Coronary artery calcium detected by digital fluoroscopy and risk factors in healthy subjects

Machine Learning Approach for Cardiovascular Risk and Coronary Artery Calcification Score

Coronary artery calcification (CAC) could assist in the discovery of new risk elements for coronary artery disorder. CAC evaluation, on the other hand, is difficult due to the wide range of CAC in the populations. As a reason, evaluating and analysing data among research have become complicated. In the Research of Inherited Risk Factors for Coronary Atherosclerosis, we used CAC information to test the effects of different analytical methodologies on the correlation with recognized cardiovascular risk elements in asymptomatic patients. Cardiac computed tomography (CT) is also seeing an increase in examinations, and machine learning (ML) could assist with the growing amount of extracted data. Furthermore, there are other sectors in cardiac CT where machine learning could be crucial, including coronary calcium scoring, perfusion, and CT angiography. The establishment of risk evaluation algorithms based on information from CAC utilizing machine learning could assist in the categorization of patients undergoing cardiovascular into distinct risk groups and effectively adapt their treatments to their unique situations. Our findings imply that for forecasting CVD occurrences in asymptomatic people, age-sex segmentation by CAC percentile rank is as effective as absolute CAC scoring. Longitudinal population-based investigations are currently underway and would offer further definitive findings. While machine learning is a strong technology with a lot of possibilities, its implementations in the domain of cardiac CAC are generally in the early stages of development and are not currently commonly accessible in medical practise because of the requirement for substantial verification. Enhanced machine learning will, however, have a significant effect on cardiovascular and coronary artery calcification in the upcoming years.

Coronary artery calcium by digital cinefluoroscopy in patients with pain suggestive of an acute coronary syndrome

BACKGROUND

Detection of coronary calcium may be a useful noninvasive approach for detecting coronary artery disease (CAD) in subjects presenting to the emergency department with chest pain.

HYPOTHESIS

We tried to assess the diagnostic value of coronary artery calcium (CAC) detection by digital cinefluoroscopy in patients with new-onset chest pain suggestive of an acute coronary syndrome.

METHODS

In 97 consecutive patients (70 men, 27 women, mean standard deviation [SD] age 55 (11) and 60 (8) years, respectively), with new-onset chest pain suggestive of an acute coronary syndrome, nondiagnostic electrocardiogram, and normal initial creatine kinase (CK)-MB, digital cinefluoroscopy was performed for CAC detection.

RESULTS

All patients underwent routine clinical evaluation with treadmill exercise test, thallium scintigraphy, dobutamine stress echocardiography, and coronary angiography, as needed clinically and blinded to the cinefluoroscopy results. Coronary artery calcium was present in 27 of 33 (81.8%) of patients with and in 10 of 64 (15.6%) of patients without CAD, p < 0.0001. The presence of CAC had 82% sensitivity, 84% specificity, 73% positive predictive value, and 90% negative predictive value for CAD diagnosis (odds ratio = 24.3, 95% confidence interval 7.98-73.94).

CONCLUSIONS

In patients with acute chest pain, nondiagnostic electrocardiogram and normal initial enzyme evaluation, CAC detection by digital cinefluoroscopy appears to have high sensitivity, specificity, and negative predictive value for CAD diagnosis.

Coronary calcium detected by digital cinefluoroscopy and coronary artery disease in patients undergoing coronary arteriography: effects of age and sex

BACKGROUND

Coronary artery calcium, detected non-invasively, correlates well with angiographically documented coronary artery disease (CAD). This study was conducted to evaluate the diagnostic efficacy of coronary artery calcium detected by digital cinefluoroscopy for CAD and assess the effects of age and sex on it.

METHODS

In 242 patients who underwent coronary angiography, coronary calcium status was determined and related to angiographic findings.

RESULTS

Calcium detection had a sensitivity 85%, specificity 52%, positive predictive value 92%, negative predictive value 33% and diagnostic accuracy 81% for significant CAD. There was a better positive predictive value in men (95% vs. 80%) and negative predictive value in women (65% vs. 16%), while a higher sensitivity and diagnostic accuracy was found in older than in younger (90% and 86% vs. 78% and 74%). The sensitivity of the method increased with the number of the diseased vessels.

CONCLUSIONS

Coronary calcium can be quite accurately detected by digital cinefluoroscopy. This, however, should be made in the context of sex and age.

Coronary arteriographic findings in symptomatic and asymptomatic subjects with coronary artery calcification

The relation of coronary artery calcification with the presence of symptoms of coronary artery disease and its angiographic severity is not clear. We studied 37 apparently healthy, asymptomatic subjects that were found by digital cinefluoroscopy to have coronary calcium and compared to age- and sex-matched group of patients with coronary calcium and symptomatic coronary artery disease. Normal coronary arteries and non-obstructive lesions only were found in 12/37 (32.4%) and 11/37 (29.7%) asymptomatic subjects vs. 1/37 (2.7%) and 2/37 (5.4%) patients; P<0.001 and P<0.012, respectively. Obstructive lesions were more rare in asymptomatic subjects than in patients, 14/37 (37.8%) vs. 34/37 (91.9%) (P<0.0001), as well as total occlusions, 2/37 (5.4%) vs. 10/37 (27%) (P<0.024). Median worst lesion stenosis was 30% in asymptomatic subjects and 95% in patients (P<0.0001). In asymptomatic usual cardiovascular risk subjects, coronary calcium detection by digital cinefluoroscopy is accompanied by a relatively high probability of obstructive disease, although less severe angiographically than in age- and sex-matched catheterized patients with symptomatic coronary artery disease.

Association of traditional risk factors with coronary calcification in persons with a family history of premature coronary heart disease: the study of the inherited risk of coronary atherosclerosis

BACKGROUND

Genetic factors strongly influence the risk of coronary heart disease (CHD), but their contribution to variation in coronary atherosclerosis beyond that measured by traditional CHD risk factors is uncertain.

METHODS

We recruited healthy subjects with family histories of premature CHD. We assessed traditional risk factors and performed electron beam tomography (EBT) to quantitate coronary artery calcification (CAC), a marker of coronary atherosclerosis. Persons with significant risk factors that included diabetes, total cholesterol >300 mg/dL, active cigarette smoking, and poorly controlled hypertension were excluded from the study. In this paper, we report on the relationship between traditional risk factors and CAC in this cohort.

RESULTS

The incidence of coronary calcification was significantly higher in this cohort than in the population-based Rochester Heart Study. In our cohort, most traditional risk factors were significantly associated with CAC on univariate analysis. On the other hand, in stepwise logistical regression, age and triglycerides were the only predictors of variation in CAC in men and accounted for only 30% of the variation; in women, age, body mass index (BMI), and triglycerides were the only traditional risk factors significantly associated with CAC variation and accounted for 22.2% of CAC variance.

CONCLUSIONS

In a cohort of subjects specifically selected for the characteristic of a family history of premature CHD, traditional risk factors accounted for less than one-third of the variation in CAC, and the most important predictors of CAC after age were plasma triglycerides. This supports the opinion that other inherited risk factors have important effects on the variation in coronary atherosclerosis and that the strategy of using EBT to phenotype clinically asymptomatic subjects with regard to coronary atherosclerosis may be a useful tool for identification of genes that are associated with CHD.