The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease

OBJECTIVES: To determine the prevalence of carotid calcification on dental panoramic radiographs in end-stage renal disease (ESRD) patients on haemodialysis and renal transplant recipients. METHODS: Panoramic radiographs of 69 adult patients with renal disease (34 with haemodialysis and 35 with renal transplantations) (age range 17-74 years; mean age 39.45 years) and 50 controls (age-match, free of systemic disease) were examined on panoramic radiographs for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. Patients with such calcifications were referred to ultrasound examination. Using Chi-squared tests, calcification prevalence rates were statistically compared. RESULTS: The statistical difference between renal disease patients and control group was significant (chi2 = 17.91, P < 0.001). On comparison of haemodialysis patients and renal transplant recipients with controls, statistical difference (P=0.007) was found to be significant. CONCLUSION: Carotid artery calcification was higher in haemodialysis patients and renal transplant recipients. These patients with such calcifications should be referred for further evaluation and treatment of carotid arteries, coronary arteries and vascular risk factors.     

Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients

BackgroundCoronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated.ObjectivesThe aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients.Methods1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients’ outcomes.ResultsNon-survivors compared to survivors had higher coronary artery [Agatston (467.76 ​± ​570.92 vs 206.80 ​± ​424.13 ​mm², p ​< ​0.001); Volume (487.79 ​± ​565.34 vs 207.77 ​± ​406.81, p ​< ​0.001)], aortic valve [Volume (322.45 ​± ​390.90 vs 98.27 ​± ​250.74 mm², p ​< ​0.001; Agatston 337.38 ​± ​414.97 vs 111.70 ​± ​282.15, p ​< ​0.001)] and thoracic aorta [Volume (3786.71 ​± ​4225.57 vs 1487.63 ​± ​2973.19 mm², p ​< ​0.001); Agatston (4688.82 ​± ​5363.72 vs 1834.90 ​± ​3761.25, p ​< ​0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046–1.637, p ​= ​0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200–3.251, p ​= ​0.007) resulted to be independent predictors of in-hospital mortality.ConclusionCoronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.     

MRI detects increased coronary wall thickness in asymptomatic individuals: the multi-ethnic study of atherosclerosis (MESA)

PURPOSE: To evaluate the use of coronary wall MRI as a measure of atherosclerotic disease burden in an asymptomatic population free of clinical cardiovascular disease. Coronary wall magnetic resonance imaging (MRI) is a noninvasive method for evaluation of arterial wall remodeling associated with atherosclerosis. MATERIALS AND METHODS: Asymptomatic participants of the Multi-Ethnic Study of Atherosclerosis (MESA) study were studied using black blood MRI. MRI-assessed coronary wall thickness was compared with computed tomography calcium score, carotid intimal-medial thickness, and risk factors for coronary artery disease. RESULTS: Eighty-eight arterial segments were evaluated in 38 MESA participants (mean age, 61.3+/-8.7 years). The maximum coronary wall thickness was greater for participants with two or more cardiovascular risk factors than for those with one or no risk factors (2.59+/-0.33 mm vs. 2.36+/-0.30 mm, respectively, P=0.05.) For participants with zero calcium score, the mean and maximum coronary wall thickness for subjects with two or more risk factors for coronary artery disease were greater than the wall thickness for subjects with one or no risk factors (mean thickness: 1.95+/-0.17 mm vs. 1.7+/-0.19 mm; maximum thickness: 2.67+/-0.24 mm vs. 2.32+/-0.27 mm, respectively, P<0.05). Subjects with increased carotid intimal-medial thickness also had increased coronary artery wall thickness (P<0.05). CONCLUSION: Coronary artery wall MRI detects increased coronary wall thickness in asymptomatic individuals with subclinical markers of atherosclerotic disease and in individuals with zero calcium score.     

