Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study

Borek Foldyna, Parastou Eslami, Jan Erik Scholtz, Kristin Baltrusaitis, Michael T. Lu, Joseph M. Massaro, Ralph B. D’Agostino, Maros Ferencik, Hugo J.W.L. Aerts, Christopher J. O’Donnell, Udo Hoffmann

    Research output: Contribution to journalArticle

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)6140-6148
    Number of pages9
    JournalEuropean Radiology
    Volume29
    Issue number11
    DOIs
    StatePublished - Nov 1 2019

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    Keywords

    • Atherosclerosis
    • Cardiovascular system
    • Coronary artery calcium
    • Coronary artery disease
    • Multi-detector computed tomography

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging

    Cite this

    Foldyna, B., Eslami, P., Scholtz, J. E., Baltrusaitis, K., Lu, M. T., Massaro, J. M., D’Agostino, R. B., Ferencik, M., Aerts, H. J. W. L., O’Donnell, C. J., & Hoffmann, U. (2019). Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study. European Radiology, 29(11), 6140-6148. https://doi.org/10.1007/s00330-019-06223-7