Limits...
Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

Jairam PM, de Jong PA, Mali WP, Isgum I, van der Graaf Y, PROVIDI study-gro - Eur Radiol (2015)

Bottom Line: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications.During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified.Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, pjairam@umcutrecht.nl.

ABSTRACT

Objective: Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings.

Methods: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification.

Results: During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).

Conclusion: Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans.

Key points: • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features.

Show MeSH

Related in: MedlinePlus

Examples of pulmonary, mediastinal and pleural CT imaging characteristics. a Airway thickening (white arrow) and ground glass in the left lower lobe (black arrows). b Consolidation in the right under lobe (black arrow). c Short axis diameter measurement of the largest mediastinal lymph node. d Pleural effusion measurement of left-sided fluid layer on axial image
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4419189&req=5

Fig2: Examples of pulmonary, mediastinal and pleural CT imaging characteristics. a Airway thickening (white arrow) and ground glass in the left lower lobe (black arrows). b Consolidation in the right under lobe (black arrow). c Short axis diameter measurement of the largest mediastinal lymph node. d Pleural effusion measurement of left-sided fluid layer on axial image

Mentions: CT examinations were examined for left anterior descending (LAD) coronary artery calcifications, mitral valve calcifications, descending aorta calcifications and cardiac diameter. This set of four cardiovascular CT features enabled adequate identification of subjects at high risk of CVD [12]. Additionally, CT images were evaluated for airway thickening, ground glass, consolidation, pleural effusion and mediastinal lymph node diameter. These five pulmonary disease-related CT findings have been previously shown to be associated with future CVD events [19]. The presence and extent of the cardiovascular and pulmonary CT abnormalities were graded using a validated simple ordinal [22] (Table 1). Extensive information about the definitions and grading of the CT features can be found in the Electronic Supplementary Material and examples in Fig. 2.Table 1


Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

Jairam PM, de Jong PA, Mali WP, Isgum I, van der Graaf Y, PROVIDI study-gro - Eur Radiol (2015)

Examples of pulmonary, mediastinal and pleural CT imaging characteristics. a Airway thickening (white arrow) and ground glass in the left lower lobe (black arrows). b Consolidation in the right under lobe (black arrow). c Short axis diameter measurement of the largest mediastinal lymph node. d Pleural effusion measurement of left-sided fluid layer on axial image
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4419189&req=5

Fig2: Examples of pulmonary, mediastinal and pleural CT imaging characteristics. a Airway thickening (white arrow) and ground glass in the left lower lobe (black arrows). b Consolidation in the right under lobe (black arrow). c Short axis diameter measurement of the largest mediastinal lymph node. d Pleural effusion measurement of left-sided fluid layer on axial image
Mentions: CT examinations were examined for left anterior descending (LAD) coronary artery calcifications, mitral valve calcifications, descending aorta calcifications and cardiac diameter. This set of four cardiovascular CT features enabled adequate identification of subjects at high risk of CVD [12]. Additionally, CT images were evaluated for airway thickening, ground glass, consolidation, pleural effusion and mediastinal lymph node diameter. These five pulmonary disease-related CT findings have been previously shown to be associated with future CVD events [19]. The presence and extent of the cardiovascular and pulmonary CT abnormalities were graded using a validated simple ordinal [22] (Table 1). Extensive information about the definitions and grading of the CT features can be found in the Electronic Supplementary Material and examples in Fig. 2.Table 1

Bottom Line: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications.During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified.Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, pjairam@umcutrecht.nl.

ABSTRACT

Objective: Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings.

Methods: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification.

Results: During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).

Conclusion: Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans.

Key points: • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features.

Show MeSH
Related in: MedlinePlus