Prediction of Cardiovascular Events by Using Non-Vascular Findings on Routine Chest CT

Background: Routine computed tomography (CT) examinations contain an abundance of findings unrelated to the diagnostic question. Those with prognostic significance may contribute to early detection and treatment of disease, irrelevant findings can be ignored. We aimed to assess the association between unrequested chest CT findings in lungs, mediastinum and pleura and future cardiovascular events. Methods: Multi-center case-cohort study in 5 tertiary and 3 secondary care hospitals involving 10410 subjects who underwent routine chest CT for non-cardiovascular reasons. 493 cardiovascular hospitalizations or deaths were recorded during an average follow-up time of 17.8 months. 1191 patients were randomly sampled to serve as a control subcohort. Hazard ratios and annualized event rates were calculated. Results: Abnormalities in the lung (26–44%), pleura (14–15%) and mediastinum (20%) were common. Hazard ratios after adjustment for age and sex were for airway wall thickening 2.26 (1.59–3.22), ground glass opacities 2.50 (1.72–3.62), consolidations 1.97 (1.12–3.47), pleural effusions 2.77 (1.81–4.25) and lymph-nodes 2.04 (1.40–2.96). Corresponding annual event rates were 5.5%, 6.0%, 3.8%, 10.2 % and 4.4%. Conclusions: We have identified several common chest CT findings that are predictive for future risk of cardiovascular events and found that other findings have little utility for this. The added value of the non-vascular predictors to establishe

Unrequested Findings on Cardiac Computed Tomography: Looking Beyond the Heart

Objectives: To determine the prevalence of clinically relevant unrequested extra-cardiac imaging findings on cardiac Computed Tomography (CT) and explanatory factors thereof. Methods: A systematic review of studies drawn from online electronic databases followed by meta-analysis with metaregression was performed. The prevalence of clinically relevant unrequested findings and potentially explanatory variables were extracted (proportion of smokers, mean age of patients, use of full FOV, proportion of men, years since publication). Results: Nineteen radiological studies comprising 12922 patients met the inclusion criteria. The pooled prevalence of clinically relevant unrequested findings was 13 % (95 % confidence interval 9–18, range: 3–39%). The large differences in prevalence observed were not explained by the predefined (potentially explanatory) variables. Conclusions: Clinically relevant extra-cardiac findings are common in patients undergoing routine cardiac CT, and their prevalence differs substantially between studies. These differences may be due to unreported factors such as different definitions of clinical relevance and differences between populations. We present suggestions for basic reporting whic

Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events

PURPOSE: To investigate the contribution of incidental findings at chest computed tomography (CT) in the detection of subjects at high risk for cardiovascular disease (CVD) by deriving and validating a CT-based prediction rule. MATERIALS AND METHODS: This retrospective study was approved by the ethical review board of the primary participating facility, and informed consent was waived. The derivation cohort comprised 10 410 patients who underwent diagnostic chest CT for noncardiovascular indications. During a mean follow-up of 3.7 years (maximum, 7.0 years), 1148 CVD events (cases) were identified. By using a case-cohort approach, CT scans from the cases and from an approximately 10% random sample of the baseline cohort (n = 1366) were graded visually for several cardiovascular findings. Multivariable Cox proportional hazards analysis with backward elimination technique was used to derive the best-fitting parsimonious prediction model. External validation (discrimination, calibration, and risk stratification) was performed in a separate validation cohort (n = 1653). RESULTS: The final model included patient age and sex, CT indication, left anterior descending coronary artery calcifications, mitral valve calcifications, descending aorta calcifications, and cardiac diameter. The model demonstrated good discriminative value, with a C statistic of 0.71 (95% confidence interval: 0.68, 0.74) and a good overall calibration, as assessed in the validation cohort. This imaging-based model allows accurate stratification of individuals into clinically relevant risk categories. CONCLUSION: Structured reporting of incidental CT findings can mediate accurate stratification of individuals into clinically relevant risk categories and subsequently allow those at higher risk of future CVD events to be distinguished

The prognostic value of vascular diameter measurements on routine chest computed tomography in patients not referred for cardiovascular indications

OBJECTIVES: The aim of the study was to investigate whether diameter measurements of the thoracic aorta and the heart can be used as prognostic markers for future cardiovascular disease. METHODS: Following a case-cohort design, a total of 10,410 patients undergoing chest computed tomography were followed up for a mean period of 17 months. The ones with a cardiovascular indication were excluded. Diameter measurements were evaluated with Cox proportional hazard analysis. RESULTS: Five hundred fifteen incident cardiovascular events occurred during follow-up. The heart (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03-1.06) and ascending thoracic (HR, 1.002; 95% CI, 1.001-1.004) diameter showed an exponential prognostic effect beyond a threshold diameter of, respectively, 11 and 30 mm; the descending aortic diameter (HR, 1.04; 95% CI, 1.01-1.13) and cardiothoracic ratio (HR, 1.06; 95% CI, 1.04-1.08) showed linear prognostic effects beyond, respectively, 25 and 0.45 mm. CONCLUSION: Intrathoracic diameter measurements can be used as markers to predict cardiovascular events in patients not referred for that disease outcome

Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose ct screening for lung cancer

OBJECTIVE. Performing coronary artery calcium (CAC) screening as part of low-dose CT lung cancer screening has been proposed as an efficient strategy to detect people with high cardiovascular risk and improve outcomes of primary prevention. This study aims to investigate whether CAC measured on low-dose CT in a population of former and current heavy smokers is an independent predictor of all-cause mortality and cardiac events. SUBJECTS AND METHODS. We used a case-cohort study and included 958 subjects 50 years old or older within the screen group of a randomized controlled lung cancer screening trial. We used Cox proportional-hazard models to compute hazard ratios (HRs) adjusted for traditional cardiovascular risk factors to predict all-cause mortality and cardiovascular events. RESULTS. During a median follow-up of 21.5 months, 56 deaths and 127 cardiovascular events occurred. Compared with a CAC score of 0, multivariate-adjusted HRs for all-cause mortality for CAC scores of 1-100, 101-1000, and more than 1000 were 3.00 (95% CI, 0.61-14.93), 6.13 (95% CI, 1.35-27.77), and 10.93 (95% CI, 2.36-50.60), respectively. Multivariate- adjusted HRs for coronary events were 1.38 (95% CI, 0.39-4.90), 3.04 (95% CI, 0.95-9.73), and 7.77 (95% CI, 2.44-24.75), respectively. CONCLUSION. This study shows that CAC scoring as part of low-dose CT lung cancer screening can be used as an independent predictor of all-cause mortality and cardiovascular events. © American Roentgen Ray Society

Coronary artery calcification scoring in low-dose ungated CT screening for lung cancer: Interscan agreement

OBJECTIVE. In previous studies detection of coronary artery calcification (CAC) with low-dose ungated MDCT performed for lung cancer screening has been compared with detection with cardiac CT. We evaluated the interscan agreement of CAC scores from two consecutive low-dose ungated MDCT examinations. SUBJECTS AND METHODS. The subjects were 584 participants in the screening segment of a lung cancer screening trial who underwent two low-dose ungated MDCT examinations within 4 months (mean, 3.1 ± 0.6 months) of a baseline CT examination. Agatston score, volume score, and calcium mass score were measured by two observers. Interscan agreement of stratification of participants into four Agatston score risk categories (0, 1-100, 101-400, > 400) was assessed with kappa values. Interscan variability and 95% repeatability limits were calculated for all three calcium measures and compared by repeated measures analysis of variance. RESULTS. An Agatston score > 0 was detected in 443 baseline CT examinations (75.8%). Interscan agreement of the four risk categories was good (κ = 0.67). The Agatston scores were in the same risk category in both examinations in 440 cases (75.3%); 578 participants (99.0%) had scores differing a maximum of one category. Furthermore, mean interscan variability ranged from 61% for calcium volume score to 71% for Agatston score (p < 0.01). A limitation of this study was that no comparison of CAC scores between low-dose ungated CT and the reference standard ECG-gated CT was performed. CONCLUSION. Cardiovascular disease risk stratification with low-dose ungated MDCT is feasible and has good interscan agreement of stratification of participants into Agatston score risk categories. High mean interscan variability precludes the use of this technique for monitoring CAC scores for individual patients. © American Roentgen Ray Society

The current situation of the usage of websites to vitalize knowledge sharing in depopulated rural areas.:Focusing on a web-site "Sato-Net" deployed in Sasayama City, Hyogo Prefecture

textabstractObjectives: To enable risk stratification of patients with various types of arterial disease by the development and validation of models for prediction of recurrent vascular event risk based on vascular risk factors, imaging or both. Design: Prospective cohort study. Setting: University Medical Centre. Patients: 5788 patients referred with various clinical manifestations of arterial disease between January 1996 and February 2010. Main outcome measures: 788 recurrent vascular events (ie, myocardial infarction, stroke or vascular death) that were observed during 4.7 (IQR 2.3 to 7.7) years' follow-up. Results: Three Cox proportional hazards models for prediction of 10-year recurrent vascular event risk were developed based on age and sex in addition to clinical parameters (model A), carotid ultrasound findings (model B) or both (model C). Clinical parameters were medical history, current smoking, systolic blood pressure and laboratory biomarkers. In a separate part of the dataset, the concordance statistic of model A was 0.68 (95% CI 0.64 to 0.71), compared to 0.64 (0.61 to 0.68) for model B and 0.68 (0.65 to 0.72) for model C. Goodness-of-fit and calibration of model A were adequate, also in separate subgroups of patients having coronary, cerebrovascular, peripheral artery or aneurysmal disease. Model A predicted <20% risk in 5

Annualised event rates for any cardiovascular event.

<p>N.A.  =  not applicable.</p