Prognostic significance of zero coronary calcium scores on cardiac computed tomography

Background

Most unexpected cardiovascular events occur in persons at intermediate risk of coronary artery disease (10%-20% 10-year risk). Coronary artery calcium (CAC) has been shown to be highly specific for atherosclerosis, occurring only in the intima of the coronary arteries. Evidence shows that elevated coronary calcium scores (CCSs) are predictive of future cardiovascular events, both independently of and incrementally to conventional cardiovascular risk factors. Several studies reported event rates of zero for those persons without CAC by cardiac computed tomography (CT).

Objectives

We sought to evaluate the event rates in persons with negative calcium scores from the reported literature to establish whether these patients may be considered at low risk for hard cardiovascular events (myocardial infarction and death).

Methods

English-language studies from January 1, 1975, through February 1, 2007, were retrieved using MEDLINE and Current Contents databases, bibliographies, and expert consultation.

Results

Summary data show that in a total follow-up of 35,765 asymptomatic persons, 16,106 (45%) had scores of zero. Pooled sensitivity for CAC to detect a cardiovascular event was 98.1% [95% confidence interval (CI), 95.1%-99.9%], and negative predictive value was 99.9% (95% CI, 98.9%-100%). There were 48 hard events in this population, with an annual event rate of 0.027%.

Conclusion

These large observational cohorts show that the absence of CAC by cardiac CT is associated with a low adverse event risk and therefore could be used as a tool to counsel patients about their risk of such events.     

The prevalence and correlation of carotid artery calcification on panoramic radiographs and peripheral arterial disease in a population from the Republic of Korea: the Dong-gu study

Objectives:

The aim of this study was to determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs and peripheral arterial disease (PAD), and to evaluate the difference in the prevalence of PAD between patients with CAC and patients without CAC detectable by panoramic radiograph.

Methods:

The surveyed population consisted of 4078 subjects aged 50 years and older (1410 males and 2668 females) who underwent medical and dental examination in Gwangju city, South Korea. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. A trained research technician measured the ankle–brachial index (ABI). An ABI <0.9 in either leg was considered evidence of PAD.

Results:

The prevalence of CAC on panoramic radiographs was 6.2% and that of PAD was 2.6%. Subjects with CAC had a significantly higher prevalence of PAD than those without CAC (5.5% vs 2.4%, respectively). The presence of CAC on panoramic radiographs was associated with PAD (odds ratio 1.84; 95% confidence interval 1.01–3.36) after adjusting for potential confounders.

Conclusion:

CACs detected on panoramic radiographs were positively associated with PAD in middle-aged and older Korean adults.     

CT低剂量技术在冠状动脉钙化积分检查中的应用现状与新进展

冠状动脉钙化积分(CACS)是无创性评估心血管风险分层及冠心病发生、发展和预后的一项重要指标,可以辅助临床治疗策略的选择制定。遵从辐射防护最优化原则(ALARA),可以采用直接方法(降低管电流、管电压,自动管电流调制技术)、间接方法(大螺距、迭代重建技术),以及直接在冠状动脉CT血管成像、双能CT虚拟平扫和非心电门控胸部CT平扫影像上测量CACS,从而降低该检查辐射剂量,并可准确、可重复地测量CACS,进行心血管风险分层。     

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of the panoramic radiograph in the detection of carotid artery calcification using CT as the gold standard. METHODS: 110 dental patients (average age 65.2 years, range 50-82 years) with both panoramic radiographs and CT scans available were selected for the evaluation of carotid artery calcification. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. CT scans were independently interpreted by a neuroradiologist. RESULTS: The accuracy of panoramic radiographs in the detection of carotid artery calcification was 62.3%. The sensitivity and the specificity were 22.2% and 90.0%, respectively. CONCLUSIONS: Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.     

Value of conventional chest radiography for the detection of coronary calcifications: comparison with MSCT

Purpose

To evaluate if computed tomography (CT) coronary calcium scoring is needed after detection of coronary calcifications on conventional chest radiographs.

