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Groen RA, Barbero FL, Fischer SE, van Dijkman PRM, Bax JJ, Tushuizen ME, Jukema JW, Coenraad MJ, de Graaf MA. Coronary artery calcium assessment on non-gated chest CT to optimize pre-operative cardiac screening in liver transplantation. Int J Cardiol 2024; 407:132015. [PMID: 38609053 DOI: 10.1016/j.ijcard.2024.132015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Guidelines recommend standard pre-operative cardiac screening in all liver transplantation (LT) recipients, despite the relatively low prevalence of obstructive coronary artery disease. Most LT recipients often have non-gated computed tomography (CT) performed of the chest and abdomen. This study evaluated the ability of coronary artery calcification (CAC) assessment on consecutively available scans, to identify a selection of low-risk patients, in whom further cardiac imaging can be safely withheld. METHODS LT recipients with prior non-gated CT chest-abdomen were included. CAC was visually scored on a semi-quantitative ordinal scale. Stress myocardial perfusion, coronary CT angiography (CCTA) and invasive coronary angiography (ICA) were used as golden standard. The sensitivity and specificity of CAC to exclude and predict obstructive CAD were assessed. In addition, peri- and postoperative mortality and cardiac events were analyzed. RESULTS 149 LT recipients (ranged 31-71 years) were included. In 75% of patients, no CAC and mild CAC could rule out obstructive CAD on CCTA and ICA with 100% certainty. The threshold of mild CAC had a sensitivity of 100% for both CCTA and ICA and a specificity of 91% and 68%, respectively. None of the patients with no or mild calcifications experienced peri- and post-operative cardiac events or died of cardiac causes. CONCLUSION Visual evaluation of CAC on prior non-gated CT can accurately and safely exclude obstructive CAD in LT recipients. Incorporation of these already available data can optimize cardiac screening, by safely withholding or correctly allocating dedicated cardiac imaging in LT recipients. Thereby, reducing patients' test burden and save health care expenses.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fei Lynn Barbero
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Susan E Fischer
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - Paul R M van Dijkman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten E Tushuizen
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
| | - Minneke J Coenraad
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Sentagne JP, Ohana M, Severac F, Le Borgne P, Sauleau EA, Bilbault P, Kepka S. Diagnostic performance of coronary calcifications on CT to rule out acute coronary syndrome in the emergency department. BMC Emerg Med 2024; 24:116. [PMID: 38997628 PMCID: PMC11242020 DOI: 10.1186/s12873-024-01038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED. METHODS This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED. RESULTS Of the 280 patients included, 141 didn't have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group. CONCLUSIONS A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone.
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Affiliation(s)
- Julie Paget Sentagne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
| | - Mickaël Ohana
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - François Severac
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
- UMR 1260, INSERM / Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Erik-André Sauleau
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
- UMR 1260, INSERM / Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France.
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France.
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France.
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Osborne-Grinter M, Ali A, Williams MC. Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: a systematic review and meta-analysis. Eur Radiol 2024; 34:4459-4474. [PMID: 38133672 PMCID: PMC11213779 DOI: 10.1007/s00330-023-10439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Coronary artery calcifications (CACs) indicate the presence of coronary artery disease. CAC can be found on thoracic computed tomography (CT) conducted for non-cardiac reasons. This systematic review and meta-analysis of non-gated thoracic CT aims to assess the clinical impact and prevalence of CAC. METHODS Online databases were searched for articles assessing prevalence, demographic characteristics, accuracy and prognosis of incidental CAC on non-gated thoracic CT. Meta-analysis was performed using a random effects model. RESULTS A total of 108 studies (113,406 patients) were included (38% female). Prevalence of CAC ranged from 2.7 to 100% (pooled prevalence 52%, 95% confidence interval [CI] 46-58%). Patients with CAC were older (pooled standardised mean difference 0.88, 95% CI 0.65-1.11, p < 0.001), and more likely to be male (pooled odds ratio [OR] 1.95, 95% CI 1.55-2.45, p < 0.001), with diabetes (pooled OR 2.63, 95% CI 1.95-3.54, p < 0.001), hypercholesterolaemia (pooled OR 2.28, 95% CI 1.33-3.93, p < 0.01) and hypertension (pooled OR 3.89, 95% CI 2.26-6.70, p < 0.001), but not higher body mass index or smoking. Non-gated CT assessment of CAC had excellent agreement with electrocardiogram-gated CT (pooled correlation coefficient 0.96, 95% CI 0.92-0.98, p < 0.001). In 51,582 patients, followed-up for 51.6 ± 27.4 months, patients with CAC had increased all cause mortality (pooled relative risk [RR] 2.13, 95% CI 1.57-2.90, p = 0.004) and major adverse cardiovascular events (pooled RR 2.91, 95% CI 2.26-3.93, p < 0.001). When CAC was present on CT, it was reported in between 18.6% and 93% of reports. CONCLUSION CAC is a common, but underreported, finding on non-gated CT with important prognostic implications. CLINICAL RELEVANCE STATEMENT Coronary artery calcium is an important prognostic indicator of cardiovascular disease. It can be assessed on non-gated thoracic CT and is a commonly underreported finding. This represents a significant population where there is a potential missed opportunity for lifestyle modification recommendations and preventative therapies. This study aims to highlight the importance of reporting incidental coronary artery calcium on non-gated thoracic CT. KEY POINTS • Coronary artery calcification is a common finding on non-gated thoracic CT and can be reliably identified compared to gated-CT. • Coronary artery calcification on thoracic CT is associated with an increased risk of all cause mortality and major adverse cardiovascsular events. • Coronary artery calcification is frequently not reported on non-gated thoracic CT.
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Affiliation(s)
- Maia Osborne-Grinter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
- University of Bristol, Bristol, UK.
| | - Adnan Ali
- School of Medicine, University of Dundee, Dundee, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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4
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Malik RF, Sun KJ, Azadi JR, Lau BD, Whelton S, Arbab-Zadeh A, Wilson RF, Johnson PT. Opportunistic Screening for Coronary Artery Disease: An Untapped Population Health Resource. J Am Coll Radiol 2024; 21:880-889. [PMID: 38382860 DOI: 10.1016/j.jacr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in the United States. At-risk asymptomatic adults are eligible for screening with electrocardiogram-gated coronary artery calcium (CAC) CT, which aids in risk stratification and management decision-making. Incidental CAC (iCAC) is easily quantified on chest CT in patients imaged for noncardiac indications; however, radiologists do not routinely report the finding. OBJECTIVE To determine the clinical significance of CAC identified incidentally on routine chest CT performed for noncardiac indications. DESIGN An informationist developed search strategies in MEDLINE, Embase, and SCOPUS, and two reviewers independently screened results at both the abstract and full text levels. Data extracted from eligible articles included age, rate of iCAC identification, radiologist reporting frequency, impact on downstream medical management, and association of iCAC with patient outcomes. RESULTS From 359 unique citations, 83 research publications met inclusion criteria. The percentage of patients with iCAC ranged from 9% to 100%. Thirty-one investigations measured association(s) between iCAC and cardiovascular morbidity and mortality, and 29 identified significant correlations, including nonfatal myocardial infarction, fatal myocardial infarction, major adverse cardiovascular event, cardiovascular death, and all-cause death. iCAC was present in 20% to 100% of the patients in these cohorts, but when present, iCAC was reported by radiologists in only 31% to 44% of cases. Between 18% and 77% of patients with iCAC were not on preventive medications in studies that reported these data. Seven studies measured the effect of reporting on guideline directed medical therapy, and 5 (71%) reported an increase in medication prescriptions after diagnosis of iCAC, with one confirming reductions in low-density lipoprotein levels. Twelve investigations reported good concordance between CAC grade on noncardiac CT and Agatston score on electrocardiogram-gated cardiac CT, and 10 demonstrated that artificial intelligence tools can reliably calculate an Agatston score on noncardiac CT. CONCLUSION A body of evidence demonstrates that patients with iCAC on routine chest CT are at risk for cardiovascular disease events and death, but they are often undiagnosed. Uniform reporting of iCAC in the chest CT impression represents an opportunity for radiology to contribute to early identification of high-risk individuals and potentially reduce morbidity and mortality. AI tools have been validated to calculate Agatston score on routine chest CT and hold the best potential for facilitating broad adoption.
