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Comparative Study
. 2016 Feb;9(2):152-9.
doi: 10.1016/j.jcmg.2015.06.030. Epub 2016 Jan 6.

Relationship of Coronary Calcium on Standard Chest CT Scans With Mortality

Jan M Hughes-Austin  1 , Arturo Dominguez 3rd  2 , Matthew A Allison  3 , Christina L Wassel  4 , Dena E Rifkin  3 , Cindy G Morgan  5 , Michael R Daniels  5 , Umaira Ikram  5 , Jessica B Knox  5 , C Michael Wright  6 , Michael H Criqui  5 , Joachim H Ix  7
Affiliations
Comparative Study

Relationship of Coronary Calcium on Standard Chest CT Scans With Mortality

Jan M Hughes-Austin et al. JACC Cardiovasc Imaging. 2016 Feb.

Abstract

Objectives: The aim of this study was to determine the correlation between coronary artery calcium (CAC) scores on 3 mm electrocardiography (ECG)-gated computed tomography (CT) scans and standard 6 mm chest CT scans, and to compare relative strength of associations of CAC on each scan type with mortality risk.

Background: Coronary artery calcification predicts cardiovascular disease (CVD) and all-cause mortality, and is typically measured on ECG-gated 3 mm CT scans. Patients undergo standard 6 mm chest CTs for various clinical indications much more frequently, but CAC is not usually quantified. To better understand the usefulness of standard chest CTs to quantify CAC, we conducted a case-control study among persons who had both scan types.

Methods: Between 2000 and 2003, 4,544 community-living individuals self- or physician-referred for "whole-body" CT scans, had 3 mm ECG-gated CTs and standard 6 mm chest CTs, and were followed for mortality through 2009. In this nested case-control study, we identified 157 deaths and 494 controls frequency matched (1:3) on age and sex. The Agatston method quantified CAC on both scan types. Unconditional logistic regression determined associations with mortality, accounting for CVD risk factors.

Results: Participants were 68 ± 11 years of age and 63% male. The Spearman correlation of CAC scores between the 2 scan types was 0.93 (p < 0.001); median CAC scores were lower on 6 mm CTs compared to 3 mm CTs (22 vs.104 Agatston units, p < 0.001). Adjusted for traditional CVD risk factors, each standard deviation higher CAC score on 6 mm CTs was associated with 50% higher odds of death (odds ratio: 1.5; 95% confidence interval: 1.2 to 1.9), similar to 50% higher odds on the 3 mm ECG-gated CTs (odds ratio: 1.5; 95% confidence interval: 1.1 to 1.9).

Conclusions: CAC scores on standard 6 mm chest CTs are strongly correlated with 3 mm ECG-gated CTs and similarly predict mortality in community-living individuals. Chest CTs performed for other clinical indications may provide an untapped resource to garner CVD risk information without additional radiation exposure or expense.

Keywords: chest computed tomography; coronary artery calcium; epidemiology; mortality.

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Figures

Figure 1
Figure 1. Scatter Plot Agatston CAC Score on 6mm Chest CT and 3mm Cardiac ECG-Gated CT Scans
Spearman Correlation r = 0.93, p < 0.001 ● = Cases (n=157) ○ = Controls (n=494)
Figure 2
Figure 2. Bland-Altman Plots for Agreement Between 3mm ECG-Gated CT Scans and 6mm Standard Chest CT Scans
*Log transformed mean bias (center line) was 1.17 (±0.855), which back transforms to 3.23, with limits of agreement ranging from 0.6 to 17.3 (top and bottom dashed lines).
Figure 3
Figure 3. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in a Single Slice within an Individual
A. 3mm ECG-gated CT (Agatston CAC Score = 372.09) B. 6mm Chest CT (Agatston CAC Score = 116.58)
Figure 3
Figure 3. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in a Single Slice within an Individual
A. 3mm ECG-gated CT (Agatston CAC Score = 372.09) B. 6mm Chest CT (Agatston CAC Score = 116.58)
Figure 4
Figure 4. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in Two Consecutive Slices within an Individual
A.1, A.2 Two consecutive slices from 3mm ECG-gated CT within an individual (Agatston CAC Score = 3212.75) B.1, B.2 Two consecutive slices from 6mm Chest CT within an individual (Agatston CAC Score = 1044.00)
Figure 4
Figure 4. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in Two Consecutive Slices within an Individual
A.1, A.2 Two consecutive slices from 3mm ECG-gated CT within an individual (Agatston CAC Score = 3212.75) B.1, B.2 Two consecutive slices from 6mm Chest CT within an individual (Agatston CAC Score = 1044.00)
Figure 4
Figure 4. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in Two Consecutive Slices within an Individual
A.1, A.2 Two consecutive slices from 3mm ECG-gated CT within an individual (Agatston CAC Score = 3212.75) B.1, B.2 Two consecutive slices from 6mm Chest CT within an individual (Agatston CAC Score = 1044.00)
Figure 4
Figure 4. Illustrative Example of the Difference in Sensitivity between 3mm ECG-Gated CT Scans and 6mm Chest CT Scans in Two Consecutive Slices within an Individual
A.1, A.2 Two consecutive slices from 3mm ECG-gated CT within an individual (Agatston CAC Score = 3212.75) B.1, B.2 Two consecutive slices from 6mm Chest CT within an individual (Agatston CAC Score = 1044.00)
Figure 5
Figure 5. Forest Plots of Odds Ratios and 95% Confidence Intervals for the Associations between 3mm ECG-Gated CT Scans and Mortality and 6mm Chest CT Scans and Mortality
*Adjusted for age, sex, diabetes, hypertension, hyperlipidemia, BMI, smoking, and family history of CVD
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Comment in

  • "See No Evil".
    Hecht HS. Hecht HS. JACC Cardiovasc Imaging. 2016 Feb;9(2):160-2. doi: 10.1016/j.jcmg.2015.08.020. Epub 2016 Jan 6. JACC Cardiovasc Imaging. 2016. PMID: 26777214 No abstract available.

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