Materials and methods

One hundred and five patients (67 men; 57.2 ± 12.8 years) with suspected coronary artery disease underwent conventional chest radiography and non-enhanced, retrospectively ECG-gated multislice spiral CT (MSCT) of the heart (4 mm × 2.5 mm, 120 kV, 133 mAs_eff.). Chest radiographs were assessed independently by two radiologists. Detection of coronary calcifications was compared between both methods. Sensitivity, specificity, negative and positive predictive values, median, 25% and 75% percentiles for the detection of coronary calcifications were calculated. Receiver operating characteristics (ROC) analyses were computed.

Results

In 90 patients, MSCT revealed coronary calcifications. The mean coronary calcium score was 526.2 (0–4784.5). On chest radiographs, coronary calcifications were correctly detected in 46 (61) patients by observer 1 (observer 2). The corresponding sensitivity was 51.1% in observer 1 and 67.8% in observer 2. Median of detected coronary calcifications was 361.9 (426.4) for observer 1 (observer 2). Corresponding 25% und 75% percentiles were 109.6 (109.6) and 798.5 (898.5). The area under the ROC curve was 0.636 for observer 1 and 0.715 for observer 2. There was no correlation between image quality and the detection of coronary calcifications on plain film radiographs.

Conclusion

As coronary calcifications of various extents are inconsistently detected on plain chest radiographs, CT calcium scoring may not be omitted even if coronary artery calcifications were detected on conventional chest radiographs.     

Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study

BackgroundCoronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear.MethodsIn the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n ?= ?560). We also classified LVDD using the American Society of Echocardiography recommendations.ResultsThe mean age of the participants was 51 ?± ?17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e’, E/e’, and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e’ and E/e’, the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e’ and E/e’ included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds.ConclusionIn the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function.Clinicaltrials.gov identifierNCT03154346.     

Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges

Background

Coronary artery calcium (CAC) is often identified on routine chest computed tomography (CT). The purpose of our study was to evaluate whether ordinal scoring of CAC on non-gated, routine chest CT is an accurate predictor of Agatston score ranges in a community-based population, and in particular to determine the accuracy of an ordinal score of zero on routine chest CT.

颈动脉粥样硬化超声检测和冠状动脉粥样硬化的相关性分析

目的:评价颈动脉粥样硬化对冠状动脉粥样硬化的预测价值,并寻找与颈动脉硬化有关的因素。方法:选择冠状动脉造影后62例患者,行颈动脉超声检查,观察颈动脉内-中膜状况,以所测最大内中膜厚度及斑块发生率为观察指标。同时作血脂生化分析。用SPSS11.0软件包进行统计学分析。结果:冠状动脉造影正常组与病变组之间、病变组之间颈动脉斑块面积、斑块积分、斑块数目、IMT比较有显著差异(P<0.05)。冠状动脉造影结果与颈动脉超声斑块形成结果比较,颈动脉超声的敏感性为82.4(42/51),特异性为72.7%(8/11),总的诊断符合率为82.3%(51/62)。逐步Logistic回归分析,显示年龄、血压、血糖、TG及HDL-ch与IMT有相关性。结论:颈动脉粥样硬化与冠状动脉粥样硬化病变之间有着显著的相关性,提示颈动脉壁内—中膜厚度及斑块能反映冠状动脉粥样硬化程度。     

Prevalence of calcified carotid artery atheromas on panoramic images of individuals with primary hyperparathyroidism

Objectives:

Primary hyperparathyroidism (PHPT), affecting 1% of the population, is associated with increased cardiovascular morbidity and mortality. The presence of calcified carotid artery plaque (CCAP) on panoramic images is a validated risk indicator of future adverse cardiovascular events. We hypothesized that military veterans aged 50 years or older diagnosed with PHPT by increased parathyroid hormone and calcium levels would frequently have CCAP on their images.

