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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.

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Related in: MedlinePlus

Multivariable-adjusted hazard ratios (HRs) and 95 % confidence interval (95 % CI) for cardiovascular events comparing the severe versus the absent category of pleural effusion (HR 1.7 [95 % CI 1.3–2.2]), lymph node diameter (HR 1.5 [95 % CI 1.3–1.8]), airway thickening (HR 1.1 [95 % CI 0.9–1.3]), consolidation (HR 1.3 [95 % CI 1.0–1.7] and ground glass (HR 2.0 [95 % CI 1.6–2.4])
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Fig3: Multivariable-adjusted hazard ratios (HRs) and 95 % confidence interval (95 % CI) for cardiovascular events comparing the severe versus the absent category of pleural effusion (HR 1.7 [95 % CI 1.3–2.2]), lymph node diameter (HR 1.5 [95 % CI 1.3–1.8]), airway thickening (HR 1.1 [95 % CI 0.9–1.3]), consolidation (HR 1.3 [95 % CI 1.0–1.7] and ground glass (HR 2.0 [95 % CI 1.6–2.4])

Mentions: In Table 3, unadjusted and adjusted hazard ratios (HRs) and their 95 % confidence intervals (CIs) for CVD events are presented for the mild, moderate and severe categories of airway thickening, ground glass, consolidation, pleural effusion as well as lymph node diameter compared with the absent category. All five pulmonary, mediastinal and pleural findings were significantly related to CVD risk in the age- and sex-adjusted analysis. When estimates were fully adjusted for age, gender, CT indication, LAD coronary artery calcifications, mitral valve calcifications and descending aorta calcifications and cardiac diameter, the association between airway thickening and consolidations with CVD events was no longer significant. Pulmonary, mediastinal and pleural findings that were independently related to future CVD events after accounting for the predictors included in the cardiovascular CT features-based model were ground glass, pleural effusion and lymph node diameter. The HRs for comparison of the severe versus the absent category for these CT features were as follows: ground glass, HR 2.0 (95 % CI 1.6–2.4); pleural effusion, HR 1.7 (95 % CI 1.3–2.2) and lymph node diameter, HR 1.5 (95 % CI 1.3–1.8) (Fig. 3).Table 3


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)

Multivariable-adjusted hazard ratios (HRs) and 95 % confidence interval (95 % CI) for cardiovascular events comparing the severe versus the absent category of pleural effusion (HR 1.7 [95 % CI 1.3–2.2]), lymph node diameter (HR 1.5 [95 % CI 1.3–1.8]), airway thickening (HR 1.1 [95 % CI 0.9–1.3]), consolidation (HR 1.3 [95 % CI 1.0–1.7] and ground glass (HR 2.0 [95 % CI 1.6–2.4])
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig3: Multivariable-adjusted hazard ratios (HRs) and 95 % confidence interval (95 % CI) for cardiovascular events comparing the severe versus the absent category of pleural effusion (HR 1.7 [95 % CI 1.3–2.2]), lymph node diameter (HR 1.5 [95 % CI 1.3–1.8]), airway thickening (HR 1.1 [95 % CI 0.9–1.3]), consolidation (HR 1.3 [95 % CI 1.0–1.7] and ground glass (HR 2.0 [95 % CI 1.6–2.4])
Mentions: In Table 3, unadjusted and adjusted hazard ratios (HRs) and their 95 % confidence intervals (CIs) for CVD events are presented for the mild, moderate and severe categories of airway thickening, ground glass, consolidation, pleural effusion as well as lymph node diameter compared with the absent category. All five pulmonary, mediastinal and pleural findings were significantly related to CVD risk in the age- and sex-adjusted analysis. When estimates were fully adjusted for age, gender, CT indication, LAD coronary artery calcifications, mitral valve calcifications and descending aorta calcifications and cardiac diameter, the association between airway thickening and consolidations with CVD events was no longer significant. Pulmonary, mediastinal and pleural findings that were independently related to future CVD events after accounting for the predictors included in the cardiovascular CT features-based model were ground glass, pleural effusion and lymph node diameter. The HRs for comparison of the severe versus the absent category for these CT features were as follows: ground glass, HR 2.0 (95 % CI 1.6–2.4); pleural effusion, HR 1.7 (95 % CI 1.3–2.2) and lymph node diameter, HR 1.5 (95 % CI 1.3–1.8) (Fig. 3).Table 3

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