Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

Abstract

Objective: Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings.

Methods: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification.

Results: During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).

Conclusion: Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans.

Key points: • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features.

Fig. 1

Flowchart of study design. CBS Central Bureau of Statistics, LMR Dutch medical data registration

Fig. 2

Examples of pulmonary, mediastinal and pleural CT imaging characteristics. a Airway thickening (white arrow) and ground glass in the left lower lobe (black arrows). b Consolidation in the right under lobe (black arrow). c Short axis diameter measurement of the largest mediastinal lymph node. d Pleural effusion measurement of left-sided fluid layer on axial image

Fig. 3

Multivariable-adjusted hazard ratios (HRs) and 95 % confidence interval (95 % CI) for cardiovascular events comparing the severe versus the absent category of pleural effusion (HR 1.7 [95 % CI 1.3–2.2]), lymph node diameter (HR 1.5 [95 % CI 1.3–1.8]), airway thickening (HR 1.1 [95 % CI 0.9–1.3]), consolidation (HR 1.3 [95 % CI 1.0–1.7] and ground glass (HR 2.0 [95 % CI 1.6–2.4])