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Chen Y, Hu Z, Li M, Jia Y, He T, Liu Z, Wei D, Yu Y. Comparison of Nongated Chest CT and Dedicated Calcium Scoring CT for Coronary Calcium Quantification Using a 256-Dector Row CT Scanner. Acad Radiol 2019; 26:e267-e274. [PMID: 30685312 DOI: 10.1016/j.acra.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronary artery calcification (CAC) is a marker of atherosclerosis and an independent risk factor for cardiac-related mortality and frequently detected on noncontrast chest CT. We aimed to investigate the reliability and accuracy of determining CAC using noncontrast, nongated chest CT with 256-detector row. MATERIALS AND METHODS A total of 1318 patients for chest examination were enrolled to undergo both nongated chest CT and dedicated calcium-scoring CT (CSCT) on a 256-detector row CT scanner. The chest CT was scanned in fast-helical mode with 8 cm collimation, 0.28 second rotation speed and pitch 0.992:1 to cover entire chest. CSCT used single prospective ECG-triggered cardiac axial mode with 0.28 second rotation speed covering only the heart. CAC scores (Agatston, mass, and volume) were determined using both image sets and were statistically compared. RESULTS Sensitivity and specificity of nongated chest CT for determining positive CAC was 94.8% (182/192) and 100%, respectively. The agreement in assessing the quantitative Agatston, volume, and mass scores between the nongated chest CT and CSCT was almost perfect, with the intraclass correlation coefficient values of 0.998, 0.999, and 0.999, respectively. Additionally, there was a good agreement in CAC quantification between the nongated chest CT and dedicated CSCT with small coefficient of variation: mass score (9.0%), volume score (9.5%), and Agatston score (12.6%). CONCLUSION Nongated chest CT with 256-detector row is a reliable imaging mode for detecting and quantifying calcifications in coronary arteries compared with dedicated calcium-scoring CT.
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Chi JM, Makaryus JN, Rahmani N, Shah AB, Shah RD, Cohen SL. Coronary CT Calcium Score in Patients With Prior Nongated CT, Is it Necessary? Curr Probl Diagn Radiol 2019; 50:54-58. [PMID: 31416649 DOI: 10.1067/j.cpradiol.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/13/2019] [Accepted: 07/21/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To 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. BACKGROUND Cardiovascular 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. METHODS Consecutive 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. RESULTS Forty-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. CONCLUSIONS A 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.
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Affiliation(s)
- Joan M Chi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY.
| | - John N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Cardiology, Manhasset, NY
| | - Navid Rahmani
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY
| | - Amar B Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY
| | - Rakesh D Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY
| | - Stuart L Cohen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY; Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY; Imaging Clinical Effectiveness and Outcomes Research program, Northwell Health, Manhasset, NY
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Chandra D, Gupta A, Fitzpatrick M, Haberlen SA, Neupane M, Leader JK, Kingsley LA, Kleerup E, Budoff MJ, Witt M, Sciurba FC, Post WS, Morris A. Lung Function, Coronary Artery Disease, and Mortality in HIV. Ann Am Thorac Soc 2019; 16:687-697. [PMID: 31113229 PMCID: PMC6543472 DOI: 10.1513/annalsats.201807-460oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/13/2019] [Indexed: 12/22/2022] Open
Abstract
Rationale: Impaired lung function is a potent independent predictor of coronary artery disease (CAD) in individuals without human immunodeficiency virus (HIV) infection; however, the relationship between lung function and CAD in HIV remains undefined. Objectives: To examine the relationship between lung function, CAD, mortality, and circulating biomarkers in HIV. Methods: Spirometry, diffusing capacity of the lung for carbon monoxide (DlCO), emphysema, coronary artery calcium, mortality, cause of death, and biomarkers were examined in HIV-infected and uninfected individuals enrolled in a cohort study at the University of Pittsburgh. Results were then validated in the Multicenter AIDS Cohort Study (MACS) cohort. Results: We examined data on 234 participants in the Pittsburgh cohort. The mean ± standard deviation age was 49.5 ± 10.2 years old, 82.1% were male, and 67.5% were ever smokers. Among the 177 of 234 individuals with HIV infection, lower DlCO (not forced expiratory volume in 1 second or emphysema) was independently associated with greater coronary artery calcium (odds ratio, 1.43 per 10% lower DlCO; 95% confidence interval, 1.14-1.81). HIV-infected individuals with both reduced DlCO and coronary artery calcium had a much higher mortality than those with either low DlCO or coronary calcium alone or with neither condition. Endothelin-1, a circulating biomarker of endothelial dysfunction, was associated with both lower DlCO and greater coronary artery calcium in those with HIV infection. Results were reproducible in 144 individuals enrolled in the MACS cohort; intercellular adhesion molecule 1 was the biomarker of endothelial dysfunction assessed in the MACS cohort. Conclusions: Impaired DlCO and CAD were associated with each other and with higher mortality in individuals with HIV infection.
