Visual Estimate of Coronary Artery Calcium Predicts Cardiovascular Disease in COPD

Bhatt, Surya P.; Kazerooni, Ella A.; Newell, John D.; Hokanson, John E.; Budoff, Matthew J.; Dass, Chandra; Martínez, Carlos H.; Bodduluri, Sandeep; Jacobson, Francine L.; Yen, Andrew; Fuhrman, Carl R.; Nath, Hrudaya; Investigators, COPDGene

doi:10.1016/j.chest.2018.05.037

Cited by 35 publications

(29 citation statements)

References 31 publications

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“…Although we used the term severe CAD to refer to Agatston scores of ≥ 400 based on precedent [27], and worse outcomes when scores ≥ 400 [8,41], it is a limitation that we did not conclusively demonstrate that these were associated with specific disease entities such as ischaemic heart disease.…”

Section: Discussionmentioning

confidence: 99%

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Treatable cardiac disease in hospitalised COPD exacerbations

et al. 2021

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IntroductionAcute exacerbations of COPD (AECOPD) are accompanied by escalations in cardiac risk superimposed upon elevated baseline risk. Appropriate treatment for coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) could improve outcomes. However, securing these diagnoses during AECOPD is difficult, so their true prevalence remains unknown, as does the magnitude of this treatment opportunity. We aimed to determine the prevalence of severe CAD and severe HFrEF during hospitalised AECOPD using dynamic computed tomography (CT).MethodsA cross-sectional study of 148 patients with hospitalised AECOPD was conducted. Dynamic CT was used to identify severe CAD (Agatston score ≥400) and HFrEF (left ventricular ejection fraction ≤40% and/or right ventricular ejection fraction ≤35%).ResultsSevere CAD was detected in 51 of 148 patients (35%), left ventricular systolic dysfunction was identified in 12 cases (8%) and right ventricular systolic dysfunction was present in 18 (12%). Clinical history and examination did not identify severe CAD in approximately one-third of cases and missed HFrEF in two-thirds of cases. Elevated troponin and brain natriuretic peptide did not differentiate subjects with severe CAD from nonsevere CAD, nor distinguish HFrEF from normal ejection fraction. Undertreatment was common. Of those with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. Of individuals with HFrEF, 50% or less received angiotensin blockers, beta blockers or antimineralocorticoids.ConclusionDynamic CT detects clinically covert CAD and HFrEF during AECOPD, identifying opportunities to improve outcomes via well-established cardiac treatments.

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Section: Discussionmentioning

confidence: 99%

“…Two common, but eminently treatable cardiac diagnoses are associated with adverse outcomes at AECOPD: coronary artery disease (CAD) [5][6][7][8] and heart failure with reduced ejection fraction (HFrEF) [9,10]. Both cardiac disorders have well established therapeutic pathways with clear reductions in mortality and morbidity [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Treatable cardiac disease in hospitalised COPD exacerbations

et al. 2021

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“…14e16 Ordinal assessment of CAC is a useful method to assess calcification on CT pulmonary angiogram (CTPA) images where motion artefact and contrast medium preclude traditional quantitative CACS methods. The presence of incidental CAC on non-gated CT is associated with mortality in a variety of patient cohorts, including patients with chronic obstructive pulmonary disease (COPD), 17,18 lung cancer screening 19,20 and other respiratory conditions. 21 International guidelines now recommend the reporting of incidental CAC on all thoracic CT. 22 This study assesses the presence of CAC and right heart strain in patients with PE, and their association with subsequent mortality.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

et al. 2019

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To assess coronary artery calcification (CAC) and vascular calcification in patients with pulmonary embolism (PE) and correlate this with mortality. MATERIALS AND METHODS: PE severity was quantified using computed tomography pulmonary angiography (CTPA) in 400 consecutive cases using the modified Miller score (1e5, mild; 6e11, moderate; 12e16, severe). Right ventricle strain was assessed using the right/left ventricle diameter (RV/LV) ratio. CAC score (CACS) was assessed using a four-point scale (CACS mild 1e3, moderate 4e8, severe 9e12) for each vessel and summed to give the total CACS. Follow-up for mortality was obtained at 3 years. RESULTS: PE severity was classified as mild in 48%, moderate in 21%, and severe in 32% of cases. The median modified Miller score was 6 (Interquartile range [IQR] 2, 14) and median total CACS was 2 (IQR 0, 7). All-cause mortality occurred in 128 (32%) patients. Patients with CAC were three times more likely to die than patients without CAC (Hazard ratio [HR] 2.96; 95% CI 1.84, 4.77; p<0.001), and patients with severe CAC were at the highest risk (HR 4.62; 95% CI 2.73, 7.83, p<0.001). Gender, modified Miller score and RV/LV ratio were not predictive of mortality. In multivariate analysis both CACS and age were independent predictors of 3-year all-cause mortality. Of the patients with CAC who died, the presence of coronary artery disease was only documented in 34 (32%). CONCLUSION: CACS is an independent predictor of all-cause mortality in patients with PE, and has important implications for subsequent patient management.

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“…But CACS based on the non-ECG-triggered chest CT was reviewed later as an ancillary study to investigate the predictive value of CACS for cardiovascular events, due to the visibility of the heart on regular chest CT [37][38][39][40][41]. The same goes for the ECLIPSE study and the COPDGene study which were primarily designed for COPD evaluation [42,43]. Vice versa, the MESA study, which was originally established for subclinical cardiovascular disease and risk factors assessment, was expanded with a lung scan acquisition to test the endothelial hypothesis of COPD and emphysema [44].…”

Section: Discussionmentioning

confidence: 99%

Early imaging biomarkers of lung cancer, COPD and coronary artery disease in the general population: rationale and design of the ImaLife (Imaging in Lifelines) Study

et al. 2019

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Lung cancer, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD) are expected to cause most deaths by 2050. State-of-the-art computed tomography (CT) allows early detection of lung cancer and simultaneous evaluation of imaging biomarkers for the early stages of COPD, based on pulmonary density and bronchial wall thickness, and of CAD, based on the coronary artery calcium score (CACS), at low radiation dose. To determine cutoff values for positive tests for elevated risk and presence of disease is one of the major tasks before considering implementation of CT screening in a general population. The ImaLife (Imaging in Lifelines) study, embedded in the Lifelines study, is designed to establish the reference values of the imaging biomarkers for the big three diseases in a well-defined general population aged 45 years and older. In total, 12,000 participants will undergo CACS and chest acquisitions with latest CT technology. The estimated percentage of individuals with lung nodules needing further workup is around 1-2%. Given the around 10% prevalence of COPD and CAD in the general population, the expected number of COPD and CAD is around 1000 each. So far, nearly 4000 participants have been included. The ImaLife study will allow differentiation between normal aging of the pulmonary and cardiovascular system and early stages of the big three diseases based on low-dose CT imaging. This information can be finally integrated into personalized precision health strategies in the general population.

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Visual Estimate of Coronary Artery Calcium Predicts Cardiovascular Disease in COPD

Abstract: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.

Cited by 35 publications

References 31 publications

Treatable cardiac disease in hospitalised COPD exacerbations

Treatable cardiac disease in hospitalised COPD exacerbations

Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

Early imaging biomarkers of lung cancer, COPD and coronary artery disease in the general population: rationale and design of the ImaLife (Imaging in Lifelines) Study

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