A Nomogram for Predicting Coronary Artery Calcification Using Achilles Tendon Cross-Sectional Area, Mechanical Parameters, and TCBI

ObjectiveTo develop a nomogram for predicting coronary artery calcification (CAC) in atherosclerosis patients using Achilles tendon cross-sectional area (CSA), tendon mechanical parameters, and a combined nutrition score.MethodsThis case-control study included atherosclerosis patients from January 2021 to January 2025. Data collected included Achilles tendon CSA, lipid content, Young's modulus, and the triglyceride-total cholesterol-body weight index (TCBI). Multivariable logistic regression was used to identify predictors of CAC. A nomogram was constructed using R, and its clinical utility was evaluated.ResultsA total of 279 patients were analyzed and randomly assigned to training (n=195) and validation (n=84) sets. Multivariable analysis identified CSA [OR=1.23 (1.13-1.33)], Young's modulus [OR=0.17 (0.05-0.58)], and TCBI [OR=2.26 (1.30-3.91)] as independent predictors of CAC (all P<0.05). The prediction model was: logit(P)= 5.22+0.20*CSA-1.76*Young's modulus+0.81*TCBI. The AUC values were 0.91 (0.87-0.95) for the training set and 0.84 (0.76-0.92) for the validation set. The Hosmer-Lemeshow test yielded P=0.962 and 0.837, and calibration curves showed good concordance. Decision curve analysis indicated net clinical benefit across risk thresholds of 2%-98% in the training set and 10%-98% in the validation set.ConclusionThe nomogram incorporating Achilles tendon CSA, mechanical parameters, and TCBI effectively predicts CAC in atherosclerosis patients. The underlying mechanisms of abnormal lipid deposition and chronic inflammation provide a theoretical basis for targeted therapeutic strategies.