rule out obstructive CAD. Objective: To determine whether the absence of coronary calcium on non-contrast, non-gated MDCT has a high NPV to rule out obstructive CAD in heart transplant recipients. Methods: We included patients with a non-contrast, non-gated chest CT within 1 year of undergoing a coronary angiogram from 2006 to 2016. Obstructive CAD was defined as stenosis >50%. Coronary artery calcium scores (CACS) were calculated by the Agatston method using the syngo.via platform (Siemens Healthcare GmbH, Germany). For analysis, CACS were categorized based on a) presence or absence of coronary calcium (i.e., CACS=0 or CACS>0) or b) severity of calcification (i.e., CACS=0, CACS 0-100 and CACS>100). Results: We reviewed 76 consecutive angiograms and corresponding CTs. Prevalence of obstructive CAD was 9.2% (n=7). Prevalence of CACS=0 was 89.5% (n=68) of which 5 had obstructive CAD presenting a NPV of 93%. 8 patients had CACS>0 of which 2 had obstructive CAD on angiogram (positive predictive value=25%). CACS was found to correlate with severity of CAD by angiography(p50% was found in 10 vessels - 5 LAD, 1 D1, 1 LCx, 2 OM branches and 1 RCA. Calculating CACS enabled detection of 1/5 LAD lesions; lesion in D1 was detected as an LAD lesion; lesions in the OM branches and RCA were not detected. Conclusion: Absence of coronary calcium on MDCT has a high NPV in ruling out obstructive CAD in heart transplant recipients. However, only 2/10 obstructive lesions on angiogram had calcification plaques detected on corresponding vessels on CT. The clinical significance of this is yet to be determined.

Background: Clinical implications of detecting subclinical coronary artery disease (CAD) in patients with atrial fibrillation (AF) are unclear. Methods: A total of 430 AF patients (age 63 ± 10 y, 65% male, 62% hypertensive, 16% diabetic, 42% dyslipidemic) without known CAD undergoing pre-procedural CT for catheter ablation were included. We evaluated the change in: 1) numbers of patients with CACS-diagnosed CAD who could potentially be on statin. 2) CHA2DS2-VASc score after incorporating CACS>100 (related to increased risk of stroke) into the original definition of vascular diseases who could potentially be on anticoagulants. Results: 1) Prevalence of subclinical CAD (CACS>0) was 74% (319/430) and 25% (106/430) had CACS>100. There were 62% (267/430) who were not on statin. Of these patients, 71% (190/267) had subclinical CAD while 21% (34/163) of statin users had CACS of 0. 2) The median original CHA2DS2-VASc score was 2. After incorporating CACS>100 into the original score, 24% (18/75) with the original score of 0 had the score changed to 1 (7/35 in persistent AF [PST-AF] and 11/40 in paroxysmal AF [PRX-AF]) (figure A) and 17% (22/131) with the original score of 1 had the score changed to ≥ 2 (10/83 in PST-AF and 12/48 in PRX-AF) (figure B). PRX-AF had more frequent increase in CHA2DS2-VASc score than PST-AF (p=0.035)(figure C). Conclusion: In AF patients without known history of CAD, detecting subclinical CAD by CACS potentially has important therapeutic implications for prevention forprogression of CAD and stroke.

Introduction: Coronary artery calcium score (CACS) and the electrocardiogram (ECG) are tests available in the evaluation and risk stratification of coronary heart disease risk. The aim of this study is to evaluate the association between conduction abnormalities detected by ECG and coronary atherosclerotic burden determined by CACS in symptomatic patients with no history of coronary artery disease (CAD). Methods: This is a cross-sectional study of 843 consecutive patients without history of CAD who presented with chest pain to our emergency department. All patients were evaluated with ECG and CACS by MDCT. The cohort was categorized into 4 groups: CACS 0, 1-100, 101-400, and >400. PR prolongation was defined as PR interval >200 ms. QTc prolongation was defined as normal (440ms). Other ECG parameters evaluated include bundle branch blocks (BBB), ST segment changes, and T wave abnormalities. Results: The cohort had a mean age of 54 ± 13 years and 44% were male. Median Framingham 10-year risk for cardiovascular disease was 5% (Interquartile range; IQR 1% - 16%). 59% of the cohort had CACS 0; 22.7% (CACS 1-100), 9.5% (CACs 101-400) and 8.8% (CACS >400). PR prolongation was present in 5% of the cohort. 66% had normal QTc and 34% had prolonged QTc - mild (180), moderate-to-severe (105). In multivariate analysis adjusted for Framingham risk, PR prolongation was independently associated with presence (OR 3.22; 95%CI 1.08, 1.12; p400) of coronary calcification (OR 2.51; 95%CI 1.10, 5.75; p=0.03). Similarly, QTc prolongation was independently associated with presence (mild: OR 1.01; 95%CI 0.70, 1.46; p=0.96, moderate-to-severe: OR 1.64; 95%CI 1.05, 2.56; p=0.03) and severity (CACS>100) of coronary calcification (mild: OR 1.66; 95%CI 1.10, 2.53; p=0.02, moderate-to-severe: OR 2.05; 95%CI 1.26, 3.35; p=0.004). BBB (3.6%), ST segment changes (11.9%), and T wave abnormalities (22.7%) were not associated with the presence or extent of coronary calcification. Conclusion: In patients without history of CAD, PR and QTc prolongation were independently associated with presence and severity of coronary atherosclerotic burden detected by CACS, while BBB, ST segment and T wave changes were not.

