Search Results (175)

Background: Delirium is a common, underdiagnosed neuropsychiatric syndrome in older adults, associated with high mortality and functional decline. Given its multifactorial nature and overlap with frailty, radiological markers may improve risk stratification in the emergency department (ED). Methods: We conducted a retrospective study on a small sample of 30 patients diagnosed with delirium in the emergency department who had recently undergone brain, thoracic, or abdominal CT scans for unrelated clinical indications. Using post-processing software, we analyzed radiological markers, including coronary artery calcifications (to estimate vascular age), cerebral atrophy (via the Global Cortical Atrophy scale), and cachexia (based on abdominal fat and psoas muscle volumetry). Results: Five domains were identified as significant predictors of 12-month mortality in univariate Cox regression: vascular age, delirium etiology, cerebral atrophy, delirium subtype (hyperactive vs. hypoactive), and cachexia. Based on these domains, we developed an exploratory 10-point delirium score. This score demonstrated acceptable diagnostic accuracy for mortality prediction (sensitivity 0.93, specificity 0.73, positive predictive value 0.77, negative predictive value 0.91) in this limited cohort. Conclusions: While preliminary and based on a small, retrospective sample of 30 patients, this multidimensional approach integrating clinical and radiological data may help improve risk stratification in elderly patients with delirium. Radiological phenotyping, particularly in terms of vascular aging and sarcopenia/cachexia, offers objective insights into patient frailty and could inform more personalized treatment pathways from the ED to safe discharge home, pending further validation. Full article

Background: Many risk factors for cancer therapy-related cardiovascular toxicity overlap with risk factors for atherosclerosis. According to the ESC 2022 Cardio-Oncology Guidelines, coronary computed tomography angiography and coronary artery calcium score are not recommended as part of routine risk assessment prior to oncological treatment. The aim of this study was to prospectively assess the influence of coronary artery calcium score (CAC score) on cancer therapy-related cardiac dysfunction in patients with moderate and high risk of cardiovascular toxicity, qualified for anthracycline treatment. Methods: In all patients, risk factors were collected, laboratory tests, echocardiography with global longitudinal strain (GLS) assessment and coronary artery tomography with coronary artery calcium score were performed. A total of 80 patients were included in the study, of which 77 (96.25%) were followed for an average of 11.5 months. The mean age at baseline was 60.5 years and 72 (93.51%) were women. Results: During observation, five patients (6.49%) died, including two due to heart failure and three due to cancer progression. The majority of patients (59, 76.6%) had breast cancer, 11 (14.3%) were diagnosed with sarcoma and seven (9.1%) with lymphoma. According to the HFA-ICOS risk score, 40 patients (51.9%) were classified as moderate risk (MR), and 37 patients (48.1%) as high risk (HR) for cancer therapy-related cardiovascular toxicity. A CAC score greater than 100 was calculated in 17 (22.1%) patients and greater than 400 in three (3.9%) patients. The CAC score above zero was more common in older patients and in patients classified as high risk (p < 0.001). There was also a significant association between CAC score and hypertension, hyperlipidemia, chronic kidney disease, and the level of NT-proBNP. During 12-month follow-up, mild CTRCD occurred in 38 (49.4%) patients, moderate CTRCD was diagnosed in seven (9.1%), and severe in three (3.9%) patients. In the univariable analysis, CTRCD was more common in the high-risk group (p = 0.005) and in patients with a CAC score greater than zero (p = 0.036). In multivariable analysis, the incidence of CTRCD remains higher in the CAC score > 0 group, even after adjusting for age, hypertension, and hyperlipidemia. In this study group, the CTRCD rates increased with the HFA-ICOS risk score. Conclusions: In moderate and high-risk patients, a coronary artery calcium score greater than zero was identified as a significant risk factor for the development of cancer therapy-related cardiac dysfunction during anthracycline-based treatment. Furthermore, the HFA-ICOS risk score demonstrated good correlation with the incidence of CTRCD in this study, supporting its validity as a predictive tool in patients receiving anthracycline therapy. 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: Coronary artery disease (CAD) is a leading global cause of mortality. The role of calcium (Ca), a key metabolic and structural element, in atherosclerosis and inflammation remains unclear. Ca influences immune cell function and is a component of atherosclerotic plaques. Hair analysis reflects long-term mineral exposure and may serve as a non-invasive biomarker. Objectives: This pilot study aimed to investigate the association between hair Ca levels and acute coronary syndrome (ACS), and to evaluate correlations with the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and selected CAD risk factors. Methods: Ca levels were measured in hair samples from patients undergoing coronary angiography for suspected myocardial infarction. Associations with ACS diagnosis, Syntax score, SII, SIRI, and CVD risk factors were analyzed. Results: Serum calcium levels were not significantly associated with the presence of acute coronary syndrome (ACS) (p = 0.392) or with its clinical subtypes, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) (p = 0.225). Diagnosis of ACS was linked to higher SII (p = 0.028) but not SIRI (p = 0.779). Ca levels correlated negatively with Syntax score (R = −0.19, p = 0.035) and SII (R = −0.22, p = 0.021) and positively with HDL-C (R = 0.18, p = 0.046). Conclusions: Hair calcium content may reflect subclinical inflammation and CAD severity. Although no direct link to ACS was observed, the associations with SII, HDL-C, and Syntax score suggest a potential diagnostic role which should be further explored in larger, well-controlled studies. Full article

