HeartLung.AI Webcast

Hosted by Society of Cardiovascular Tomography (SCCT)

Agatston 2.0:

The next generation of calcium scoring in the era of AI-CAC and AI-CVD

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Webcast Summary

Thirty years ago, the Agatston Score pioneered CT-based coronary atherosclerosis imaging. Since then, extensive evidence has established CAC as the strongest predictor of CHD events. However, two limitations have constrained its clinical utility:

1. “Power of Zero” exceptions: Although a CAC score of zero is strongly protective, CHD events still occur in younger individuals (<55 years) with a score of zero. These cases are uncommon but clinically important.

   
   

2. Inability to monitor treatment: Because the Agatston Score increases in both treated and untreated patients, repeat CAC scans cannot reliably guide therapy and are therefore not recommended.

   
   

How Agatston 2.0 / AI-CAC Solves These Problems

By eliminating the fixed 130-HU threshold using a reference medium to correct for noise, and by removing the 3 mm slice thickness constraint, Agatston 2.0 detects small and semi-calcified (“soft”) plaques that traditional CAC scoring misses. This strengthens the “Power of Zero.”

In pooled analyses from MESA and the Framingham Heart Study, the 5-year CHD event rate in the AI-CAC zero population was below 0.05%. Considering that a portion of CHD events (5–10%, especially in women) arise from microvascular disease rather than epicardial plaque, the few remaining events in the AI-CAC-zero group may be unrelated to coronary atheroma. Thus, Agatston 2.0 brings us close to the maximal predictive potential of CT-based coronary anatomy.

In addition, by quantifying changes in plaque density versus area or volume, Agatston 2.0 enables monitoring of plaque progression and stabilization. Lower-density plaques confer higher risk, and increasing plaque density reflects stabilization.

AI-CVD: Beyond Coronary Arteries

AI-CVD incorporates AI-CAC and extends well beyond coronary disease. It provides automated quantitative measurements of:

• Cardiac chamber volumes and left ventricular mass (for detecting LVH and predicting heart failure, atrial fibrillation, and stroke)

• Aortic wall and valve calcification

• Aortic and pulmonary artery dimensions

• Pericardial fat

• Thoracic muscle volume and myosteatosis

• Hepatosteatosis

• Osteopenia and osteoporosis

• Emphysema and interstitial lung abnormalities

—all derived from the same CAC scan that today is used only to report the traditional Agatston Score.

Agatston 2.0 AI-CAC Slides-V7 3.pdf

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Agatston 2.0 AI-CAC Slides-V7 3.pptx

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