AbstractBackground: All plaques that trigger acute coronary syndromes (ACS) present various characteristics of vulnerability. However, not all vulnerable plaques (VP) lead to an ACS. This raises the question as to which of the established CT vulnerability features hold the highest probability of developing ACS.Aim: To identify the distinct phenotype of VP that exposes the unstable atheromatous plaque to a higher risk of rupture.Material and Methods: In total, 20 patients in whom cardiac computed tomographic angiography (CCTA) identified the presence of a vulnerable plaque and who developed an ACS within 6 months after CCTA examination were enrolled in the study, and compared to 20 age- and gender-matched subjects with VPs who did not develop an ACS. All included patients presented VPs at baseline, defined as the presence of minimum 50% degree of stenosis and at least one CT marker of vulnerability (low attenuation plaques [LAP], napkin-ring sign [NRS], positive remodeling [PR], spotty calcifications [SCs]).Results: The two groups were not different in regards to age, gender, cardiovascular risk factors, and comorbidities. Patients who developed an ACS at six months presented higher volumes of lipid-rich (p = 0.01) and calcified plaques (p = 0.01), while subjects in the control group presented plaques with a larger fibrotic content (p = 0.0005). The most frequent vulnerability markers within VPs that had triggered ACS were LAPs (p <0.0001) and PR (p <0.0001). Multivariate analysis identified LAP as the strongest independent predictor of ACS at 6 months in our study population (OR 8.18 [1.23-95.08], p = 0.04).Conclusions: VPs producing an ACS exhibit a different phenotype compared to VPs that remain silent. The CCTA profile of VPs producing an ACS includes the presence of low attenuation, positive remodeling, and lipid-rich atheroma. The presence of these features in VPs identifies very high-risk patients, who can benefit from adapted therapeutic strategies in order to prevent an ACS.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022). Background Pericoronary fat attenuation index is a novel CT-derived marker used to quantify vascular inflammation at the level of coronary vessels. It has prognostic value for major adverse cardiovascular events and provides improvements in cardiac risk assessment beside classical risk factors and coronary artery calcium score. However, the influence of local factors related to coronary circulation in the right versus left coronary bed, on the development of pericoronary inflammation, has not been elucidated so far. Purpose The aim of the study was to evaluate the regional differences in the level of inflammation between right and left sided coronary arteries. Methods In total, 153 patients (mean age 62 years, male patients 70.5%) who underwent clinically indicated coronary computed tomography angiography (CCTA) were included in the study. All the plaque features classically associated with vulnerability were evaluated for identification of high-risk plaques. Fat attenuation index (FAI) and the corresponding FAI score (which takes into consideration the risk factors and age) were calculated for all cases at the level of the left anterior descending artery (LAD), circumflex artery (Cx) and right coronary artery (RCA). Results A total of 459 coronary arteries were included in the analysis and both FAI and FAI score were higher at the level of RCA compared with LAD and Cx. FAI score was 15.23±11.97 at RCA vs 10.55±6.78 at LAD and 11.48±6.5 for Cx, p = 0.02. Also, a significantly higher value of FAI at the level of RCA was noted in comparison with the other two coronary arteries: −76±7.68 HU for RCA compared to −73.04±8.9 HU for LAD and −71.25±7.47 HU for Cx, p&lt;0.0001. This difference was maintained in all the study sub-group analysis: for patients undergoing CT scan after COVID infection (−75.49±7.62 HU for RCA vs -72.89±9.40 HU for Cx and −71.28 ±7.82 HU for LAD, p = 0.01), or patients with high-risk plaques (20.98±16.29 for RCA vs 11.77±7.68 for Cx and 12.83±6.47 for LAD, p = 0.03). Conclusion Plaques located in different coronary territories exhibit different vulnerability patterns and different levels of inflammation. RCA seems to have a more pronounced susceptibility to inflammation, right coronary plaques exhibiting higher scores of inflammation in the territories surrounding coronary plaques.

