Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population
Abstract Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on...
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| creator | Mahabadi, Amir A., MD Lehmann, Nils, PhD Möhlenkamp, Stefan, MD Pundt, Noreen, PhD Dykun, Iryna, MD Roggenbuck, Ulla Moebus, Susanne, PhD Jöckel, Karl-Heinz, PhD Erbel, Raimund, MD Kälsch, Hagen |
| description | Abstract Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology. |
| doi_str_mv | 10.1016/j.jcmg.2015.12.024 |
| format | Article |
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Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2015.12.024</identifier><identifier>PMID: 27450878</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adipose Tissue - diagnostic imaging ; Aged ; Aorta, Thoracic - diagnostic imaging ; Area Under Curve ; cardiac CT ; Cardiovascular ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; epicardial adipose tissue ; Female ; Germany ; Heart Atria - diagnostic imaging ; Heinz Nixdorf Recall Study ; Humans ; Kaplan-Meier Estimate ; left atrial size ; Male ; Middle Aged ; Mitral Valve - diagnostic imaging ; Multivariate Analysis ; Myocardial Infarction - etiology ; Pericardium - diagnostic imaging ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; ROC Curve ; Stroke - etiology ; thoracic aortic calcification ; Tomography, X-Ray Computed ; Vascular Calcification - complications ; Vascular Calcification - diagnostic imaging ; Vascular Calcification - mortality</subject><ispartof>JACC. Cardiovascular imaging, 2016-10, Vol.9 (10), p.1177-1185</ispartof><rights>American College of Cardiology Foundation</rights><rights>2016 American College of Cardiology Foundation</rights><rights>Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c547t-7761b565fe592b533495d5f68f5fe9cb57a072ca9df975e346c258b03e07b54f3</citedby><cites>FETCH-LOGICAL-c547t-7761b565fe592b533495d5f68f5fe9cb57a072ca9df975e346c258b03e07b54f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936878X16304089$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27450878$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mahabadi, Amir A., MD</creatorcontrib><creatorcontrib>Lehmann, Nils, PhD</creatorcontrib><creatorcontrib>Möhlenkamp, Stefan, MD</creatorcontrib><creatorcontrib>Pundt, Noreen, PhD</creatorcontrib><creatorcontrib>Dykun, Iryna, MD</creatorcontrib><creatorcontrib>Roggenbuck, Ulla</creatorcontrib><creatorcontrib>Moebus, Susanne, PhD</creatorcontrib><creatorcontrib>Jöckel, Karl-Heinz, PhD</creatorcontrib><creatorcontrib>Erbel, Raimund, MD</creatorcontrib><creatorcontrib>Kälsch, Hagen</creatorcontrib><creatorcontrib>Heinz Nixdorf Investigative Group</creatorcontrib><title>Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Abstract Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.</description><subject>Adipose Tissue - diagnostic imaging</subject><subject>Aged</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Area Under Curve</subject><subject>cardiac CT</subject><subject>Cardiovascular</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>epicardial adipose tissue</subject><subject>Female</subject><subject>Germany</subject><subject>Heart Atria - diagnostic imaging</subject><subject>Heinz Nixdorf Recall Study</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>left atrial size</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - etiology</subject><subject>Pericardium - diagnostic imaging</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Stroke - etiology</subject><subject>thoracic aortic calcification</subject><subject>Tomography, X-Ray Computed</subject><subject>Vascular Calcification - complications</subject><subject>Vascular Calcification - diagnostic imaging</subject><subject>Vascular Calcification - mortality</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ustu1TAQjRCIlsIPsEBesknw24mEkK6itiAVqOgFsbMce0Kd5sYXO6nUL-A3-Ba-DEe3sGDBaqyZc44150xRPCe4IpjIV0M12N23imIiKkIrTPmD4pjUSpZKNORhfjdMlrWqvx4VT1IaMJZYcvW4OKKKC5wHx8WPD2GyIYbJxDv0HkxaIiR0Ol2byQKarwFdRnDezv4W0BczLoBCj1oTnTcWtVu06UKebKNxfvZZZkSffLpBZ8bOISZkJofaTYuu8ieA_PTr56p5DhPEDL0M-2U0K-9p8ag3Y4Jn9_Wk-Hx2um3flhcfz9-1m4vSCq7mUilJOiFFD6KhnWCMN8KJXtZ9bjW2E8pgRa1pXN8oAYxLS0XdYQZYdYL37KR4edDdx_B9gTTrnU8WxtFMEJakSU2lYpwKnqH0ALUxpBSh1_vod9knTbBeA9CDXgPQawCaUJ0DyKQX9_pLtwP3l_LH8Qx4fQBA3vLWQ9TJeshmOx_BztoF_3_9N__Q7egnb814A3eQhrDEnEHeQ6dM0FfrCawXQCTDHNcN-w2Bo60i</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Mahabadi, Amir