| Naghavi et al.26 | 2024 | 5,830 | 62 ± 10 | Prospective cohort study (MESA) | Non-contrast CAC scans enhanced by Al-enabled automated cardiac chamber volumetry and calcified plaque characterization |
Survival analysis using Cox proportional hazards regression Discrimination was assessed using time-dependent ROC area under the curve (AUC) and Uno’s C-statistic AUC difference calculated using inverse probability of censoring weighting (IPCW) estimator | The AI–CAC model significantly improved the prediction of all CVD events (including HF, AF, and stroke) compared to the Agatston score alone. |
| Sakuragi et al.28 | 2016 | 487 | 69 ± 11 | Prospective cohort study | MDCT |
One-way AN0VA and the Kruskal–Wallis test (for continuous variables) Chi-squared test (for categorical variables) Kaplan–Meier analysis with the log-rank test Cox proportional hazards regression | Severe CAC is an independent determinant of high N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and a predictor of admission for HF in patients without a history of CAD or HF. |
| Ota et al.25 | 2022 | 550 | 72.5 ± 13.5 | Retrospective cohort study | Non-ECG-gated MDCT Invasive coronary angiography |
Mann-Whitney U test (for continuous variables) Chi-squared test (for categorical variables) Kaplan–Meier analysis with the log-rank test Cox proportional hazards regression | Higher CAC score detected via non-contrast chest CT is significantly associated with all-cause mortality among patients with CHF. |
| Carr et al.21 | 2017 | 3,043 | 40.3 ± 3-6 | Prospective cohort study (CARDIA) | Non-contrast CT | | In younger adults, a CAC score > 0 was associated with incident all CHD and all-cause death. |
| Kälsch et al.8 | 2010 | 4,230 | 59 ± 8 | Prospective cohort study (Heinz Nixdorf Recall Study) | EBCT |
Mann-Whitney U test (for continuous variables) Chi-squared test or Fisher’s exact test (for categorical variables) Multivariable analysis using logistic regression | CAC is associated with the presence of CHF. This association is partially diminished after adjusting for traditional risk factors. |
| Haddad et al.17 | 2022 | 2,082 | 50.6 ± 17.0 | Prospective cohort study | Non-contrast CT |
Multidimensional analysis using maximal information coefficient (MIC) to weight edges Multivariable regression analysis Stepwise linear regression | CAC score was independently associated with LV diastolic function. |
| de la Rosa et al.11 | 2025 | 6,667 | 62 ± 10 | Prospective cohort study (MESA) | Non-contrast CT EBCT | | CAC score was a significant predictor of new-onset HFrEF. |
| Nitta et al.18 | 2019 | 157 | 71 ± 8 years for patients with CAC66 ±13 years for patients without CAC | Retrospective cohort study | Non-contrast CT Gated SPECT for myocardial perfusion TTE |
Chi-squared test (for categorical variables) Mann-Whitney U test (for continuous variables) Pearson’s correlation Linear regression analysis (univariate and multivariate) | Log-transformed CAC score was significantly and independently associated with indices of impaired LV diastolic function (PFR and 1/3MFR). |
| Mhaimeed et al.10 | 2025 | 66,636 | 54.4 ± 10.6 | Retrospective cohort study | Non-contrast CT EBCT | | A higher CAC score was associated with an increasing incidence of HF-related mortality in primary prevention patients. |
| Kitjanukit et al.29 | 2024 | 442 | 62.5 ± 10.4 | Retrospective cohort study | Non-contrast CT |
Extended Wilcoxon rank-sum test by Cuzick (for trending variables) Cox regression (to estimate HR) Weighted Cohen’s Kappa (to measure disagreement | Increasing CAC score categories were associated with a significantly increased HR for MACE. |
| Leening et al.5 | 2012 | 1,897 | 69.9 ± 6.5 | Prospective populationbased cohort study (The Rotterdam Study) | EBCT |
Cox proportional hazards models (implied by use of HR, C-statistic, and reclassification metrics) Measures included c-statistic, integrated discrimination index (IDI), and continuous net reclassification index (NRI). | CAC has a clear and graded association with the risk of developing HF in the elderly population, independent of traditional cardiovascular risk factors and incident overt CHD |
| Fathala et al.6 | 2019 | 204 | 48 ± 13 | Retrospective cohort study | Contrast CT ICA |