Methods:

We determined the prevalence rates of CCAP on the images of patients diagnosed with PHPT and evaluated their atherogenic risk profiles, including hypertension, dyslipidaemia, diabetes and obesity. Comparisons of atherogenic risk factors were made between subjects with and without observed CCAP on their panoramic images.

Results:

Of the 60 patients (86.7% males and 13.3% females, mean age 73.2 ± 11.3 years) with PHPT, 40% had atheromas. There were no significant differences between CCAP+ and CCAP− groups in gender or race (p > 0.05). The atherogenic profile (age, body mass index, hypertension, diabetes, hyperlipidaemia) in the CCAP+ and CCAP− groups was not significantly different (p > 0.05).

Conclusions:

Calcified carotid artery atheromas are often seen on the panoramic images of patients with PHPT. Thus, dentists must be uniquely vigilant for these lesions when evaluating these studies.     

Systemic arterial calcium burden in patients with chronic limb-threatening ischemia

Introduction5-year mortality of chronic limb-threatening ischemia (CLTI) is 50–60% and coronary artery disease (CAD) is the main cause of death of CLTI patients, followed by stroke. The aim of this study is to quantify and qualify the calcium load in different arterial territories in patients with CLTI.MethodsProspectively, 60 patients with CLTI were included and received a full-body CT scan. 6 patients were excluded. Different arterial territories (the peripheral lower extremity arteries, coronary arteries, extracranial and intracranial carotid arteries, thoracic and abdominal aorta) were analyzed. Analysis and interrelations of both quantitative and semi-quantitative CT measurements was performed.ResultsMean age was 72 years (range 47–95; SD 11.4). Almost all CLTI patients had calcified arterial beds (femoropopliteal 100%, crural 98.1%, coronary 100%, carotid bifurcation 96.2%, internal carotid artery 98.1%, thoracic aorta 96.2%, abdominal aorta 92.3%). Nearly all arterial territories had severe calcifications. 57% had a very high coronary Agatston score (>1000), and 35% extremely high (>2000). Calcifications in the lower extremity were significantly correlated to CAC score, carotid artery bifurcation calcification score, and to a lesser extent correlated to annular calcifications in the aorta. Very high and extremely high total CAC scores were strongly correlated with severe lower extremity arterial calcifications and severe carotid and intracranial internal carotid artery, thoracic and abdominal aorta calcifications in patients with CLTI patients.ConclusionsIn CLTI patients nearly all arterial territories are severely calcified, suggesting that systemic calcification plays an important role in the poor outcome of this disease.     

Lack of correlation between coronary artery calcium and myocardial perfusion imaging

BACKGROUND: Coronary artery calcium (CAC) provides evidence of coronary atherosclerosis and has significant prognostic power. Although prior studies have documented a relationship between CAC and hemodynamically significant coronary artery stenosis, the results have not been conclusive. METHODS AND RESULTS: We evaluated 126 consecutive patients who underwent electron beam computed tomography CAC scoring by use of the Agatston method and stress myocardial perfusion imaging (MPI) within 3 months of each other. The analysis revealed no correlation between absolute CAC score and age- and gender-adjusted CAC scores with MPI. Overall, 18% of patients had abnormal MPI results irrespective of their CAC. CONCLUSION: CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for coronary artery disease.     

Rationale, design and methods of CTCA-PRORECAD (Computed Tomography Coronary Angiography Prognostic Registry for Coronary Artery Disease): a multicentre and multivendor registry

Purpose

This study was done to assess the prognostic value of computed tomography coronary angiography (CTCA) in a large multicentre population of patients with suspected coronary artery disease (CAD) and, in particular, its incremental value compared with traditional methods for risk stratification.

