Comparability of coronary risk assessment methods with chest ultra-LDCT and CT coronography with ECG synchronization

Purpose. To assess the comparability of coronary calcium values measured on ultralow-dose computed tomography studies without ECG-synchronization versus a) non-contrast computed tomography with ECG synchronization, b) CT coronography with ECG synchronization.Materials and methods. The study comprised 283 studies: 68 patients who underwent contrast-free ultra-LDCT without ECG synchronization and contrast-free CT with ECG synchronization performed in a single visit, and 49 patients with contrast-free ultra-LDCT without ECG synchronization, non-contrast CT with ECG synchronization, and CT coronography with ECG synchronization and intravenous injection of contrast agent, also carried out in one visit, meeting all inclusion and exclusion criteria of the study.Quantitative coronary calcium values were calculated with the Agatston score and the CAC-DRS scale (score of calcification degree from 0 to 3 and the number of affected arteries from 0 to 4 points). The degree of coronary artery stenosis was analyzed with CAD-RADS scale (0-5).The above parameters were compared using visual/quantitative assessment of coronary calcium on ultra-LDCT without ECG synchronization and visual/quantitative assessment for CT with ECG synchronization, as well as the degree of stenosis on CT coronography in the same patients.Results. Based on the results of accuracy indices comparison, the possibility to use quantitative scale (Agatston score, CAC-DRS quantitative scale) to assess coronary calcification in the lung cancer screening in comparison with ECG-synchronized CT was determined during interpretation of ultra-LDCT without ECG synchronization. The correlation matrix to assess correlation between visual, quantitative scales of coronary artery changes and calcification at ultra-LDCT without ECG synchronization and quantitative scale at CT with ECG synchronization vs. CT coronography identifies very strong positive statistically significant correlations.Conclusion. Methods of coronary calcinosis assessment with chest ultra-LDCT and CT with ECG synchronization are comparable, therefore it is possible to assess coronary calcium in lung cancer screening by ultra-LDCT data at a reliable-high level using both quantitative and visual CAC-DRS scales.

Matrix Gla-protein expression in peripheral blood mononuclear cells is related to risk factors in cardiovascular diseased patients

Objectives Matrix Gla protein (MGP) is a calcification inhibitor that plays a role in preventing soft tissue calcification and local mineralization of the vascular wall. The present study aimed to assess the expression of MGP in Peripheral Blood Mononuclear Cells (PBMC) in adult patients with CVD pathologies and its association with the presence and severity of coronary artery calcium score (CACS) and conventional CVD risk factors. Methods MGP expression was measured in 87 individuals using real time qPCR. Subgrouping was performed according etiologic and metabolic CVD risk factors. Results A clear trend for a decreased MGP expression was observed in all subgroups with high CVD risk. This decrease was significant in abdominally obese hypertensive individuals and in those with dyslipidemia. MGP expression was significantly lower in patients representing high Total cholesterol and LDL cholesterol levels. A positive correlation between MGP expression and smoking status in patients with coronary calcium and in the CVD group was established. Atrial hypertension duration correlated negatively with MGP expression in the group without coronary calcium deposits. Conclusions The current study supports the hypothesis that MGP expression in PBMC probably reflects CVD pathology and is related to lipid metabolism dysregulation.

260 Impact of ‘atherosclerotic pabulum’ on in hospital mortality for SARS-CoV-2 infection. Is calcium score alone enough to identify at risk patients?

Although the primary cause of death in COVID-19 infection is respiratory failure, there are evidences that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID-19 is associated with a high incidence of thrombotic complications. Two-hundred-eighty-four patients with proven SARS-CoV-2 infection who had a non-contrast Chest CT at our facility were analysed for coronary calcium score. Clinical and radiological data were retrieved. Patients with coronary calcium had higher inflammatory burden at admission (d-dimer, CRP, Procalcitonin) and higher Troponin at admission and at zenith. While there was no correlation with presence of consolidation and ground glass opacities, patients with coronary calcium had higher incidence of bilateral infiltration and higher in-hospital mortality. Peak troponin was associated with higher mortality, intensive care unit admission and mechanical ventilation in both univariable at multivariate analysis. Calcium score has demonstrated to be a good prognostic indicator for in-hospital mortality in patients with SARS-CoV-2 infection. Patients with higher atherosclerotic burden are at higher risk of fatality and complications. Our findings could have significant clinical implications in selecting at risk patients for allocation of resources especially in those with ‘atherosclerotic pabulum’, where inflammation activated by SARS-CoV-2 may play a role in fatal and non-fatal events.