Search Results (67)

Early stages of chronic kidney disease (CKD) are closely associated with vascular remodeling and coronary artery calcification. The aim of this study is to determine whether adropin is associated with asymptomatic coronary calcification in patients in the early stages of CKD. This study enrolled 337 individuals fulfilling the inclusion criteria of the early stages of CKD (G1–2, A1–3) and divided them into two subgroups with (n = 196) and without (n = 141) asymptomatic coronary artery calcification. Native coronary multi-detector computed tomography angiography was conducted to determine coronary artery calcification, which was stratified into four grades according to the Agatston method. Serum levels of adropin were measured by ELISA. The patients with known asymptomatic coronary artery calcification had significantly lower levels of adropin than those without this condition. The levels of adropin in individuals with mild (130–199 HU), moderate (200–299 HU), severe (300–399 HU) and very severe (≥400 HU) calcification were 3.13 (95% CI = 1.92–4.21) ng/mL, 2.3 (95% CI = 1.45–3.6) ng/mL, 2.1 (95% CI = 1.22–3.25) ng/mL and 1.26 (95% CI = 1.13–1.98) ng/mL, respectively. In multivariate logistic regression low adropin (<2.95 ng/mL), a presence of hypertension, type 2 diabetes mellitus (T2DM) exerted their independent potencies to predict asymptomatic coronary calcification. Moreover, adropin demonstrated better discriminative potency than concomitant hypertension and T2DM. Conclusions: Low levels of circulating adropin significantly predicted a risk of coronary artery calcification in patients in the early stages of CKD. Full article

Radiographic axial spondyloarthritis (r-axSpA) is associated with increased cardiovascular disease (CVD) risk. The coronary artery calcification (CAC) score, an atherosclerosis burden indicator that predicts CVD risk, is not well studied in r-axSpA. This study investigates CAC scores in patients with r-axSpA compared to controls without rheumatic disease and factors associated with CAC scores in r-axSpA patients. Fifty-eight r-axSpA patients from southwestern Sweden were assessed cross-sectionally using clinical disease measures, physical function, spinal mobility, lipid profiles, inflammation markers, and long-term time-averaged C-reactive protein (CRP). Four controls per patient were selected from the Swedish CArdioPulmonary bioImage Study (SCAPIS). CAC was scored on cardiac computed tomography (CT) using the Agatston method. The presence of CAC in the right coronary artery (RCA) was higher in patients compared to controls. However, no significant difference in total CAC scores was observed between r-axSpA patients and controls, despite numerically higher total CAC scores in patients. In r-axSpA patients, CAC scores correlated positively with time-averaged CRP, reduced physical function, and impaired spinal mobility. These findings suggest that chronic inflammation may contribute to coronary calcification and CVD risk in r-axSpA, highlighting the need for effective anti-inflammatory treatments. Further research is warranted to explore the association between coronary calcification, spinal immobility, and limitations in physical function. Full article

Background: Cardiovascular diseases are the leading cause of global mortality, with 80% of coronary heart disease in patients over 65. Understanding aging cardiovascular structures is crucial. Photon-counting computed tomography (PCCT) offers improved spatial and temporal resolution and better signal-to-noise ratio, enabling texture analysis in clinical routines. Detecting structural changes in aging left-ventricular myocardium may help predict cardiovascular risk. Methods: In this retrospective, single-center, IRB-approved study, 90 patients underwent ECG-gated contrast-enhanced cardiac CT using dual-source PCCT (NAEOTOM Alpha, Siemens). Patients were divided into two age groups (50–60 years and 70–80 years). The left ventricular myocardium was segmented semi-automatically, and radiomics features were extracted using pyradiomics to compare myocardial texture features. Epicardial adipose tissue (EAT) density, thickness, and other clinical parameters were recorded. Statistical analysis was conducted with R and a Python-based random forest classifier. Results: The study assessed 90 patients (50–60 years, n = 54, and 70–80 years, n = 36) with a mean age of 63.6 years. No significant differences were found in mean Agatston score, gender distribution, or conditions like hypertension, diabetes, hypercholesterolemia, or nicotine abuse. EAT measurements showed no significant differences. The Random Forest Classifier achieved a training accuracy of 0.95 and a test accuracy of 0.74 for age group differentiation. Wavelet-HLH_glszm_GrayLevelNonUniformity was a key differentiator. Conclusions: Radiomics texture features of the left ventricular myocardium outperformed conventional parameters like EAT density and thickness in differentiating age groups, offering a potential imaging biomarker for myocardial aging. Radiomics analysis of left ventricular myocardium offers a unique opportunity to visualize changes in myocardial texture during aging and could serve as a cardiac risk predictor. Full article

