Coronary Artery Calcium Score as a Potential Non-Invasive Marker for Pulmonary Artery Hypertension
Keywords:
Coronary Artery Calcium Score, Non-Invasive Marker, Pulmonary Artery HypertensionAbstract
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.References
Adelhoefer S, Uddin SI, Osei AD, Obisesan OH, Blaha MJ, Dzaye O. Coronary artery calcium scoring: new insights into clinical interpretation—lessons from the CAC Consortium. Radiology: Cardiothoracic Imaging. 2020;2(6):e200281.
Peters SA, Bakker M, den Ruijter HM, Bots ML. Added value of CAC in risk stratification for cardiovascular events: a systematic review. European journal of clinical investigation. 2012;42(1):110-6.
Wang FM, Reiter–Brennan C, Dardari Z, et al. Association between coronary artery calcium and cardiovascular disease as a supporting cause in cancer: the CAC consortium. American Journal of Preventive Cardiology. 2020;4:100119.
Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. Journal of the American College of Cardiology. 2018;72(4):434-47.
Yoon H-C, Greaser III LE, Mather R, Sinha S, McNitt-Gray MF, Goldin JG. Coronary artery calcium: alternate methods for accurate and reproducible quantitation. Academic radiology. 1997;4(10):666-73.
Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications: a statement for health professionals from the American Heart Association. Circulation. 1996;94(5):1175-92.
Osawa K, Miyoshi T, Oe H, et al. Association between coronary artery calcification and left ventricular diastolic dysfunction in elderly people. Heart and vessels. 2016;31:499-507.
Mansour MJ, Chammas E, Hamoui O, Honeine W, AlJaroudi W. Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification. Echocardiography. 2020;37(2):253-9.
Jamiel A, Ahmed AM, Farah I, Al-Mallah MH. Correlation between diastolic dysfunction and coronary artery disease on coronary computed tomography angiography. Heart Views. 2016;17(1):13-8.
Dykun I, Mahabadi AA, Lehmann N, et al. Left ventricle size quantification using non-contrast-enhanced cardiac computed tomography–association with cardiovascular risk factors and coronary artery calcium score in the general population: The Heinz Nixdorf Recall Study. Acta Radiologica. 2015;56(8):933-42.
Maragiannis D, Schutt RC, Gramze NL, et al. Association of left ventricular diastolic dysfunction with subclinical coronary atherosclerotic disease burden using coronary artery calcium scoring. Journal of Atherosclerosis and Thrombosis. 2015;22(12):1278-86.
Hoeper MM, Bogaard HJ, Condliffe R, et al. Definitions and diagnosis of pulmonary hypertension. Journal of the American College of Cardiology. 2013;62(25S):D42-D50.
Hoeper MM, Humbert M, Souza R, et al. A global view of pulmonary hypertension. The Lancet Respiratory Medicine. 2016;4(4):306-22.
Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. Journal of the American College of Cardiology. 2009;53(13):1119-26.
Kim SC, Chang HJ, Kim M-G, Jo S-K, Cho W-Y, Kim H-K. Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients. Kidney research and clinical practice. 2015;34(1):28-34.
Ruffenach G, Chabot S, Tanguay VF, et al. Role for runt-related transcription factor 2 in proliferative and calcified vascular lesions in pulmonary arterial hypertension. American Journal of Respiratory and Critical Care Medicine. 2016;194(10):1273-85.
Lin M-E, Chen T, Leaf EM, Speer MY, Giachelli CM. Runx2 expression in smooth muscle cells is required for arterial medial calcification in mice. The American Journal of Pathology. 2015;185(7):1958-69.
Rossdale J, Graby J, Charters P, et al. P9 Coronary artery calcification on thoracic CT is associated with pulmonary hypertension and is an independent predictor of mortality in systemic sclerosis. BMJ Publishing Group Ltd and British Cardiovascular Society; 2022.
Mahammedi A, Oshmyansky A, Hassoun PM, Thiemann DR, Siegelman SS. Pulmonary artery measurements in pulmonary hypertension: the role of computed tomography. Journal of Thoracic Imaging. 2013;28(2):96-103.
Chaouat A, Savale L, Chouaid C, et al. Role for interleukin-6 in COPD-related pulmonary hypertension. Chest. 2009;136(3):678-87.
Takasu J, Katz R, Shavelle DM, et al. Inflammation and descending thoracic aortic calcification as detected by computed tomography: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2008;199(1):201-6.
Santhanam P, Marcus C, Solnes LB, Kral BG, Javadi MS, Rowe SP. Incidental pulmonary arterial dilatation and coronary calcifications in patients with hypertension and normal findings on myocardial perfusion technetium‐99m sestamibi single‐photon emission computed tomography. The Journal of Clinical Hypertension. 2017;19(10):1054.
Sharma RK, Donekal S, Rosen BD, et al. Association of subclinical atherosclerosis using carotid intima-media thickness, carotid plaque, and coronary calcium score with left ventricular dyssynchrony: The multi-ethnic Study of Atherosclerosis. Atherosclerosis. 2015;239(2):412-8.
Eleid MF, Appleton CP, Lopez AG, Cha S, Hurst RT. Coronary artery plaque burden does not affect left ventricular diastolic function in asymptomatic adults with normal ejection fraction. Journal of the American Society of Echocardiography. 2011;24(8):909-14.
Raggi P, Shaw LJ, Berman DS, Callister TQ. Gender-based differences in the prognostic value of coronary calcification. Journal of Women's Health. 2004;13(3):273-83.
Bellasi A, Lacey C, Taylor AJ, et al. Comparison of prognostic usefulness of coronary artery calcium in men versus women (results from a meta-and pooled analysis estimating all-cause mortality and coronary heart disease death or myocardial infarction). The American journal of cardiology. 2007;100(3):409-14.
De Kat A, Dam V, Onland-Moret N, Eijkemans M, Broekmans F, Van Der Schouw Y. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Medicine. 2017;15:1-11.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Shahin Mirzamohammadi, Niloofar Shirazi, Niloofar Deravi, Rasoul Hossein Zadeh, Reza Khademi, Mojan Ayati, Reza Hossein zadeh, Taraneh Faghihi Langaroudi, Sara Besharat

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.