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Affiliation(s)
- Rubab F Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristie J Sun
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javad R Azadi
- Assistant Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Assistant Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus Whelton
- Associate Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Armin Arbab-Zadeh
- Director of Cardiac CT, Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renee F Wilson
- Evidence Based Practice Center, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Pamela T Johnson
- Vice President of Care Transformation, Vice Chair of Quality and Safety in Radiology, and Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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5
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Groen RA, van Dijkman PR, Jukema JW, Bax JJ, Lamb HJ, de Graaf MA. Coronary calcifications as assessed on routine non-gated chest CT; a gatekeeper to tailor downstream additional imaging in patients with stable chest pain. IJC HEART & VASCULATURE 2024; 52:101418. [PMID: 38737706 PMCID: PMC11087706 DOI: 10.1016/j.ijcha.2024.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Background and aims Currently applied methods for risk-assessment in coronary artery disease (CAD) often overestimate patients' risk for obstructive CAD. To enhance risk estimation, assessment of coronary artery calcium (CAC) can be applied. In 10 % of patients presenting with stable chest pain a previous non-gated computed tomography (CT) has been performed, suitable for CAC-assessment. This study is the first to investigate the clinical utility of CAC-assessment on non-gated CT for risk-assessment of obstructive CAD in symptomatic patients. Methods For this analysis, all patients referred for coronary computed tomography angiography (CCTA), in whom a previous non-gated chest CT was performed were included. The extent of CAC was assessed on chest CT and ordinally scored. CAD was assessed on CCTA and obstructive CAD defined as stenosis of ≥70 %. Patients were stratified according to CAC-severity and percentages of patients with obstructive CAD were compared between the CAC groups. Results In total, 170 patients of 32-88 years were included and 35 % were male. The percentage of obstructive CAD between the CAC groups differed significantly (p < 0.01). A calcium score of 0 ruled out obstructive CAD irrespective of sex, pre-test probability, type of complaints and number of risk factors with a 100 % certainty. Furthermore, a mild CAC score ruled out obstructive CAD in patients with low - intermediate PTP or non-anginal complaints with 100 % certainty. Conclusion When available, CAC on non-gated chest CT can accurately rule out obstructive CAD and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging in patients presenting with stable chest pain.
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Affiliation(s)
- Roos A. Groen
- Leiden University Medical Center, Department of Cardiology, The Netherlands
| | | | - J. Wouter Jukema
- Leiden University Medical Center, Department of Cardiology, The Netherlands
- Netherlands Heart Institute, Utrecht, Leiden, The Netherlands
| | - Jeroen J. Bax
- Leiden University Medical Center, Department of Cardiology, The Netherlands
| | - Hildo. J. Lamb
- Leiden University Medical Center, Department of Radiology, The Netherlands
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6
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Parsa S, Saleh A, Raygor V, Hoeting N, Rao A, Navar AM, Rohatgi A, Kay F, Abbara S, Khera A, Joshi PH. Measurement and Application of Incidentally Detected Coronary Calcium: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1557-1567. [PMID: 38631775 DOI: 10.1016/j.jacc.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease risk stratification. The nongated, noncontrast chest computed tomography scan (NCCT) has emerged as a source of CAC characterization with tremendous potential due to the high volume of NCCT scans. Application of incidental CAC characterization from NCCT has raised questions around score accuracy, standardization of methodology including the possibility of deep learning to automate the process, and the risk stratification potential of an NCCT-derived score. In this review, the authors aim to summarize the role of NCCT-derived CAC in preventive cardiovascular health today as well as explore future avenues for eventual clinical applicability in specific patient populations and broader health systems.
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Affiliation(s)
- Shyon Parsa
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA; Department of Internal Medicine, Stanford University Hospital, Stanford, California, USA
| | - Adam Saleh
- Texas A&M University, Engineering Medicine, Houston, Texas, USA
| | - Viraj Raygor
- Sutter Health, Cardiovascular Health, Palo Alto, California, USA
| | - Natalie Hoeting
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anjali Rao
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Kay
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA.
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7
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Martinez-Perez S, McCluskey SA, Davierwala PM, Kalra S, Nguyen E, Bhat M, Borosz C, Luzzi C, Jaeckel E, Neethling E. Perioperative Cardiovascular Risk Assessment and Management in Liver Transplant Recipients: A Review of the Literature Merging Guidelines and Interventions. J Cardiothorac Vasc Anesth 2024; 38:1015-1030. [PMID: 38185566 DOI: 10.1053/j.jvca.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024]
Abstract
Liver transplantation (LT) is the second most performed solid organ transplant. Coronary artery disease (CAD) is a critical consideration for LT candidacy, particularly in patients with known CAD or risk factors, including metabolic dysfunction associated with steatotic liver disease. The presence of severe CAD may exclude patients from LT; therefore, precise preoperative evaluation and interventions are necessary to achieve transplant candidacy. Cardiovascular complications represent the earliest nongraft-related cause of death post-transplantation. Timely intervention to reduce cardiovascular events depends on adequate CAD screening. Coronary disease screening in end-stage liver disease is challenging because standard noninvasive CAD screening tests have low sensitivity due to hyperdynamic state and vasodilatation. As a result, there is overuse of invasive coronary angiography to exclude severe CAD. Coronary artery calcium scoring using a computed tomography scan is a tool for the prediction of cardiovascular events, and can be used to achieve risk stratification in LT candidates. Recent literature shows that qualitative assessment on both noncontrast- and contrast-enhanced chest computed tomography can be used instead of calcium score to assess the presence of coronary calcium. With increasing prevalence, protocols to address CAD in LT candidates must be reconsidered. Percutaneous coronary intervention could allow a shorter duration of dual-antiplatelet therapy in simple lesions, with safer perioperative outcomes. Hybrid coronary revascularization is an option for high-risk LT candidates with multivessel disease nonamenable to percutaneous coronary intervention. The objective of this review is to evaluate existing methods for preoperative cardiovascular risk stratification, and to describe interventions before surgery to optimize patient outcomes and reduce cardiovascular event risk.
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Affiliation(s)
- Selene Martinez-Perez
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart A McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre Toronto, General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sanjog Kalra
- Division of Cardiology, Interventional Cardiology Section, Peter Munk Cardiac Center Toronto General Hospital, University Health Network and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elsie Nguyen
- Department of Medical Imaging, Cardiothoracic Imaging Division Lead, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Department of Gastroenterology, Hepatology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Borosz
- Department of Gastroenterology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Carla Luzzi
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elmar Jaeckel
- Department of Gastroenterology, Ajmera Transplant Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elmari Neethling
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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8
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Groen RA, Jukema JW, van Dijkman PRM, Bax JJ, Lamb HJ, Antoni ML, de Graaf MA. The Clear Value of Coronary Artery Calcification Evaluation on Non-Gated Chest Computed Tomography for Cardiac Risk Stratification. Cardiol Ther 2024; 13:69-87. [PMID: 38349434 PMCID: PMC10899125 DOI: 10.1007/s40119-024-00354-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
To enhance risk stratification in patients suspected of coronary artery disease, the assessment of coronary artery calcium (CAC) could be incorporated, especially when CAC can be readily assessed on previously performed non-gated chest computed tomography (CT). Guidelines recommend reporting on patients' extent of CAC on these non-cardiac directed exams and various studies have shown the diagnostic and prognostic value. However, this method is still little applied, and no current consensus exists in clinical practice. This review aims to point out the clinical utility of different kinds of CAC assessment on non-gated CTs. It demonstrates that these scans indeed represent a merely untapped and underestimated resource for risk stratification in patients with stable chest pain or an increased risk of cardiovascular events. To our knowledge, this is the first review to describe the clinical utility of different kinds of visual CAC evaluation on non-gated unenhanced chest CT. Various methods of CAC assessment on non-gated CT are discussed and compared in terms of diagnostic and prognostic value. Furthermore, the application of these non-gated CT scans in the general practice of cardiology is discussed. The clinical utility of coronary calcium assessed on non-gated chest CT, according to the current literature, is evident. This resource of information for cardiac risk stratification needs no specific requirements for scan protocol, and is radiation-free and cost-free. However, some gaps in research remain. In conclusion, the integration of CAC on non-gated chest CT in general cardiology should be promoted and research on this method should be encouraged.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
| | - Paul R M van Dijkman
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - M Louisa Antoni
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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9
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Grenier PA, Brun AL, Mellot F. [The contribution of artificial intelligence (AI) subsequent to the processing of thoracic imaging]. Rev Mal Respir 2024; 41:110-126. [PMID: 38129269 DOI: 10.1016/j.rmr.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
The contribution of artificial intelligence (AI) to medical imaging is currently the object of widespread experimentation. The development of deep learning (DL) methods, particularly convolution neural networks (CNNs), has led to performance gains often superior to those achieved by conventional methods such as machine learning. Radiomics is an approach aimed at extracting quantitative data not accessible to the human eye from images expressing a disease. The data subsequently feed machine learning models and produce diagnostic or prognostic probabilities. As for the multiple applications of AI methods in thoracic imaging, they are undergoing evaluation. Chest radiography is a practically ideal field for the development of DL algorithms able to automatically interpret X-rays. Current algorithms can detect up to 14 different abnormalities present either in isolation or in combination. Chest CT is another area offering numerous AI applications. Various algorithms have been specifically formed and validated for the detection and characterization of pulmonary nodules and pulmonary embolism, as well as segmentation and quantitative analysis of the extent of diffuse lung diseases (emphysema, infectious pneumonias, interstitial lung disease). In addition, the analysis of medical images can be associated with clinical, biological, and functional data (multi-omics analysis), the objective being to construct predictive approaches regarding disease prognosis and response to treatment.
