Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events

Lehmann, Nils; Erbel, Raimund; Mahabadi, Amir A.; Rauwolf, Michael; Möhlenkamp, Stefan; Moebus, Susanne; Kälsch, Hagen; Budde, Thomas; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl‐Heinz

doi:10.1161/circulationaha.116.027034

Cited by 163 publications

(120 citation statements)

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“…Recently, a number of new measures for quantifying the added value from new markers were proposed, including the IDI and the NRI. These two measures have drawn much attention in the medical research, especially in the evaluation of markers for cardiovascular disease progression [11][12][13] . We used the NRI and IDI to quantify the improved survival prognostication for all confirmed prognostic factors incorporated into the TNM staging system.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nomogram For Locoregionally Advanced Nasopharyngeal Carcinoma

Jiang

Pan

et al. 2020

Sci Rep

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the tnM staging system of npc is the most important model for survival prediction. However, this model does not consider the biological variability of the tumor itself. this study aimed to develop a nomogram for predicting the overall survival of loco-regionally advanced nasopharyngeal carcinoma. 487 Patients with confimed nasopharyngeal carcinoma who underwent IMRT and chemotherapy were included in this study. We established prognostic nomogram for overall survival (oS) based on the cox proportional hazards model. the predictive accuracy and discriminative ability were measured using the concordance index (c-index) and calibration curve. nomogram was validated externally by assessing discrimination and calibration using an independent data set. Continuous net reclassification improvement (nRi) and integrated discrimination improvement (iDi) were used to analyze whether nomogram improve the prediction of survival than tnM stage system. Recursive partitioning analysis (RpA) was performed to stratifying risk of patients. Age, t-stage, n-stage, nLR, LDH were included in the nomogram for OS. The C-index of the nomogram for OS were 0.726 (95% CI, 0.690 to 0.762); The calibration curve showed the nomogram was able to predict 5-year OS accurately. The nomogram had a higher C-index than the TNM stage system (0.726 VS 0.632, P-value < 0.001). The NRI was 0.235 (95% CI: 0.129 to 0.396, P < 0.001), the IDI was 0.079 (95% CI: 0.034 to 0.396, p < 0.001). RPA was performed to stratify patients into three risk group, OS was significantly different between all three risk groups. High risk groups can be benefited survival from adjuvant chemotherapy. The nomogram outperformed the tnM staging system in predicting the oS of loco-regionally advanced nasopharyngeal carcinoma underwent intensity modulated radiation therapy and chemotherapy. Nasopharyngeal carcinoma (NPC) is endemic to the south of China and Asia; an NPC incidence of 2 per million people in China has been reported 1. More than 70% of the newly diagnosed cases are classified as locoregionally advanced disease 2. Concurrent chemoradiotherapy is the standard treatment for locally advanced nasopharyngeal carcinoma 3. However, in some patients, the disease progresses within a few years after chemoradiotherapy. Therefore, identifying a prognostic model for early progression would allow for a better therapeutic plan. The TNM staging system of NPC is the most important model for survival prediction. However, this model does not consider the biological variability of the tumor itself. The prognosis of patients at the same stage receiving the same treatment varies greatly. Therefore, another prognostic model, based on the TNM staging system combined with other prognosis factors, has been evaluated 4 ; however, this model was not validated and has limited clinical applicability. Therefore, in this study, we established and validated a nomogram for locoregionally advanced NPC patients who received intensity-modulated radiation therapy (IMRT) and chemotherapy. Results Baseline chara...

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Section: Discussionmentioning

confidence: 99%

Prognostic Nomogram For Locoregionally Advanced Nasopharyngeal Carcinoma

Jiang

Pan

et al. 2020

Sci Rep

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“…Coronary artery calcification has been reported to be an important predictor of significant coronary artery stenosis [10,[19][20][21][22]. Until now, only some risk-predicting score systems such as the Multi-Ethnic Study of Atherosclerosis risk score implanted CACS into their models, even though a recent study reported that CACS is the most important predictor of CAD-related outcomes [23].…”

