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Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease

  • CARDIAC RADIOLOGY
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Abstract

Objective

To evaluate the correlation between aortic root calcification (ARC) markers and coronary artery calcification (CAC) derived from coronary artery calcium scoring (CACS) and their ability to predict obstructive coronary artery disease (CAD).

Methods

We retrospectively analyzed 189 patients (47% male, age 60.3 ± 11.1 years) with an intermediate probability of CAD who underwent clinically indicated CACS and coronary CT angiography (CCTA). ARC markers [aortic root calcium score (ARCS) and volume (ARCV)] were calculated and compared to CAC markers: coronary artery calcium score (CACS), volume (CACV), and mass (CACM). CCTA datasets were visually evaluated for significant CAD (stenosis ≥ 50%) and the ability of ARC markers to predict obstructive CAD was assessed.

Results

ARCS (mean 67.7 ± 189.5) and ARCV (mean 67.3 ± 184.7) showed significant differences between patients with and without CAC (109.4 ± 238.6 vs 9.42 ± 31.4, p < 0.0001; 108.5 ± 232.4 vs 9.9 ± 30.5, p < 0.0001). A strong correlation was found for ARCS and ARCV with CACS, CACM, and CACV (all p < 0.0001). In a multivariate analysis, ARCS (OR 1.09, p = 0.033) and ARCV (OR 1.12, p = 0.046) were independent markers for CAC. Using a receiver-operating characteristics analysis, the AUC to detect severe CAC was 0.71 (p < 0.0001) and 0.71 (p < 0.0001) for ARCS and ARCV, respectively. ARCS (0.67, p < 0.0001) and ARCV (0.68, p < 0.0001) showed discriminatory power for predicting obstructive CAD, yielding sensitivities 61 and 78% and specificities of 62 and 80%, respectively.

Conclusion

ARC markers are associated with and independently predict the presence of CAC and obstructive CAD. Further testing is required in patients with severe ARC and significant CAD in order to reliably obtain these markers from thoracic-CT or X-ray for proper risk classification.

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Abbreviations

ARC:

Aortic root calcification

ARCS:

Aortic root calcification score

ARCV:

Aortic root calcification volume

BMI:

Body mass index

CACS:

Coronary artery calcium score

CACM:

Coronary artery calcium mass

CACV:

Coronary artery calcium volume

CAD:

Coronary artery disease

CCTA:

Coronary computed tomographic angiography

CI:

Confidence interval

DSCT:

Dual-source CT

LAD:

Left anterior descending

LCX:

Left circumflex

LM:

Left main

NPV:

Negative predictive value

PPV:

Positive predictive value

RCA:

Right coronary artery

SD:

Standard deviation

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Authors and Affiliations

  1. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA

    Christian Tesche, Carlo N. De Cecco, Andrew Stubenrauch, Brian E. Jacobs, Akos Varga-Szemes, Sheldon E. Litwin, B. Devon Ball, Ullrich Ebersberger & U. Joseph Schoepf

  2. Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany

    Christian Tesche, Ullrich Ebersberger & Ellen Hoffmann

  3. Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Piazzale Aldo Moro 5, 00185, Rome, Italy

    Carlo N. De Cecco

  4. Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA

    Sheldon E. Litwin, Richard R. Bayer 2nd, Daniel H. Steinberg & U. Joseph Schoepf

  5. Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany

    Moritz Baquet & David Jochheim

Authors
  1. Christian Tesche
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Corresponding author

Correspondence to U. Joseph Schoepf.

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Conflict of interest

Dr. Schoepf receives research support from Astellas, Bayer, Bracco, GE, Medrad, and Siemens. Drs. Schoepf, De Cecco, and Varga-Szemes are consultants for Guerbet. All other authors have no conflicts of interest to disclose.

Christian Tesche is an exchange visiting scholar supported by a grant from the Fulbright Visiting Scholar Program of the U.S. Department of State, Bureau of Educational and Cultural Affairs (ECA). This single-center study was approved by the local Institutional Review Board and written informed consent was obtained from all individual patients included in the study. The study was performed in compliance with HIPAA regulations. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Tesche, C., De Cecco, C.N., Stubenrauch, A. et al. Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease. Radiol med 122, 113–120 (2017). https://doi.org/10.1007/s11547-016-0707-5

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