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Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Abdominal aortic calcification on a plain X-ray and the relation with significant coronary artery disease in
M K de Bie1, M S Buiten1, J I Rotmans2
1Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Insights
Abdominal aortic calcification (AAC) on X-ray predicts coronary artery disease (CAD) in dialysis patients. This simple screening can help identify high-risk individuals for early intervention.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Coronary artery disease (CAD) is a major cause of mortality in asymptomatic chronic dialysis patients.
- Early identification of CAD risk in this population is crucial for improving survival rates.
- Abdominal aortic calcification (AAC) has shown a correlation with CAD in autopsy studies.
Purpose of the Study:
- To investigate if the extent of abdominal aortic calcification (AAC), quantified from lateral lumbar X-rays, can predict significant coronary artery disease (CAD) in asymptomatic dialysis patients.
- To evaluate AAC as a non-invasive screening tool for CAD in this high-risk group.
Main Methods:
- Included were 90 asymptomatic chronic dialysis patients without prior revascularization procedures.
- Abdominal aortic calcification (AAC) was quantified using a validated scoring system on lateral lumbar X-rays.
- Patients underwent CT-angiography (CTA) to assess for significant coronary artery disease (CAD).
Main Results:
- Significant CAD was present in 46 patients.
- The AAC score was significantly higher in patients with CAD (10.1 ± 4.9 vs. 6.3 ± 4.6, p < 0.05).
- AAC score independently predicted CAD presence (OR 1.2 per point increase, p < 0.01) with 85% sensitivity and 57% specificity.
Conclusions:
- Abdominal aortic calcification (AAC) assessed via lateral lumbar X-ray is a significant predictor of coronary artery disease (CAD) in asymptomatic dialysis patients.
- This readily available, non-invasive, and cost-effective screening method can aid in the early detection of CAD.
- Utilizing AAC assessment may facilitate timely referral for further CAD evaluation in dialysis patients.
Background:
Coronary artery disease (CAD) is common in asymptomatic chronic dialysis patients and plays an important role in their poor survival. Early identification of these high-risk patients could improve treatment and reduce mortality. Abdominal aortic calcification (AAC) has previously been associated with CAD in autopsy studies. Since the AAC can be quantified easily using a lateral lumbar X-ray we hypothesized that the extent of AAC as assessed on a lateral lumbar X-ray might be predictive of the presence of significant CAD in dialysis patients.
Methods:
All patients currently enrolled in the ICD2 trial without a history of CABG or a PCI with stent implantation were included in this study. All patients underwent CT-angiography (CTA) and a lateral X-ray of the abdomen. AAC on X-ray was quantified using a previously validated scoring system whereupon the association between AAC and the presence of significant CAD was assessed.
Results:
A total of 90 patients were included in this study (71% male, 67 ± 7 years old). Forty-six patients were found to have significant CAD. AAC-score was significantly higher in patients with CAD (10.1 ± 4.9 vs 6.3 ± 4.6 (p < 0.05). Multivariate regression analysis revealed that AAC score is an independent predictor for the presence of CAD with a 1,2 fold higher risk per point increase (p < 0.01). The AAC score has a sensitivity of 85% and a specificity of 57% for the presence of significant CAD.
Conclusion:
This study shows that abdominal aortic calcification as assessed on a lateral lumbar X-ray is predictive for the presence of significant coronary artery disease in asymptomatic dialysis patients. This simple, non-invasive and cheap screening method could contribute to early identification of patients eligible for further screening of CAD.
Trial Registration:
NTR948 , registered 10-4-2007 ; ISRCTN20479861 , registered 2-5-2007.
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