(1) Background: Our aim was to evaluate the diagnostic performance of combined coronary computed tomography angiography (CCTA) and dynamic CT myocardial perfusion imaging (CT-MPI) for detecting hemodynamically significant coronary artery disease (CAD) in patients with intermediate pretest probability. (2) Methods: Patients with an intermediate pretest probability of CAD were retrospectively enrolled. All patients underwent CCTA and dynamic CT-MPI using a third-generation dual-source CT scanner prior to invasive coronary angiography (ICA). Anatomically significant stenosis was defined as ≥50% luminal narrowing on both CCTA and ICA. Fractional flow reserve (FFR) was performed during ICA in selected cases. Hemodynamically significant CAD was defined per vessel as FFR ≤ 0.80, angiographic stenosis ≥70%, or having undergone revascularization. The diagnostic performance of CCTA alone and CCTA combined with CT-MPI was compared against this reference standard. (3) Results: Seventy-four patients (mean age, 66.8 ± 11.1 years; 59 men) were included. The median coronary calcium score was 508.5 Agatston units (interquartile range: 147–1173). ICA and CCTA detected anatomically significant stenoses in 137 (61.7%) and 146 (65.8%) coronary vessels, respectively, and in 62 (83.8%) and 71 (95.9%) patients, respectively. Hemodynamically significant stenosis was present in 56 patients (76%) and 99 vessels (45%). On a per-vessel basis, CCTA alone yielded a sensitivity of 96.7%, specificity of 60.3%, positive predictive value (PPV) of 64.4%, and negative predictive value (NPV) of 96.1%. Combined CCTA and CT-MPI demonstrated a sensitivity of 90.1%, specificity of 84.3%, PPV of 82.7%, and NPV of 91.1%. The area under the receiver operating characteristic curve improved from 0.787 (95% confidence interval: 0.73–0.84) for CCTA to 0.872 (95% confidence interval: 0.82–0.91) for the combined approach (p < 0.05). The median total radiation dose for both CCTA and CT-MPI was 8.05 mSv (interquartile range: 6.71–11.0). (4) Conclusions: In patients with intermediate pretest probability of CAD, combining CCTA with dynamic CT-MPI significantly enhances the diagnostic performance for identifying hemodynamically significant coronary stenosis compared to CCTA alone. Full article

Background/Objectives: Bisphosphonates may influence vascular calcification and atheroma formation via farnesyl pyrophosphate synthase inhibition in the mevalonate pathway regulating bone and lipid metabolism. However, the clinical impact of NCB use on cardiovascular outcomes remains uncertain, largely due to methodological heterogeneity in prior studies. We aimed to evaluate the association between nitrogen-containing bisphosphonate (NCB) therapy and coronary artery calcium (CAC) progression, as well as the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) events. Methods: From 6814 participants in MESA Exam 1, we excluded males (insufficient male NCB users in the MESA cohort), pre-menopausal women, baseline NCB users, and users of hormone replacement therapy, raloxifene, or calcitonin. Among 166 NCB initiators and 1571 non-users with available CAC measurements, propensity score matching was performed using the available components of FRAX, namely age, race, BMI, LDL cholesterol, alcohol, smoking, and steroid use, and baseline CAC yielded 165 NCB initiators matched to 473 non-users (1:3 ratio). Linear mixed-effects models evaluated CAC progression, and Cox models analyzed incident CVD and CHD events. Results: In the overall cohort, NCB use was not significantly associated with CAC progression (annual change: −0.01 log Agatston units; 95% CI: −0.05 to 0.01). However, among participants with a baseline estimated glomerular filtration rate (eGFR) < 65 mL/min/1.73 m², NCB use was associated with attenuated CAC progression compared with non-users (−0.06 log Agatston units/year; 95% CI: −0.12 to −0.007). No significant association was observed between NCB use and incident CVD events in the overall cohort (HR: 0.90; 95% CI: 0.60−1.36) or within kidney function subgroups. Conclusions: Incident NCB use among postmenopausal women with mild or no CAC at baseline was associated with reduced CAC progression only in women with impaired kidney function. However, this association did not correspond to a decreased risk of subsequent cardiovascular events, suggesting that the observed imaging benefit may not translate into meaningful clinical association. Full article

