Mortality impact of low CAC density predominantly occurs in early atherosclerosis: explainable ML in the CAC consortiumOriginal TOC summary: We used SHAP, an explainable machine learning (ML) technique, to determine the risk predictive value and age interaction of coronary artery calcium (CAC) characteristics among 63,215 asymptomatic patients in the CAC consortium. The addition of CAC density and number of calcified vessels to an ML model with clinical characteristics + CAC did not improve prediction for all-cause mortality (p = 0.23), but did improve for cardiovascular mortality (p = 0.03). Lower CAC density increased mortality, particularly very low CAC density ≤0.75, which occurred predominantly in CAC1-100. Explainable ML should be applied in clinical research for transparent predictive modeling.
Coronary volume to left ventricular mass ratio in patients with diabetes mellitusDiabetes mellitus is a major risk factor for coronary artery disease (CAD) and may provoke structural and functional changes in coronary vasculature. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes.
Detection of small coronary calcifications in patients with Agatston coronary artery calcium score of zeroThe conventional Agatston coronary artery calcium score (CACS) method may fail to detect very small or less dense calcified plaques; smaller than 3 continuous pixels (1 mm2) or with a density lower than 130 Hounsfield Units (HU). A significant proportion of patients classified as CACS = 0, could potentially be reclassified as >0 by altering these thresholds. The increased sensitivity with lower HU threshold comes at a cost of reduced specificity by introducing false positive (noise) cases. Modifying the threshold to <1 mm 2 and HU > 120, allows 12.1% of patients with CACS = 0 to be reclassified as CACS> 0 while introducing only 0.9% of noise.
Comparison of coronary atherosclerotic plaque progression in East Asians and Caucasians by serial coronary computed tomographic angiography: A PARADIGM substudyTo investigate potential differences in plaque progression (PP) between in East Asians and Caucasians as well as to determine clinical predictors of PP in East Asians.
Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registryThe role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.
Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRctThe degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone.
The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiographyHigh amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain.
The clinical utility of FFRCT stratified by ageCT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known.
Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM studyDifferent methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.
Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patientsWe aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores – which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) – and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders.
A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiographyNon-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated.
Rationale and design of the coronary artery calcium consortium: A multicenter cohort studyAlthough coronary artery calcium (CAC) has been investigated for over two decades, there is very limited data on the association of CAC with cause of death. The CAC Consortium is a large ongoing multi-center observational cohort of individuals who underwent non-contrast cardiac-gated CAC testing and systematic, prospective, long-term follow-up for mortality with ascertainment of cause of death.