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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. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions.

Abstract Coronary heavy calcification (HC) poses a sturdy challenge to percutaneous coronary intervention (PCI). Scores considering calcification length, thickness, or circumferential extent, are widely accepted to dictate upfront calcium modification to improve PCI outcomes. Although often marginalized, calcification shape (morphology) may require consideration during procedure planning in selected cases. This case demonstrates how a focal but spur-shaped calcification led to a massive proximal left anterior descending (LAD) dissecting intramural hematoma.

Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions. [ABSTRACT FROM AUTHOR]

The safety and efficacy of coronary orbital atherectomy (OA) for treatment of ostial lesions are not yet fully established. We sought to evaluate (OA) treatment of severely calcified ostial and non-ostial lesions. A retrospective analysis of subjects treated with OA for severely calcified ostial and non-ostial lesions, at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) from January 2014 to September 2020, was completed. Study baseline characteristics, lesion and vessel characteristics, procedural outcomes, and in-hospital major adverse cardiovascular events (MACE) were analyzed and compared. A total of 609 patients that underwent PCI with OA were identified. The majority of patients (81.9 %) had non-ostial lesions, while 16.6 % had ostial lesions (of which 2.8 % classified as aorto-ostial) and 1.5 % had unknown lesion anatomy. The mean age of the overall cohort was 74.0 ± 9.3 years, and 63.5 % were male. All patients received drug-eluting stent (DES) placement, and the overall freedom from MACE was 98.5 %, with no significant difference observed between the ostial and non-ostial groups. The freedom from cardiac death and MI was also similar between the two groups. There were low rates of bleeding complications and severe angiographic complications, and no persistent slow flow/no reflow was reported. This study demonstrated no significant differences in in-hospital MACE outcomes between patients with ostial versus non-ostial lesions, indicating that OA is a safe and effective treatment option for both lesion types, including those classified as aorto-ostial. • There is limited atherectomy data in patients with severely calcified ostial lesions. • All patients had successful drug-eluting stent (DES) placement. • The overall freedom from MACE was 98.5 %, with no significant difference between the ostial and non-ostial groups. • The freedom from cardiac death and MI was also similar between the two groups. • Coronary orbital atherectomy can be used safely and effectively in ostial lesions. [ABSTRACT FROM AUTHOR]

There is a lack of consensus regarding universally accepted criteria for metabolic health (MH). A simple definition of MH was systematically derived in a recent prospective cohort study. The present cross-sectional study aimed to explore the applicability of these criteria in Korean population, using coronary calcification as an indicator of cardiovascular risk. In total, 1049 healthy participants, who underwent coronary artery calcification testing at university hospital health promotion centers between January and December 2022, were included. Applying the main components of the newly derived definition, MH was defined as follows: (1) systolic blood pressure < 130 mmHg and no use of blood pressure-lowering medication; (2) waist circumference < 90 cm for males and < 85 cm for females; and (3) absence of diabetes. Multivariate logistic regression was conducted to examine the odds ratio (OR) and 95 % confidence interval (CI) for coronary artery calcium score across different phenotypes. The prevalence of coronary artery calcification in this study was 41.1 %. Compared with metabolically healthy, normal weight subjects, those with the metabolically healthy obesity phenotype did not exhibit increased odds for coronary atherosclerosis. (OR 0.93 [95 % CI 0.48–1.79]) Conversely, metabolically unhealthy subjects had increased risk, regardless of their body mass index category (OR 3.10 [95 % CI 1.84–5.24] in metabolically unhealthy normal weight; OR 3.21 [95 % CI 1.92–5.37] in metabolically unhealthy overweight; OR 2.73 [95 % CI 1.72–4.33] in metabolically unhealthy obese phenotype). These findings suggest that the new definition for MH has the potential to effectively distinguish individuals at risk for cardiovascular disease from those who are not. [ABSTRACT FROM AUTHOR]

Coronary heavy calcification (HC) poses a sturdy challenge to percutaneous coronary intervention (PCI). Scores considering calcification length, thickness, or circumferential extent, are widely accepted to dictate upfront calcium modification to improve PCI outcomes. Although often marginalized, calcification shape (morphology) may require consideration during procedure planning in selected cases. This case demonstrates how a focal but spur-shaped calcification led to a massive proximal left anterior descending (LAD) dissecting intramural hematoma. [ABSTRACT FROM AUTHOR]

In recent years, percutaneous coronary intervention (PCI) has become established as a treatment for angina pectoris and acute coronary syndromes due to technological advances and improved devices. However, highly calcified lesions, which cause stent failures after stent implantation, are one of the major problems in PCI. Therefore, optical coherence tomography (OCT) is used to determine the thickness of calcification in the vessel wall to guide the treatment strategy for calcified lesions. Although OCT can evaluate the angle and thickness of calcification, it requires skilled reading and is only available in a limited number of centers. In this study, we focused on the amount of calcification measurable by CT coronary angiography (CCTA) and used CCTA to delineate slices of all calcified areas and measure their volumes. Similarly, we used OCT images to measure the angle of calcification and the thickness of calcium in the vessel wall in all slices where calcification was observed. In 18 patients undergoing PCI for angina pectoris, calcification volume on CCTA images was significantly positively correlated with calcification angle and thickness summation on OCT images. These results suggest that CCTA calcification volume may allow estimation of calcification severity by OCT and may serve as a noninvasive index to complement OCT calcification assessment. [ABSTRACT FROM AUTHOR]

We investigated the prognostic utility of visually estimated coronary artery calcification (VECAC) from low dose computed tomography attenuation correction (CTAC) scans obtained during SPECT/CT myocardial perfusion imaging (MPI), and assessed how it compares to coronary artery calcifications (CAC) quantified by calcium score on CTACs (QCAC). From the REFINE SPECT Registry 4,236 patients without prior coronary stenting with SPECT/CT performed at a single center were included (age: 64 ± 12 years, 47% female). VECAC in each coronary artery (left main, left anterior descending, circumflex, and right) were scored separately as 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), yielding a possible score of 0–12 for each patient (overall VECAC grade zero:0, mild:1–2, moderate: 3–5, severe: >5). CAC scoring of CTACs was performed at the REFINE SPECT core lab with dedicated software. VECAC was correlated with categorized QCAC (zero: 0, mild: 1–99, moderate: 100–399, severe: ≥400). A high degree of correlation was observed between VECAC and QCAC, with 73% of VECACs in the same category as QCAC and 98% within one category. There was substantial agreement between VECAC and QCAC (weighted kappa: 0.78 with 95% confidence interval: 0.76–0.79, p < 0.001). During a median follow-up of 25 months, 372 patients (9%) experienced major adverse cardiovascular events (MACE). In survival analysis, both VECAC and QCAC were associated with MACE. The area under the receiver operating characteristic curve for 2-year-MACE was similar for VECAC when compared to QCAC (0.694 versus 0.691, p = 0.70). In conclusion, visual assessment of CAC on low-dose CTAC scans provides good estimation of QCAC in patients undergoing SPECT/CT MPI. Visually assessed CAC has similar prognostic value for MACE in comparison to QCAC. [ABSTRACT FROM AUTHOR]

