Development and Validation of a Coronary Artery Calcium Volume and Density Score.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2026-10-12 DOI:10.1161/CIRCIMAGING.126.020112

Harpreet S Bhatia, Alexander C Razavi, Zeina Dardari, Robyn L McClelland, David R Jacobs, James G Terry, J Jeffrey Carr, Daniel Duprez, Parag H Joshi, Anand Rohatgi, Amit Khera, Jamal S Rana, Ankeet Bhatt, Tara S Allen, Julie Denenberg, Matthew Budoff, Matthew Allison, Michael J Blaha, Michael Criqui

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引用次数: 0

Abstract

Background: Coronary artery calcium (CAC) scoring is a useful tool for coronary heart disease (CHD) risk prediction. The current standard method, the Agatston score, weights plaque area upward by density. However, higher density is inversely associated with CHD. We aimed to develop and validate a CAC score accounting for the inverse association of density with CHD, and the nonlinear association between CAC volume and density in a prospective cohort study.

Methods: A CAC volume and density score was developed, which adjusts CAC volume for density based on whether the volume level was <130 mm³. We used data from the MESA (Multi-Ethnic Study of Atherosclerosis) to develop and assess the score, including all participants with CAC>0 and follow-up for CHD events. Score performance for CHD risk prediction was compared with the pooled cohort equations and the Agatston score using Cox proportional hazards models and Harrell C-index and continuous and categorical net reclassification improvement. Analyses were also stratified by Agatston score, age, sex, race/ethnicity, and statin use. Finally, performance was evaluated in 4 longitudinal cohorts for external validation.

Results: The MESA cohort included 3360 individuals. CAC volume and density score improved the C-index for CHD to a greater degree over the pooled cohort equation (0.699 [95% CI, 0.675-0.723]) compared with the Agatston score (0.687 [95% CI, 0.663-0.711]) and resulted in greater continuous net reclassification improvement (0.54 [95% CI, 0.43-0.64]) compared with the Agatston score (0.45 [95% CI, 0.34-0.56]) when added to the pooled cohort equation. The greatest improvement in risk prediction was in those with lower burden of CAC (Agatston <300). Consistent results were seen in stratified analyses and external validation cohorts.

Conclusions: The CAC volume and density score, which adjusts CAC volume downward for higher density, and can be calculated from existing CAC reports, significantly improves risk discrimination and reclassification compared with the Agatston score.

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冠状动脉钙容量和密度评分的发展和验证。

背景：冠状动脉钙（CAC）评分是预测冠心病（CHD）危险的有效工具。目前的标准方法是Agatston评分，根据密度对斑块面积进行加权。然而，高密度与冠心病呈负相关。我们的目的是在一项前瞻性队列研究中建立和验证CAC评分，以解释密度与冠心病的负相关关系，以及CAC体积和密度之间的非线性关系。方法：建立CAC体积和密度评分，根据体积等级是否为3调整CAC体积对密度的影响。我们使用数据从台面(动脉粥样硬化多种族研究)开发和评估分数,包括所有参与者与CAC > 0和冠心病事件的后续。采用Cox比例风险模型、Harrell c指数和连续分类净重分类改善，比较合并队列方程和Agatston评分对冠心病风险预测的评分效果。分析还按Agatston评分、年龄、性别、种族/民族和他汀类药物的使用进行分层。最后，在4个纵向队列中进行绩效评估，以进行外部验证。结果：MESA队列包括3360名个体。与合并队列方程相比，CAC体积和密度评分更大程度地改善了冠心病的c -指数（0.699 [95% CI, 0.675-0.723]），与Agatston评分（0.687 [95% CI, 0.663-0.711]）相比（0.54 [95% CI, 0.43-0.64]），当加入合并队列方程时，与Agatston评分（0.45 [95% CI, 0.34-0.56]）相比，导致更大的持续净再分类改善（0.54 [95% CI, 0.43-0.64]）。结论：与Agatston评分相比，CAC体积和密度评分可以根据现有的CAC报告，将CAC体积向下调整以适应更高的CAC密度，显著提高了风险的区分和再分类。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.