Materials and methods

This is a retrospective observational study that began in January 2003 conducted on patients with suspected CAD assessed with CTCA on the basis of symptoms (chest pain, dyspnoea) and/or abnormal or equivocal stress test and/or a high cardiovascular risk profile. The participating centres will provide data obtained with CTCA performed with 16-slice or higher equipment. Exclusion criteria are renal insufficiency, allergy to iodinated contrast material, pregnancy and previous myocardial infarction or revascularisation (percutaneous coronary intervention and/or coronary artery bypass graft). All patients are stratified by means of clinical assessment and/or data retrieved from a clinical database. Risk factors considered are hypertension, dyslipidaemia, diabetes mellitus, smoking, family history and obesity. Symptoms are classified as absent, typical chest pain, atypical chest pain and dyspnoea. Primary endpoints are death, major adverse cardiovascular events (cardiac death, unstable angina requiring hospitalisation, acute myocardial infarction) and shifting of cardiovascular risk category on the basis of coronary plaque burden. The secondary endpoint is coronary revascularisation. Telephone interviews and/or clinical databases are used for the follow-up. The study will be conducted on a population >1,000 patients.

Conclusions

The information collected from the Prognostic Registry for Coronary Artery Disease (PRORECAD) will provide insight into the prognostic value of CTCA in addition to demographic and clinical features. The results will allow for better use and interpretation of CTCA for prognostic purposes.     

Morphomic calcification score from clinical CT scans: A proxy for coronary artery calcium

BackgroundScreening of cardiovascular risk is essential in preventing cardiac events and quantifying asymptomatic risk. Coronary artery calcium (CAC) scores are a well-established in predicting cardiovascular risk, but require specialized computed tomography (CT) scans. Given the relationship of aortic calcification with cardiovascular risk, we sought to determine whether aortic calcification measures from incidental CT scans may approximate CAC.Study designRetrospective CT scans and corresponding volumetric CAC scores were obtained from patients at the University of Michigan. Aortic calcifications were measured in 166 scans. Correlations between a novel morphomic calcium (MC) percent score and CAC score were evaluated using Kendall's correlation coefficients. Comparison of receiver operating characteristic (ROC) curves based on MC at different vertebral levels showed the highest predictive values for measures taken at L4.ResultsMC at L4 shows promise in predicting CAC (AUC 0.90 in non-contrast scans, 0.70 in post-contrast scans). Proposed MC threshold are (4.21% for best sensitivity, B 12.93% for balance, C = 19.26% for specificity) in scans without contrast enhancement and (D = 7.31 for sensitivity, E 8.06 for specificity) in scans with contrast enhancement.ConclusionThe MC score demonstrates promising potential in approximating CAC, particularly at the L4 level. The utilization of MC from incidental CT scans may be useful for assessment of cardiovascular risk. The ability to extract MC from contrast scans makes it especially valuable to patients receiving additional medical or surgical care. Recognition of high-risk patients would allow the use of indicated preventative strategies to avoid hard cardiovascular events in at risk patients.     

Association between socioeconomic position and coronary artery calcium score in patients with symptoms suggestive of obstructive coronary artery disease

AimLow socioeconomic-position (SEP) is associated with increased prevalence of cardiovascular disease. Whether this is caused by earlier development of atherosclerotic calcifications is not well understood. This study aimed to investigate the association between SEP and coronary artery calcium score (CACS) in a population presenting with symptoms suggestive of obstructive coronary artery disease.MethodsWe included 50,561 patients (mean age 57 ​± ​11, 53% women) from a national registry undergoing coronary computed tomography angiography (CTA) from 2008 to 2019. CACS was used as outcome in categories; 1–399 and ​≥ ​400 in regression analyses. SEP was obtained from central registries and defined as mean personal income and length of education.ResultsThe number of risk factors were negatively associated with income and education among both men and women. The adjusted OR of having a CACS≥400 was 1.67(1.50–1.86) among women with <10 years of education compared to >13 years. For men the corresponding OR was 1.03(0.91–1.16).For women with low income the adjusted OR of CACS ≥400 was 2.29(1.96–2.69) using high income as a reference. For men the corresponding OR was 1.13(0.99–1.29).ConclusionIn patients referred for coronary CTA we found an increased level of risk factors among men and women with short education and low income. Among women with longer education and a higher income we demonstrated a lower CACS compared to other women and men. Socioeconomic differences seem to affect the development of CACS beyond what can be explained by traditional risk factors. Part of the observed result may be due to referral bias.ClinicalTrials.gov identifierNone.     