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Affiliation(s)
- P A Grenier
- Délégation à la recherche clinique et l'innovation, hôpital Foch, Suresnes, France.
| | - A L Brun
- Service de radiologie, hôpital Foch, Suresnes, France
| | - F Mellot
- Service de radiologie, hôpital Foch, Suresnes, France
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Kasprzyk P, Undrunas A, Dziadziuszko K, Dziedzic R, Kuziemski K, Szurowska E, Rzyman W, Zdrojewski T. Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort. J Cardiovasc Dev Dis 2024; 11:16. [PMID: 38248886 PMCID: PMC10816916 DOI: 10.3390/jcdd11010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.
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Affiliation(s)
- Piotr Kasprzyk
- First Department of Cardiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Aleksandra Undrunas
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Katarzyna Dziadziuszko
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Krzysztof Kuziemski
- Department of Allergology and Pneumonology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
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11
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Groen RA, Jukema JW, van Dijkman PRM, Timmermans PT, Bax JJ, Lamb HJ, de Graaf MA. Evaluation of Clinical Applicability of Coronary Artery Calcium Assessment on Non-Gated Chest Computed Tomography, Compared With the Classic Agatston Score on Cardiac Computed Tomography. Am J Cardiol 2023; 208:92-100. [PMID: 37820552 DOI: 10.1016/j.amjcard.2023.08.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
Given current pretest probability (PTP) estimations tend to overestimate patients' risk for obstructive coronary artery disease, evaluation of patients' coronary artery calcium (CAC) is more precise. The value of CAC assessment with the Agatston score on cardiac computed tomography (CT) for risk estimation has been well indicated in patients with stable chest pain. CAC can be equally well assessed on routine non-gated chest CT, which is often available. This study aims to determine the clinical applicability of CAC assessment on non-gated CT in patients with stable chest pain compared with the classic Agatston score on gated CT. Consecutive patients referred for evaluation of the Agatston score, who had a previously performed non-gated chest CT for evaluation of noncardiac diseases, were included. CAC on non-gated CT was ordinally scored. Subsequently, patients were stratified according to CAC severity and PTP. The agreement and correlation between the classic Agatston score and CAC on non-gated CT were evaluated. The discriminative power for risk reclassification of both CAC assessment methods was assessed. Invasive coronary angiography was used as the gold standard, when available. A total of 140 patients aged between 30 and 88 years were included. The agreement between ordinally scored CAC and the Agatston score was excellent (κ = 0.82) and the correlation strong (r = 0.94). Most patients (80%) with an intermediate PTP had no or mild CAC on non-gated CT. They were reclassified at low risk with 100% accuracy compared with invasive coronary angiography. Similarly, 86% of patients had an Agatston score <300. These patients were reclassified with 98% accuracy. In patients with high PTP, the accuracy remained substantial and comparable, 94% and 89%, respectively. In conclusion, we believe this is the first study to assess the clinical applicability of CAC on non-gated CT in patients with stable chest pain, compared with the classic Agatston score. The agreement between methods was excellent and the correlation strong. Furthermore, CAC assessment on non-gated CT could reclassify patients' risk for obstructive coronary artery disease as accurately as could the classic Agatston score.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, The Netherlands; The Netherlands Heart Institute, Utrecht, The Netherlands.
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, The Netherlands
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12
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Silva BV, Menezes MN, Plácido R, Jorge C, Rigueira J, Garcia AB, Martins AM, Oliveira C, Abrantes A, Pinto FJ, Almeida AG. Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care. Heart Lung Circ 2023; 32:1312-1320. [PMID: 37867042 DOI: 10.1016/j.hlc.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. METHODS Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. RESULTS A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. CONCLUSION Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Miguel Nobre Menezes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Beatriz Garcia
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Margarida Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Oliveira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Abrantes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana G Almeida
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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13
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Tisi S, Creamer AW, Dickson J, Horst C, Quaife S, Hall H, Verghese P, Gyertson K, Bowyer V, Levermore C, Hacker AM, Teague J, Farrelly L, Nair A, Devaraj A, Hackshaw A, Hurst JR, Janes S. Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort. BMJ Open Respir Res 2023; 10:e001664. [PMID: 37321665 PMCID: PMC10277548 DOI: 10.1136/bmjresp-2023-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol. METHODS The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT. RESULTS In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25. CONCLUSIONS Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
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Affiliation(s)
- Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Andrew W Creamer
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jennifer Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anne-Marie Hacker
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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14
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Coronary calcium score in COVID-19 survivors: Association with cardiac injury and cardiac function after 6 weeks. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100280. [PMID: 36852285 PMCID: PMC9946728 DOI: 10.1016/j.ahjo.2023.100280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Aims Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors. Methods This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE. Results In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks. Conclusion The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.
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15
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Kim SY, Suh YJ, Kim NY, Lee S, Nam K, Kim J, Kim H, Lee H, Han K, Yong HS. A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated Chest Computed Tomography: A Multiple-Observer Study. Korean J Radiol 2023; 24:284-293. [PMID: 36996903 PMCID: PMC10067688 DOI: 10.3348/kjr.2022.0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/19/2022] [Accepted: 02/04/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT). MATERIALS AND METHODS This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen's kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods. RESULTS For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496-0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636-0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen's kappa, 0.565 [95% CI: 0.511-0.619 for visual assessment vs. 0.695 [95% CI: 0.638-0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001). CONCLUSION The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.
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Affiliation(s)
- Suh Young Kim
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
- Department of Medicine, Yonsei University Graduate School, College of Medicine, Seoul, Korea
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Na Young Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suji Lee
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungsun Nam
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongyun Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunji Lee
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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16
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Majeed A, Ruane B, Shusted CS, Austin M, Mirzozoda K, Pimpinelli M, Vojnika J, Ward L, Sundaram B, Lakhani P, Kane G, Lev Y, Barta JA. Frequency of Statin Prescription Among Individuals with Coronary Artery Calcifications Detected Through Lung Cancer Screening. Am J Med Qual 2022; 37:388-395. [PMID: 35302536 DOI: 10.1097/jmq.0000000000000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. We assessed the frequency of statin prescription in LCS patients with moderate levels of CAC. Among 259 individuals with moderate CAC, 95% had ASCVD risk ≥ 7.5%. Despite this, 27% of patients were statin-free prior to LDCT and 21.2% remained statin-free after LDCT showing moderate CAC. Illustratively, while a substantial proportion of LCS patients are statin-eligible, many lack a statin prescription, even after findings of CAC burden. CAC reporting should be standardized, and interdisciplinary communication should be optimized to ensure that LCS patients are placed on appropriate preventive therapy.