Carotid intima-media thickness (cIMT) is inconsistent in predicting cardiovascular risk. This may stem from the variability of the media thickness (cM) outweighing the intimal thickness (cIT) as the sign of atherosclerosis. Thus, we evaluated in type 2 diabetes (T2D) individuals, the association between carotid measures and coronary artery calcification (CAC). Association between the presence of CAC and cIT, cM, and cIMT were examined on 224 individuals. Logistic binary regression was used to assess CAC predictors. The Akaike information criterion (AIC) and log-likelihood test (LLT) were used to assess differences among univariate models. The cIT (0.335 mm vs 0.363 mm; p = 0.001) and cIMT (0.715 vs 0.730; p = 0.019), but not cM (0.386 mm vs 0,393 mm; p = 0.089) were higher among individuals with CAC. In unadjusted analysis, cIT (273;-134; p = 0.001) showed greater relationship with CAC, when compared to cIMT (279;-137; p = 0.022) and cM (281;-139; p = 0.112) based on the AIC and LLT, respectively. In multivariate logistic regression, CAC was related to carotid plaque (OR): 1.91, 95% confidence interval (CI):1.08, 3.38; p = 0.027), and high-cIT (OR: 2.70, 95%CI:1.51, 4.84; p = 0.001), but not to high-cIMT (OR:1.70, 95%CI:0.96, 3.00; p = 0.067) nor high-cM (OR:1.33, 95%CI:0.76, 2.34; p = 0.322). In T2D individuals, cIT is a better predictor of CAC than cIMT; cM is not associated with CAC. • Carotid intima-media thickness (cIMT) is inconsistent in predicting cardiovascular risk. • Coronary artery calcification (CAC) is reliable for risk stratification, its access however is limited. • In individuals with type 2 diabetes, carotid intima thickness is a better predictor of CAC than cIMT; media thickness is not associated with CAC. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) is recommended to be the most appropriate modality in assessing calcium thickness, however, it has limitations associated with infrared attenuation. Although coronary computed tomography angiography (CCTA) detects calcification, it has low resolution and hence not recommended to measure the calcium size. The aim of this study was to devise a simple algorithm to estimate calcium thickness based on the CCTA image. A total of 68 patients who had CCTA for suspected coronary artery disease and subsequently went on to have OCT were included in the study. 238 lesions of them divided into derivation and validation dataset at 2:1 ratio (47 patients with 159 lesions and 21 with 79, respectively) were analyzed. A new method was developed to estimate calcium thickness from the maximum CT density within the calcification and compared with calcium thickness measured by OCT. Maximum Calcium density and measured calcium-border CT density had a good correlation with a linear equation of y = 0.58x + 201 (r = 0.892, 95% CI 0.855–0.919, p < 0.001). The estimated calcium thickness derived from this equation showed strong agreement with measured calcium thickness in validation and derivation dataset (r2 = 0.481 and 0.527, 95% CI 0.609–0.842 and 0.497–0.782, p < 0.001 in both, respectively), more accurate than the estimation by full width at half maximum and inflection point method. In conclusion, this novel method provided the estimation of calcium thickness more accurately than conventional methods. [ABSTRACT FROM AUTHOR]

Purpose: High triglyceride glucose (TyG) index level is one of the risks for cardiovascular events. The purpose of this research was to examine the correlation of the triglyceride glucose (TyG) index levels with plaque characteristics and calcification types determined by intravascular ultrasound (IVUS) in acute coronary syndrome (ACS) patients. Methods: A total of 234 acute coronary syndromes (ACS) participants who completed intravascular ultrasound (IVUS) and coronary angiography (CAG) were finally enrolled. Results: Logistic regression analysis manifested that the TyG index was independently correlated with the occurrence of coronary calcification, minimum lumen area (MLA) ≤ 4.0 mm², plaque burden (PB) > 70%, and spotty calcification. Taking the lowest group as a reference, the risk of coronary calcification (OR, 2.57; 95%CI, 1.04–6.35; p = 0.040), MLA ≤ 4.0 mm² (OR, 7.32; 95%CI, 2.67–20.01; p < 0.001), PB > 70% (OR, 2.68; 95%CI, 1.04–6.91; p = 0.041), and spotty calcification (OR, 1.48; 95%CI, 0.59–3.71; p = 0.407) was higher in the highest TyG index group. TyG index was converted into a dichotomous variable or a continuous variable for analysis, and we found that a similar result was observed. In addition, optimal predictive models consisting of clinical variables and the TyG index distinctly improved the ability to predict the prevalence of coronary calcification and MLA ≤ 4.0 mm² (p < 0.05). Conclusion: The TyG index may serve as a potential predictor for calcification patterns and plaque vulnerability. [ABSTRACT FROM AUTHOR]

A 40-year-old female with a history of steroid therapy for juvenile rheumatoid arthritis was brought to our hospital because of chest pain. A diagnosis of non-ST elevation myocardial infarction was made, and emergency coronary angiography revealed stenotic lesions with severe calcification in the left anterior descending artery and the right coronary artery. Percutaneous coronary intervention with rotational atherectomy followed by a drug-coated balloon was performed to the lesion in the left anterior descending artery. The patient had characteristic physical findings including short stature, a round face, and 'knuckle-dimple sign'. Whole-body computed tomography showed many ectopic calcifications, indicating Albright's hereditary osteodystrophy. Ellsworth-Howard test revealed that urinary cyclic adenosine monophosphate response was positive, thus a diagnosis of pseudo-pseudohypoparathyroidism (PPHP) was made. Here, we describe a rare case of PPHP complicated by acute coronary syndrome with severely calcified coronary arteries. Pseudo-pseudohypoparathyroidism (PPHP) presents with several characteristic physical findings and ectopic calcifications. Since PPHP involves coronary artery calcification as in the present case, it may be considered as a cause of coronary artery disease. [ABSTRACT FROM AUTHOR]

