Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population

Amir A. Mahabadi; Iryna Dykun; Raimund Erbel; Hagen Kälsch; Nils Lehmann; Noreen Pundt; Ulla Roggenbuck; Susanne Moebus; Karl Heinz Jöckel; Stefan Möhlenkamp; Martin Nixdorf; Jur Gerhard Schmidt; D. Grönemeyer; R. Seibel; U. Slomiany; E. M. Beck; A. Öffner; S. Münkel; M. Bauer; S. Schrader; R. Peter; H. Hirche; K. Lauterbach; T. Meinertz; C. Bode; P. J. de Feyter; B. Güntert; F. Gutzwiller; H. Heinen; O. Hess; B. Klein; H. Löwel; M. Reiser; M. Schwaiger; C. Steinmüller; T. Theorell; S. N. Willich; C. Bode; K. Berger; M. Dichgans; H. R. Figulla; C. Hamm; P. Hanrath; W. Köpcke; E. B. Ringelstein; C. Weimar; A. Zeiher

doi:10.1016/j.jcmg.2015.12.024

Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population

Amir A. Mahabadi, Iryna Dykun, Raimund Erbel, Hagen Kälsch, Nils Lehmann, Noreen Pundt, Ulla Roggenbuck, Susanne Moebus, Karl Heinz Jöckel, Stefan Möhlenkamp, Martin Nixdorf, Jur Gerhard Schmidt, D. Grönemeyer, R. Seibel, U. Slomiany, E. M. Beck, A. Öffner, S. Münkel, M. Bauer, S. SchraderR. Peter, H. Hirche, K. Lauterbach, T. Meinertz, C. Bode, P. J. de Feyter, B. Güntert, F. Gutzwiller, H. Heinen, O. Hess, B. Klein, H. Löwel, M. Reiser, M. Schwaiger, C. Steinmüller, T. Theorell, S. N. Willich, C. Bode, K. Berger, M. Dichgans, H. R. Figulla, C. Hamm, P. Hanrath, W. Köpcke, E. B. Ringelstein, C. Weimar, A. Zeiher

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Abstract

Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.

Original language	English
Pages (from-to)	1177-1185
Number of pages	9
Journal	JACC: Cardiovascular Imaging
Volume	9
Issue number	10
DOIs	https://doi.org/10.1016/j.jcmg.2015.12.024
State	Published - 1 Oct 2016

Keywords

Heinz Nixdorf Recall Study
cardiac CT
epicardial adipose tissue
left atrial size
thoracic aortic calcification

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcmg.2015.12.024

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Mahabadi, A. A., Dykun, I., Erbel, R., Kälsch, H., Lehmann, N., Pundt, N., Roggenbuck, U., Moebus, S., Jöckel, K. H., Möhlenkamp, S., Nixdorf, M., Gerhard Schmidt, J., Grönemeyer, D., Seibel, R., Slomiany, U., Beck, E. M., Öffner, A., Münkel, S., Bauer, M., ... Zeiher, A. (2016). Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population. JACC: Cardiovascular Imaging, 9(10), 1177-1185. https://doi.org/10.1016/j.jcmg.2015.12.024

@article{ff4734ed3bf043999ac64598ad91df4e,

title = "Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population",

abstract = "Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.",

keywords = "Heinz Nixdorf Recall Study, cardiac CT, epicardial adipose tissue, left atrial size, thoracic aortic calcification",

author = "Mahabadi, {Amir A.} and Iryna Dykun and Raimund Erbel and Hagen K{\"a}lsch and Nils Lehmann and Noreen Pundt and Ulla Roggenbuck and Susanne Moebus and J{\"o}ckel, {Karl Heinz} and Stefan M{\"o}hlenkamp and Martin Nixdorf and {Gerhard Schmidt}, Jur and D. Gr{\"o}nemeyer and R. Seibel and U. Slomiany and Beck, {E. M.} and A. {\"O}ffner and S. M{\"u}nkel and M. Bauer and S. Schrader and R. Peter and H. Hirche and K. Lauterbach and T. Meinertz and C. Bode and {de Feyter}, {P. J.} and B. G{\"u}ntert and F. Gutzwiller and H. Heinen and O. Hess and B. Klein and H. L{\"o}wel and M. Reiser and M. Schwaiger and C. Steinm{\"u}ller and T. Theorell and Willich, {S. N.} and C. Bode and K. Berger and M. Dichgans and Figulla, {H. R.} and C. Hamm and P. Hanrath and W. K{\"o}pcke and Ringelstein, {E. B.} and C. Weimar and A. Zeiher",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/j.jcmg.2015.12.024",