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Affiliation(s)
- Amry Majeed
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Brooke Ruane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Christine S Shusted
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Melissa Austin
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Khulkar Mirzozoda
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Jetmir Vojnika
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | - Lawrence Ward
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Paras Lakhani
- Department of Radiology, Thomas Jefferson University
| | - Gregory Kane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Yair Lev
- Division of Cardiology, Thomas Jefferson University
| | - Julie A Barta
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
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17
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Llewellyn O, Williams MC. What should we do about Coronary Calcification on Thoracic CT? ROFO-FORTSCHR RONTG 2022; 194:833-840. [PMID: 35272359 DOI: 10.1055/a-1752-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Coronary artery calcification is a frequent incidental finding on thoracic computed tomography (CT) performed for non-cardiac indications. On electrocardiogram-gated cardiac CT, it is an established marker of coronary artery disease and is associated with increased risk of subsequent cardiac events. MATERIALS AND METHODS This review discusses the current evidence and guidelines regarding the reporting of coronary artery calcification on non-electrocardiogram-gated thoracic CT performed for non-cardiac indications. RESULTS For patients undergoing routine thoracic CT, coronary artery calcification is associated with an increased risk of myocardial infarction and mortality. Coronary artery calcification can be accurately assessed on non-gated thoracic CT compared to gated CT. Guidelines support the reporting of coronary artery calcification on thoracic CT. However, radiologist opinions vary. The identification of coronary artery calcification on thoracic CT may identify patients with previously unknown coronary artery disease. For asymptomatic patients this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications. CONCLUSION Future research will address whether changing management based on calcification on thoracic CT will improve outcomes and automated assessment of calcification using machine learning techniques. KEY POINTS · Coronary artery calcification is a frequent incidental finding on thoracic CT.. · The presence and severity of coronary artery calcification is associated with cardiac outcomes and mortality.. · Reporting coronary artery calcification on thoracic CT is supported by national and international guidelines.. CITATION FORMAT · Williams MC, Llewellyn O, . What Should We Do About Coronary Calcification on Thoracic CT?. Fortschr Röntgenstr 2022; 194: 833 - 840.
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Affiliation(s)
- Oliver Llewellyn
- Department of Radiology, Royal Infirmary of Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C Williams
- Centre for Cardiovascular Science, The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain and Northern Ireland
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18
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Tanoue LT, Sather P, Cortopassi I, Dicks D, Curtis A, Michaud G, Bader A, Gange C, Detterbeck F, Killam J. Standardizing the Reporting of Incidental, Non-Lung Cancer (Category S) Findings Identified on Lung Cancer Screening Low-Dose CT Imaging. Chest 2022; 161:1697-1706. [DOI: 10.1016/j.chest.2021.12.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
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19
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Perdomo CM, Ezponda A, Núñez-Córdoba JM, Herrero JI, Bastarrika G, Frühbeck G, Escalada J. Transient elastography and serum markers of liver fibrosis associate with epicardial adipose tissue and coronary artery calcium in NAFLD. Sci Rep 2022; 12:6564. [PMID: 35449229 PMCID: PMC9023439 DOI: 10.1038/s41598-022-10487-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease morbimortality. However, it is not clear if NAFLD staging may help identify early or subclinical markers of cardiovascular disease. We aimed to evaluate the association of liver stiffness and serum markers of liver fibrosis with epicardial adipose tissue (EAT) and coronary artery calcium (CAC) in an observational cross-sectional study of 49 NAFLD patients that were seen at Clínica Universidad de Navarra (Spain) between 2009 and 2019. Liver elastography and non-invasive fibrosis markers were used to non-invasively measure fibrosis. EAT and CAC, measured through visual assessment, were determined by computed tomography. Liver stiffness showed a direct association with EAT (r = 0.283, p-value = 0.049) and CAC (r = 0.337, p-value = 0.018). NAFLD fibrosis score was associated with EAT (r = 0.329, p-value = 0.021) and CAC (r = 0.387, p-value = 0.006). The association of liver stiffness with CAC remained significant after adjusting for metabolic syndrome features (including carbohydrate intolerance/diabetes, hypertension, dyslipidaemia, visceral adipose tissue, and obesity). The evaluation of NAFLD severity through liver elastography or non-invasive liver fibrosis biomarkers may contribute to guide risk factor modification to reduce cardiovascular risk in asymptomatic patients. Inversely, subclinical cardiovascular disease assessment, through Visual Scale for CAC scoring, may be a simple and effective measure for patients with potential liver fibrosis, independently of the existence of other cardiovascular risk factors.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pio XII, 36, 31008, Pamplona, Spain.
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge M Núñez-Córdoba
- Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - José I Herrero
- Hepatology Unit, Clínica Universidad de Navarra, Pamplona, Spain.,CIBERehd (CIBER Enfermedades Hepáticas y Digestivas), Madrid, Spain.,IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain
| | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pio XII, 36, 31008, Pamplona, Spain.,CIBERObn (CIBER Fisiopatología de la Obesidad y Nutrición), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pio XII, 36, 31008, Pamplona, Spain.,CIBERObn (CIBER Fisiopatología de la Obesidad y Nutrición), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain
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20
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest 2021; 160:e427-e494. [PMID: 34270968 PMCID: PMC8727886 DOI: 10.1016/j.chest.2021.06.063] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; Boston University School of Medicine, Boston, MA
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21
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Lee JC, Luis SA, Alghamry A. Using Thoracic Artery Calcium Score to Predict Stroke. Am J Cardiol 2021; 153:146-147. [PMID: 34148632 DOI: 10.1016/j.amjcard.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph C Lee
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Sushil Allen Luis
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Alaa Alghamry
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Internal Medicine Services, The Prince Charles Hospital, Brisbane, Australia
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22
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Relationships between cardiovascular risk factors and white-coat hypertension diagnosed by home blood pressure recordings in a middle-aged population. J Hypertens 2021; 39:2009-2014. [PMID: 33973957 PMCID: PMC8452319 DOI: 10.1097/hjh.0000000000002888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To study risk in white-coat hypertension (WCH) by measurement of coronary artery calcium score (CACS), carotid--femoral pulse-wave velocity (PWV) and carotid plaques. Methods: Cross-sectional population-based cohort with randomized selection of participants from Linköping, Sweden. An Omron m10-IT oscillometric device was used for clinic and home blood pressures (HBP) in the morning and evening for 1 week. Results: We recruited 5029 middle-aged and mainly defined WCH as SBP at least 140 mmHg and/or DBP at least 90 mmHg with HBP less than 135/85 mmHg. There were 2680 normotensive participants and 648 had WCH after exclusion of treated participants. More women (59.5%) than men (42.8%, P < 0.001) had WCH. We found higher prevalence of CACS greater than 100 compared with less than 100 (12.4 vs. 7.2%, P < 0.001), PWV (11.5 ± 1.5 vs. 10.4 ± 1.3 m/s, P < 0.001) and a higher prevalence of one or more carotid plaques (59.5 vs. 48%, P < 0.001) in participants with WCH than in normotension. Participants with WCH also had more dyslipidemia and higher glucose levels. Normotensive women scored lower on nervousness than women with WCH (P = 0.022). After matching of 639 participants with WCH to normotensive participants according to age, gender and systolic HBP the prevalence of a high CACS (12.1 vs. 8.6%, P = 0.003,) PWV (11.0 ± 0.068 vs. 11.5 ± 0.068 m/s, estimated marginal means ± SE, P < 0.001 by ANOVA) but not more carotid plaques (59.5 vs. 55.6%, P = 0.23), remained in the participants with WCH compared with the matched normotensive participants. Conclusion: WCH is particularly common in middle-aged women, and it displays metabolic dysfunction and increased prevalence of arteriosclerotic manifestations in both genders. As markers of increased cardiovascular risk were present also after matching normotensive and WCH participants according to systolic HBP, age and gender, the presence of WCH signals an increased cardiovascular risk burden that is not fully explained by elevated BP levels at home.
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23
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Kim JY, Suh YJ, Han K, Choi BW. Reliability of Coronary Artery Calcium Severity Assessment on Non-Electrocardiogram-Gated CT: A Meta-Analysis. Korean J Radiol 2021; 22:1034-1043. [PMID: 33856134 PMCID: PMC8236368 DOI: 10.3348/kjr.2020.1047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The purpose of this meta-analysis was to investigate the pooled agreements of the coronary artery calcium (CAC) severities assessed by electrocardiogram (ECG)-gated and non-ECG-gated CT and evaluate the impact of the scan parameters. MATERIALS AND METHODS PubMed, EMBASE, and the Cochrane library were systematically searched. A modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality of the studies. Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and the correlation coefficient of the CAC scores or the weighted kappa for the categorization of the CAC severities detected by the two modalities. The heterogeneity among the studies was also assessed. Subgroup analyses were performed based on factors that could affect the measurement of the CAC score and severity: slice thickness, reconstruction kernel, and radiation dose for non-ECG-gated CT. RESULTS A total of 4000 patients from 16 studies were included. The pooled bias was 62.60, 95% LOA were -36.19 to 161.40, and the pooled correlation coefficient was 0.94 (95% confidence interval [CI] = 0.89-0.97) for the CAC score. The pooled weighted kappa of the CAC severity was 0.85 (95% CI = 0.79-0.91). Heterogeneity was observed in the studies (I² > 50%, p < 0.1). In the subgroup analysis, the agreement between the CAC categorizations was better when the two CT examinations had reconstructions based on the same slice thickness and kernel. CONCLUSION The pooled agreement of the CAC severities assessed by the ECG-gated and non-ECG-gated CT was excellent; however, it was significantly affected by scan parameters, such as slice thickness and the reconstruction kernel.