Background: This single-center retrospective observational study reviewed data from 2305 persons examined for coronary artery calcium (CAC) with non-contrast-enhanced cardiac CT. Other cardiac structures, including chamber volumes, were evaluated besides the CAC scoring. We proposed a novel body size indexing measure that may outperform common indices for quantifying total heart volume (THV). Methods: This index is the sum of height and the difference between height (unitless) and body surface area (unitless), [h+(h-BSA)], and if the (h-BSA) equals “zero”, it is a feature of the “standard human”. Results: We found that, in subjects with a low cardiovascular (CV) risk, the THV normalized for the novel index was simply a function of BW gain, being the highest in obese. If high-CV-risk features (hypertension, diabetes) were present, the measured THV was larger than expected for BW gain, exceeding values observed in low-CV-risk ones. Differences were found to be sex-independent in all BMI categories. Conclusions: Common BSA correction hides these differences and makes the prognostication of CV risk error-introducing. The indexation we proposed might help distinguish the effects of body weight gain from the ones resulting from the presence of certain cardiovascular diseases. Full article

Aortic valve stenosis (AS) is a valvular heart disease that imposes a high afterload on the left ventricle (LV) due to restricted opening of the aortic valve, resulting in LV hypertrophy. Severe AS can lead to syncope, angina pectoris, and heart failure. The number of patients with AS has been increasing due to aging populations, the growing prevalence of lifestyle-related diseases, and advances in diagnostic technologies. Therefore, accurate diagnosis and appropriate treatment of AS are essential. In recent years, transcatheter aortic valve implantation (TAVI) has become feasible, and the number of procedures has rapidly increased, particularly among elderly patients. As treatment options for AS expand and diversify, detailed pre-procedural evaluation has become increasingly important. In particular, diagnostic imaging modalities such as computed tomography (CT) have advanced significantly, with notable improvements in image quality. With recent advancements in CT technology—such as increased detector rows, faster gantry rotation speeds, new image reconstruction methods, and the introduction of dual-energy imaging—the scope of cardiac assessment has expanded beyond the coronary arteries to include valves, myocardium, and the entire heart. This includes evaluating restricted AV opening and cardiac function using four-dimensional imaging, assessing AV annulus diameter and AS severity via calcium scoring with a novel motion correction algorithm, and detecting myocardial damage through late-phase contrast imaging using new reconstruction techniques. In cases of pre-TAVI evaluation or congenital bicuspid valves, CT is also valuable for assessing extracardiac structures, such as access routes and associated congenital heart anomalies. In addition, recent advancements in CT technology have made it possible to significantly reduce radiation exposure during cardiac imaging. CT has become an extremely useful tool for comprehensive cardiac evaluation in patients with aortic stenosis, especially those being considered for surgical treatment. Full article

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, especially in regions like Eastern Europe, South Asia, and Latin America. A significant portion of these cases (80%) is linked to atherosclerosis, which can lead to severe conditions like ischemic heart disease and stroke, with atherosclerosis (ATS) responsible for the majority of cases. This review explores the multifaceted relationship between insulin resistance (IR) and ATS, highlighting their roles as both independent and interrelated contributors to cardiovascular risk. ATS is characterized by lipid accumulation and chronic inflammation within arterial walls, driven by factors such as hypertension, dyslipidemia, and genetic predisposition, with endothelial dysfunction as a key early event. The early detection of subclinical ATS is critical and can be achieved through a combination of non-invasive imaging techniques—such as coronary artery calcium scoring and carotid ultrasound—and comprehensive risk profiling. IR, marked by impaired glucose uptake in liver, muscle, and adipose tissue, often precedes early diabetes and is associated with metabolic disturbances, including dyslipidemia and chronic inflammation. The diagnosis of IR relies on surrogate indices such as HOMA-IR, the QUICKI, and the TyG index, which facilitate screening in clinical practice. Compelling evidence indicates that IR independently predicts the progression of atherosclerotic plaques, even in non-diabetic individuals, and operates through both traditional risk factors and direct vascular effects. Understanding and targeting the IR–ATS axis is essential for the effective prevention and management of cardiovascular disease. Full article

