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01-12-2019 | Coronary Heart Disease | Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)

Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography

Authors: Jesiana Ferreira Pedrosa, Sandhi Maria Barreto, Márcio Sommer Bittencourt, Antonio Luiz Pinho Ribeiro

Published in: Current Atherosclerosis Reports | Issue 12/2019

Abstract

Purpose of Review

Thoracic aortic calcium (TAC) has received some interest in recent studies as an important subclinical marker of atherosclerosis. Besides that, using computed tomography (CT) scans performed with cardiac or chest protocols, ECG-gated, or non-gated, TAC can be easily evaluated with no addition in radiation dose. This review discusses the particularities of the aortic wall calcium formation, as well as the differences between the aortic segments and summarizes the current status of TAC evaluation, mainly concerning the anatomical references used in the studies.

Recent Findings

The studies have evaluated TAC considering different anatomical references. It was identified two different study groups. In the first one, researchers have analyzed the aorta as the sum of calcium in the ascending aorta (ATAC), aortic arch (AAC), and descending thoracic aorta (DTAC). The second group has used cardiac CT scans to assess TAC; therefore, they did not include AAC; however, the aortic root calcium (ARC) was added in the analysis. So, caution is advisable when interpreting and comparing studies that used different TAC anatomical references.

Summary

The broad methodological variability, in addition to the variations in the population characteristics of the studies on TAC, may be in part contributing to the differences between results of different studies. Currently TAC does not have a role in clinical decisions, so it is necessary to create a standard protocol for the aortic calcium research as well as exists for the coronary artery calcium evaluation.

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Rodríguez-Palomares JF, Evangelista MA. Aortic calcium score and vascular atherosclerosis in asymptomatic individuals: beyond the coronary arteries. Rev Española Cardiol (English Ed). 2016;69:813–6 Elsevier BV Available from: https://linkinghub.elsevier.com/retrieve/pii/S1885585716301347.CrossRef

Wang Y, Osborne MT, Tung B, Li M, Li Y. Imaging cardiovascular calcification. J Am Heart Assoc. 2018;7:1–15.

Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging. 2015;8:579–96. https://doi.org/10.1016/j.jcmg.2015.02.006 Elsevier.CrossRefPubMed

Brodov Y, Gransar H, Rozanski A, Hayes SW, Friedman JD, Thomson LEJ, et al. Extensive thoracic aortic calcification is an independent predictor of development of coronary artery calcium among individuals with coronary artery calcium score of zero. Atherosclerosis. 2015;238:4–8 Elsevier Ireland Ltd.CrossRef

Cho I-J, Chang H-J, Park H-B, Heo R, Shin S, Shim CY, et al. Aortic calcification is associated with arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction in elderly male patients with hypertension. J Hypertens. 2015;33:1633–41 Available from: https://insights.ovid.com/crossref?an = 00004872-201508000-00021.CrossRef

Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol. 2008;105:1652–60.CrossRef

Nasir K, Roguin A, Sarwar A, Rumberger J a, Blumenthal RS. Gender differences in coronary arteries and thoracic aorta calcification. Arterioscler Thromb Vasc Biol. 2007;27:1220–2.CrossRef

Takasu J, Katz R, Nasir K, Carr JJ, Wong N, Detrano R, et al. Relationships of thoracic aortic wall calcification to cardiovascular risk factors: The Multi–Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2008;155:765–71 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002870307009477.CrossRef

Allison MA, Budoff MJ, Nasir K, Wong ND, Detrano R, Kronmal R, et al. Ethnic-Specific Risks for Atherosclerotic Calcification of the Thoracic and Abdominal Aorta (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol. 2009;104:812–7. https://doi.org/10.1016/j.amjcard.2009.05.004 Elsevier Inc.CrossRefPubMedPubMedCentral

10.

Kälsch H, Lehmann N, Möhlenkamp S, Hammer C, Mahabadi AA, Moebus S, et al. Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study. Int J Card Imaging. 2013;29:207–16.CrossRef

11.