A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

BackgroundThe Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf RECALL (Risk factors, Evaluation of Coronary Calcium and Lifestyle Factors) study (HNR) differed in regard to informing physicians and patients of the results of their subclinical atherosclerosis.ObjectiveThis study investigates whether the association of the presence of coronary calcium with incident nonfatal and fatal cardiovascular events is different among these 2 large, population-based observational studies.MethodsAll white subjects aged 45 to 75 years, free of baseline cardiovascular disease were included (n = 2232 in MESA; n = 3119 HNR participants). We studied the association between coronary calcium and event rates at 5 years, including hard cardiac events (myocardial infarction, cardiac death, resuscitated cardiac arrest), and separately added revascularizations and strokes (fatal and nonfatal) to determine adjusted hazard ratios.ResultsBoth cohorts showed low coronary heart disease (including revascularization) rates with zero coronary calcium (1.13% and 1.16% over 5 years in MESA and HNR, respectively) and increasing significantly in both groups with Agatston score 100 to 399 (6.71% and 4.52% in MESA and HNR, respectively) and Agatston score > 400 (12.5% and 13.54% in MESA and HNR, respectively) and showing strong independent predictive values for Agatston scores of 100 to 399 and >400, despite multivariable adjustment for risk factors. Risk factor-adjusted 5-year revascularization rates were nearly identical for HNR and MESA and were generally low for both studies (1.4% [45 of 3119] for HNR and 1.9% [43 of 2232] for MESA) over 5 years.ConclusionsAcross 2 culturally diverse populations, Agatston score >400 is a strong predictor of events. High Agatston score did not statistically result in revascularization, and knowledge of the presence of coronary calcium did not increase revascularizations.     

Coronary CT Calcium Score in Patients With Prior Nongated CT,Is it Necessary?

PurposeTo evaluate the percentage of patients undergoing gated coronary artery calcium score CTs that had a prior nongated chest CT. To assess the accuracy of prior nongated chest CTs in the detection of coronary calcium.BackgroundCardiovascular disease is the most common cause of death worldwide. Quantifying coronary artery calcification on gated calcium score CT has proven to be strongly predictive of adverse coronary artery disease events. However, visual estimation and ordinal scoring on nongated chest CTs is predictive of coronary calcium burden.MethodsConsecutive gated calcium score CTs at a single institution from 10/2014 to 10/2016 were retrospectively evaluated with IRB approval/waiver of informed consent. The presence or absence of coronary calcium and ordinal score on nongated chest CT was compared to Agatston score on gated calcium score CT.ResultsForty-two of 441 patients (9.5%) with a gated calcium score had a prior nongated chest CT, with a mean time difference of 810 days. Of the 42 prior chest CTs, 69% had coronary artery calcium (CAC) and 31% did not, with 100% predictive accuracy for the presence or absence of CAC on subsequent gated calcium score CTs. There was 86% correlation of Agatston score on gated calcium score CT with ordinal score on the prior chest CT. Ordinal score divided into independent groups of severity was related to increased severity of Agatston score on the gated calcium score CT (P< 0.001). A majority of prior chest CT studies with coronary calcium failed to include this information in the final report.ConclusionsA large percentage of gated calcium score CTs were performed despite a prior chest CT. The ordinal score on chest CTs correlated with Agatston score on gated calcium score CTs. The presence of CAC on chest CTs was underreported in a majority of cases.     

Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population: The Multi-Ethnic Study of Atherosclerosis (MESA)

BackgroundAssessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening.MethodsWe included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%–10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined.ResultsOf 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01).ConclusionsCHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.