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Affiliation(s)
| | | | | | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Eric Kleerup
- Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California; and
| | - Mallory Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California; and
| | | | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Tomizawa N. Could coronary calcification identified at non-gated chest CT be a predictor for cardiovascular events in breast cancer patients? Int J Cardiol 2019; 282:108-109. [PMID: 30745257 DOI: 10.1016/j.ijcard.2019.01.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 11/26/2022]
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Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography. J Thorac Imaging 2019; 34:160-169. [DOI: 10.1097/rti.0000000000000379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kalisz K, Enzerra M, Ansari-Gilani K. Cardiovascular findings on cross-sectional imaging: spectrum of incidental and critical findings and clinical relevance for the abdominal radiologist. Abdom Radiol (NY) 2019; 44:1161-1180. [PMID: 30737548 DOI: 10.1007/s00261-019-01922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although not the primary focus of the exams, cardiovascular structures are included to some extent on all abdominal or whole-body cross-sectional studies. Cardiovascular findings often present incidentally and may range from chronic to acute and emergent pathologies. Among the most common cardiovascular findings are the presence of cardiac calcifications, most commonly coronary, which correlate with the presence of coronary artery and valvular disease. Signs of myocardial ischemia, both acute and chronic, and its complications may also be visualized. Cardiac filling defects most commonly represent thrombus and are associated with systemic arterial embolic complications. Pericardial findings often manifest as effusion or thickening, which may lead to hemodynamic consequences visible at imaging. Incidental pulmonary emboli and systemic venous thrombi may be incidentally detected, particularly in hospitalized and oncologic patients, and warrant immediate attention. This review will highlight the appearance of common and important incidental cardiovascular findings and related pitfalls and discuss reporting and follow-up recommendations relevant to the abdominal radiologist.
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Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | - Michael Enzerra
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Phillips WJ, Johnson C, Law A, Turek M, Small AR, Dent S, Ruddy TD, Beanlands RS, Chow BJW, Small GR. Comparison of Framingham risk score and chest-CT identified coronary artery calcification in breast cancer patients to predict cardiovascular events. Int J Cardiol 2019; 289:138-143. [PMID: 30696608 DOI: 10.1016/j.ijcard.2019.01.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/10/2018] [Accepted: 01/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In breast cancer patients, coincidental detection of CAC at chest CT may be important in determining cardiovascular (CV) outcomes and facilitate CV disease primary prevention strategies. METHODS 408 consecutive breast cancer patients referred to cardiac oncology clinic were included in the study. 256 patients without a prior history of coronary artery disease had undergone a chest CT. CT images were reviewed to detect CAC. Framingham risk score (FRS) was calculated and patient electronic medical records were interrogated to document the incidence of a composite clinical end point of all-cause mortality and cardiac events (coronary revascularization, heart failure hospitalization and de novo atrial fibrillation). Prevalence of statin prescribing was also collected. RESULTS Patients were followed for a median of 6.5 years. 112 clinical events occurred. Clinical follow up was 98%. CAC was found in 26% of patients. On multivariable analysis, CAC and advance cancer stage, but not FRS predicted the composite clinical end point (OR for CAC 2.59, p < 0.01). CAC but not FRS also predicted the incidence of cardiac events (OR for CAC 4.90, p < 0.01). CAC was present in 7.3% of patients with low FRS; none had been prescribed a statin. In patients with CAC and FRS ≥ 10%, 45% were not on a statin. CONCLUSION CAC is a common coincidental finding at CT chest in breast cancer patients referred to cardiac oncology. CAC but not FRS was predictive of composite clinical events and cardiac events. Detection of CAC at chest CT could alter the prescribing of primary prevention strategies to help prevent future cardiac events in breast cancer patients.