Background and Objectives: Screening, primary prevention, and the early identification of high-risk individuals are crucial for minimising the burden of cardiovascular diseases (CVDs). In this study, we aimed to evaluate the association of retinal microvascular features with myocardial dysfunction and CVD risk factors in a group of patients with significant coronary artery disease (CAD) compared to patients with newly diagnosed isolated arterial hypertension and healthy controls. Materials and Methods: We performed a single-centre cross-sectional study on 214 individuals divided into three groups: a group of 99 cases diagnosed with significant CAD, a group of 61 cases with newly diagnosed isolated arterial hypertension, and a control group of 54 cases with no confirmed cardiovascular pathology. Colour optic disc-centred retinal photographs were taken in all cases, and the following parameters were quantified using MONA REVA 3.0.0 software (VITO Health, Mol, Belgium): central retinal arteriolar equivalent, central retinal venular equivalent, arteriovenous ratio, fractal dimension, tortuosity index, and lacunarity. Univariable and multivariable statistical analyses were performed to assess changes in retinal microvascular features in CVD. Results: Dyslipidaemia (p = 0.009), systolic blood pressure (p = 0.008), and LDL cholesterol (p = 0.003) were negatively associated while left ventricular (LV) strain (0.043) was positively associated with the CRAE. In the case of the CRVE, the coronary Agatston score (p = 0.016) proved a positive and HDL cholesterol (p = 0.018) a negative association. A lower fractal dimension was associated with the presence of diabetes mellitus (p = 0.006), dyslipidaemia (p = 0.011), and a history of acute myocardial infarction (p = 0.018), while a higher fractal dimension was associated with increased left ventricular ejection fraction (LVEF) (p = 0.006) and medical treatment (p = 0.005). Lacunarity was higher in patients of female gender (p = 0.005), with decreased HDL (p = 0.014) and LVEF (0.005), and with increased age (p < 0.001) and Agatston score (p = 0.001). The vessel tortuosity index increased with LV strain (p = 0.05), medical treatment (p = 0.043), and male gender (p = 0.006). Conclusions: Retinal microvascular features may serve as additional risk stratification tools in patients with CVD, particularly CAD, pending prospective validation. Full article

Background: Cardiovascular risk assessment relies heavily on coronary calcium scoring. With an emphasis on varying slice increments, this study investigates the effectiveness of true and virtual non-contrast reconstructions on photon-counting CT. Reconstruction methods’ effects on calcium severity classifications are critical to the improvement in imaging techniques. Methods: This study comprised 77 participants (mean age: 63 ± 10 years, 43% female), of whom 0 had a coronary artery calcium score (CACS) of zero. In contrast to true non-contrast (TNC) 3 × 3 mm, the reconstructions included TNC 3 × 1.5 mm, virtual non-contrast (VNC) 3 × 3 mm, and VNC 3 × 1.5 mm. Agatston units served as the basis for classifications into standard clinical diagnostic categories. Results: High concordance between acquisition types was revealed by interclass correlation values (0.97–0.99). Comparing TNC 3 × 1.5 mm reconstructions to their VNC counterparts, misclassifications were less common (Cohen Kappa = 0.94). (K = 0.83–0.85). Significant differences in the average calcium scores and rates of misclassification highlighted the impact of reconstruction methods on precise evaluations. Conclusions: VNC methods demonstrated high agreement; however, with a small rate of misclassifications as compared to the gold standard method. VNC CACS may help optimize workflows but may need differing cutoffs as compared to traditional methods. Full article