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Affiliation(s)
- Jin Young Kim
- Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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24
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Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13071553. [PMID: 33800614 PMCID: PMC8036563 DOI: 10.3390/cancers13071553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The results of several randomized studies showed the efficacy of organized, low-dose, computed-tomography (CT) scan lung-cancer screening in lowering all-cause and lung-cancer-specific mortality rates. Low-dose CT scans can also detect and quantify coronary artery calcifications (CACs). By means of meta-analysis, we were able to show that the presence of CACs in CT performed in this setting was associated with an enhanced risk of cardiovascular and all-cause mortality for men and women. These finding plead for the implementation of preventive interactions against cardiovascular risk in lung-cancer screening-program participants found to have CACs. Abstract Although organized, low-dose, computed-tomography (CT) scan lung-cancer screening has been shown to lower all-cause and lung-cancer-specific mortality, the primary cause of death for subjects eligible for such screening remains cardiovascular (CV) mortality. This meta-analysis study was undertaken to evaluate the impact of screening-scan-detected coronary artery calcifications (CACs) on CV and all-cause mortality. We conducted a systematic review and meta-analysis of studies reporting CV mortality according to the Agatson CAC score for participants in a lung-cancer screening program of randomized clinical or cohort studies. PubMed, Embase, and Cochrane databases were screened in June 2020. Two authors independently selected articles and extracted data. Six studies, including 20,175 subjects, were retained. CV and all-cause mortality rates were higher for subjects with CAC scores >0, with respective relative risks of 2.02 [95% CI 1.23–3.32] and 2.29 [95% CI 1.00–5.21]. Both mortality rates were even higher for those with high CAC scores (>400 or >1000). CACs are more common in men than in women, with an odds ratio of 1.49 [95% CI 1.40–1.59]. The presence of CAC is associated with CV mortality with an RR of 2.05 [95% CI 1.20–3.57] in men and 2.37 [CI 95% 1.29–5.09] in women, respectively. Analysis of lung-cancer-screening scans for CACs is a tool able to predict CV mortality. Prospective studies within those programs are needed to assess the benefit of primary CV prevention based on CAC detection.
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25
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Obisesan OH, Osei AD, Uddin SI, Dzaye O, Blaha MJ. An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT. Radiol Cardiothorac Imaging 2021; 3:e200484. [PMID: 33778659 PMCID: PMC7977732 DOI: 10.1148/ryct.2021200484] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Coronary artery calcium (CAC) is a marker of overall coronary atherosclerotic burden in an individual. As such, it is an important tool in cardiovascular risk stratification and preventive treatment of asymptomatic patients with unclear cardiovascular disease risk. Several guidelines have recommended the use of CAC testing in shared decision making between the clinician and patient. With recent updates in clinical management guidelines and broad recommendations for CAC, there is a need for concise updated information on CAC interpretation on traditional electrocardiographically gated scans and nongated thoracic scans. Important points to report when interpreting CAC scans include: the absolute Agatston score and the age, sex, and race-specific CAC percentile; general recommendations on time-to-rescan for individuals with a CAC score of 0; the number of vessels with CAC; the presence of CAC in the left main coronary artery; and specific highlighting of individuals with very high CAC scores of greater than 1000. When risk factor information is available, the 10-year coronary heart disease risk can also be easily assessed using the free online Multi-Ethnic Study of Atherosclerosis risk score calculator. Recent improvements in standardizing the reporting of CAC findings across gated and nongated studies, such as the CAC Data and Reporting System, show promise for improving the widespread clinical value of CAC in clinical practice. © RSNA, 2021.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Albert D. Osei
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - S.M. Iftekhar Uddin
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Omar Dzaye
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Michael J. Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
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26
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Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J, Schmitt M, Hughes GM, Stirrup J, Holloway B, Gopalan D, Deshpande A, Weir-McCall J, Agrawal B, Rodrigues JCL, Brady AJB, Roditi G, Robinson G, Bull R. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI. Br J Radiol 2020; 94:20200894. [PMID: 33053316 PMCID: PMC7774698 DOI: 10.1259/bjr.20200894] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Incidental coronary and cardiac calcification are frequent findings on non-gated thoracic CT. We recommend that the heart is reviewed on all CT scans where it is visualised. Coronary artery calcification is a marker of coronary artery disease and it is associated with an adverse prognosis on dedicated cardiac imaging and on non-gated thoracic CT performed for non-cardiac indications, both with and without contrast. We recommend that coronary artery calcification is reported on all non-gated thoracic CT using a simple patient-based score (none, mild, moderate, severe). Furthermore, we recommend that reports include recommendations for subsequent management, namely the assessment of modifiable cardiovascular risk factors and, if the patient has chest pain, assessment as per standard guidelines. In most cases, this will not necessitate additional investigations. Incidental aortic valve calcification may also be identified on non-gated thoracic CT and should be reported, along with ancillary findings such as aortic root dilation. Calcification may occur in other parts of the heart including mitral valve/annulus, pericardium and myocardium, but in many cases these are an incidental finding without clinical significance.
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Affiliation(s)
- Michelle Claire Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.,Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Ausami Abbas
- University Hospital Southampton, Southampton, UK
| | - Erica Tirr
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Shirjel Alam
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Edward Nicol
- Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | | | | | | | - James Stirrup
- Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, UK
| | | | - Deepa Gopalan
- Imperial College London & Cambridge University Hospital, Cambridge, UK
| | - Aparna Deshpande
- Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | | | - Bobby Agrawal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Adrian J B Brady
- Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow, UK.,University of Glasgow, University Avenue, Glasgow, UK
| | - Giles Roditi
- Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow, UK
| | | | - Russell Bull
- Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK
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27
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Warfarin Accelerates Aortic Calcification by Upregulating Senescence-Associated Secretory Phenotype Maker Expression. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2043762. [PMID: 33149806 PMCID: PMC7603623 DOI: 10.1155/2020/2043762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023]
Abstract
Warfarin, a vitamin K antagonist (VKA), is known to promote arterial calcification (AC). In the present study, we conducted a case-cohort study within the Multi-Ethnic Study of Atherosclerosis (MESA); 6655 participants were included. From MESA data, we found that AC was related to both age and vitamin K; furthermore, the score of AC increased with SASP marker including interlukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) rising. Next, a total of 79 warfarin users in our center developed significantly more calcified coronary plaques as compared to non-VKA users. We investigated the role of warfarin in phosphate-induced AC in different ages by in vitro experimental study. Furthermore, dose-time-response of warfarin was positively correlated with AC score distribution and plasma levels of the SASP maker IL-6 among patients < 65 years, but not among patients ≥ 65 years. In addition, in vitro research suggested that warfarin treatment tended to deteriorate calcification in young VSMC at the early stage of calcification. Our results suggested that aging and warfarin-treatment were independently related to increased AC. Younger patients were more sensitive to warfarin-related AC than older patients, which was possibly due to accumulated warfarin-induced cellular senescence.
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28
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Fisher R, Vandehei A, Haller C, Boster J, Shipley B, Kaatz C, Harris J, Shin SR, Townsend L, Rouse J, Davis S, Aden J, Thomas D. Reporting the Presence of Coronary Artery Calcium in the Final Impression of Non-gated CT Chest Scans Increases the Appropriate Utilization of Statins. Cureus 2020; 12:e10579. [PMID: 33110715 PMCID: PMC7580491 DOI: 10.7759/cureus.10579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Coronary artery calcium (CAC) scoring based on gated non-contrast cardiac computed tomography (CT) is a validated risk marker of major adverse cardiovascular events (MACE). Reporting of CAC on non-gated CT chest (NGCT) scans and the impact on medical therapy is not well studied. Methods A retrospective cohort of 5,043 NGCT scans was reviewed for the presence of CAC. The radiology report was reviewed to determine whether CAC was mentioned in either the body of the report or the final impression. Electronic medical records (EMR) were abstracted for baseline demographics, cardiovascular (CV) risk factors, lipid-lowering agents, and aspirin (ASA) prior to and after NGCT. Results CAC was present in 63.0% of NGCT scans. Of these scans, CAC was mentioned in the body of the report in 81.6% of studies. Conversely, CAC was mentioned in the final impressions in only 15.1% of these scans. Amongst patients with CAC, initiation of a statin in treatment-naive patients was more common when CAC was mentioned in the final impression versus the body only (12.3% vs. 4.9%, p=0.001) despite the fact that baseline utilization of statins in this cohort was higher (71.1% vs. 64.1%, p=0.005). Initiation of a statin in treatment-naive patients had a trend towards significance when CAC was mentioned in the body of the report versus not reported (4.9% vs. 2.62%, p=0.142). Reporting of CAC in the final impression significantly increased the initiation of ASA in treatment-naive patients (9.52% vs. 4.33%, p=0.033). Reporting of CAC in either the final impression or the body of the report did not affect the initiation of non-statin lipid-lowering therapies in patients with CAC. Conclusion The inclusion of CAC in the final impression of NGCT radiology reports positively impacts the appropriate initiation of statin and aspirin therapy in treatment-naive patients. Universal adherence to a standardized reporting system for the presence of CAC on NGCT should be considered to improve the initiation of guideline-directed medical therapy.