Elevation of the ST segment after percutaneous coronary intervention (PCI) using rotational atherectomy (RA) for severely calcified lesions often persists after disappearance of the slow-flow phenomenon on angiography. We investigated clinical factors relevant to prolonged ST-segment elevation following RA among 152 patients with stable angina undergoing elective PCI. PCI procedures were divided into two strategies, RA without (primary RA strategy) or with (secondary RA strategy) balloon dilatation before RA. Incidence of prolonged ST-segment elevation after disappearance of slow-flow phenomenon was higher in the 56 patients with primary RA strategy (13%) than in the 96 patients with secondary RA strategy (3%, p = 0.039). Univariate logistic regression analysis showed levels of low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.93–0.99; p = 0.013), levels of triglycerides (OR 0.97, 95%CI 0.94–0.99; p = 0.040), and secondary RA strategy (OR 0.23, 95% CI 0.05–0.85; p = 0.028) were inversely associated with occurrence of prolonged ST-segment elevation following ablation. However, hemodialysis, diabetes mellitus, left-ventricular ejection fraction, lesion length ≥ 20 mm, and burr size did not show significant associations. Multivariate logistic regression analysis modeling revealed that secondary RA strategy was significantly associated with the occurrence of prolonged ST-segment elevation (Model 1: OR 0.24, 95% CI 0.05–0.95, p = 0.042; Model 2: OR 0.17, 95% CI 0.03–0.68, p = 0.018; Model 3: OR 0.21, 95% CI 0.03–0.87, p = 0.041) even after adjusting for levels of LDL-C and triglycerides. Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following RA. [ABSTRACT FROM AUTHOR]

Our study presents a case of angina with a zero calcium score yet severe coronary stenosis from noncalcified plaque. We highlight the limitation of otherwise prognostically powerful coronary calcium score as a singular predictive tool especially when used in symptomatic patients.

[Display omitted] [ABSTRACT FROM AUTHOR]

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.

Background and Aim:The present study was designed to estimate the coronary artery calcium score (CACS) and its association with the incidence of major adverse cardiovascular events (MACE) in asymptomatic patients who are at the risk of coronary artery disease (CAD).Materials and Methods:In this prospective cross-sectional observational study, 108 consecutive patients were enrolled. The patients at intermediate risk of cardiovascular disease, atypical chest pain, and a positive family history of CAD were included. Demographic details and clinical data including lipid profile, systolic blood pressure, electrocardiography, 2D echocardiography, and routine blood investigations were reported. CACS was derived from computed tomography using a 256-slice scanner with a rotation time of 270 milliseconds. MACE was recorded at 1-year follow-up.Results:The mean age was 54.55 ± 7.7 years with male predominance (62%). CACS categories 0, 1-99, 100-399, 400-999, and more than 1000 constituted 43.5%, 28.7%, 17.6%, 9.3%, 0.9%, respectively. The correlation between the groups of positive and negative CACS and presence or absence of standard risk factors was found to be statistically significant in diabetes mellitus (P = 0.001), hypertension (P = 0.001), and history of CAD in the family (P= 0.029). Although the association between smokers and calcium was statistically insignificant, it had clinical significance (P = 0.212). Out of 108 patients, MACE was observed in 16 (14.81%) patients with positive CACS at 1-year follow-up.Conclusion:CACS measurement is often regarded as the primary non-invasive approach for risk stratification, MACE estimation, and promptly identifying high-risk asymptomatic individuals.