Background: There is a large overlap in the risk profiles and pathophysiologies of coronary artery disease (CAD) and cerebrovascular macroangiopathy. Therefore, this study aimed to analyse whether findings in CAD examination by coronary angiography or cardio-computer tomography (cardio-CT) are predictive of cerebrovascular macroangiopathy. Methods: Our study was a prospective, bicentric, cross-sectional cohort study. A total of 191 patients without earlier CAD diagnosis who underwent a cardio-CT scan or coronary angiography for the screening of CAD during clinical routine were serially included. Two groups were formed based on the criterion of CAD (yes/no), and both were subsequently examined using sonography of the carotids. The CAD scores Syntax score I, Agatston equivalent score, and CAD-RADS score as well as AHA classification were determined. In cerebrovascular examinations, plaques and stenoses of the internal carotid artery (ICA) and the intima-media thickness (IMT) of the common carotid artery were analysed. Demographic and medical data such as the presence of arterial hypertension, diabetes mellitus, obesity, nicotine abuse, and dyslipidaemia were documented. The primary endpoint was the nominal association between CAD and ICA stenosis controlled for age and gender; secondary endpoints were correlations between ICA stenoses and CAD scores. Results: Of the 191 serially recruited patients (58% male, 65 ± 11 yrs.), 101 fulfilled CAD criteria; 90 did not. Of all patients, 137 had ICA plaques, and 11 thereof had an ICA stenosis ≥ 50%. No association was found between CAD and ICA stenosis (Wald = 0.24; p = 0.624). Accordingly, there was no association between IMT and Syntax score I (Wald = 0.38; p = 0.706), Agatston equivalent score (Wald = 0.89; p = 0.380), CAD-RADS score (Wald = 0.90; p = 0.377), or AHA classification (Wald = 0.21; p = 0.837). Common cardiovascular risk factors, i.e., arterial hypertension (Wald = 4.47; p = 0.034), diabetes mellitus (Wald = 7.61; p = 0.006), and nicotine abuse (Wald = 0.83; p = 0.028), were associated with newly diagnosed CAD but not with ICA plaques, stenosis, or increased IMT. Conclusions: In our cohort, newly diagnosed CAD was associated with typical risk factors. However, neither CAD nor these risk factors were associated with cerebrovascular disease. This suggests that in patients without prior CAD diagnosis, findings from CAD examinations might not be reliably predictive of cerebrovascular disease. Full article

Background: Patients with heterozygous familial hypercholesterolemia (HeFH) are at a high risk of atherosclerotic cardiovascular disease. The coronary artery calcification (CAC) score by the Ct-scan Agatston calcium score (ACS) > 100 classifies FH at a higher risk. The echocardiographic calcium score (ECS) evaluates aortic valve calcifications and is considered a good predictor of the atherosclerotic burden and cardiovascular outcome. Objective: To test the ECS as a predictor of ACS > 100 in a HeFH cohort. Methods: A coronary calcium CT scan with the calculation of ACS and an at rest-transthoracic echocardiogram with ECS evaluation were performed in 81 HeFH patients. Patients were divided into two groups according to the ACS: high-risk ACS patients (High-ACS) with Agatston value > 100 and low risk ACS patients (Low-ACS) with Agatston value ≤ 100. Patients were stratified according to ECS = 0 or ECS > 0. Results: High-ACS patients were older than Low-ACS patients; BMI, waist circumference, and blood systolic pressure were significantly higher (p < 0.001) in High-ACS patients. The ECS predicted an ACS > 100 with sensitivity = 0.84, specificity = 0.89, accuracy = 0.86, and precision = 0.76. Conclusions: The ECS could be a good surrogate of a coronary calcium CT scan for ACS evaluation in the specific subset of HeFH patients. Full article

