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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Opportunistic coronary calcium progression on routine chest CT improves cardiovascular risk stratification in
Qi Zhang1,2,3, Yanxun Su4, Chenyao Song3,4
1Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Insights
Coronary artery calcium (CAC) progression detected on routine chest CT scans significantly improves cardiovascular risk assessment in inflammatory bowel disease (IBD) patients. This method offers greater prognostic value than baseline CAC alone.
Area of Science:
- Cardiovascular Medicine
- Inflammatory Bowel Disease Research
- Medical Imaging Analysis
Background:
- Patients with inflammatory bowel disease (IBD) exhibit an elevated risk of atherosclerotic cardiovascular disease.
- Conventional risk factors may underestimate the true cardiovascular risk in the IBD population.
- The prognostic utility of coronary artery calcium (CAC) progression beyond baseline CAC in IBD patients remains uncertain.
Purpose of the Study:
- To evaluate whether CAC progression provides additional prognostic information for major adverse cardiovascular events (MACE) in IBD patients.
- To assess the incremental value of CAC progression compared to baseline CAC and conventional risk factors.
- To determine the association between CAC progression and incident atrial fibrillation (AF).
Main Methods:
- A multicenter retrospective cohort study included 467 IBD patients without prior atherosclerotic cardiovascular disease.
- Participants underwent at least two non-contrast chest CT scans with a mean interval of 21.2 months.
- CAC progression was defined by incident CAC, absolute increase (≥10 annualized), or relative increase (≥10% annualized). MACE and incident AF were primary and secondary outcomes, respectively. Cox regression and reclassification analyses were employed.
Main Results:
- CAC progression was observed in 27.6% of patients and strongly predicted MACE (HR 7.41, P < 0.001), with graded risk across different progression types.
- Incorporating CAC progression into risk models significantly enhanced discrimination (C-index 0.67 vs. 0.73) and reclassification (NRI 0.22, P < 0.001).
- Baseline CAC offered only modest incremental value (NRI 0.04, P = 0.021), and CAC progression was linked to incident AF.
Conclusions:
- Opportunistic assessment of CAC progression from routine chest CT scans is a valuable tool for cardiovascular risk stratification in IBD.
- CAC progression provides prognostic information beyond conventional risk factors and baseline CAC, even in patients with no initial CAC.
- This approach can help identify high-risk IBD patients who may benefit from intensified cardiovascular prevention strategies.
Background:
Patients with inflammatory bowel disease (IBD) have increased atherosclerotic cardiovascular risk that may be underestimated by conventional factors. Whether coronary artery calcium (CAC) progression adds prognostic value beyond baseline CAC in IBD is unclear.
Methods:
In this multicenter retrospective cohort, 467 IBD patients without known atherosclerotic cardiovascular disease underwent ≥2 routine non-contrast chest CT scans (mean interval 21.2 months). CAC progression was defined as incident CAC (0 to >0), absolute progression (0 < baseline <100 with annualized increase ≥10), or relative progression (baseline ≥100 with annualized increase ≥10%). Major adverse cardiovascular events (MACE) were the primary outcome; incident atrial fibrillation (AF) was secondary. Cox proportional hazard regression was utilized to estimate hazard ratios (HRs) for time to MACE regarding CAC progression. Incremental value was assessed by C-index and continuous net reclassification improvement (NRI).
Results:
Over a median follow-up of 37 months, 59 patients had MACE and 41 developed AF. CAC progression occurred in 27.6% and predicted MACE (HR 7.41, P < 0.001), with graded risk (relative HR 10.31; absolute HR 8.14; incident HR 5.22; all P < 0.001). Adding CAC progression to conventional factors improved discrimination (C-index 0.67 vs. 0.73) and reclassification (NRI 0.22, P < 0.001), whereas baseline CAC added modest value (C-index 0.67 vs. 0.68; NRI 0.04, P = 0.021). CAC progression was also associated with incident AF.
Conclusions:
Opportunistic CAC progression assessment from routine chest CT improves cardiovascular risk stratification in IBD beyond conventional factors and baseline CAC, including among patients with zero baseline CAC.
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