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Affiliation(s)
| | - Christopher Johnson
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Angeline Law
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Michele Turek
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Alex R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Susan Dent
- University of Ottawa, Department of Medicine (Oncology), Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Rob S Beanlands
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Gary R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada.
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Milgrom SA, Varghese B, Gladish GW, Choi AD, Dong W, Patel ZS, Chung CC, Rao A, Pinnix CC, Gunther JR, Dabaja BS, Lin SH, Hoffman KE, Huff JL, Slagowski J, Abe JI, Iliescu CA, Banchs J, Yusuf SW, Lopez-Mattei JC. Coronary Artery Dose-Volume Parameters Predict Risk of Calcification After Radiation Therapy. J Cardiovasc Imaging 2019; 27:268-279. [PMID: 31614398 PMCID: PMC6795565 DOI: 10.4250/jcvi.2019.27.e38] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiation exposure increases the risk of coronary artery disease (CAD). We explored the association of CAD with coronary artery dose-volume parameters in patients treated with 3D-planned radiation therapy (RT). METHODS Patients who received thoracic RT and were evaluated by cardiac computed tomography ≥ 1 year later were included. Demographic data and cardiac risk factors were retrospectively collected. Dosimetric data (mean heart dose, dmax, dmean, V50 - V5) were collected for the whole heart and for each coronary artery. A coronary artery calcium (CAC) Agatston score was calculated on a per-coronary basis and as a total score. Multivariable generalized linear mixed models were generated. The predicted probabilities were used for receiver operating characteristic analyses. RESULTS Twenty patients with a median age of 53 years at the time of RT were included. Nine patients (45%) had ≥ 3/6 conventional cardiac risk factors. Patients received RT for breast cancer (10, 50%), lung cancer (6, 30%), or lymphoma/myeloma (4, 20%) with a median dose of 60 Gy. CAC scans were performed a median of 32 months after RT. CAC score was significantly associated with radiation dose and presence of diabetes. In a multivariable model adjusted for diabetes, segmental coronary artery dosimetric parameters (dmax, dmean, V50, V40 V30, V20, V10, and V5) were significantly associated with CAC score > 0. V50 had the highest area under the ROC curve (0.89, 95% confidence interval, 0.80-0.97). CONCLUSIONS Coronary artery radiation exposure is strongly correlated with subsequent segmental CAC score. Coronary calcification may occur soon after RT and in individuals with conventional cardiac risk factors.
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Affiliation(s)
- Sarah A Milgrom
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bibin Varghese
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory W Gladish
- Department of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, George Washington University School of Medicine, Washington, DC, USA
| | - Wenli Dong
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Caroline C Chung
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea C Pinnix
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Karen E Hoffman
- Division of Radiation Oncology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Janice L Huff
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, USA.,MEI Technologies, Houston, TX, USA
| | - Jordan Slagowski
- Division of Radiation Oncology, Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Ichi Abe
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cezar A Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose Banchs
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan C Lopez-Mattei
- Department of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX, USA.,Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol 2018; 72:434-447. [PMID: 30025580 PMCID: PMC6056023 DOI: 10.1016/j.jacc.2018.05.027] [Citation(s) in RCA: 530] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. On the basis of single-center and multicenter clinical and population-based studies with short-term and long-term outcomes data (up to 15-year follow-up), CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost effective across a broad range of baseline risk. This review summarizes evidence concerning CAC, including its pathobiology, modalities for detection, predictive role, use in prediction scoring algorithms, CAC progression, evidence that CAC changes the clinical approach to the patient and patient behavior, novel applications of CAC, future directions in scoring CAC scans, and new CAC guidelines.