Objectives: Our study aims to investigate the correlation between epicardial adipose tissue (EAT) volume assessed with non-contrast cardiac CT (NCCCT) and sex, age, coronary artery disease reporting and data system (CAD-RADS 2.0) categories, and coronary artery calcification (CAC) extent. The secondary aim is to establish the average values of EAT in a population considered healthy for coronary artery disease (CAD). Materials and Methods: We retrospectively analyzed patients who underwent coronary computed tomography angiography (CCTA) at our institution from January 2023 to August 2024. The CAD-RADS 2.0 scoring system was applied to assess the extent of CAD; CAC extent was quantified according to the Agatston score. EAT was segmented semi-automatically in NCCCT images, and its volume was subsequently measured. Correlation analyses between EAT volume, sex, patient age, CAC, and CAD-RADS categories were conducted. Results: A total of 489 consecutive patients met the inclusion criteria (63.96 ± 12.18 years; 214 females). The mean EAT volume ± SD in those categorized as CAD-RADS 0 (57.25 ± 15.45 years, 120 patients) was 117.43 ± 50.30 cm³: values were higher in men (121.07 ± 53.31 cm³) than in women (114.54 ± 47.98 cm³). EAT volumes positively correlated with age, male sex, CAD severity, and CAC scores. Conclusions: According to our results, males in all CAD-RADS categories have a greater amount of EAT than females. A positive correlation between the volume of EAT and factors such as age (p = 0.003), CAD-RADS categories (p: 0.004), and coronary calcium score (p = 0.0001) with a strong influence exerted by sex was demonstrated. Our results reinforce the observation that higher EAT volumes are associated with a more severe coronary artery disease. Full article

Background/Objectives: As an endocrine organ, adipose tissue produces adipokines that influence coronary artery disease (CAD). The objective of this study was to assess the potential value of CTRP5 and chemerin in differentiating coronary computed tomography angiography (CCTA)-confirmed coronary artery disease (CAD) versus non-CAD. Secondarily, within the CCTA-confirmed CAD group, the aim was to investigate the relationship between the severity and extent of CAD, as determined by coronary artery calcium score (CACS), and the levels of CTRP5 and chemerin. Methods: Consecutive individuals with chest pain underwent CCTA to evaluate coronary artery anatomy and were divided into two groups. The CCTA-confirmed CAD group included patients with any atherosclerotic plaque (soft, mixed, or calcified) regardless of calcification, while the non-CAD group consisted of individuals without plaques on CCTA, with zero CACS, and without ischemia on stress ECG. Secondarily, in the CCTA-confirmed CAD group, the severity and extent of CAD were evaluated using CACS. Blood samples were collected and stored at −80 °C for analysis of CTRP5 and chemerin levels via ELISA. Results: Serum CTRP5 and chemerin levels were significantly higher in the CAD group compared to the non-CAD group (221.83 ± 103.81 vs. 149.35 ± 50.99 ng/mL, p = 0.003 and 105.02 ± 35.62 vs. 86.07 ± 19.47 ng/mL, p = 0.005, respectively). Receiver operating characteristic (ROC) analysis showed that a CTRP5 cutoff of 172.30 ng/mL had 70% sensitivity and 73% specificity for identifying CAD, while a chemerin cutoff of 90.46 ng/mL had 61% sensitivity and 62% specificity. A strong positive correlation was observed between CTRP5 and chemerin, but neither adipokine showed a correlation with the Agatston score, a measure of CAD severity and extent, nor with coronary artery stenosis as determined by CCTA. Conclusions: CTRP5 and chemerin were significantly elevated in the CCTA-confirmed CAD group compared to the non-CAD group, with CTRP5 showing greater sensitivity and specificity. However, neither adipokine was linked to CAD severity and extent, differing from findings based on invasive coronary angiography (ICA). CTRP5 may serve as a promising “all-or-none biomarker” for CAD presence. Full article