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Incidental Coronary Artery Calcium on Breast Radiation Therapy Planning Scans Identifies Patients for Cardiac Preventive Therapy. Am J Clin Oncol 2020; 43:826-831. [PMID: 32925202 DOI: 10.1097/coc.0000000000000752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE/OBJECTIVE(S) The presence of coronary artery calcium (CAC>0) is associated with increased cardiac-related mortality and is a common indication to initiate statin therapy to prevent future long-term cardiac-related adverse events. CAC is also well visualized on noncontrast chest computed tomography simulation (CT sim) scans used for breast radiation planning. We hypothesize that by screening for incidental CAC on CT sims, radiation oncologists could help identify patients who may benefit from additional preventive medical interventions with their primary care physician or cardiologist. METHODS A retrospective analysis of 126 consecutive patients with breast cancer treated with external beam radiation therapy at a single institution was performed. Noncontrast CT sim scans were reviewed for the presence of CAC and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated to identify patients who may benefit from initiating statin therapy. Patients with CAC>0 and/or ASCVD risk >20% were identified as those who may benefit from statin therapy. RESULTS Out of 72 patients with CAC>0, only 12(16%) had reported pre-existing coronary artery disease and 32(44%) were not already on recommended statin therapy. CAC>0 visualized on CT sim was able to identify 29 additional patients who would benefit from statin beyond what the ASCVD risk calculator could identify. CONCLUSION Observation of incidental CAC on breast radiation-planning CT scans identified patients who could benefit from cardiac-related preventive strategies. By increasing attention, awareness, and reporting of incidental CAC visible on CT sims, radiation oncologists may fulfill a unique role to bridge a potential gap in cardiovascular preventive medicine.
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30
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Suh YJ, Lee JW, Shin SY, Goo JM, Kim Y, Yong HS. Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry. Eur Radiol 2020; 30:3684-3691. [DOI: 10.1007/s00330-020-06707-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/26/2019] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
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Chen X, Ma T, Yip R, Perumalswami PV, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Elevated prevalence of moderate-to-severe hepatic steatosis in World Trade Center General Responder Cohort in a program of CT lung screening. Clin Imaging 2019; 60:237-243. [PMID: 31945662 DOI: 10.1016/j.clinimag.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS To determine the prevalence of moderate-to-severe hepatic steatosis (HS) and associated risk factors in members of the World Trade Center (WTC) General Responder Cohort (GRC) who qualify for low-dose non-contrast computed tomography for lung cancer screening and compare them to non-WTC participants in the same screening program. METHODS All participants gave written informed consent before participating in this IRB-approved study. Clinical variables and laboratory values were recorded. Hepatic attenuation measurement (Hounsfield unit; HU) was measured on low-dose computed tomography (LDCT) and a threshold attenuation value <40HU indicated moderate-to-severe HS. Bivariate and multivariable linear and logistic regression analyses were performed. Propensity scores (PS) were calculated and inverse probability weighting (IPW) was used to adjust for potential confounders when comparing the WTC with non-WTC participants. RESULTS The prevalence of moderate-to-severe HS was 16.2% among 154 WTC participants compared to 5.3% among 170 non-WTC participants. In WTC members, moderate-to-severe HS was associated with higher BMI, higher laboratory liver function tests, and former smoking status. Using PS analysis and IPW to account for potential confounders, the odds ratio for moderate-to-severe HS was 3.4-fold higher (95% confidence interval: 1.7-6.7) in the WTC participants compared with non-WTC participants. Moderate-to-severe HS was also associated with higher BMI and former smoker status. CONCLUSION Prevalence of moderate-to-severe HS was >3-fold higher in the WTC-GRC group than in other participants.
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Affiliation(s)
- Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Radiology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, Tong Ren Hospital, Capital Medical University, Beijing 100730, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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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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Leigh A, McEvoy JW, Garg P, Carr JJ, Sandfort V, Oelsner EC, Budoff M, Herrington D, Yeboah J. Coronary Artery Calcium Scores and Atherosclerotic Cardiovascular Disease Risk Stratification in Smokers. JACC Cardiovasc Imaging 2019; 12:852-861. [PMID: 29454784 PMCID: PMC6085167 DOI: 10.1016/j.jcmg.2017.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study assessed the utility of the pooled cohort equation (PCE) and/or coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk assessment in smokers, especially those who were lung cancer screening eligible (LCSE). BACKGROUND The U.S. Preventive Services Task Force recommended and the Centers for Medicare & Medicaid Services currently pays for annual screening for lung cancer with low-dose computed tomography scans in a specified group of cigarette smokers. CAC can be obtained from these low-dose scans. The incremental utility of CAC for ASCVD risk stratification remains unclear in this high-risk group. METHODS Of 6,814 MESA (Multi-Ethnic Study of Atherosclerosis) participants, 3,356 (49.2% of total cohort) were smokers (2,476 former and 880 current), and 14.3% were LCSE. Kaplan-Meier, Cox proportional hazards, area under the curve, and net reclassification improvement (NRI) analyses were used to assess the association between PCE and/or CAC and incident ASCVD. Incident ASCVD was defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke. RESULTS Smokers had a mean age of 62.1 years, 43.5% were female, and all had a mean of 23.0 pack-years of smoking. The LCSE sample had a mean age of 65.3 years, 39.1% were female, and all had a mean of 56.7 pack-years of smoking. After a mean of 11.1 years of follow-up 13.4% of all smokers and 20.8% of LCSE smokers had ASCVD events; 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during the follow-up. One SD increase in the PCE 10-year risk was associated with a 68% increase risk for ASCVD events in all smokers (hazard ratio: 1.68; 95% confidence interval: 1.57 to 1.80) and a 22% increase in risk for ASCVD events in the LCSE smokers (hazard ratio: 1.22; 95% confidence interval: 1.00 to 1.47). CAC was associated with increased ASCVD risk in all smokers and in LCSE smokers in all the Cox models. The C-statistic of the PCE for ASCVD was higher in all smokers compared with LCSE smokers (0.693 vs. 0.545). CAC significantly improved the C-statistics of the PCE in all smokers but not in LCSE smokers. The event and nonevent net reclassification improvements for all smokers and LCSE smokers were 0.018 and -0.126 versus 0.16 and -0.196, respectively. CONCLUSIONS In this well-characterized, multiethnic U.S. cohort, CAC was predictive of ASCVD in all smokers and in LCSE smokers but modestly improved discrimination over and beyond the PCE. However, 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during follow-up.
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Affiliation(s)
- Adam Leigh
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - John W McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parveen Garg
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - J Jeffrey Carr
- Departments of Cardiology and Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Veit Sandfort
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth C Oelsner
- Departments of Medicine and Epidemiology, Columbia University, New York, New York
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance California
| | - David Herrington
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome. J Thorac Imaging 2019; 34:116-125. [DOI: 10.1097/rti.0000000000000391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Parab SY, Patil VP, Shetmahajan M, Kanaparthi A. Coronary artery calcification on chest computed tomography scan - Anaesthetic implications. Indian J Anaesth 2019; 63:663-666. [PMID: 31462814 PMCID: PMC6691644 DOI: 10.4103/ija.ija_40_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The significance of coronary artery calcification noted on noncontrast chest computed tomography (CT) scan is unknown. We report a case where coronary artery calcification on chest CT scan incidentally detected in an asymptomatic patient who was found to have significant coronary artery disease which resulted in perioperative morbidity.