A., MD</creator><creator>Lehmann, Nils, PhD</creator><creator>Möhlenkamp, Stefan, MD</creator><creator>Pundt, Noreen, PhD</creator><creator>Dykun, Iryna, MD</creator><creator>Roggenbuck, Ulla</creator><creator>Moebus, Susanne, PhD</creator><creator>Jöckel, Karl-Heinz, PhD</creator><creator>Erbel, Raimund, MD</creator><creator>Kälsch, Hagen</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population</title><author>Mahabadi, Amir A., MD ; Lehmann, Nils, PhD ; Möhlenkamp, Stefan, MD ; Pundt, Noreen, PhD ; Dykun, Iryna, MD ; Roggenbuck, Ulla ; Moebus, Susanne, PhD ; Jöckel, Karl-Heinz, PhD ; Erbel, Raimund, MD ; Kälsch, Hagen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c547t-7761b565fe592b533495d5f68f5fe9cb57a072ca9df975e346c258b03e07b54f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adipose Tissue - diagnostic imaging</topic><topic>Aged</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Area Under Curve</topic><topic>cardiac CT</topic><topic>Cardiovascular</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>epicardial adipose tissue</topic><topic>Female</topic><topic>Germany</topic><topic>Heart Atria - diagnostic imaging</topic><topic>Heinz Nixdorf Recall Study</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>left atrial size</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - etiology</topic><topic>Pericardium - diagnostic imaging</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Stroke - etiology</topic><topic>thoracic aortic calcification</topic><topic>Tomography, X-Ray Computed</topic><topic>Vascular Calcification - complications</topic><topic>Vascular Calcification - diagnostic imaging</topic><topic>Vascular Calcification - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mahabadi, Amir A., MD</creatorcontrib><creatorcontrib>Lehmann, Nils, PhD</creatorcontrib><creatorcontrib>Möhlenkamp, Stefan, MD</creatorcontrib><creatorcontrib>Pundt, Noreen, PhD</creatorcontrib><creatorcontrib>Dykun, Iryna, MD</creatorcontrib><creatorcontrib>Roggenbuck, Ulla</creatorcontrib><creatorcontrib>Moebus, Susanne, PhD</creatorcontrib><creatorcontrib>Jöckel, Karl-Heinz, PhD</creatorcontrib><creatorcontrib>Erbel, Raimund, MD</creatorcontrib><creatorcontrib>Kälsch, Hagen</creatorcontrib><creatorcontrib>Heinz Nixdorf Investigative Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mahabadi, Amir A., MD</au><au>Lehmann, Nils, PhD</au><au>Möhlenkamp, Stefan, MD</au><au>Pundt, Noreen, PhD</au><au>Dykun, Iryna, MD</au><au>Roggenbuck, Ulla</au><au>Moebus, Susanne, PhD</au><au>Jöckel, Karl-Heinz, PhD</au><au>Erbel, Raimund, MD</au><au>Kälsch, Hagen</au><aucorp>Heinz Nixdorf Investigative Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>9</volume><issue>10</issue><spage>1177</spage><epage>1185</epage><pages>1177-1185</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Abstract Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27450878</pmid><doi>10.1016/j.jcmg.2015.12.024</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adipose Tissue - diagnostic imaging Aged Aorta, Thoracic - diagnostic imaging Area Under Curve cardiac CT Cardiovascular Coronary Artery Disease - complications Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality epicardial adipose tissue Female Germany Heart Atria - diagnostic imaging Heinz Nixdorf Recall Study Humans Kaplan-Meier Estimate left atrial size Male Middle Aged Mitral Valve - diagnostic imaging Multivariate Analysis Myocardial Infarction - etiology Pericardium - diagnostic imaging Predictive Value of Tests Prognosis Proportional Hazards Models Prospective Studies Risk Factors ROC Curve Stroke - etiology thoracic aortic calcification Tomography, X-Ray Computed Vascular Calcification - complications Vascular Calcification - diagnostic imaging Vascular Calcification - mortality |
| title | Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population |
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