• Subclinical coronary atherosclerosis is frequent (42%) in SSc patients and is mainly associated with the dysmetabolic syndrome and other atherosclerotic lesions (carotid plaque or peripheral artery disease). • All most common cardiovascular risk scores (SCORE 2, QRISK, CUORE, Framingham risk score, and MESA-CAC) seem to have similar ability to discriminate the presence of coronary artery calcifications, with the best performance of SCORE 2. The evaluation of these scores is recommended for a more complete assessment of SSc patients and to identify patients for earlier preventive therapy. • Pulmonary arterial hypertension PAH remains the leading cause of the occurrence of major cardiovascular events in five years of follow-up in SSc patients; even though a high prevalence of a "not pure" pattern of PAH (associated with subclinical coronary atherosclerosis) is evidenced for the first time. Particular clinical attention should be paid to this group of patients, applying more aggressive therapeutic strategies to improve the survival in SSc patients. Spreading data describe cardiovascular disease (CVD) as a growing cause of hospitalization in systemic sclerosis (SSc) patients. Although interstitial lung disease and pulmonary arterial hypertension (PAH) remain the principal causes of mortality, the presence of CVD has been shown to further increase mortality in SSc patients. Few and contrasting data are available on cardiovascular impairment, particularly of subclinical coronary arteries disease, in SSc patients. The aims of this study were: 1) to determine the demographic, clinical, and cardiovascular differences between the groups of SSc patients with and without subclinical coronary atherosclerosis (SCA) assessed by coronary calcium score; 2) to verify the performance of cardiovascular risk scores in SSc for detection of SCA major cardiovascular events (MCVE); 3) to evaluate the risk factors associated to MCVE in 5 years of follow-up in this study group of patients. Sixty-seven SSc patients were enrolled in this study. SCA was assessed using quantification of coronary calcium score by computerized tomography, reported as Agatson. Evaluation of common cardiovascular risk scores, carotid plaques by Doppler ultrasonography, the history of peripheral artery disease (PAD), lipid profiles, and clinical and laboratiristic characteristics of SSc were assessed at baseline visits for each patient. Factors associated with the presence of SCA were assessed by multivariate logistic analysis. A five years prospective study was performed for the evaluation of MCVE occurrence and its possible predictors. The prevalence of SCA was 42% (Agatston scores of 266.04 ± 455.9 units) in our group of SSc patients. Patients with SCA were principally older (p = 0.0001) and had higher rates of CENP-B antibodies (57% vs 26%; p = 0.009), pulmonary arterial hypertension (PAH) (25% vs 3%; p = 0.008), dysphagia (86% vs 61%; p = 0.027), and users of statins (36% vs 8%; p = 0.004), carotid plaque (82% vs 13%; p = 0.0001), PAD (79% vs 18%; p = 0.0001), and metabolic syndrome (25% vs 0%; p = 0.002) than patients without SCA. Metabolic syndrome (OR: 8.2, p = 0.0001), presence of a PAD (OR: 5.98, p = 0.031), and carotid plaque (OR: 5.49, p = 0.010) were the main factors associated with SCA in SSc patients, by multivariate regression analysis. MCVE occurred in 7 patients. By multivariate COX regression analysis unique predictor of MCVE in 5 years of follow-up in our SSc patients was the presence of PAH (HR: 10.33, p = 0.009). Of note, the contemporary presence of PAH and SCA (defined as "not pure" pattern of PAH) was observed in 71% of patients with the occurrence of MCVE This study evidenced the high presence of the new "not pure" pattern of PAH, which could worsen the outcome in SSc in a medium-term (5 years) observation period. Furthermore, our data confirmed a higher cardiovascular impairment in SSc due to the presence of both SCA, mainly associated with typical cardiovascular risk factors, and PAH, life-threatening complications of SSc, that is the principal cause of the occurrence of MCVE in our SSc patients. A careful assessment of cardiovascular involvement in SSc and a more aggressive therapeutic strategy for preventing CAD and treating PAH should be highly suggested to reduce MCVE in SSc patients. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) can assess calcium thickness, a key factor for predicting good stent expansion; however, it underestimates coronary calcium severity due to its penetration limitation. This study aimed to evaluate computed tomography (CT) and OCT images to assess calcification. We investigated 25 left anterior descending arteries of 25 patients, using coronary CT and OCT, and assessed their calcification. Of the 25 vessels, 1811 pairs of CT and OCT cross-sectional images were co-registered. Of the 1811 cross-sectional CT images, calcification was not detectable in 256 (14.1%) of the corresponding OCT images due to limited penetration. In the 1555 OCT calcium-detectable images, the maximum calcium thickness was not detectable in 763 (49.1%) images compared to the CT images. In CT images of slices corresponding to undetected calcium in OCT images, the angle, thickness, and maximum density of calcium were significantly smaller compared to slices corresponding to detected calcium in OCT. Calcium with an undetectable maximum thickness in the corresponding OCT image had a significantly greater calcium angle, thickness, and density than calcium with a detectable maximum thickness. There was an excellent correlation between CT and OCT with respect to calcium angle (R= 0.82, P < 0.001). The calcium thickness on the OCT image had a stronger correlation with the maximum density on the corresponding CT image (R = 0.73, P < 0.001) than with the calcium thickness on the CT image (R = 0.61, P < 0.001). Cross-sectional CT imaging allows for pre-procedural assessment of calcium morphology and severity and could complement the lack of information on calcium severity in OCT-guided percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate the accuracy and downstream testing and statin prescribing of real-world reporting of coronary calcification on lung cancer screening (LCS) CT.Materials and Methods: We retrospectively reviewed LCS CTs from January 2015 to November 2021 for reporting of coronary calcification; reports that denoted coronary calcification as a significant incidental finding ("S" modifier) were also noted. We evaluated calcium scoring accuracy in patients in whom a cardiac or calcium scoring CT was performed within 1 year of the LCS CT. For the first LCS CT in all patients, we evaluated whether a stress test was performed within 6 months and whether a new statin prescription was written within 90 days of the LCS CT. Patients were stratified by atherosclerotic cardiovascular disease (ASCVD) risk group, used in a multivariable regression analysis for new statin prescriptions.Results: Eight thousand nine hundred eighty-seven patients underwent screening. In 117 patients who had a paired cardiac CT, scores were concordant in 65 (56%), and LCS CTs did not mention or underestimated calcifications in 40 (34%). Reporting of coronary artery calcifications led to new statin prescriptions, with OR of 1.8 for calcifications without S modifier and 4.4 for calcifications with S modifier. Reporting of coronary artery calcification with S modifier led to subsequent stress testing in 141/1582 (9%) of patients.Conclusion: Coronary calcifications are frequently not mentioned or underestimated at LCS CT. Reporting of coronary calcifications leads to new statin prescriptions, and radiologists should consider reporting these to allow for a risk-benefit discussion with the patient's physician. [ABSTRACT FROM AUTHOR]

BackgroundDespite the importance of attaining optimal lipid levels from a young age to secure long-term cardiovascular health, the detailed impact of non-optimal lipid levels in young adults on coronary artery calcification (CAC) is not fully explored. We sought to investigate the risk of CAC progression as per lipid profiles and to demonstrate lipid optimality in young adults.MethodsFrom the KOrea Initiative on Coronary Artery calcification (KOICA) registry that was established in six large volume healthcare centers in Korea, 2,940 statin-naïve participants aged 20–45 years who underwent serial coronary calcium scans for routine health check-ups between 2002 and 2017 were included. The study outcome was CAC progression, which was assessed by the square root method. The risk of CAC progression was analyzed according to the lipid optimality and each lipid parameter.ResultsIn this retrospective cohort (mean age, 41.3 years; men 82.4%), 477 participants (16.2%) had an optimal lipid profile, defined as triglycerides 60 mg/dl. During follow-up (median, 39.7 months), CAC progression was observed in 434 participants (14.8%), and more frequent in the non-optimal lipid group (16.5% vs. 5.7%; p

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Background Vascular calcification is a known risk factor for cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, since there is a lack of studies examining several arterial regions at a time, we aimed to evaluate the risk of major adverse cardiovascular events (MACE) and all-cause mortality according to calcium scores in five major arterial sites. Methods This was a prospective study of 580 patients from the Copenhagen CKD Cohort. Multidetector computed tomography of the coronary and carotid arteries, the thoracic aorta, the abdominal aorta and the iliac arteries was used to determine vascular calcification at baseline. Calcium scores were divided into categories: 0, 1–100, 101–400 and >400. Results During the follow-up period of 4.1 years a total of 59 cardiovascular events and 64 all-cause deaths occurred. In Cox proportional hazards models adjusted for age, sex, estimated glomerular filtration rate, hypertension, diabetes mellitus, hypercholesterolemia and smoking, only the coronary and carotid arteries, and the thoracic aorta were independent predictors of the designated endpoints. When examining the potential of calcification in the five arterial sites for predicting MACE, the difference in C-statistic was also most pronounced in these three sites, at 0.21 [95% confidence interval (CI) 0.16%–0.26%, P  < .001], 0.26 (95% CI 0.22%–0.3%, P  < .001) and 0.20 (95% CI 0.16%–0.24%, P  < .001), respectively. This trend also applied to all-cause mortality. Conclusions The overall results, including data on specificity, suggest that calcium scores of the coronary and carotid arteries have the most potential for identifying patients with CKD at high cardiovascular risk and for evaluating new therapies. [ABSTRACT FROM AUTHOR]