Background/Objectives: Given the conflicting results and limited published data on the correlation of vitamin A, E, and D, parathyroid hormone (PTH), and thyroid-stimulating hormone (TSH) levels, the triglyceride to high-density lipoprotein (TG/HDL) ratio, and glucose levels with the coronary artery calcium score (CAC score) in individuals at risk of coronary artery disease (CAD), this relationship requires extensive investigation. Therefore, our study aimed to investigate the correlations between the aforementioned metrics and the CAC score in individuals at risk of CAD in Saudi Arabia. Methods: This analytical cross-sectional study was conducted at the Department of Physiology, College of Medicine at King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia, between November 2024 and April 2025, targeting patients at risk of CAD. After recruiting patients from cardiology and primary care clinics, data regarding blood vitamin A, E, and D and PTH and TSH levels and CAC scores were collected from each patient’s electronic medical records. A score of 10 points was used as a cutoff between low and high CAC scores. Results: Our sample size was 172 patients. The majority of the patients were male (62.2%), and 37.8% were female. The mean age of the sample was 59.98 ± 9.26 years, with an age range spanning 40 years. Serum vitamin A levels had a significant negative correlation with CAC scores, (odds ratio (OR) = 0.147, p-value = 0.002), whereas vitamin D and E, PTH, and TSH levels did not correlate with this score. The TG/HDL ratio was positively and significantly correlated with CAC scores (OR = 1.654, p-value = 0.030). The analysis model showed that a patient’s mean serum glycated hemoglobin (HbA1c) level positively and significantly influenced their odds of having a high CAC score (OR = 1.364, p-value = 0.018). Patient ethnicity was not significantly associated with the CAC score (CAC ≥ 10 points) (p = 0.749). Similarly, BMI did not correlate with the CAC score (p = 0.722). However, male patients were 3.42 times more likely than females to have a high CAC score (CAC ≥ 10 points), a statistically significant difference (p = 0.005). No significant differences were observed between males and females in terms of their mean vitamin A (1.74 ± 0.58 vs. 1.80 ± 0.52, p = 0.633), vitamin E (41.41 ± 15.99 vs. 37.61 ± 11.78, p = 0.189), or vitamin D levels (80.35 ± 31.07 vs. 77.16 ± 26.15, p = 0.479). Additionally, the patient’s age was significantly positively associated with the likelihood of having a high CAC score, with OR = 1.102 times (p < 0.001). Conclusions: The findings of our study indicate the strong impact of vitamin A, the TG/HDL ratio, and HbA1c on CAC scores, among other factors affecting CAC scores, and they need more concern and attention. Understanding the cellular mechanism of vitamin A correlation with calcification is of great clinical value. The TG/HDL ratio is emerging as a novel index for CVD when compared to other lipid profile parameters. Intensive large-scale studies are needed to explore the interpretations as well as cutoff values of this valuable index. Males are more prone to CVD due to their high correlation with CAC scores. Therefore, vitamin A administration and strict HbA1c and TG/HDL ratio monitoring could help as prophylactic measures to prevent cardiovascular disease in these patients. These findings could influence specific preventive measures or screening strategies for cardiovascular disease in high-risk populations. A lifestyle medicine approach that involves caregivers as well as patients should be implemented to minimize the incidence and complications of detrimental diseases. Full article

Background: Sepsis survivors are at risk of developing myocardial infarction and heart failure. It remains unclear whether coronary artery disease (CAD) is a major contributor to the development of these complications. This study sought to characterize the burden and distribution of significant CAD in sepsis survivors. Methods: Sepsis survivors who underwent computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA) in a UK tertiary cardiac center for suspected ischemic heart disease were retrospectively studied. Results: Of the 30 sepsis survivors (age 57 ± 12 years; 50% males), 21 patients underwent CTCA and 9 patients underwent ICA a median 39 days [IQR 12–152] from the sepsis episode. Eight patients (~27%) had angiographically significant CAD (n = 6 severe [>70%] stenosis; n = 2 moderate [50–70%] stenosis). The CT coronary calcium score was higher in patients with significant CAD compared to patients without significant CAD (638 [368–1015] vs. 4 [1–72]; p < 0.001). Of the 8 patients with significant CAD, 3 patients had LV systolic dysfunction (38%) on echocardiography and 8/21 (38%) patients without significant CAD had LV systolic dysfunction (p = 1.00). Long-term adverse complications (all-cause mortality and/or heart failure hospitalization) occurred 3/8 (38%) patients with significant CAD and 4/22 (18%) patients without significant CAD (p = 0.345). Conclusions: A minority of sepsis survivors have significant CAD. The presence of significant CAD cannot fully explain the occurrence of post-sepsis LV systolic dysfunction and adverse outcomes. The ischemic and non-ischemic mechanisms underlying post-sepsis cardiovascular disease require further investigation. Full article