Section: Discussionmentioning

confidence: 99%

Calcium scoring: a personalized probability assessment predicts the need for additional or alternative testing to coronary CT angiography

et al. 2020

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Objective To assess whether anthropometrics, clinical risk factors, and coronary artery calcium score (CACS) can predict the need of further testing after coronary CT angiography (CTA) due to non-diagnostic image quality and/or the presence of significant stenosis. Methods Consecutive patients who underwent coronary CTA due to suspected coronary artery disease (CAD) were included in our retrospective analysis. We used multivariate logistic regression and receiver operating characteristics analysis containing anthropometric factors: body mass index, heart rate, and rhythm irregularity (model 1); and parameters used for pre-test likelihood estimation: age, sex, and type of angina (model 2); and also added total calcium score (model 3) to predict downstream testing. Results We analyzed 4120 (45.7% female, 57.9 ± 12.1 years) patients. Model 3 significantly outperformed models 1 and 2 (area under the curve, 0.84 [95% CI 0.83–0.86] vs. 0.56 [95% CI 0.54–0.58] and 0.72 [95% CI 0.70–0.74], p < 0.001). For patients with sinus rhythm of 50 bpm, in case of non-specific angina, CACS above 435, 756, and 944; in atypical angina CACS above 381, 702, and 890; and in typical angina CACS above 316, 636, and 824 correspond to 50%, 80%, and 90% probability of further testing, respectively. However, higher heart rates and arrhythmias significantly decrease these cutoffs (p < 0.001). Conclusion CACS significantly increases the ability to identify patients in whom deferral from coronary CTA may be advised as CTA does not lead to a final decision regarding CAD management. Our results provide individualized cutoff values for given probabilities of the need of additional testing, which may facilitate personalized decision-making to perform or defer coronary CTA. Key Points • Anthropometric parameters on their own are insufficient predictors of downstream testing. Adding parameters of the Diamond and Forrester pre-test likelihood test significantly increases the power of prediction. • Total CACS is the most important independent predictor to identify patients in whom coronary CTA may not be recommended as CTA does not lead to a final decision regarding CAD management. • We determined specific CACS cutoff values based on the probability of downstream testing by angina-, arrhythmia-, and heart rate–based groups of patients to help individualize patient management.

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“…Увеличение коронарного кальция более 400 на втором ýтапе исследования приводило к почти двукратному повышению риска коронарных и общих сердечно-сосудистых событий по сравнению с лицами, у которых уровень данного показателя при повторной КТ не превышал 400. У пациентов с нулевым уровнем кальция на двух ýтапах КТ 10-летний риск составил 1,4; 2,0 и 2,8% [30].…”

Section: оценка коронарной кальцифика-ции и прогноз риска отдаленных unclassified

Assessment of calcification of the coronary arteries and long-term prognosis of cardiovascular disease

et al. 2020

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1 Научно-исследовательский институт терапии и профилактической медицины (НИИТПМ)филиал Федерального исследовательского центра «Институт цитологии и генетики» Сибирского отделения Российской академии наук (ФИЦ ИЦиГ СО РАН) Россия, 630089, г. Новосибирск, ул. Бориса Богаткова, 175/1 2 Новосибирский государственный технический университет (НГТУ) Россия, 630073, г. Новосибирск, пр. Карла Маркса, 20 РЕЗЮМЕ Сосудистая кальцификация является отличительной чертой сердечно-сосудистых заболеваний атеросклеросклеротического генеза. Визуализация кальцификатов осуществляется инвазивными и неинвазивными методами. Çнания о наличии и степени кальциноза могут предсказать клинические исходы у пациентов с высоким риском коронарных событий, помочь при проведении профилактики и лечении ишемической болезни сердца.В статье представлены краткая характеристика методов визуализации сосудистого кальция и обзор исследований по изучению связи кальцификации с риском отдаленных неблагоприятных сердечнососудистых событий.Ключевые слова: кальцификация, коронарный атеросклероз, методы оценки кальцификации, сердечно-сосудистые заболевания.Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи Источник финансирования. Работа выполнена в рамках и при финансовой поддержке гранта РФФИ № 19-015-00055, бюджетной темы по Государственному заданию № 0324-2018-0001.Для цитирования: Полонская Я.В., Каштанова Е.В., Аникина А.В., Рагино Ю.И. Оценка кальцификации коронарных артерий и отдаленный прогноз сердечно-сосудистых заболеваний. Бюллетенü сибирской медиöины. 2020; 19 (1): 172-179. https://doi. ABSTRACTVascular calcification is a distinctive feature of cardiovascular diseases of atherosclerotic origin. Visualization of calcifications is carried out by invasive and non-invasive methods. Knowledge of the presence and degree of calcification can predict clinical outcomes in patients at high risk of coronary events, help in the prevention and treatment of coronary heart disease.The article presents a brief description of the methods of visualization of vascular calcium and a review of studies on the relationship of calcification with the risk of long-term adverse cardiovascular events.

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Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events

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Cited by 163 publications

References 53 publications

Prognostic Nomogram For Locoregionally Advanced Nasopharyngeal Carcinoma

Prognostic Nomogram For Locoregionally Advanced Nasopharyngeal Carcinoma

Calcium scoring: a personalized probability assessment predicts the need for additional or alternative testing to coronary CT angiography

Assessment of calcification of the coronary arteries and long-term prognosis of cardiovascular disease

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