Introduction: This study aimed to investigate associations of red cell distribution width (RDW), RBC mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with coronary artery calcium score (CACS) in patients without history of coronary artery disease (CAD). Methods: In this cross-sectional study, 832 consecutive patients without history of CAD who presented with acute chest pain and underwent coronary artery calcium scoring by MDCT were included. Differences in CACS among multiple RBC indices categories which were high RDW (>55 fL) VS low-to-normal RDW, low MCV ( Results: The cohort comprised of 60% men (500 of 832) with mean age of 59±14 years. Median Framingham’s 10-year risk for cardiovascular disease was 4% (Interquartile range; IQR 1%-16%). Sixty percent of patients had zero CACS followed by 21.5% with CACS 1-100, 9.9% with CACS 101-400 and 8.1% with CACS>400. Mean ± SD of the RBC indices were 43±14 fL for RDW, 88±6 fL for MCV, 30±2 pg for MCH and 34±2 g/dL for MCHC. Compared to patients with normal-to-high MCV, those with low MCV (n=73) had significant lower CACS (0; IQR 0-5 VS 0; IQR 0-49; p 0.047). There was no statistically significant difference in CACS between RDW groups (p 0.45), MCH groups (p 0.19), MCHC groups (p 0.26) as shown in the figure. Multivariate analysis showed no statistically significant association of all the RBC indices with either CACS>0 (high RDW - p 0.83, low MCV - p 0.17, low MCH - p 0.26, low MCHC − p 0.06) or CACS>100 (high RDW - p 0.69, low MCV - p 0.18, low MCH - p 0.93, low MCHC − p 0.77). Conclusion: Our study did not show significant association of RDW, MCV, MCH and MCHC with either presence or severity of coronary calcification in patients without history of CAD

Introduction: This study aimed to investigate associations between monocyte count derived from complete blood count and coronary artery calcium score (CACS) in patients without history of coronary artery disease (CAD). Methods: In this cross-sectional study, 831 consecutive patients without history of CAD who presented with chest pain and underwent coronary artery calcium scoring by MDCT were included. Patients with any clinical signs of infection were excluded. High monocyte count was defined as absolute monocyte count of > 950/uL. Presence of coronary calcification and moderate-to-severe coronary calcification were determined when CACS>0 and CACS>100 respectively. Results: The cohort comprised of 60% men with mean age of 59±14 years. Median Framingham’s 10-year risk for cardiovascular disease was 4% (Interquartile range; IQR 1%-16%). Sixty percent of patients had zero CACS followed by 21.5% with CACS 1-100, 9.9% with CACS 101-400 and 8.1% with CACS>400. Mean ± SD absolute monocyte count was 588±379 /uL. There was no statistically significant difference in rate of CACS>0 between high monocyte count group and normal monocyte count group (p 0.83). In patients with non-zero CACS (N=328), those with absolute monocyte count > 90 percentile had higher rate of CACS>100 than those in the bottom 10 percentile (55.9% VS 30%; p 0.037) as shown in the left figure. Those with high monocyte count had higher rate of CACS>100 than those with normal monocyte count (68.4% VS 44%; p = 0.038) as shown in the right figure. In multivariate regression analysis, high monocyte count was associated with CACS>100 (HR 2.84; 95% confidence interval 1.05, 7.73; p = 0.040). Conclusion: In patients without history of CAD, high monocyte count was not associated with presence of coronary calcification. However, high monocyte count is independently associated with more severe calcification in those with coronary calcification.