Background and Aim: The present study was designed to estimate the coronary artery calcium score (CACS) and its association with the incidence of major adverse cardiovascular events (MACE) in asymptomatic patients who are at the risk of coronary artery disease (CAD). Materials and Methods: In this prospective cross-sectional observational study, 108 consecutive patients were enrolled. The patients at intermediate risk of cardiovascular disease, atypical chest pain, and a positive family history of CAD were included. Demographic details and clinical data including lipid profile, systolic blood pressure, electrocardiography, 2D echocardiography, and routine blood investigations were reported. CACS was derived from computed tomography using a 256-slice scanner with a rotation time of 270 milliseconds. MACE was recorded at 1-year follow-up. Results: The mean age was 54.55 ± 7.7 years with male predominance (62%). CACS categories 0, 1-99, 100-399, 400-999, and more than 1000 constituted 43.5%, 28.7%, 17.6%, 9.3%, 0.9%, respectively. The correlation between the groups of positive and negative CACS and presence or absence of standard risk factors was found to be statistically significant in diabetes mellitus (P = 0.001), hypertension (P = 0.001), and history of CAD in the family (P = 0.029). Although the association between smokers and calcium was statistically insignificant, it had clinical significance (P = 0.212). Out of 108 patients, MACE was observed in 16 (14.81%) patients with positive CACS at 1-year follow-up. Conclusion: CACS measurement is often regarded as the primary non-invasive approach for risk stratification, MACE estimation, and promptly identifying high-risk asymptomatic individuals. [ABSTRACT FROM AUTHOR]

Abstract Background Calcified nodule (CN) is a type of potentially vulnerable plaque. Its formation mechanism remains unknown. This study was to assess serum marker and computed tomography angiography (CTA) characteristics of CN validated by intravascular ultrasound (IVUS). Methods Patients who underwent coronary CTA followed by invasive coronary angiography and IVUS were retrospectively analyzed. Serum levels of alkaline phosphatase (ALP), gamma-glutamyltransferase, and calcium were collected. Results IVUS detected 128 de novo calcified lesions in 79 patients with coronary artery disease (CAD). CNs were identified in 11.4% (9/79) of patients and 9.4% (12/128) of lesions. Compared with patients with non-nodular calcified plaques, CN patients had higher serum level of ALP (82.00 vs 65.00 U/L, P = 0.022) and total plaque volume (673.00 vs 467.50 mm3, P = 0.021). Multivariable analyses revealed that serum ALP level and total plaque volume were independently associated with the prevalence of CN in CAD patients with calcified plaques. At lesion level, the CN group had a higher frequency of moderate to heavy calcification on angiography (75.00% vs 40.52%, P = 0.017). In terms of CTA characteristics, plaques with CN had a more severe diameter stenosis (79.00% vs 63.00%, P = 0.007), higher plaque burden (85.40% vs 77.05%, P = 0.005), total plaque density (398.00 vs 283.50 HU, P = 0.008), but lower lipid percentage (14.65% vs 19.75%, P = 0.010) and fiber percentage (17.90% vs 25.65%, P = 0.011). Mean plaque burden is an independent predictor of the prevalence of CN in calcified plaques (odds ratio = 1.102, 95% confidence interval: 1.025–1.185, P = 0.009). The AUC is 0.753 (95% confidence interval: 0.615–0.890, P = 0.004). When using 84.85% as the best cutoff value, the diagnostic sensitivity and specificity of mean plaque burden for predicting the presence of CN within calcified plaques were 66.7% and 80.2%, respectively. Conclusions CN had different CTA imaging features from non-nodular coronary calcification. The presence of a CN was associated with a higher serum ALP level and plaque burden.

Introduction: Tertiary hyperparathyroidism (THPT) and vitamin D deficiency are commonly seen in kidney transplant recipients, which may result in persistently elevated fibroblast growth factor 23 (FGF23) level after transplantation and decreased graft survival. The aim of this study is to evaluate the effect of vitamin D supplementation on THPT, FGF23-alpha Klotho (KLA) axis and cardiovascular complications after transplantation. Materials and methods: Two hundred nine kidney transplant recipients were included and further divided into treated and untreated groups depending on whether they received vitamin D supplementation. We tracked the state of THPT, bone metabolism and FGF23–KLA axis within 12 months posttransplant and explored the predictors and risk factors for intact FGF23 levels, KLA levels, THPT and cardiovascular complications in recipients. Results: Vitamin D supplementation significantly improved FGF23 resistance, THPT and high bone turnover status, preserved better graft function and prevented coronary calcification in the treated group compared to the untreated group at month 12. The absence of vitamin D supplementation was an independent risk factor for THPT and a predictor for intact FGF23 and KLA levels at month 12. Age and vitamin D deficiency were independent risk factors for coronary calcification in recipients at month 12. Conclusion: Vitamin D supplementation effectively improved THPT, FGF23 resistance and bone metabolism, preserved graft function and prevented coronary calcification after transplantation.

Introduction Systemic lupus erythematosus (SLE) is characterized by early atherothrombosis. Pulse wave velocity (PWV) is a promising tool for the diagnosis of early vascular remodelling and initial atherosclerotic plaque formation. Our objective was to evaluate PWV and its relationship with coronary atherosclerosis and thrombotic biomarkers in patients with SLE. Material and methods In 26 patients with SLE with stable clinical conditions, mean age of 39.1 ±11.7 years and without a history of coronary artery disease, multidetector computed tomography (MDCT)-based coronary calcium scoring (CACS) was performed and PWV measured. Laboratory evaluation included serum levels of anticardiolipin and anti-β2-glycoprotein antibodies (anti-β2-GPI), lupus anticoagulant (LA), D-dimers, thrombin–antithrombin complexes (TAT), and von Willebrand factor (vWF). Results Multidetector computed tomography revealed coronary calcifications in 8 (30.8%) patients and the median CACS was 52.4 HU (range 2–843.2). The mean PWV was 9.0 ±3.2 m/s and was higher in patients aged > 50 years (+33.7% vs.