Inflammation is a key factor in the development of atherosclerosis, a disease characterized by the buildup of plaque in the arteries. COVID-19 infection is known to cause systemic inflammation, but its impact on local plaque vulnerability is unclear. Our study aimed to investigate the impact of COVID-19 infection on coronary artery disease (CAD) in patients who underwent computed tomography angiography (CCTA) for chest pain in the early stages after infection, using an AI-powered solution called CaRi-Heart®. The study included 158 patients (mean age was 61.63 ± 10.14 years) with angina and low to intermediate clinical likelihood of CAD, with 75 having a previous COVID-19 infection and 83 without infection. The results showed that patients who had a previous COVID-19 infection had higher levels of pericoronary inflammation than those who did not have a COVID-19 infection, suggesting that COVID-19 may increase the risk of coronary plaque destabilization. This study highlights the potential long-term impact of COVID-19 on cardiovascular health, and the importance of monitoring and managing cardiovascular risk factors in patients recovering from COVID-19 infection. The AI-powered CaRi-Heart® technology may offer a non-invasive way to detect coronary artery inflammation and plaque instability in patients with COVID-19.

The new coronavirus (COVID-19) outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Since then, important changes have been observed in the medical world, both in terms of patient management and patient presentations to the hospital. A dramatic decrease in the number of cardiovascular emergencies presenting to the emergency rooms has been reported in every country affected by the COVID-19 pandemic. This resulted mainly from the fear of patients to present at the hospital due to the risk of infection with the new coronavirus. Moreover, a significant increase in the time spent for investigations and specialized treatment has been reported for patients suffering from acute cardiovascular diseases. This adds to the longer times reported from symptom onset to presentation, and also to the longer period spent for triage in the emergency room. The aim of this paper is to highlight the dramatic reduction in the number of cardiovascular emergencies during the COVID-19 period and its possible explanations.

The aim of this review is to provide a short update on whether treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) has beneficial or harmful effects in patients infected with SARS-CoV-2. Epidemiological studies have shown that SARS-CoV-2 infects all age groups, presenting a higher incidence in elderly patients with various comorbidities such as hypertension, diabetes mellitus, and cardiovascular diseases. A large proportion of these patients are treated with ACEIs and ARBs. Since it has been demonstrated that SARS-CoV-2 uses angiotensin converting enzyme type 2 (ACE2) as an entry point into host cells, it is important to know whether ACEIs and ARBs could modify the expression of this enzyme, and thus promote the viral infection. Animal studies and a few studies in humans have shown that renin angiotensin system (RAS) inhibitors increase tissue expression of ACE2, but with potentially beneficial effects. In this context, it is imperative to provide appropriate guidance for clinicians and patients. The major cardiology associations across the world have released statements in which they recommend healthcare providers and patients to continue their treatments for hyper-tension and heart failure as prescribed.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Background Inflammation plays an essential role in all stages of atherosclerosis, with stable plaques characterized by chronic inflammation and vulnerable or ruptured plaques exhibiting "active" inflammation. COVID infection may significantly increase systemic inflammation, but the role of SARS COV-2 infection on local plaque vulnerability is still not elucidated. Mapping the PCAT - FAI on routine CCTA can detect coronary artery inflammation non-invasively by measuring changes in the composition of pericoronary fat. Purpose The aim of this study was to assess the impact of COVID-19 infection on CAD in patients who underwent CCTA examinations for chest pain in the early stages after infection, using the new AI - powered CaRi-Heart® solution. Methods In our study, we included 158 patients (mean age was 61.63 ± 10.14 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA for assessment of coronary anatomy, atherosclerosis, and determination of FAI – Score. The study population was divided into two main groups: Group 1 (n = 75) – patients who had a COVID-19 infection a few months prior to their CCTA examination, and Group 2 (n = 83) – patients adjusted for age and gender, who did not have a COVID-19 infection. Results The FAI - Score was consistently higher in the non COVID-19 group: LAD (11.61 ± 7.60 vs. 9.32 ± 6.00, p = 0.05), LCX (12.43 ± 6.65 vs. 10.48 ± 6.24, p = 0.05), RCA (15.40 ± 11.36 vs. 14.54 ± 12.17, p = ns), the average FAI - Score (12.81 ± 8.28 vs. 10.47 ± 7.19, p = 0.001). For the FAI-Score Centile, the overall pattern shifts significantly, as the values for all three coronary arteries are higher for the subjects in the COVID-19 positive group, as follows: LAD (0.66 ± 0.29 vs. 0.58 ± 0.28, p = 0.05), LCX (0.79 ± 0.16 vs. 0.68 ± 0.26, p = 0.03), RCA (0.83 ± 0.20 vs. 0.68 ± 0.29, p = 0.05). In both cases, the CaRi Heart® Risk (p &lt; 0.0001) and the Duke Score (p &lt; 0.0001) had significantly higher values for the patients in the COVID-negative group. Conclusion Lesions with higher pericoronary FAI - Score Centile values were more commonly found in patients who had previously been infected with COVID-19. The higher levels of inflammation in the pericoronary adipose tissue suggests that COVID-19 infection is linked to an increased risk of coronary plaque destabilization.

