Coronary Artery Calcium Score as a Potential Non-Invasive Marker for Pulmonary Artery Hypertension

Background: Early prediction of cardiac dysfunction is crucial in preventing the progression to heart failure and associated complications. To achieve this, the utilization of clinical indicators, molecular and pathological markers, and non-invasive evaluation methods has gained significant interest. One potential predictive tool that can be measured through non-invasive imaging modalities is the coronary artery calcium (CAC) score. Recent studies have extensively examined the correlation between coronary atherosclerotic plaque calcium score and cardiac dysfunction. However, data are scarce regarding the usefulness of the calcium score in predicting pulmonary artery hypertension, which is a known consequence of ventricular dysfunction. Methods: A total of 167 patients with suspected coronary artery involvement were included in the study. Before performing CT angiography, the score of CAC was measured in all patients based on their CT results. The CAC value was calculated using Vitrea software. The CAC score of each coronary artery, as well as the total CAC score (by summing the scores of each artery), was determined based on the Agatston method. Then the patients were subjected to CT angiography, and the value of pulmonary artery pressure or PAP, as well as the pulmonary artery dilatation, was measured based on the results of CT angiography. Results: The average CAC score in the two groups with and without PAH was 107.57 ± 268.60 and 35.47 ± 93.98, respectively, which indicated a significant difference between the two groups (P value 0.011). Accordingly, the number of cases with a positive CAC score in the two groups with and without PAH was 24 (49.0%) and 47 (39.8%), respectively, which showed a significant difference between the two groups (P = 0.046). There was a significant correlation between CAC score and PAH. Based on the analysis of the area under the ROC curve, CAC score evaluation had a high ability to predict PAH in women and in patients over 50 years old. Conclusion: The measurement of CAC score could be incorporated as a predictive index for the increase of pulmonary artery pressure and the occurrence of PAH. However, this predictive value is more evident in women and in older patients.