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Affiliation(s)
- Swapnil Y Parab
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijaya P Patil
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Madhavi Shetmahajan
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Astha Kanaparthi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Fan R, Shi X, Qian Y, Wang Y, Fan L, Chen R, Xiao Y, Liu S. Optimized categorization algorithm of coronary artery calcification score on non-gated chest low-dose CT screening using iterative model reconstruction technique. Clin Imaging 2018; 52:287-291. [PMID: 30193187 DOI: 10.1016/j.clinimag.2018.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the optimized categorization algorithm of coronary artery calcification score (CACS) for more accurate risk assessment on non-gated chest low-dose CT (LDCT) screening using iterative model reconstruction (IMR) technique. METHODS We enrolled 102 patients who required coronary artery CTA examination and had coronary artery calcification (CAC) in this study. The CACS on non-gated LDCT and ECG-gated CT images were both measured by Agatston analysis software on Philips workstation. RESULTS According to the original algorithm (1-100, 100-400 and >400), the CACS measured by non-gated LDCT scan showed a good agreement with ECG-gated CT scan (weighted kappa value of 0.602, P < 0.05). Two ROC curves were drawn to evaluate the accuracy of CACS categorization. The cutoff values were 87.44 and 255.26 respectively. Based on the best diagnostic cutoff value, the CACS measured by the non-gated LDCT scan showed an excellent agreement with ECG-gated CT scan (weighted kappa value of 0.781, P < 0.05). CONCLUSIONS The CACS on non-gated LDCT may have been underestimated. We therefore developed an optimized categorization algorithm of non-gated CACS in this study.
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Affiliation(s)
- Rongrong Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolei Shi
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Qian
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rutan Chen
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Xiao
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Balata H, Blandin Knight S, Barber P, Colligan D, Crosbie EJ, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Kirwan M, Macnab A, Mellor S, Miller C, Newton T, Novasio J, Sawyer R, Sharman A, Slevin K, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Waplington S, Whittaker J, Booton R, Crosbie PAJ. Targeted lung cancer screening selects individuals at high risk of cardiovascular disease. Lung Cancer 2018; 124:148-153. [PMID: 30268454 DOI: 10.1016/j.lungcan.2018.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Blandin Knight
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Barber
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - D Colligan
- Manchester Health and Care Commissioning, Manchester, UK
| | - E J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Duerden
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Elton
- Greater Manchester Health & Social Care Partnership, Manchester, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - M Greaves
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - J Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - K Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Kirwan
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Macnab
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - C Miller
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - T Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - J Novasio
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - R Sawyer
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Sharman
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - K Slevin
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - E Smith
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - B Taylor
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - S Taylor
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Tonge
- Manchester Health and Care Commissioning, Manchester, UK
| | - A Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - S Waplington
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - R Booton
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Raffield LM, Cox AJ, Criqui MH, Hsu FC, Terry JG, Xu J, Freedman BI, Carr JJ, Bowden DW. Associations of coronary artery calcified plaque density with mortality in type 2 diabetes: the Diabetes Heart Study. Cardiovasc Diabetol 2018; 17:67. [PMID: 29751802 PMCID: PMC5946410 DOI: 10.1186/s12933-018-0714-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Coronary artery calcified plaque (CAC) is strongly predictive of cardiovascular disease (CVD) events and mortality, both in general populations and individuals with type 2 diabetes at high risk for CVD. CAC is typically reported as an Agatston score, which is weighted for increased plaque density. However, the role of CAC density in CVD risk prediction, independently and with CAC volume, remains unclear. METHODS We examined the role of CAC density in individuals with type 2 diabetes from the family-based Diabetes Heart Study and the African American-Diabetes Heart Study. CAC density was calculated as mass divided by volume, and associations with incident all-cause and CVD mortality [median follow-up 10.2 years European Americans (n = 902, n = 286 deceased), 5.2 years African Americans (n = 552, n = 93 deceased)] were examined using Cox proportional hazards models, independently and in models adjusted for CAC volume. RESULTS In European Americans, CAC density, like Agatston score and volume, was consistently associated with increased risk of all-cause and CVD mortality (p ≤ 0.002) in models adjusted for age, sex, statin use, total cholesterol, HDL, systolic blood pressure, high blood pressure medication use, and current smoking. However, these associations were no longer significant when models were additionally adjusted for CAC volume. CAC density was not significantly associated with mortality, either alone or adjusted for CAC volume, in African Americans. CONCLUSIONS CAC density is not associated with mortality independent from CAC volume in European Americans and African Americans with type 2 diabetes.
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Affiliation(s)
- Laura M. Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, 5100 Genetic Medicine Building, 120 Mason Farm Road, Chapel Hill, NC 27599 USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Amanda J. Cox
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
- Molecular Basis of Disease, Griffith University, Southport, Brisbane, QLD Australia
| | - Michael H. Criqui
- Department of Family and Preventive Medicine, University of California, San Diego, CA USA
| | - Fang-Chi Hsu
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - James G. Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN USA
| | - Jianzhao Xu
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Barry I. Freedman
- Department of Internal Medicine—Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - J. Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN USA
| | - Donald W. Bowden
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC USA
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Messerli M, Hechelhammer L, Leschka S, Warschkow R, Wildermuth S, Bauer RW. Coronary risk assessment at X-ray dose equivalent ungated chest CT: Results of a multi-reader study. Clin Imaging 2018; 49:73-79. [DOI: 10.1016/j.clinimag.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
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Malcolm KB, Dinwoodey DL, Cundiff MC, Regis SM, Kitts AKB, Wald C, Lynch ML, Al-Husami W, McKee AB, McKee BJ. Qualitative coronary artery calcium assessment on CT lung screening exam helps predict first cardiac events. J Thorac Dis 2018; 10:2740-2751. [PMID: 29997936 DOI: 10.21037/jtd.2018.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Results A total of 1,513 individuals underwent CTLS. Downstream data, pre-test cardiac risk factors and CAC scores were available for 88.3% (1,336/1,513). The average length of follow-up was 2.64 (SD ±0.72) years. There were a total of 43 events, occurring in 1.55% (6/386) of patients with mild CAC, 3.24% (11/339) of patients with moderate CAC, and 8.90% (26/292) of patients with marked CAC. There were no events among patients with no reported CAC (0/319). Using multivariable logistic modeling, the increased odds of an initial cardiac event was 2.56 (95% CI, 1.76-3.92, P<0.001) for mild CAC, 6.57 (95% CI, 3.10-15.4, P<0.001) for moderate CAC, and 16.8 (95% CI, 5.46-60.3, P<0.001) for marked CAC, as compared to individuals with no CAC. Time to event analysis showed distinct differences among the four CAC categories (P<0.001). Conclusions Qualitative coronary artery calcification scoring of CTLS exams may provide a novel method to help select individuals at elevated risk for an initial cardiac event.
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Affiliation(s)
- Katherine B Malcolm
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Internal Medicine, University of California, San Francisco, CA, USA
| | - Danya L Dinwoodey
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Michael C Cundiff
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Shawn M Regis
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Andrea K Borondy Kitts
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Christoph Wald
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Miranda L Lynch
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wael Al-Husami
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Andrea B McKee
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Brady J McKee
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
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Mulshine JL. Status of lung cancer screening. J Thorac Dis 2017; 9:4311-4314. [PMID: 29266114 PMCID: PMC5720982 DOI: 10.21037/jtd.2017.10.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
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2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Thorac Imaging 2017; 32:W54-W66. [DOI: 10.1097/rti.0000000000000287] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Silveira de Souza VV, Soares Torres F, Hochhegger B, Watte G, Sartori G, Lucchese F, Azambuja Gonçalves B. Performance of ultra-low-dose CT for the evaluation of coronary calcification: a direct comparison with coronary calcium score. Clin Radiol 2017; 72:745-750. [PMID: 28413071 DOI: 10.1016/j.crad.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the diagnostic performance of ultra-low-dose computed tomography (ULDCT) in comparison to standard coronary calcium score (CCS) acquisition for the evaluation of coronary artery calcification (CAC). MATERIALS AND METHODS Standard CCS acquisition and ULDCT were performed in patients referred for coronary CT angiography for the evaluation of coronary artery disease. CAC in ULDCT was graded subjectively using a four-point scale (from 0, no calcification, to 3, severe calcification) for the complete study and for each individual coronary segment. The summation of all individual coronary segment scores generated an ULDCT total CAC score. ULDCT results were compared to standard Agatston score and sensitivity and specificity of ULDCT were calculated. RESULTS CCS and ULDCT were performed in 74 patients, with a mean DLP of 77.7 mGy·cm (±12.1) and 9.3 mGy·cm (±0.6), respectively (p<0.001). Coronary calcification was detected in 47 patients (63.5%) in standard CCS acquisition (median Agatston score of 41; interquartile range [IQR]:0263), in comparison to 42 patients (56.8%) in ULDCT (p<0.001). The sensitivity and specificity of the ULDCT total CAC score ≥1 was 80.9% and 85.2%, respectively, with an accuracy of 82.4%. The area under the receiver operating characteristic curve for the presence of CAC was 0.87. CONCLUSION ULDCT shows good sensitivity, specificity, and overall accuracy for the detection of coronary calcification with a markedly lower radiation dose in comparison to CCS. ULDCT is unlikely to miss coronary calcification in individuals with at least moderate calcium load (Agatston score >100).
