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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcium score is a prognostic factor for mortality in idiopathic pulmonary fibrosis
Antonella Caminati1, Maurizio Zompatori2,3, Nicoletta Fuccillo4
1Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy - lafitta@libero.it.
Insights
Idiopathic pulmonary fibrosis (IPF) patients with a high coronary artery calcium (CAC) score at diagnosis face a poor prognosis. A CAC score of 405 or higher predicts mortality and adverse cardiovascular events in IPF.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Cardiovascular diseases are common in idiopathic pulmonary fibrosis (IPF) and significantly affect patient survival.
- Investigating the link between coronary artery calcium (CAC) scores and cardiovascular outcomes in IPF is crucial.
Purpose of the Study:
- To assess the association of CAC scores at IPF diagnosis and mid-term follow-up with adverse cardiovascular events and all-cause mortality.
- To determine the prognostic value of CAC scores in IPF patients.
Main Methods:
- Retrospective analysis of consecutive IPF patients.
- Collection of demographic data, smoking history, comorbidities, and pulmonary function tests (PFTs).
- Calculation of total CAC score and visual fibrotic score from high-resolution computed tomography (HRCT) scans taken at least 2 years apart.
Main Results:
- The study included 79 IPF patients (mean age 74.4 years).
- A CAC score at diagnosis (T0) of ≥405 demonstrated 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events.
- Multivariate analysis revealed male sex and CAC score at T0 as significant predictors of mortality and cardiovascular events.
Conclusions:
- IPF patients with a CAC score ≥405 at diagnosis have a poor mid-term prognosis.
- Elevated CAC scores are significantly associated with increased mortality and cardiovascular events in IPF patients.
- CAC scoring may serve as a valuable tool for risk stratification in IPF.
Background:
Cardiovascular diseases are frequent in idiopathic pulmonary fibrosis (IPF) and impact on survival. We investigated the association of coronary artery calcium (CAC) score at IPF diagnosis and during mid-term follow-up, with adverse cardiovascular events and all-cause mortality.
Methods:
Consecutive patients with IPF were retrospectively analyzed. Demographic data, smoking history, comorbidities and pulmonary function tests (PFTs) were recorded. All patients had at least two chest high resolution computed tomography (HRCT) performed 2 years apart. The total CAC score and visual fibrotic score were calculated, and all clinically significant cardiovascular events and deaths were reported.
Results:
The population consisted of 79 patients (57 males, mean age: 74.4±7.6 years); 67% of patients had a history of smoking, 48% of hypertension, 37% of dyslipidemia and 22.8% of diabetes. The visual score was 21.28±7.99% at T0 and 26.54±9.34% at T1, respectively (T1-T0 5.26±6.13%, P<0.001). CAC score at T0 and at T1 was 537.93±839.94 and 759.98±1027.6, respectively (T1-T0 224.66±406.87, P<0.001). Mean follow-up time was 2.47±1.1 years. On multivariate analysis, male sex (HR=3.58, 95% CI: 1.14-11.2) and CAC score at T0 (HR=1.04, 95% CI: 1.01-1.07) correlated with mortality and cardiovascular events. CAC score at T0≥405 showed 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events.
Conclusions:
IPF patients with a CAC score at diagnosis ≥405 have a poor prognosis over a mid-term follow-up. A higher CAC score is associated with mortality and cardiovascular events.
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