AbstractBackground: Atrial fibrillation (AF), a common arrhythmia in clinical practice, is associated with a high rate of complications and an increased risk for thromboembolic events. Pulmonary vein ablation is a new therapeutic option to cure AF; however, it remains associated with a high rate of recurrence. In this study we aimed to identify the clinical characteristics and imaging-based features that may predict the risk of recurrence after pulmonary veins ablation in atrial fibrillation.Materials and method: Twenty-four patients with paroxysmal and persistent AF, who underwent radiofrequency catheter ablation and a 12-month follow-up were included in the study. Group 1 included 8 patients with AF recurrence, and group 2 included 16 patients with no AF recurrence. In all cases, cardiovascular risk factors, ejection fraction, left atrial diameter, atrial volumes, and epicardial fat volume were analyzed.Results: CT analysis revealed that patients with AF recurrence presented a significantly larger mean index of left atrial volume (59.57 ± 8.52 mL/m2 vs. 49.99 ± 10.88 mL/m2, p = 0.04), right atrial volume (58.94 ± 8.37 mL/m2 vs. 43.21 ± 6.4 mL/m2, p<0.0001), and indexed bi-atrial volume (118.5 ± 15.82 mL/m2 vs. 93.19 ± 16.42 mL/m2, p = 0.005). At the same time, CT analysis of the epicardial adipose tissue volume indicated that patients with AF recurrence have a larger amount of epicardial fat than those without AF recurrence (176.4 ± 100.8 mL vs. 109.8 ± 40.73 mL, p = 0.02).Conclusion: Left atrial diameter, indexed atrial volumes, and epicardial fat volume may be used as factors to identify patients at risk for developing recurrence after pulmonary vein ablation.

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number 164/20/10.01.2023. Background Epicardial fat (EF) and pericoronary adipose tissue (PCAT) have been extensively studied in the last decade as markers and promotors of local coronary inflammation. Quantification of EF and PCAT via CCTA, can predict the risk of acute events across various cardiovascular disorders, and has been linked to markers of local or systemic inflammation. Mapping the fat attenuation index (FAI) on routine CCTA can detect coronary artery inflammation at different levels of the coronary tree. Objectives This study aimed to evaluate the regional differences between left and right coronary inflammation in patients who had CCTA examinations for chest pain in the early stages after COVID-19 infection COVID-19 infection, using the AI-powered CaRi-Heart® medical software. Methods In this study, we included 172 patients (mean age: 62.43 ± 11.62 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA to assess coronary anatomy, atherosclerosis, and FAI – Score determination. The study population was divided into two groups: Group 1 (n = 80) – with COVID-19 infection 2–3 months prior to their CCTA examination, Group 2 (n = 92) – adjusted for age and gender, without COVID-19 infection. For each patient, we recorded and analyzed demographic and clinical characteristics, cardiovascular risk factors, and the onset of signs and symptoms before the CCTA examination. Results The FAI - Score was considerably higher in the non COVID-19 group: LAD (11.87 ± 8.23 vs. 9.12 ± 6.20, p = 0.05), LCX (13.02 ± 6.76 vs. 10.77 ± 6.13, p = 0.05), RCA (15.88 ± 10.36 vs. 14.74 ± 12.24, p = ns), the average FAI - Score (13.23 ± 8.92 vs. 10.34 ± 7.22, p = 0.001). Comparing the FAI - Score between the left and right coronary artery, we found that for the entire study population, the FAI score was significantly higher at the RCA level (15.23 ± 11.97 vs. 11.21 ± 6.98, p = 0.02), and this difference was also maintained in the COVID-19 positive group (14.54 ± 12.17 vs. 9.77 ± 5.94, p = 0.0002), but not in the non-COVID-19 group (14.20 ± 10.78 vs. 12.88 ± 7.41, p = ns). In both groups, the CaRi Heart® Risk (p &lt; 0.0001) and Duke Score (p &lt; 0.0001) were significantly higher for the COVID-negative patients. Conclusions COVID-19 infection is associated with a higher risk of coronary plaque destabilization, as shown by increased inflammation in the PCAT. For the entire study population, the FAI - Score was significantly higher at the RCA level, the difference being driven by the increased RCA inflammation in the post-COVID group. This indicates a potential role of local hemorheological factors in the complex process of inflammation-mediated plaque vulnerabilization.