Multi-slice computed tomography (CT) allows noninvasive evaluation of the severity of coronary calcification. However, there has yet to be a definitive parameter based on the cross-sectional CT image for predicting the need for rotational atherectomy (RA). Therefore, we aimed to investigate the mean density of cross-sectional CT images to predict the need for RA during percutaneous coronary intervention (PCI). A total of 154 lesions with moderate to severe calcification detected in coronary angiography were identified in 126 patients who underwent coronary CT prior to PCI for stable angina. PCI with RA was performed for 48 lesions, and the remaining 106 were treated without RA. Multi-slice CT was retrospectively evaluated for its ability to predict the use of RA. We chose the most severely calcified cross-sectional image for each lesion. The mean density within the outer vessel contour, calcium arc quadrant of the cross-sectional CT image, calcium length, calcification remodeling index, and per-lesion coronary artery calcium score was studied. Receiver-operator characteristic curve analysis revealed 637 Hounsfield units (HU) (area under the curve ​= ​0.98, 95% confidence interval: 0.97–1.00, p ​< ​0.001) as the best mean density cutoff value for predicting RA. Multivariate logistic regression analysis showed that a mean calcium level >637 HU was a strong independent predictor (odds ratio: 32.8, 95% confidence interval: 7.0–153, p ​< ​0.001) for using RA. The mean density of the cross-sectional CT image, a simple quantitative parameter, was the strongest predictor of the need for RA during PCI. TOC Summary : We investigated the mean density of cross-sectional computed tomography (CT) images to predict the need for rotational atherectomy (RA) during the percutaneous coronary intervention (PCI). A total of 154 lesions (48 with RA and 106 without RA) of stable angina were enrolled. Receiver operator characteristic curve analysis revealed that the area under the curve of mean density for predicting RA was 0.98 (95% confidence interval:0.97–1.00). A mean density >637 Hounsfield units was the strongest independent predictor for RA, among other potential predictors: calcium arc quadrant, calcium length, calcification remodeling index, and per-lesion coronary artery calcium score. [ABSTRACT FROM AUTHOR]

Coronary artery calcification is a complex process found predominantly in the elderly population. Coronary angiography frequently lacks sensitivity to detect, evaluate and quantify these lesions. Yet calcified lesions are considered stable, it remains associated with a higher rate of peri procedural complications during percutaneous coronary intervention (PCI) including an increased risk of stent under expansion and struts mal apposition leading to poor clinical outcome. Intracoronary imaging (Intravascular Ultra Sound (IVUS) and Optical Coherence Tomography (OCT)) allows better calcified lesions identification, localization within the coronary artery wall (superficial or deep calcifications), quantification. This lesions characterization allows a better choice of dedicated plaque-preparation tools (modified balloons, rotational or orbital atherectomy, intravascular lithotripsy) that are crucial to achieve optimal PCI results. OCT could also assess the impact of these tools on the calcified plaque morphology (plaque fracture, burring effects...). An OCT-guided tailored PCI strategy for calcified lesions still requires validation by clinical studies which are currently underway. [ABSTRACT FROM AUTHOR]

All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA (p < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR. [ABSTRACT FROM AUTHOR]

Background: Coronary artery calcifications comprise one of the most significant factors interfering with the diagnostic accuracy of Multi-Slice Computed Tomography (MSCT). Despite this fact, measurement of Coronary Artery Calcification (CAC) score using Agatston method is a useful noninvasive test for expecting rare but serious potentially life - threatening Percutaneous Coronary Intervention (PCI) complications, our aim to highlight the role of MSCT in coronary disease severity and CAC score as a predictor tool to determine PCI associated complications. Methods: A prospective study was carried out in the period from January 2022 to May 2022, conducted at the radiology and cardiology departments of Zagzig University Hospitals, and enrolled 60 patients with 78 significant stenotic calcified coronary lesions diagnosed by conventional coronary angiography and MSCT coronary angiography with total, target vessel and significant lesion CAC scores calculation using the Agatston method prior to percutaneous coronary intervention (PCI). Results: Our patients were divided into a lower CAC score cases (CAC score, =300, n=12 cases/12 lesions) and a higher CAC case (CAC score, >300, n=48 cases/66 lesions). The highest vessel CAC score mean is of LAD 100.1± 61.98 followed by RCA then LCX and lastly LM, with only three cases of higher CAC score group developed dissection during PCI. with significant difference between successful and complicated PCI regarding the total, target vessel and significant lesion CAC scores with P value < 0.02 Conclusion: Using MSCT to measure CCS prior to intervention can anticipate PCI problems and improve PCI outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study compared the long-term outcomes between rotational atherectomy (RA) for specific indications and on-label use of RA for severely calcified coronary lesions. Methods: Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed. The specific indication group included patients with ostial lesions, unprotected left main coronary artery stenosis, chronic total occlusions, stent ablation, angulated lesions, and cardiac dysfunction, whereas patients with none of the above-mentioned characteristics were included in the on-label group. The primary endpoint was compared between groups. Results: A total of 176 patients in the on-label group and 125 patients in the specific indication group were included. Patient clinical characteristics were comparable between groups. The incidence of complications during the procedure was higher in the specific indication group than in the on-label group (20.0% vs. 10.8%, P=0.018). No significant difference was observed in in-hospital MACCE between groups (12.5% vs 9.7%, P=0.392). During 35 (10–57) months of follow-up, MACCE occurred in 46 patients (15.3%). The incidence of MACCE was much higher in the specific indication group than the on-label group (25.6% vs 13.6%, P=0.034). Conclusions: RA for specific indications, compared with on-label use, had a higher incidence of complications during the procedure and poorer long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Coronary calcium score (CCS) is a highly sensitive marker for estimating coronary artery calcification (CAC) and detecting coronary artery disease (CAD). Mean platelet volume (MPV (is a platelet indicator that represent platelet stimulation and production. The aim of the current study was to examine the association between MPV values and CAC. We examined 290 patients who underwent coronary computerized tomography (CT) exam between the years 2017 and 2020 in a tertiary care medical center. Only patients evaluated for chest pain were included. The Multi-Ethnic Study of Atherosclerosis (MESA) CAC calculator was used to categorize patients CCS by age, gender, and ethnicity to CAC severity percentiles (<50, 50-74, 75-89, ≥90). Thereafter, the association between CAC percentile and MPV on admission was evaluated. Out of 290 patients, 251 (87%) met the inclusion and exclusion criteria. There was a strong association between higher MPV and higher CAC percentile (P= .009). The 90th CAC percentile was associated with the highest prevalence of diabetes mellitus (DM), hypertension, dyslipidemia, and statin therapy (P =.002, .003, .001, and .001, respectively). In a multivariate analysis (including age, gender, DM, hypertension, statin therapy, and low-density lipoprotein level) MPV was found to be an independent predictor of CAC percentile (OR 1.55- 2.65, P < .001). Higher MPV was found to be an independent predictor for CAC severity. These findings could further help clinicians detect patients at risk for CAD using a simple and routine blood test. [ABSTRACT FROM AUTHOR]