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Affiliation(s)
- V V Silveira de Souza
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil.
| | - F Soares Torres
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - B Hochhegger
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - G Watte
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - G Sartori
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - F Lucchese
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - B Azambuja Gonçalves
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
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Hecht HS, Cronin P, Blaha MJ, Budoff MJ, Kazerooni EA, Narula J, Yankelevitz D, Abbara S. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr 2016; 11:74-84. [PMID: 27916431 DOI: 10.1016/j.jcct.2016.11.003] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 12/17/2022]
Abstract
The Society of Cardiovascular Computed Tomography (SCCT) and the Society of Thoracic Radiology (STR) have jointly produced this document. Experts in this subject have been selected from both organizations to examine subject-specific data and write this guideline in partnership. A formal literature review, weighing the strength of evidence has been performed. When available, information from studies on cost was considered. Computed tomography (CT) acquisition, CAC scoring methodologies and clinical outcomes are the primary basis for the recommendations in this guideline. This guideline is intended to assist healthcare providers in clinical decision making. The recommendations reflect a consensus after a thorough review of the best available current scientific evidence and practice patterns of experts in the field and are intended to improve patient care while acknowledging that situations arise where additional information may be needed to better inform patient care.
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Affiliation(s)
- Harvey S Hecht
- Lenox Hill Heart & Vascular Institute, New York, NY, United States
| | - Paul Cronin
- University of Michigan Health System, Ann Arbor, MI, United States
| | | | | | - Ella A Kazerooni
- University of Michigan Health System, Ann Arbor, MI, United States
| | - Jagat Narula
- Icahn School of Medicine at Mt. Sinai, New York, NY, United States
| | | | - Suhny Abbara
- UTSouthwestern Medical Center, Radiology, 5323 Harry Hines Blv, Dallas, TX 75390-9316, United States.
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Azour L, Kadoch MA, Ward TJ, Eber CD, Jacobi AH. Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges. J Cardiovasc Comput Tomogr 2016; 11:8-15. [PMID: 27743881 DOI: 10.1016/j.jcct.2016.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
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. METHODS Two thoracic radiologists reviewed consecutive same-day ECG-gated and routine non-gated chest CT scans of 222 individuals. CAC was quantified using the Agatston scoring on the ECG-gated scans, and using an ordinal method on routine scans, with a score from 0 to 12. The pattern and distribution of CAC was assessed. The correlation between routine exam ordinal scores and Agatston scores in ECG-gated exams, as well as the accuracy of assigning a zero calcium score on routine chest CT was determined. RESULTS CAC was most prevalent in the left anterior descending coronary artery in both single and multi-vessel coronary artery disease. There was a strong correlation between the non-gated ordinal and ECG-gated Agatston scores (r = 0.811, p < 0.01). Excellent inter-reader agreement (k = 0.95) was shown for the presence (total ordinal score ≥1) or absence (total ordinal score = 0) of CAC on routine chest CT. The negative predictive value for a total ordinal score of zero on routine CT was 91.6% (95% CI, 85.1-95.9). Total ordinal scores of 0, 1-3, 4-5, and ≥6 corresponded to average Agatston scores of 0.52 (0.3-0.8), 98.7 (78.2-117.1), 350.6 (264.9-436.3) and 1925.4 (1526.9-2323.9). CONCLUSION Visual assessment of CAC on non-gated routine chest CT accurately predicts Agatston score ranges, including the zero score, in ECG-gated CT. Inclusion of this information in radiology reports may be useful to convey important information on cardiovascular risk, particularly premature atherosclerosis in younger patients.
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Affiliation(s)
- Lea Azour
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Michael A Kadoch
- Department of Radiology, University of California Davis, Sacramento, CA 95817, United States
| | - Thomas J Ward
- Radiology Specialists of Florida, Maitland, FL 32751, United States
| | - Corey D Eber
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Adam H Jacobi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Yankelevitz DF, Henschke CI. Advancing and sharing the knowledge base of CT screening for lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:154. [PMID: 27195272 DOI: 10.21037/atm.2016.04.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CT screening for lung cancer is gaining in acceptance and is now moving from the research domain into standard clinical practice. Coincident with this, there is also increasing awareness of the usefulness of collecting large datasets obtained in the clinical domain and how this can be used to advance practice. Toward this end, in the United States, the Centers for Medicare and Medicaid Services (CMS) are requiring data from screening to be entered into certified registries. While this is still in its early stage and only limited datasets are required, this would be particularly relevant if images as well as clinical information were collected as it will allow for additional evaluation of all imaging findings including ancillary ones and understanding how they integrate into the screening process. All of this needs to be considered in the context of how this information can be shared with a person interested in being screened. In particular, the potential benefit of screening needs to be presented in terms of what is meaningful to the individual including their chances of having lung cancer and also their chance of being cured. This is very different then presenting it in terms of mortality reduction which was never meant to be used for that purpose. Also, how findings made on the CT scans, in addition to those related to lung cancer will be meaningful to them.
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Affiliation(s)
- David F Yankelevitz
- 1 Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; 2 Phoenix Veterans Health Care System, Phoenix, AZ, USA
| | - Claudia I Henschke
- 1 Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; 2 Phoenix Veterans Health Care System, Phoenix, AZ, USA
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Shemesh J. Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:159. [PMID: 27195277 DOI: 10.21037/atm.2016.04.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The recent acceptance of low dose chest computed tomography (LDCT) as a screening modality for early lung cancer detection will significantly increase the number of LDCT among high risk population. The target subjects are at the same time at high risk to develop cardiovascular (CV) events. The routine report on coronary artery calcification (CAC) will therefore, enhances the screening benefit by providing the clinicians with an additive powerful risk stratification tool for the management or primary prevention of CV events. This review will provide the radiologists with helpful information for the daily practice regarding on what is CAC, its clinical applications and how to diagnose, quantify and report on CAC while reading the LDCT.
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Affiliation(s)
- Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Henschke CI, Li K, Yip R, Salvatore M, Yankelevitz DF. The importance of the regimen of screening in maximizing the benefit and minimizing the harms. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:153. [PMID: 27195271 PMCID: PMC4860488 DOI: 10.21037/atm.2016.04.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In CT screening for lung cancer, the regimen of screening is critical in diagnosing lung cancer early while limiting unnecessary tests and invasive procedures. The International Early Lung Cancer Action Program (I-ELCAP) has developed a regimen based on evidence collected in the I-ELCAP cohort of more than 70,000 participants. METHODS Important in the development of the regimen is the recognition of the profound difference between the first, baseline round of screening and all subsequent rounds of repeat screening. For each person undergoing screening, the baseline round happens only once while repeat rounds will be performed annually for many years. This difference needs to be clearly recognized as it is these annual rounds which allow for identification of small, early, yet aggressive, lung cancers which have high cure rates despite their aggressiveness. The importance of nodule consistency and size are key factors in the regimen. The regimen needs to be continuously updated by incorporating advances in technology and knowledge. RESULTS The use of the I-ELCAP regimen reduces the workup of participants in the screening program to less than 10% in the baseline round and less than 6% in the annual repeat rounds. By use of this regimen, estimated cure rate of lung cancers diagnosed under screening is 80% or higher in both baseline and annual repeat rounds. CONCLUSIONS The I-ELCAP collaboration provides a new paradigm that answers the 2002 NCI call for multiple approaches to address relevant questions about screening and the Institute of Medicine (IOM) Roundtable on Evidence-based Medicine from the National Academy of Science's call for a "new clinical research paradigm that takes better advantage of data generated in the course of healthcare delivery would speed and improve the development of evidence for real-world decision making".
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Margolies L, Salvatore M, Hecht HS, Kotkin S, Yip R, Baber U, Bishay V, Narula J, Yankelevitz D, Henschke C. Digital Mammography and Screening for Coronary Artery Disease. JACC Cardiovasc Imaging 2016; 9:350-60. [DOI: 10.1016/j.jcmg.2015.10.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/21/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
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