TY - JOUR
T1 - Density and morphology of coronary artery calcium for the prediction of cardiovascular events
T2 - insights from the Framingham Heart Study
AU - Foldyna, Borek
AU - Eslami, Parastou
AU - Scholtz, Jan Erik
AU - Baltrusaitis, Kristin
AU - Lu, Michael T.
AU - Massaro, Joseph M.
AU - D’Agostino, Ralph B.
AU - Ferencik, Maros
AU - Aerts, Hugo J.W.L.
AU - O’Donnell, Christopher J.
AU - Hoffmann, Udo
N1 - Funding Information:
This study used in part data and resources from the Framingham Heart Study of the National Heart, Lung, and Blood Institute of the National Institutes of Health and Boston University School of Medicine. Dr. Borek Foldyna, Dr. Udo Hoffmann, and Dr. Christopher J. O’Donnell have had full access to all the study data and take responsibility for the data integrity and the analysis accuracy. Our project was presented at the SCCT 2018 in Dallas, TX, USA, and received the Siemens Outstanding Academic Research (SOAR) award.
Publisher Copyright:
© 2019, European Society of Radiology.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Objectives: To investigate the association between directly measured density and morphology of coronary artery calcium (CAC) with cardiovascular disease (CVD) events, using computed tomography (CT). Methods: Framingham Heart Study (FHS) participants with CAC in noncontrast cardiac CT (2002–2005) were included and followed until 2016. Participants with known CVD or uninterpretable CT scans were excluded. We assessed and correlated (Spearman) CAC density, CAC volume, and the number of calcified segments. Moreover, we counted morphology features including shape (cylindrical, spherical, semi-tubular, and spotty), location (bifurcation, facing pericardium, or facing myocardium), and boundary regularity. In multivariate Cox regression analyses, we associated all CAC characteristics with CVD events (CVD-death, myocardial infarction, stroke). Results: Among 1330 included participants (57.8 ± 11.7 years; 63% male), 73 (5.5%) experienced CVD events in a median follow-up of 9.1 (7.8–10.1) years. CAC density correlated strongly with CAC volume (Spearman’s ρ = 0.75; p < 0.001) and lower number of calcified segments (ρ = − 0.86; p < 0.001; controlled for CAC volume). In the survival analysis, CAC density was associated with CVD events independent of Framingham risk score (HR (per SD) = 2.09; 95%CI, 1.30–3.34; p = 0.002) but not after adjustment for CAC volume (p = 0.648). The extent of spherically shaped and pericardially sided calcifications was associated with fewer CVD events accounting for the number of calcified segments (HR (per count) = 0.55; 95%CI, 0.31–0.98; p = 0.042 and HR = 0.66; 95%CI, 0.45–0.98; p = 0.039, respectively). Conclusions: Directly measured CAC density does not predict CVD events due to the strong correlation with CAC volume. The spherical shape and pericardial-sided location of CAC are associated with fewer CVD events and may represent morphological features related to stable coronary plaques. Key Points: • Coronary calcium density may not be independently associated with cardiovascular events. • Coronary calcium density correlates strongly with calcium volume. • Spherical shape and pericardial-sided location of CAC are associated with fewer CVD events.
AB - Objectives: To investigate the association between directly measured density and morphology of coronary artery calcium (CAC) with cardiovascular disease (CVD) events, using computed tomography (CT). Methods: Framingham Heart Study (FHS) participants with CAC in noncontrast cardiac CT (2002–2005) were included and followed until 2016. Participants with known CVD or uninterpretable CT scans were excluded. We assessed and correlated (Spearman) CAC density, CAC volume, and the number of calcified segments. Moreover, we counted morphology features including shape (cylindrical, spherical, semi-tubular, and spotty), location (bifurcation, facing pericardium, or facing myocardium), and boundary regularity. In multivariate Cox regression analyses, we associated all CAC characteristics with CVD events (CVD-death, myocardial infarction, stroke). Results: Among 1330 included participants (57.8 ± 11.7 years; 63% male), 73 (5.5%) experienced CVD events in a median follow-up of 9.1 (7.8–10.1) years. CAC density correlated strongly with CAC volume (Spearman’s ρ = 0.75; p < 0.001) and lower number of calcified segments (ρ = − 0.86; p < 0.001; controlled for CAC volume). In the survival analysis, CAC density was associated with CVD events independent of Framingham risk score (HR (per SD) = 2.09; 95%CI, 1.30–3.34; p = 0.002) but not after adjustment for CAC volume (p = 0.648). The extent of spherically shaped and pericardially sided calcifications was associated with fewer CVD events accounting for the number of calcified segments (HR (per count) = 0.55; 95%CI, 0.31–0.98; p = 0.042 and HR = 0.66; 95%CI, 0.45–0.98; p = 0.039, respectively). Conclusions: Directly measured CAC density does not predict CVD events due to the strong correlation with CAC volume. The spherical shape and pericardial-sided location of CAC are associated with fewer CVD events and may represent morphological features related to stable coronary plaques. Key Points: • Coronary calcium density may not be independently associated with cardiovascular events. • Coronary calcium density correlates strongly with calcium volume. • Spherical shape and pericardial-sided location of CAC are associated with fewer CVD events.
KW - Atherosclerosis
KW - Cardiovascular system
KW - Coronary artery calcium
KW - Coronary artery disease
KW - Multi-detector computed tomography
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U2 - 10.1007/s00330-019-06223-7
DO - 10.1007/s00330-019-06223-7
M3 - Article
C2 - 31049733
AN - SCOPUS:85065429847
VL - 29
SP - 6140
EP - 6148
JO - European Radiology
JF - European Radiology
SN - 0938-7994
IS - 11
ER -