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Background: Proteomic studies investigating novel molecular markers of coronary artery calcification (CAC) are scarce. This study compared the protein expression in the serum of patients with severe CAC and non-CAC. Methods: The serum from 30 patients with severe CAC and 30 matched-controls were screened by data-independent acquisition(DIA)-based proteomic technology. Bioinformatics analysis tools were used to analyze the underlying molecular mechanisms of the differentially expressed proteins. Candidate proteins were further validated by an enzyme-linked immunosorbent assay (ELISA) in an independent cohort. A receiver operating characteristic (ROC) curve was used to estimate the diagnostic power of the candidate proteins. Results: Among the 110 identified proteins, the expression of 81 was significantly upregulated, whereas 29 proteins were downregulated (fold change ≥1.5; p < 0.05) between patients with and without CAC. Bioinformatics analysis indicated that the differential proteins are involved in complement and coagulation cascades, platelet activation, regulation of actin cytoskeleton, or glycolysis/gluconeogenesis pathways. Further verification showed that serum levels of complement C5 (C5), fibrinogen gamma (FGG), pyruvate kinase isoform M2 (PKM2), and tropomyosin 4 (TPM4) were consistent with the proteomic findings, which could allow discrimination between CAC and non-CAC patients. Conclusions: This study revealed that high serum levels of serum C5, FGG, PKM2, and TPM4 proteins were linked to severe CAC. These proteins may be developed as biomarkers to predict coronary calcification. [ABSTRACT FROM AUTHOR]

Background: Calcified nodule (CN) is a type of potentially vulnerable plaque. Its formation mechanism remains unknown. This study was to assess serum marker and computed tomography angiography (CTA) characteristics of CN validated by intravascular ultrasound (IVUS).Methods: Patients who underwent coronary CTA followed by invasive coronary angiography and IVUS were retrospectively analyzed. Serum levels of alkaline phosphatase (ALP), gamma-glutamyltransferase, and calcium were collected.Results: IVUS detected 128 de novo calcified lesions in 79 patients with coronary artery disease (CAD). CNs were identified in 11.4% (9/79) of patients and 9.4% (12/128) of lesions. Compared with patients with non-nodular calcified plaques, CN patients had higher serum level of ALP (82.00 vs 65.00 U/L, P = 0.022) and total plaque volume (673.00 vs 467.50 mm3, P = 0.021). Multivariable analyses revealed that serum ALP level and total plaque volume were independently associated with the prevalence of CN in CAD patients with calcified plaques. At lesion level, the CN group had a higher frequency of moderate to heavy calcification on angiography (75.00% vs 40.52%, P = 0.017). In terms of CTA characteristics, plaques with CN had a more severe diameter stenosis (79.00% vs 63.00%, P = 0.007), higher plaque burden (85.40% vs 77.05%, P = 0.005), total plaque density (398.00 vs 283.50 HU, P = 0.008), but lower lipid percentage (14.65% vs 19.75%, P = 0.010) and fiber percentage (17.90% vs 25.65%, P = 0.011). Mean plaque burden is an independent predictor of the prevalence of CN in calcified plaques (odds ratio = 1.102, 95% confidence interval: 1.025-1.185, P = 0.009). The AUC is 0.753 (95% confidence interval: 0.615-0.890, P = 0.004). When using 84.85% as the best cutoff value, the diagnostic sensitivity and specificity of mean plaque burden for predicting the presence of CN within calcified plaques were 66.7% and 80.2%, respectively.Conclusions: CN had different CTA imaging features from non-nodular coronary calcification. The presence of a CN was associated with a higher serum ALP level and plaque burden. [ABSTRACT FROM AUTHOR]

Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted. • A total of 220 lesions (76.7% de novo lesions / DNL and 23.3% intra stentrestenosis/ISR) were treated by intravascular lithotripsy in 202 patients. • Procedural success was achieved in 95.5% of patients, with no difference between DNL and ISR groups (96.5% vs 92%; p=0.24). • MACE-free survival at 1 year was 86.6% in the overall cohort, with no difference between DNL and ISR (91.5% vs 83.8%; p = 0.15). [ABSTRACT FROM AUTHOR]

Introduction: Interventional cardiologists make adjustments in the presence of coronary calcifications known to limit stent expansion, but proper balloon sizing, plaque-modification approaches, and high-pressure regimens are not well established. Intravascular optical coherence tomography (IVOCT) provides high-resolution images of coronary tissues, including detailed imaging of calcifications, and accurate measurements of stent deployment, providing a means for detailed study of stent deployment.Objective: Evaluate stent expansion in an ex vivo model of calcified coronary arteries as a function of balloon size and high-pressure, post-dilatation strategies.Methods: We conducted experiments on cadaver hearts with calcified coronary lesions. We assessed stent expansion as a function of size and pressure of non-compliant (NC) balloons (i.e., nominal, 0.5, 1.0, and 1.5 mm balloons at 10, 20 and 30 atm). IVOCT images were acquired pre-stent, post-stent, and at all post-dilatations. Stent expansion was calculated using minimum expansion index (MEI).Results: We analyzed 134 IVOCT pullbacks from ten ex-vivo experiments. The mean distal and proximal reference lumen diameters were 2.2 ± 0.5 mm and 2.5 ± 0.7 mm, respectively, 80% of times using a 3.0 mm diameter stent. Overall, based on stent sizing, a good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at 20 atm, and expansion > 100% was reached using the 1:1 NC balloon at 30 atm. In the subgroup analysis, comparing low-calcified and high-calcified lesions, good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at nominal pressure (10 atm) versus using 1:1 NC balloon at 30 atm, respectively. Significant vessel rupture was identified in all the vessels mainly upon post-dilatation with larger balloons, and 60% of the experiments (6 vessels, 3 in each calcium subgroup) presented rupture with the +1.0 mm NC balloon at 20 atm.Conclusion: When treating calcified lesions, good stent expansion was reached using smaller balloons at higher pressures without coronary injuries, whereas bigger balloons yielded unpredictable expansion even at lower pressures and demonstrated potential harmful damages to the vessels. As these findings could help physicians with appropriate planning of stent post-dilatation for calcified lesions, it will be important to clinically evaluate the recommended protocol. [ABSTRACT FROM AUTHOR]

