Background Coronary artery calcium (CAC) has been demonstrated as a noninvasive, low-cost means of assessing atherosclerotic burden and risk of major cardiovascular events. While it has been previously shown that CAC progression predicts all-cause mortality, we sought to quantify this association by examining a large cohort over a follow-up period of 1-22 years. MethodsWe studied 3260 persons aged 30-89 years referred by their primary physician for CAC measurement, with a follow-up scan at least 12 months from the initial scan. Receiver operator characteristic (ROC) curves assessed a level of annualized CAC progression that predicted all-cause mortality. Multivariate analyses using Cox proportional hazards models were used to compute hazard ratios and 95% confidence intervals (CIs) for the association between annualized CAC progression and death after adjusting for relevant cardiovascular risk factors. ResultsThe average time between scans was 4.7 ± 3.2 years with an additional average of 9.1 ± 4.0 years of follow-up time. The average age of the cohort was 58.1 ± 10.5 years, 70% being male, and 164 deaths occurred. Annualized CAC progression of 20 units optimized sensitivity (58%) and specificity (82%) in ROC curve analysis. Annualized CAC progression of 20 units was significantly associated with mortality while adjusting for age, sex, race, diabetes, hypertension, hyperlipidemia, smoking, baseline CAC level, family history, and time between scans, hazard ratio 1.84 (95% CI, 1.28-2.64) P = 0.001. ConclusionAnnualized CAC progression of greater than 20 units per year significantly predicts all-cause mortality. This may add clinical value in encouraging close surveillance and aggressive treatment of individuals within this range.

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Objectives: Successful and safe percutaneous closure of atrial septal defects (ASD) is contingent upon the accurate measurement of defect size and adjacent rim tissue, as well as the spatial relationship to other cardiac structures. Previous studies utilizing three-dimensional echocardiography have found significant changes in ASD defect size throughout the cardiac cycle. Cardiac computed tomography (CT) provides excellent spatial and temporal resolution of cardiac structures. Our study examines the efficacy of cardiac CT as a modality for evaluating dynamic changes in ASD defect size throughout the cardiac cycle. Methods: Thirty patients with an ostium secundum ASD underwent cardiovascular CT imaging prior to percutaneous or surgical repair. Cardiovascular CT was performed with a multidetector scanner and images were analyzed using a GE Advantage Workstation capable of advanced image processing and manipulation. ASD defect size was measured in the axial, coronal, and sagittal views at (end-systolic phase) 35% and (end-diastolic phase) 95% of the cardiac cycle. Results: In 30 participants the mean defect size was not significantly different across the three planes, axial mean was 22.4±15.3, coronal 23.7±16.2, and sagittal at 22.3±16.9, p=0.923. However, the change in defect size during the cardiac cycle was significantly different in all three views, P<0.0001 for all. On the axial view, the mean change from 35% to 95% was 6.5±4.9, while the coronal view change was 7.4±5.7, and the sagittal view change was 4.3±3.9. Additionally, the change in size increases with the defect size (figure 1). Conclusions: Cardiac CT imaging accurately depicts dynamic changes in ASD defect size throughout the cardiac cycle, and as such, may be considered a valuable and non-invasive imaging modality for patients undergoing pre-procedural evaluation.

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