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Affiliation(s)
- Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland. https://twitter.com/MichaelJBlaha
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Clinic, Essen, Germany
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. https://twitter.com/kewatson
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Small GR, Ernst J, Gauthier N, Chow BJW. Coronary CTA for Preoperative Risk Assessment in Noncardiac Surgery. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Margolies LR, Salvatore M, Yip R, Tam K, Bertolini A, Henschke C, Yankelevitz D. The chest radiologist's role in invasive breast cancer detection. Clin Imaging 2018; 50:13-19. [DOI: 10.1016/j.clinimag.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/25/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022]
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Abstract
Lung cancer screening has been shown in the National Lung Screening Trial (NLST) to result in a statistically significant decrease in lung cancer specific mortality. Also within that trial there was shown to be a 7% decrease in all-cause mortality. While the reasons for this benefit are not entirely clear, it may relate to the detection and treatment of other important findings. Smokers not only have a higher risk of lung cancer, but also increased risk of atherosclerosis. The latter can be detected by the discovery of aortic and/or coronary artery calcium on unenhanced CT. As coronary artery calcium scoring can be used as a screening tool to detect asymptomatic coronary artery atherosclerosis, its detection on lung cancer screening exams has the potential to provide both a teachable moment and treatment aimed at the reduction of major coronary artery events and mortality. In this review we will discuss the use of coronary artery calcium scoring for the detection of atherosclerotic disease and its potential application to lung cancer screening populations.
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Affiliation(s)
- James G Ravenel
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John W Nance
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
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Lichtenstein G, Perlman A, Shpitzen S, Durst R, Shaham D, Leitersdorf E, Szalat A. Correlation between coronary artery calcification by non-cardiac CT and Framingham score in young patients. PLoS One 2018; 13:e0195061. [PMID: 29590197 PMCID: PMC5874063 DOI: 10.1371/journal.pone.0195061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/15/2018] [Indexed: 01/07/2023] Open
Abstract
Background Previous studies have established a correlation between coronary artery calcification (CAC) measured by ECG-gated chest computed tomography (CT) and cardiovascular disease. Recent reports which included asymptomatic patients suggest that CAC measured on non-ECG gated CT is similarly associated with cardiovascular risk. This study investigates the correlation between the Framingham Risk Score (FRS) and an incidental finding of CAC on a non-gated chest CT performed for non-cardiac indications in young and seemingly healthy adults. Methods A cross-sectional study that included 162 CT scans performed in young patients aged 18–50 years old for non-cardiac indications in our institution was conducted. CAC score (CACS) was calculated using the Agatston method. FRS was calculated and compared to the CACS using three different approaches. The correlations between the CACS and several specific factors (i.e. age, body mass index, smoking, statins, etc.), were also evaluated. Results Mean age of patients was 36.43 year old and 105 (64.8%) were male. We found a significant positive correlation between the CACS and the FRS in all three approaches (p<0.05). Increased age, smoking and statin use were the only individual factors clearly associated with an increase in CACS (p = 0.002, p = 0.045 and p = 0.009, respectively). Conclusion This is the first report indicating that incidental CACS identified in non-gated MDCT is also associated with cardiovascular risk evaluated by FRS in a young population. Our findings suggest that young asymptomatic individuals with incidental CAC should be seriously evaluated for cardiovascular risk factors despite presumption of belonging to a low cardiovascular risk category.
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Affiliation(s)
- Gabriel Lichtenstein
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amichai Perlman
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shoshana Shpitzen
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Durst
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dorit Shaham
- Medical Imaging Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Leitersdorf
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Auryan Szalat
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- * E-mail:
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Phillips WJ, Johnson C, Law A, Turek M, Small AR, Inacio JR, Dent S, Ruddy T, Beanlands RS, Chow BJW, Small GR. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events. IJC HEART & VASCULATURE 2018; 18:12-16. [PMID: 29750180 PMCID: PMC5941242 DOI: 10.1016/j.ijcha.2018.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
Abstract
Background The identification of coronary artery calcification (CAC) detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results CAC was identified in 70 patients (26%). CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01) and increased during the period of the study (p < 0.05). Conclusions CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population.
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Affiliation(s)
| | - Christopher Johnson
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Angeline Law
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Michele Turek
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Alex R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Joao R Inacio
- Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Susan Dent
- Department of Medicine (Oncology), Ottawa, Ontario, Canada
| | - Terrence Ruddy
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Rob S Beanlands
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Gary R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
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