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Global Molecular Calcium Score Improves Traditional Cardiovascular Risk Score Performance
Session:
Sessão de Comunicações Orais 16 – Imagiologia avançada para estratificação de risco: do ECV à RMC em contexto de vida real
Speaker:
Mafalda de Oliveira Griné
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mafalda Oliveira Grine; Rita Bertão Ventura; Manuel Oliveira-Santos; João Borges-Rosa; Rodolfo Silva; Andreia Gomes; Antero Abrunhosa; Miguel Castelo-Branco; Lino Gonçalves; Maria João Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">BACKGROUND</span></strong><span style="font-family:Calibri,sans-serif">: Positron emission tomography computed tomography with 18F sodium fluoride (18F-NaF-PET-CT) detects active microcalcification, a marker of atherosclerotic plaque instability. We sought to explore whether cardiac microcalcification activity could change traditional scores’ ability to predict the risk of cardiovascular (CV) events. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">METHODS</span></strong><span style="font-family:Calibri,sans-serif">: We conducted a patient-level outcomes analysis of the ROPPET-NAF trial (<em>Rosuvastatin Effect on Atherosclerotic Plaque Metabolism – a Subclinical Atherosclerosis Imaging Study With <sup>18</sup>F–NaF PET-CT</em>: NCT 03233243) and its pilot study, in which high CV risk individuals underwent 18F-NaF-PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS). The primary endpoint was a composite of CV death, nonfatal myocardial infarction, nonfatal stroke, or heart failure hospitalization. GMCS’s potential to alter the discriminative ability of the PREVENT equation was assessed using receiver operator characteristic analysis. Area under the curve values were compared with the DeLong test.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">RESULTS</span></strong><span style="font-family:Calibri,sans-serif">: A total of 57 participants were included in this analysis. Mean age was 64 years, 63% were male, most had hypertension (96%) and diabetes (82%). Over a median of approximately 4 years, 8 patients (14%) experienced the primary endpoint: 4 nonfatal strokes, 3 heart failure hospitalizations, 1 fatal myocardial infarction. Among participants who experienced an event, diabetes was less frequent, there was a higher median systolic blood pressure and more current smokers. Median GMCS was significantly higher in those with CV events (187 (134, 288) vs. 413 (339, 537); p<0.001. Adding GMCS to the PREVENT score improved its discriminative ability in our cohort from AUC of 0.626 to 0.917 (p = 0.027).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">CONCLUSION</span></strong><span style="font-family:Calibri,sans-serif">: In this patient-level analysis of the ROPPET-NAF trial and its pilot study, GMCS improved the discriminative ability of a contemporary CV risk score. As we shift from the "vulnerable plaque" to the "vulnerable patient" paradigm, GMCS appears to be a promising tool to refine CV risk stratification.</span></span></span></span></p>
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