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Influence of BMI on virtual coronary artery calcium scoring

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Abstract

Purpose

Virtual non-contrast (VNC) coronary artery calcium scoring (CAC) may obviate the need for traditional non-contrast (TNC) CAC. There is no data on the influence of body mass index (BMI) on VNC reliability. We aimed to evaluate the influence of BMI on VNC CAC agreement with TNC.

Materials and methods

All patients who underwent sequential CAC and coronary CT angiography (CCTA) using spectral CT with TNC CAC > 0 between August 2020 and December 2021 were included. Agatston CAC scores were calculated manually by 2 blinded readers from VNC scans. A correction factor was calculated from the slope of the linear regression using the method of least squares and applied to the VNC scores. Bland-Altman plots and Cohen’s weighted Kappa were utilized.

Results

We included 174 patients (57.5% female). Mean BMI was 32.6 ± 7.02 kg/m2 [BMI < 30 (39.7%); BMI 30–40 (45.4%); and BMI > 40 kg/m2 (14.9%)]. Mean TNC CAC was 177.8 ± 316.86 and mean VNC CAC after applying the correction factor 149.34 ± 296.73. The TNC value strongly correlated with VNC (r = 0.94; p < 0.0001). As BMI increased there was a progressive reduction in signal-to-noise ratio, contrast-to-noise ratio and coronary enhancement (p < 0.05). The degree of agreement between VNC and TNC CAC decreased as BMI increased (agreement = 91.79 (weighted Kappa = 0.72), 91.14 (weighted Kappa = 0.58) and 88.46% (weighted Kappa = 0.48) (all P values < 0.001) for BMI < 30; 30–40 and > 40 kg/m2, respectively).

Conclusion

BMI has a significant influence on the accuracy of VNC CAC. VNC CAC shows substantial agreement in non-obese patients but performs poorly in BMI > 40 kg/m2.

Summary statement

This is the first study to evaluate the influence of body mass index (BMI) on virtual non-contrast (VNC) coronary artery calcium scoring (CAC) as compared to traditional non-contrast (TNC). We retrospectively evaluated 174 patients with TNC CAC and two blinded reviewers manually calculated the VNC CAC. All cases were included without specific selection for quality. The ratio between the two directly proportional values was determined using the slope from the linear regression through the method of least squares. This correction factor of 2.65 was applied to the calcium scores obtained from VNC images. We found that VNC CAC shows substantial risk-class agreement with TNC in non-obese patients (agreement = 91.79 and weighted Kappa = 0.72) but performs poorly in BMI > 40 kg/m2 (agreement: 88.46% and weighted Kappa = 0.48). These findings show the potential use of VNC CAC to avoid additional radiation in non-obese patients. However, further research on potential improvement strategies for VNC CAC in obese patients is needed.

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Funding

No funding was received.

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Authors and Affiliations

  1. Cardiology Division, Complejo Hospitalario Universitario, Badajoz, Spain

    Javier Perez-Cervera

  2. Cardiology Division, Montefiore Medical Center, 111 E 210th, 10467, Bronx, NY, USA

    Javier Arce, Michael Fattouh, Toshiki Kuno, Aldo L Schenone, Vikram Brahmanandam, Mario J Garcia & Leandro Slipczuk

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    Aldo L Schenone, Vikram Brahmanandam, Un Jung Lee, Linda B Haramati, Jeffrey M Levsky, Mario J Garcia & Leandro Slipczuk

  4. Radiology Department, Montefiore Medical Center, Bronx, NY, USA

    Linda B Haramati & Jeffrey M Levsky

  5. Cardiovascular Medicine, University of Virginia, Charlottesville, VG, USA

    Todd C Villines

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  1. Javier Perez-Cervera
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Contributions

All authors contributed in the design, analysis and presentation of the data and contributed to the writing of the manuscript.

Corresponding author

Correspondence to Leandro Slipczuk.

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Conflict of interest

LS has received consulting honoraria from Phillips.

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IRB: The study was approved by our Institutional Review Board (Office of Human Research Affairs at Albert Einstein College of Medicine) and was HIPAA compliant.

Presented in part at SCCT Annual Scientific Meeting in Las Vegas, NV, July 15-17th, 2022.

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Perez-Cervera, J., Arce, J., Fattouh, M. et al. Influence of BMI on virtual coronary artery calcium scoring. Int J Cardiovasc Imaging 39, 863–872 (2023). https://doi.org/10.1007/s10554-022-02785-8

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