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

Eur Radiol. 2015 Jun;25(6):1646-54. doi: 10.1007/s00330-014-3495-0. Epub 2015 Mar 14.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / diagnostic imaging*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidental Findings
  • Lung / diagnostic imaging
  • Lung Diseases / complications*
  • Lung Diseases / diagnostic imaging*
  • Male
  • Mediastinum / diagnostic imaging
  • Middle Aged
  • Pleura / diagnostic imaging
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Tomography, X-Ray Computed / methods*