language = "English",

volume = "9",

pages = "1177--1185",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "10",

}

Mahabadi, AA, Dykun, I, Erbel, R, Kälsch, H, Lehmann, N, Pundt, N, Roggenbuck, U, Moebus, S, Jöckel, KH, Möhlenkamp, S, Nixdorf, M, Gerhard Schmidt, J, Grönemeyer, D, Seibel, R, Slomiany, U, Beck, EM, Öffner, A, Münkel, S, Bauer, M, Schrader, S, Peter, R, Hirche, H, Lauterbach, K, Meinertz, T, Bode, C, de Feyter, PJ, Güntert, B, Gutzwiller, F, Heinen, H, Hess, O, Klein, B, Löwel, H, Reiser, M, Schwaiger, M, Steinmüller, C, Theorell, T, Willich, SN, Bode, C, Berger, K, Dichgans, M, Figulla, HR, Hamm, C, Hanrath, P, Köpcke, W, Ringelstein, EB, Weimar, C & Zeiher, A 2016, 'Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population', JACC: Cardiovascular Imaging, vol. 9, no. 10, pp. 1177-1185. https://doi.org/10.1016/j.jcmg.2015.12.024

TY - JOUR

T1 - Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population

AU - Mahabadi, Amir A.

AU - Dykun, Iryna

AU - Erbel, Raimund

AU - Kälsch, Hagen

AU - Lehmann, Nils

AU - Pundt, Noreen

AU - Roggenbuck, Ulla

AU - Moebus, Susanne

AU - Jöckel, Karl Heinz

AU - Möhlenkamp, Stefan

AU - Nixdorf, Martin

AU - Gerhard Schmidt, Jur

AU - Grönemeyer, D.

AU - Seibel, R.

AU - Slomiany, U.

AU - Beck, E. M.

AU - Öffner, A.

AU - Münkel, S.

AU - Bauer, M.

AU - Schrader, S.

AU - Peter, R.

AU - Hirche, H.

AU - Lauterbach, K.

AU - Meinertz, T.

AU - Bode, C.

AU - de Feyter, P. J.

AU - Güntert, B.

AU - Gutzwiller, F.

AU - Heinen, H.

AU - Hess, O.

AU - Klein, B.

AU - Löwel, H.

AU - Reiser, M.

AU - Schwaiger, M.

AU - Steinmüller, C.

AU - Theorell, T.

AU - Willich, S. N.

AU - Bode, C.

AU - Berger, K.

AU - Dichgans, M.

AU - Figulla, H. R.

AU - Hamm, C.

AU - Hanrath, P.

AU - Köpcke, W.

AU - Ringelstein, E. B.

AU - Weimar, C.

AU - Zeiher, A.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.

AB - Objectives The aim of this study was to determine whether noncoronary measures from cardiac computed tomography (CT) may enhance the prognostic value of this imaging technology. Background When cardiac CT is performed for quantification of coronary artery calcium (CAC) score, information on other cardiac and thoracic structures is available. Methods Participants without known cardiovascular disease from the prospective population based Heinz Nixdorf Recall study underwent noncontrast cardiac CT for CAC score quantification. From CT, epicardial adipose tissue (EAT) volume, left ventricular and left atrial (LA) axial area index, ascending and descending aortic diameters, as well as aortic valve, mitral ring, and thoracic aortic calcification (TAC) were assessed. Incident cardiovascular events included myocardial infarction, stroke, and cardiovascular death. The prognostic value of CT-derived parameters was assessed by Cox regression analysis, receiver operating characteristics, and net reclassification improvement. Results From 3,630 subjects (59 ± 8 years of age, 46% male), 241 (6.6%) developed a cardiovascular event during 9.9 ± 2.6 years of follow-up. In multivariable Cox regression analysis including Framingham Risk Score, CAC (as log[CAC + 1]), and CT parameters, LA index (hazard ratio [HR]: 1.22 [95% confidence interval [CI]: 1.05 to 1.41] per SD; p = 0.010) and EAT volume (HR: 1.15 [95% CI: 1.01 to 1.30] per SD; p = 0.031) were significantly associated with incident events. In addition, presence of TAC showed an elevated event rate (HR: 1.33 [95% CI: 0.97 to 1.81]; p = 0.08), whereas all other CT-derived parameters showed no relevant association. The LA index, EAT volume, and presence of TAC together improved the prediction of events over Framingham Risk Score and CAC in receiver operating characteristics analysis (area under the curve: 0.749 to 0.764; p = 0.011), and let to a significant net reclassification improvement (HR: 38.0%; 95% CI: 25.1% to 50.8%). Conclusion Assessment of LA index, EAT volume, and TAC from non–contrast-enhanced cardiac CT improves the prediction of incident hard cardiovascular events above CAC and established risk factors, indicating that quantification of these noncoronary measures may improve the prognostic value of this imaging technology.

KW - Heinz Nixdorf Recall Study

KW - cardiac CT

KW - epicardial adipose tissue

KW - left atrial size

KW - thoracic aortic calcification

UR - http://www.scopus.com/inward/record.url?scp=84994157616&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2015.12.024

DO - 10.1016/j.jcmg.2015.12.024

M3 - Article

C2 - 27450878

AN - SCOPUS:84994157616

SN - 1936-878X

VL - 9

SP - 1177

EP - 1185

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 10

ER -

Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population

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