Background: This study is to examine relationship between coronary artery disease (CAD) and types of atrial fibrillation (AF) Methods: A total of 403 nonvalvular atrial fibrillation patients without known history of CAD underwent coronary artery calcium score (CACS) evaluation by multi-detector cardiac computed tomography. Clinical characteristics and CACS were compared between patients with persistent type of AF and paroxysmal type of AF. Results: The cohort comprised of 65% (279 of 430) male with a mean (SD) age of 63(10) years. Prevalence of persistent AF was 60% (259 of 430). Mean (SD) 10-year risk of CAD by Framingham score was 14(7)%. Median CACS was 22 (range 0-5402) with 75% CACS>0 (321 of 430). Compared to paroxysmal type, those with persistent type had higher prevalence of CAC>0 as shown in Figure1 and more history of hypertension (p0 (OR 1.938; 95%CI 1.197, 3.138; p0.007). Conclusion: In patients with AF, persistent type of AF is independently associated with CACS>0. Our findings suggest potential benefit from evaluation of CAD in this population.

Background: This study is to examine association of CHADS2 and CHA2DS2-VASc score with coronary artery disease (CAD) in nonvalvular atrial fibrillation (AF) Method: A total of 676 consecutive nonvalvular AF patients without known history of CAD underwent coronary artery calcium score (CACS) evaluation by multi-detector cardiac computed tomography. Clinical characteristics and CACS were compared between different CHADS2 and CHA2DS2-VASc score groups. Results: The cohort comprised of 68% (461 of 676) male with a mean ± SD age of 63 ± 10 years. Median 10-year risk of CAD by Framingham score was 11% (range 2%-53%). Median CHADS2 score was 1 (range 0-6) and median CHA2DS2-VASc score was 2 (range 0-8). Mean ± SD CACS was 215 ± 504. Compared to CHADS2 score ≤ 1, those with CHADS2 score > 1 had higher mean ± SD CACS (359 ± 738 VS 158 ± 359; p 1 is associated with CACS > 0 (OR 1.751; 95%CI 1.168, 2.624; p 0.007) and CACS > 400 (OR 2.528; 95%CI 1.641, 3.896; p < 0.001). Similarly, compared to CHA2DS2-VASc score ≤ 1, those with CHA2DS2-VASc score > 1 had higher mean ± SD CACS (270 ± 586 VS 150 ± 376; p 1 is associated with CACS > 0 (OR 1.713; 95%CI 1.217, 2.409; p 0.002) and CACS > 400 (OR 2.683; 95%CI 1.678, 4.289; p < 0.001). Receiver operating characteristics of CHADS2 and CHA2DS2-VASc score models for CACS > 400 is shown in the figure. Conclusion: In nonvalvular AF patients, higher CHADS2 and CHA2DS2-VASc score are comparably associated with presence and severity of CAD.

Background Platelet interaction and the clotting cascade are known to play an important role in the process of atherosclerosisHowever, the relationship between platelet count and calcium scores is not well known. Methods This is a sub-group analysis of 974 consecutive patients who presented to our institution for chest pain without evidence of myocardial infarction. Calcium scores were determined in these patients using cardiac CT scans. The platelet count was divided in quartiles. Pearson’s correlation was used to test association between platelet count and calcium scores. Results The predominant gender was female (60%) and the mean age was 57. Sixty percent of the population was Caucasian. The mean Framingham score was 8.16 ± 8.15. There was no difference seen in the prevalence of low calcium scores (100) in different platelet groups when divided in quartiles. Similarly, there was no difference in mean calcium scores in different groups. Conclusion The serum platelet count does not correlate with calcium scores.

Background: Elevated white count ( WBC) as inflammatory marker has been associated with more severe CAD and worse outcome in patients with acute myocardial infarction (MI). However, the relationship between total white count and calcium score (CACS) and epicardial fat (EAT) in patients with acute chest pain but no MI is not known. Methods: : CACS was evaluated by non contrast cardiac computed tomography in 974 consecutive patients with no history of CAD but admitted with acute chest pain and no MI by ECG and enzymes. Epicardial fat volume was measured in 713 pts . We divided the WBC count by the median and then at 10 K ( close to top quartile) . Pearson’s correlation was used to test association between log (CAC +1) and epicardial fat volume . Results: The mean age for this population was 57.4 with 60 % female. The predominant race was Caucasians (60%). The mean Framingham score was 8.16 ± 8.15. The mean WBC was 7.8± 4.38 ( x 10 K) . The median WBC was 7.3 x 10k. The mean CACS and EAT volume did not differ between the groups when different cut off of WBC was used ( see table) There is no difference in the prevalence of CACS >0 or moderate CACS ( > 100) in different WBC group ( for WBC > 10 K 17 % has CACS > 100 vs 18 % in WBC Conclusion: WBC does not predict calcium scores or epicaridal fat volume in patients with acute chest pain .