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Published on: June 2, 2022
Coronary Artery Calcium Dispersion and Cause-Specific Mortality
Ramzi Dudum1, Zeina A Dardari2, David I Feldman3
1Department of Cardiovascular Medicine, Stanford University, Stanford, California; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Insights
Coronary artery calcium (CAC) dispersion, indicated by more calcified vessels or diffuse patterns, significantly increases risks for all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery calcium (CAC) scoring is crucial for assessing subclinical atherosclerosis and refining cardiovascular risk stratification.
- Existing research suggests that specific CAC characteristics, such as vessel involvement, volume, and density, differentially influence risk.
- The impact of CAC dispersion, defined by the number of calcified vessels or CAC phenotype, on cause-specific mortality requires further investigation.
Purpose of the Study:
- To evaluate the association between CAC dispersion, encompassing the number of calcified vessels and CAC phenotype (diffuse vs. concentrated), and cause-specific mortality.
- To determine if CAC dispersion provides incremental prognostic information beyond the overall CAC score.
Main Methods:
- Retrospective analysis of the CAC Consortium cohort (n=28,147) with CAC > 0, excluding individuals with pre-existing coronary heart disease (CHD).
- Calculation of CAC area, density, and phenotype using the index of diffusion.
- Statistical assessment of the relationship between CAC characteristics and cause-specific mortality, controlling for overall CAC score.
Main Results:
- Increasing numbers of calcified vessels (dispersion) showed a graded increase in all-cause, cardiovascular disease (CVD), and CHD-specific mortality.
- A diffuse CAC phenotype, compared to a concentrated phenotype among those with multi-vessel involvement, was associated with higher CVD-specific mortality and trends toward higher all-cause and CHD-specific mortality.
- Diffuse CAC was characterized by less dense calcifications, larger CAC area, and involvement of multiple coronary vessels.
Conclusions:
- CAC dispersion, both in terms of the number of calcified vessels and the diffuse phenotype, is a significant independent predictor of increased all-cause, CVD, and CHD mortality.
- These findings highlight the prognostic importance of evaluating the spatial distribution and pattern of coronary calcifications beyond the total CAC score.
Abstract:
Coronary artery calcium (CAC) measures subclinical atherosclerosis and improves risk stratification. CAC characteristics-including vessel(s) involved, number of vessels, volume, and density-have been shown to differentially impact risk. We assessed how dispersion-either the number of calcified vessels or CAC phenotype (diffuse, normal, and concentrated)-impacted cause-specific mortality. The CAC Consortium is a retrospective cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC scoring. This study included patients with CAC >0 (n = 28,147). CAC area, CAC density, and CAC phenotypes (derived from the index of diffusion = 1 - [CAC in most concentrated vessel/total Agatston score]) were calculated. The associations between CAC characteristics and cause-specific mortality were assessed. The participant details included (n = 28,147): mean age 58.3 years, 25% female, 89.6% White, and 66% had 2+ calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p <0.001). After controlling for the overall CAC score, those with 4-vessel CAC involvement had more CAC area and less dense calcifications than those with 1-vessel. There was a graded increase in all-cause and cardiovascular disease (CVD)- and CHD-specific mortality as the number of calcified vessels increased. Among those with ≥2 vessels involved (n = 18,516), a diffuse phenotype was associated with a higher CVD-specific mortality and had a trend toward higher all-cause and CHD-specific mortality than a concentrated CAC phenotype. Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. There is a graded increase in all-cause and CVD- and CHD-specific mortality with increasing CAC dispersion.
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