Moderate-severe calcification increases procedural complications and impairs long-term prognosis post-PCI. Intravascular imaging (particularly optical coherence tomography [OCT]) is useful in guiding the treatment of calcified lesions. Weighted sum of calcium length, arc, and thickness on OCT can predict adequate stent expansion, identifying when atherectomy is required. With intravascular imaging guidance, various techniques alone or in combination may be used in an algorithmic fashion to modify calcified lesions. Calcium fracture by balloon angioplasty, cutting/scoring balloons, intravascular lithotripsy (IVL), atherectomy devices, or Excimer laser improves stent expansion. Intravascular imaging is essential in the treatment of in-stent restenosis when luminal and/or abluminal peri-strut calcium is present [ABSTRACT FROM AUTHOR]

Intravascular lithotripsy (IVL) uses acoustic shock waves in a balloon-based delivery system to modify severely calcified atherosclerotic coronary vascular lesions in preparation for stent implantation. IVL results in circumferential and longitudinal calcium fracture, which improves transmural vessel compliance and facilitates subsequent stent expansion without requiring high-pressure balloon dilation. Clinical trials have demonstrated IVL to be safe (low rates of major adverse cardiac events in hospital and to 1 year; low rates of severe angiographic complications), effective (high rates of procedural success), and easy to use (little or no learning curve) when applied in the treatment of severely calcified coronary arteries. [ABSTRACT FROM AUTHOR]

Background: Calcified coronary lesions are challenging to the interventional cardiologists to manage. Debulking the calcified lesions with Rotablation is a well known strategy. Shockwave intravascular lithotripsy (IVL) is the newer novel therapeutic procedure found to be very effective in PCI of calcified lesions. Aims and Objectives: To assess the clinical utility of Shockwave IVL in densly calcified coronary lesions. Materials and Methods: Four patients underwent PCI with Shockwave IVL for densly calcified lesions between Febraury and March of 2020 and were followed up clinically in our centre. Results: All patients are doing well clinically without any coronary events. Conclusion: Shockwave IVL is safe and accepted modality of debulking the densly calcified coronary lesions and prepare the bed for optimal stent deployment.

Background and Objective: Angiographic assessment of chronic total occlusion (CTO) anatomy and collateral characteristics of coronary arteries are necessary for CTO intervention. Materials and Methods: This was a hospital-based observational study of 100 coronary angiograms (CAG) with CTOs. CTO anatomy and collateral characteristics of coronary arteries were studied for predicting anterograde and retrograde CTO intervention. Results: Right coronary artery (RCA) CTO was the most common (62%), followed by left anterior descending (LAD). More than two-thirds of RCA and LAD CTO lesions were >20 mm and half were in mid-segment. Left circumflex artery (LCX) and RCA lesions were more frequently calcified. LAD CTOs often had blunt stump; LCX CTOs frequently had bending >45°. The mean J-CTO score was lowest in RCA CTOs (2.0 ± 1.19). There were 10 different types of collaterals in RCA CTOs, 8 in LAD CTOs, and only 4 in LCX CTOs. The most common RCA CTOs collateral was LAD septal to the right posterior descending artery (RPDA) (69.4%) and in LAD CTOs, the most common was septal collaterals from the RPDA to LAD (40.9%). RCA CTOs had a higher percentage of septal collaterals, less tortuosity, and favorable entry and exit angle when compared with other two arteries. Conclusion: RCA CTOs were the most common. Angiographic features in CTO lesions vary among three major coronary arteries. The RCA CTOs had lesser mean J-CTO score, more number of septal collaterals, less tortuous collaterals, and favorable entry and exit angle. RCA CTOs were better accessible for anterograde and retrograde intervention.

This document is a reply to a letter regarding a recent publication titled "Association Between Red Blood Cell Distribution Width and Coronary Calcification in Patients Referred for Invasive Coronary Angiography." The authors express gratitude for the comments and provide additional information about their research methodology. They acknowledge limitations in their study, such as the lack of analysis on the association between red blood cell distribution width (RDW) and diseases of the peripheral and carotid arteries. The authors suggest that this area is worth exploring further. [Extracted from the article]

Obstructive sleep apnea (OSA) may accelerate arterial calcification, but the relation remains unexplored in diabetic kidney disease (DKD). We examined the associations between OSA, coronary calcification and large artery stiffness in patients with DKD and reduced renal function. Patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and urine albumin-creatinine ratio (UACR) > 30 mg/g were tested for OSA quantified by the apnea-hypopnea index (AHI, events/hour). Patients without OSA (AHI< 5) were compared to patients with moderate (AHI 15–29) or severe (AHI ≥30) OSA and underwent computed tomography angiography with coronary Agatston scoring (CAS) to quantify coronary calcification. Arterial stiffness was determined as carotid-femoral pulse wave velocity (PWV). Among 114 patients with acceptable AHI recordings had 43 no OSA, 33 mild OSA and 38 moderate-severe OSA. Mean age of the 74 patients completing the study was 71.5 ± 9.4 years (73% males), eGFR 32.2 ± 12.3 ml/min/1.73 m2 and UACR 533 (192–1707) mg/g. CAS (ln-transformed) was significantly higher in patients with OSA compared to patients without (6.6 ± 1.7 vs. 5.6 ± 2.4, p = 0.04), and the same was observed for PWV (11.9 ± 2.7 vs. 10.5 ± 2.2 m/s, p = 0.02). In multivariable linear regression analyses adjusted for sex, age, body mass index, UACR, and mean arterial pressure, moderate-severe OSA remained significantly associated with PWV but not with CAS. Dominance analysis revealed OSA as the third and second most important factor relative to CAS and PWV respectively. In DKD patients, moderate-severe OSA is a significant predictor of arterial stiffness but is not independently associated with coronary calcification. [Display omitted] • Obstructive sleep apnea (OSA) is associated with cardiovascular disease. • OSA is very frequent in diabetic kidney disease (DKD) patients. • OSA has more impact on large artery stiffness than coronary calcification in DKD. [ABSTRACT FROM AUTHOR]