Descriptive statistics Pearson’s Chi-squared test Independent samples t-test or ANOVA Multivariate logistic regression | The mean CAC score was significantly higher in the CAD HF group compared to the non-CAD HF group. |
| Choi et al.19 | 2025 | 15,193 | 55.8 ± 8.6 | Longitudinal cohort study | Non-contrast CT Echocardiography |
Linear regression models Log-binomial regression Linear mixed models | CAC ≥ 100 significantly affects the progression of DD independently of other clinical factors. |
| Singh et al.30 | 2024 | 1,988 | DM cohort: 63.4 ± 8.9 Non-DM cohort: 60.3 ± 9.6 | Prospective cohort study | Contrast CT |
t-tests and p-tests (for categorical variables) Survival analysis metrics including c-index and hazard ratio (HR) Cox proportional hazard models with elastic net regularization 5-f0ld cross-validation with bootstrap iterations Kaplan–Meier curves | Models leveraging radiomic features of calcium-omics and epicardial adipose tissue (fat-omics) extracted via deep learning from CTCS scans showed competitive or superior performance in predicting incident HF compared to traditional models. |
| Wakaki et al.22 | 2025 | 353 | 68.6 ± 12.7 | Retrospective cohort study | Non-ECG-gated CT ICA | | The CAC score significantly predicted cardiovascular events (including CHF). |
| Hashimoto et al.23 | 2021 | 108 | 74 ±13 | Retrospective observational study | Non-contrast CT I-BMIPP SPECT | | Increased CAC scores were associated with all-cause mortality in patients with CHF. |
| Tian et al.27 | 2025 | 1,310 | 56.5 ± 11.8 | Prospective cohort study (Chronic Renal Insufficiency Cohort) |
|
t test and chi-squared test Multiple imputation Comparison of models using Akaike’s information criterion Schoenfeld residuals to confirm proportional hazard assumptions Survival analysis using methods appropriate for competing risks | Progression of CAC is associated with a higher risk of atherosclerotic CVD and all-cause mortality, but not with CHF. |
| Ahmad et at.15 | 2025 | 6,592 | 62 ± 10 | Prospective cohort study (MESA) | Non-contrast CT EBCT | Chi-squared testANOVAKruskal–Wallis testKaplan–Meier plot and log-rank testMultivariable Cox proportional hazard models Proportional hazards assumption evaluated using Schoenfeld residuals and formal testing Benjamin-Hochberg (BH) adjusted p value. | The combination of elevated IL-6 and CAC > 0 was associated with a higher risk of HFrEF, showing significant additive and multiplicative interactions. There was an antagonistic interaction for HFpEF. |
| Wada et al.20 | 2023 | 982 | 64.7 ± 6.6 | Prospective cohort study (NADESICO) | Non-contrast CT | Univariable and multivariable analysis Cox proportional hazard models C-statistic analysis | Adding the CAC score to the conventional cardiovascular risk factors (Suita score) significantly improved the predictive ability for future MACE in Japanese patients. |
| Elnagar et al.31 | 2024 | 435 | 48.04 ± 7.19 (Group I: CAC <400)and 49·77 ± 7.15 (Group II: CAC >400). | Retrospective cohort study | Contrast CT | Independent sample t-test Chi-squared test Multivariate logistic regression analysis | CAC scores ≥ 400 predict MACE. |
| Sharma et al.12 | 2017 | 5,282 | 62 ± 10 | Prospective cohort study (MESA) | Non-contrast CT EBCT | Cox proportional hazard models Proportional hazard assumption Test for trend | The CAC score was positively associated with incident HFpEF risk in women, but not in men. |
| Abunassar et al.32 | 2011 | 4,394 | No prior HF/LV dysfunction: 51.7 ± 10.3 HF and abnormal EF: 58.8 ± 11.7 High-risk CAD: 62.1 ± 9.7 | Retrospective cohort study | Contrast CT | Wilcoxon rank-sum test Fisher’s exact test | CAC = 0 excludes ischemic cardiomyopathy in patients presenting with HF. |
| Lehmann et al.33 | 2018 | 3,281 | 58.7 ± 7·5 | Prospective cohort study (Heinz Nixdorf Recall study) | EBCT | Chi-squared testMann-Whitney U test Univariate and multivariable logistic regressionMultivariable Cox proportional hazards regressionNet reclassification indexIntegrated discrimination index | The CAC score is associated with CHF in persons without clinically overt CAD, but in longitudinal progression analysis, the predictive value of CAC progression has reduced risk prediction for CVDE when compared to the most recent CAC value. |
