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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
The relationship between coronary artery calcium scores and left atrium size in hemodialysis patients
Ismail Baloglu1, Kultigin Turkmen2, H Zeki Tonbul2
1Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey. i_baloglu@hotmail.com.
Insights
In hemodialysis patients, higher coronary artery calcification scores (CACS) are linked to larger left atrial (LA) size. Echocardiography may help assess coronary artery disease risk in these individuals.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Cardiovascular mortality is significantly elevated in patients undergoing hemodialysis.
- Coronary artery calcification score (CACS) in uremic patients reflects atherosclerotic disease severity and predicts cardiovascular events.
- Left atrial (LA) size is an important prognostic indicator in cardiac conditions.
Purpose of the Study:
- To investigate the relationship between coronary artery calcification and left atrial size in hemodialysis patients.
- To explore the prognostic value of LA size in predicting cardiovascular risk in this population.
Main Methods:
- A cross-sectional study included 32 hemodialysis patients (mean age 52.4 ± 14.1 years).
- Coronary artery calcium scoring was performed using a 16-MDCT scanner, with CACS calculated by Agatston score.
- Patients were divided into two groups based on median CACS: ≤45.85 (n=16) and >45.85 (n=16).
Main Results:
- Mean CACS was 245.57 ± 373.91.
- Left atrial size was significantly larger in patients with CACS > 45.85 compared to those with CACS ≤ 45.85.
- Total CACS positively correlated with LA size (r=0.47, p=0.006) and age (r=0.43, p=0.014). LA size correlated with diastolic blood pressure and inversely with ejection fraction.
Conclusions:
- A positive relationship exists between CACS and LA size in hemodialysis patients.
- Echocardiography, being non-invasive and cost-effective, could be valuable for coronary artery disease risk stratification in hemodialysis patients.
Purpose:
Hemodialysis patients have extremely increased cardiovascular mortality. The coronary artery calcification score (CACS) in uremic patients receiving hemodialysis reflects the severity of atherosclerotic vascular disease and predicts the cardiovascular events. In cardiac conditions, left atrial (LA) size has a prognostic importance. In this study, relationship between coronary artery calcification and left atrial size was investigated.
Methods:
This was a cross-sectional study involving 32 hemodialysis patients (16 females, 16 males; mean age, 52.4 ± 14.1 years) receiving HD for ≥6 months. Coronary artery calcium scoring was performed by a 16-MDCT scanner, and CACS was calculated by Agatston score. A calcification was defined as a minimum of two adjacent pixels (>0.52 mm2) with a density over 130 Hounsfield units. Patients were divided into two subgroups (group 1: CACS ≤ 45.85, n = 16 and group 2: CACS > 45.85, n = 16) according to median CACS value.
Results:
Mean CACS value of 32 hemodialysis patients was 245.57 ± 373.91. LA size was significantly higher in patients with CACS > 45.85 (group 2) than in patients with CACS ≤ 45.85 (group 1). In the bivariate correlation analysis, total CACS was positively correlated with left atrium size (r = 0.47, p = 0.006). Total CACS was positively correlated with age (r = 0.43, p = 0.014). LA size was positively correlated with diastolic blood pressure (r = 0.42, p = 0.016) and negatively correlated with ejection fraction (r = -0.42, p = 0.016). The clinical parameters such as BMI, duration of dialysis, blood pressure, ejection fraction, serum levels of calcium, phosphorus, uric acid, albumin, CRP, triglyceride, cholesterol, hemoglobin and ferritin were not independently associated with total CACS.
Conclusions:
We found a positive relationship between the CACS and LA size measured by echocardiography in hemodialysis patients. Therefore; echocardiography, which is cheaper and non-invasive than tomographic examinations, might be considered for the risk stratification of coronary artery disease in hemodialysis patients.
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