Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV<sub>1</sub>, and Emphysema in Lung Cancer Screening Population: The MILD Trial

Sverzellati, Nicola; Cademartiri, Filippo; Bravi, Francesca; Martini, Chiara; Gira, Federica A.; Maffei, Erica; Marchianò, Alfonso; Vecchia, Carlo La; Filippo, Massimo De; Kuhnigk, Jan-Martin; Rossi, Cristina; Pastorino, Ugo

doi:10.1148/radiol.11110364

Cited by 81 publications

(82 citation statements)

References 34 publications

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“…Several investigators have studied the association between pulmonary function and subsequent cardiovascular disease [16][17][18]20]. Our data are consistent with these studies as we observed clear trends across quartiles of FEV 1 %predicted, similar to Schroeder et al [16], linking pulmonary function impairment with cardiovascular events.…”

Section: Discussionsupporting

confidence: 92%

“…This association persisted after controlling for age, smoking status and packyears. Sverzellati et al investigated the association between CT quantified emphysema and the prediction of cardiovascular events [20]. Similar to our study, they found that coronary calcium was the strongest predictor for cardiovascular events, though in contrast we did observe an association between cardiovascular events and CT quantified emphysema and FEV1%.…”

Section: Discussionsupporting

confidence: 87%

“…Several studies observed an association between pulmonary function and cardiovascular events, even after correcting for confounders like smoking [16][17][18][19][20]. Forced expiratory volume in one second (FEV 1 ) is a robust accurate index reflecting pulmonary physiology and is associated with a higher risk of dying from cardiovascular conditions [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

et al. 2014

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Objective The objective of this study was to investigate the association of spirometry and pulmonary CT biomarkers with cardiovascular events. Methods In this lung cancer screening trial 3,080 male participants without a prior cardiovascular event were analysed. Fatal and non-fatal cardiovascular events were included. Spirometry included forced expiratory volume measured in units of one-second percent predicted (FEV 1 %predicted) and FEV 1 divided by forced vital capacity (FVC; FEV 1 /FVC). CT examinations were quantified for coronary artery calcium volume, pulmonary emphysema (perc15) and bronchial wall thickness (pi10). Data were analysed via a Cox proportional hazard analysis, net reclassification improvement (NRI) and C-indices.Results 184 participants experienced a cardiovascular event during a median follow-up of 2.9 years. Age, pack-years and smoking status adjusted hazard ratios were 0.992 (95 % confidence interval (CI) 0.985-0.999) for FEV 1 %predicted, 1.000 (95%CI 0.986-1.015) for FEV 1 /FVC, 1.014 (95%CI 1.005-1.023) for perc15 per 10 HU, and 1.269 (95%CI 1.024-1.573) for pi10 per 1 mm. The incremental C-index (<0.015) and NRI (<2.8 %) were minimal. Coronary artery calcium volume had a hazard ratio of 1.046 (95%CI 1.034-1.058) per 100 mm 3 , an increase in C-index of 0.076 and an NRI of 16.9 % (P<0.0001). Conclusions Pulmonary CT biomarkers and spirometry measurements were significantly associated with cardiovascular events, but did not contain clinically relevant independent prognostic information for cardiovascular events. Key Points • Pulmonary CT biomarkers and spirometry are associated with cardiovascular events • These pulmonary measurements do not contain clinically relevant independent prognostic information • Only coronary calcium score improved cardiovascular risk prediction above age and smoking

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

et al. 2014

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“…The most commonly used slice thicknesses were 2.5/3 mm and 5 mm. Four studies used a (medium-) smooth kernel, 10,20,21,25 the other studies did not indicate the applied kernel. Six studies used Agatston scoring, 10,[17][18][19]21,25 whereas 4 others used visual grading of the presence and extent of coronary calcification.…”

Section: Study Characteristicsmentioning

confidence: 99%

Validation and Prognosis of Coronary Artery Calcium Scoring in Nontriggered Thoracic Computed Tomography