Objective: This study develops a BI-RADS-like scoring system for vascular microcalcifications in mammographies, correlating breast arterial calcification (BAC) in a mammography with coronary artery calcification (CAC), and specifying differences between microcalcifications caused by BAC and microcalcifications potentially associated with malignant disease. Materials and Methods: This retrospective single-center cohort study evaluated 124 consecutive female patients (with a median age of 57 years). The presence of CAC was evaluated based on the Agatston score obtained from non-enhanced coronary computed tomography, and the calcifications detected in the mammography were graded on a four-point Likert scale, with the following criteria: (1) no visible or sporadically scattered microcalcifications, (2) suspicious microcalcification not distinguishable from breast arterial calcification, (3) minor breast artery calcifications, and (4) major breast artery calcifications. Inter-rater agreement was assessed in three readers using the Fleiss’ kappa, and the correlation between CAC and BAC was evaluated using the Spearman’s rank-order and by the calculation of sensitivity/specificity. Results: The reliability of the visual classification of BAC was high, with an overall Fleiss’ kappa for inter-rater agreement of 0.76 (ranging between 0.62 and 0.89 depending on the score). In 15.1% of patients, a BAC score of two was assigned indicating calcifications indistinguishable regarding vascular or malignant origin. In 17.7% of patients, minor or major breast artery calcifications were found (BAC 3–4). BAC was more prevalent among the patients with CAC (p < 0.001), and the severity of CAC increased with the BAC score; in the group with a BAC score of one, 15% of patients exhibited mild and severe CAC, in those with a BAC of two, this was 31%, in those with BAC of three, this was 38%, and in those with a BAC of four, this was 44%. The sensitivity for detecting CAC, based on the mammographic BAC score, was 30.3% at a specificity of 96.7%. Conclusions: The standardized visual grading of BAC in mammographies on a four-point scale is feasible with substantial interobserver agreement, potentially improving the treatment of patients with suspicious microcalcifications and CAC. Full article

The introduction of CT scans and the subsequent Agatston score in the 1990s drastically improved our ability to detect coronary artery calcification (CAC). This led to its incorporation into cardiovascular risk assessment guidelines set forth by organizations such as the American Heart Association (AHA) and the American College of Cardiology (ACC). Over time, these guidelines have evolved significantly, reflecting an increasing understanding of CAC. Physical activity has become a key factor in the management of cardiovascular disease. However, the relationship between physical activity and CAC remains complex. Although physical activity is generally beneficial for cardiovascular health, paradoxically, high levels of physical activity have been associated with elevated CAC scores. However, these higher CAC levels may indicate the presence of more stable, calcified plaques that provide protection against plaque rupture. These contradictory findings call for balanced interpretations that acknowledge the cardiovascular benefits of physical activity. This review examines the historical development of clinical guidelines for CAC, the paradoxical relationship between physical activity and CAC, and potential underlying mechanisms. It emphasizes the need for future research to utilize objective measures and consistent methodologies to better understand the relationship between physical activity and CAC. Full article

Background: The coronary artery calcium score and left atrial volume have been shown to predict the incidence of acute myocardial infarction and death from cardiovascular disease in patients undergoing peritoneal dialysis. However, the association between these factors has not been well-established. Methods: This cross-sectional, prospective, single-center study was conducted on patients undergoing outpatient peritoneal dialysis, who were followed up at a university hospital between March 2018 and August 2019. The coronary artery calcium score was calculated based on cardiovascular computed tomography findings. The score was “positive” when it was ≥100 Agatston and “negative” when it was <100 Agatston. The left atrial volume was obtained using the biplane disc method at the end of the left ventricular systole, and then it was indexed to the body surface. Results: Forty-four patients were evaluated. They had an age [mean (range)] of 56 (43–65) years and had been on dialysis therapy for 11.7 (6.8–25.4) months. Univariate analysis revealed a relationship between the coronary artery calcium score and left atrial volume index and the following variables: age, diabetes, overhydration, pulse wave velocity, E/A ratio, and left ventricular mass index. In multivariate logistic regression analysis, only the left atrial volume index was independently associated with a positive coronary artery calcium score. Conclusions: The left atrial volume index was associated with a positive coronary artery calcium score in patients on peritoneal dialysis, regardless of other factors. It may be a useful risk marker for coronary artery disease in this population. Full article

The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25–50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25–50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used. Full article