Cardiovascular diseases, including coronary artery disease, are the leading cause of mortality in the general population. The likelihood of significant coronary artery disease occurring in young women (<40 years of age) is very low. Diagnosis is challenging and often delayed, treatment tends to be suboptimal, and the long-term prognosis is poor. We present the case of a 38-year-old woman with typical anginal chest pain whose coronary computed tomography angiography (CCTA) revealed significant narrowing in the left anterior descending artery (LAD) despite a coronary artery calcium score (CACS) of zero. To assess the significance of the lesion, coronary angiography and intravascular ultrasound (IVUS) were performed, which revealed borderline narrowing. Conservative treatment was recommended. Full article

Interleukin-6, myeloperoxidase, and tumor necrosis factor alpha are proinflammatory cytokines that play a role both in cardiovascular and oncological diseases. The study aimed to prospectively investigate the clinical value of interleukin-6, myeloperoxidase, and tumor necrosis factor alpha as potential biomarkers of cancer therapy-related cardiac dysfunction (CTRCD) in patients receiving anthracycline treatment. A total of 80 patients were included, with 77 (96.25%) followed for an average for 11.5 months. The mean age at baseline was 60.5 years, and 72 (93.51%) were women. Clinical risk factors were documented for all patients, and laboratory assessments, including measurements of IL-6, MPO, and TNF-α, were conducted. All participants also underwent echocardiography with assessment of global longitudinal strain (GLS). In the study group, coronary CT angiography with coronary artery calcium (CAC) score calculation was performed once at the beginning of the study. During observation, any degree of CTRCD was diagnosed in 48 (62.4%) patients. Mild CTRCD occurred in 38 (49.4%) patients, moderate CTRCD was diagnosed in 7 (9.1%), and severe in 3 (3.9%). In patients with high baseline risk, IL-6 levels were significantly elevated compared to those with moderate risk (p = 0.018). Higher levels of IL-6 were found to correlate with an increased grade of CTRCD. In a multivariate repeated measures model of the biomarkers studied, only a higher level of IL-6 was significantly associated with the diagnosis of CTRCD. Among the novel biomarkers studied, we found evidence for IL-6 for its potential use in the detection of cardiac dysfunction related to cancer therapy in patients treated with anthracyclines. Full article

(1) Background: The SCORE2-Diabetes model has been developed as an effective tool to estimate the 10-year cardiovascular risk in patients with diabetes. Coronary computed tomography angiography (CCTA) and its derived Coronary Artery Calcium Score (CACS) are widely used non-invasive imaging tools for assessing coronary artery disease (CAD). This study aimed to evaluate the correlation between CACS and SCORE2-Diabetes in patients with T2DM. (2) Methods: A cross-sectional study was conducted from October 2023 to May 2024. We included patients aged 40 to 69 years with T2DM who underwent a coronary multislice CT scan due to atypical angina. The correlation between CACS and SCORE2-Diabetes was analyzed using Spearman’s rank correlation coefficient. (3) Results: A total of 100 patients met the inclusion criteria, including 71 males and 29 females, with a mean age of 61.9 ± 5.4 years. The differences in CACS and SCORE2-Diabetes among different degrees of coronary artery stenosis were statistically significant (p < 0.05). A statistically significant but weak positive correlation was observed between CACS and SCORE2-Diabetes across all risk categories, with Spearman’s rank correlation coefficients ranging from 0.27 to 0.28 (p < 0.01). (4) Conclusions: Despite the weak correlation between CACS and SCORE2-Diabetes, understanding their relationship and independent associations with disease severity is valuable. The combination of these two tools may warrant investigation in future studies to potentially enhance cardiovascular risk assessment in T2DM patients. 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

Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging being the preferred method. Coronary computed angiography (CCTA) and coronary artery calcium score (CACS) offer direct anatomical assessment of atherosclerotic coronary arteries and help gauge the extent and severity of coronary artery disease. Strong evidence supports that CCTA and CACS, either alone or in combination, are reliable methods for assessing the risk of both perioperative and long-term postoperative MACE, often demonstrating equal or superior prognostic performance compared to traditional imaging tools. Moreover, integrating CCTA or CACS into standard preoperative imaging protocols further enhances perioperative risk prediction and improves the ability to accurately stratify patients. Future research is needed to better define the role of CCTA and CACS in preoperative cardiovascular risk evaluation of patients undergoing noncardiac surgery. Full article