Xie

Zhao

Bock

et al. 2013

Circ: Cardiovascular Imaging

164

114

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Compared with electrocardiography-triggered CT, nontriggered CT is extensively used. In 2007, 13.6 million nontriggered thoracic CT examinations were performed in the United States, in contrast to 0.7 million electrocardiography-triggered CT examinations for calcium scoring. 7 Recent trial results have increased the interest in lung cancer screening by thoracic CT.8 Thus, the number of nontriggered examinations will likely further increase. Age and smoking, the current selection criteria for lung cancer screening, are also correlated with coronary calcification and coronary heart disease.9 In lung cancer screening, coronary calcification is a frequent finding.10 If nontriggered CT can be used for calcium scoring, to stratify individuals in categories of cardiovascular risk and to identify Background-Coronary calcium score (CS), traditionally based on electrocardiography-triggered computed tomography (CT), predicts cardiovascular risk. Currently, nontriggered thoracic CT is extensively used, such as in lung cancer screening. The purpose of the study was to determine the correlation in CS between nontriggered and electrocardiographytriggered CT, and to evaluate the prognostic performance of the CS derived from nontriggered CT.

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“…prognosis in chronic obstructive pulmonary disease (COPD) (10)(11)(12)(13)(14), among smokers (15), and in the general population (16) independent of lung function.…”

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confidence: 99%

Variation in the Percent of Emphysema-like Lung in a Healthy, Nonsmoking Multiethnic Sample. The MESA Lung Study

Hoffman

Ahmed²,

Baumhauer³

et al. 2014

Annals ATS

107

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Rationale: Computed tomography (CT)-based lung density is used to quantitate the percentage of emphysema-like lung (hereafter referred to as percent emphysema), but information on its distribution among healthy nonsmokers is limited.Objectives: We evaluated percent emphysema and total lung volume on CT scans of healthy never-smokers in a multiethnic, population-based study. Methods:The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study investigators acquired full-lung CT scans of 3,137 participants (ages 54-93 yr) between 2010-12. The CT scans were taken at full inspiration following the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) protocol. "Healthy never-smokers" were defined as participants without a history of tobacco smoking or respiratory symptoms and disease. "Percent emphysema" was defined as the percentage of lung voxels below 2950 Hounsfield units. "Total lung volume" was defined by the volume of lung voxels.Measurements and Main Results: Among 854 healthy neversmokers, the median percent emphysema visualized on full-lung scans was 1.1% (interquartile range, 0.5-2.5%). The percent emphysema values were 1.2 percentage points higher among men compared with women and 0.7, 1.2, and 1.2 percentage points lower among African Americans, Hispanics, and Asians compared with whites, respectively (P , 0.001). Percent emphysema was positively related to age and height and inversely related to body mass index. The findings were similar for total lung volume on CT scans and for percent emphysema defined at 2910 Hounsfield units and measured on cardiac scans. Reference equations to account for these differences are presented for never, former and current smokers.Conclusions: Similar to lung function, percent emphysema varies substantially by demographic factors and body size among healthy never-smokers. The presented reference equations will assist in defining abnormal values for percent emphysema and total lung volume on CT scans, although validation is pending.

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Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV₁, and Emphysema in Lung Cancer Screening Population: The MILD Trial

Abstract: mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.

Cited by 81 publications

References 34 publications

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Validation and Prognosis of Coronary Artery Calcium Scoring in Nontriggered Thoracic Computed Tomography

Variation in the Percent of Emphysema-like Lung in a Healthy, Nonsmoking Multiethnic Sample. The MESA Lung Study

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Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD Trial

Abstract: mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.

Cited by 81 publications

References 34 publications

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Validation and Prognosis of Coronary Artery Calcium Scoring in Nontriggered Thoracic Computed Tomography

Variation in the Percent of Emphysema-like Lung in a Healthy, Nonsmoking Multiethnic Sample. The MESA Lung Study

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Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV₁, and Emphysema in Lung Cancer Screening Population: The MILD Trial