Pedrosa JF, Ribeiro ALP, Santana PC, Araújo LF, Barreto SM. Relation of thoracic aortic and coronary artery calcium to cardiovascular risk factors (From The Brazilian Longitudinal Study of Adult Health [ELSA-Brasil]). Am J Cardiol. 2019; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002914919309956.

12.

Kälsch H, Lehmann N, Moebus S, Hoffmann B, Stang A, Jöckel K, et al. Aortic calcification onset and progression: association with the development of coronary atherosclerosis. J Am Heart Assoc. 2017;6:1–12 John Wiley and Sons Inc. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.116.005093.CrossRef

13.

Dudink EAMP, Peeters FECM, Altintas S, Heckman LIB, Haest RJ, Kragten H, et al. Agatston score of the descending aorta is independently associated with coronary events in a low-risk population. Open Hear. 2018;5:1–8.CrossRef

14.

Rodríguez-Granillo GA, Reynoso E, Capuñay C, Antoniades C, Shaw LJ, Carrascosa P. Prognostic value of vascular calcifications and regional fat depots derived from conventional chest computed tomography. J Thorac Imaging. 2019;34:33–40.CrossRef

15.

Budoff MJ, Nasir K, Kinney GL, Hokanson JE, Barr RG, Steiner R, et al. Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD Gene cohort. J Cardiovasc Comput Tomogr. 2011;5:113–8.CrossRef

16.

Leroux-Berger M, Queguiner I, MacIel TT, Ho A, Relaix F, Kempf H. Pathologic calcification of adult vascular smooth muscle cells differs on their crest or mesodermal embryonic origin. J Bone Miner Res. 2011;26:1543–53.CrossRef

17.

Wong ND, Gransar H, Shaw L, Polk D, Moon JH, Miranda-Peats R, et al. Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events. JACC Cardiovasc Imaging. 2009;2:319–26. https://doi.org/10.1016/j.jcmg.2008.12.010 Elsevier Inc.CrossRefPubMed

18.

Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, et al. Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus. J Cardiovasc Comput Tomogr. 2015;9:373–81 Elsevier Inc.CrossRef

19.

Thomas IC, McClelland RL, Michos ED, Allison MA, Forbang NI, Longstreth WT, et al. Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events. Atherosclerosis. 2017;265:190–6. https://doi.org/10.1016/j.atherosclerosis.2017.09.009 Elsevier Ireland Ltd.CrossRefPubMedPubMedCentral

20.

• Thomas IC, Thompson CA, Yang M, Allison MA, Forbang NI, Michos ED, et al. Thoracic aorta calcification and noncardiovascular disease-related mortality the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol. 2018;38:1926–32 Recent and the only analysis of DTAC and noncardiovascular mortality.CrossRef

21.

• Thomas IC, McClelland RL, Allison MA, Ix JH, Michos ED, Forbang NI, et al. Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events. Eur Heart J Cardiovasc Imaging. 2018;19:1343–50 Oxford University Press Recent and the only analysis of ATAC and cardiovascular events.CrossRef

22.

Lanzer P, Boehm M, Sorribas V, Thiriet M, Janzen J, Zeller T, et al. Medial vascular calcification revisited: review and perspectives. Eur Heart J. 2014;35:1515–25.CrossRef

23.

• Desai MY, Cremer PC, Schoenhagen P. Thoracic Aortic Calcification: Diagnostic, Prognostic, and Management Considerations. JACC Cardiovasc Imaging. 11:2018, 1012–26 Elsevier Inc. Recent review concerning thoracic aortic calcium.

24.

• Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Porcelain aorta: a comprehensive review. Circulation. 2015;131:827–36 Recent and comprehensive review of porcelain aorta.CrossRef

25.

• Craiem D, Chironi G, Casciaro ME, Graf S, Simon A. Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT. Hendrikse J, editor. PLoS One. Public Library of Science; 2014;9:e109584. Available from: https://dx.plos.org/10.1371/journal.pone.0109584 The first study to propose an extended CAC scan to include aortic arch and measure the difference between TAC prevalences considering and not the aortic arch.

26.

Craiem D, Chironi DG, Casciaro ME, Sirieix ME, Mousseaux E, Simon A. Association of thoracic aorta calcium and non-cardiac vascular events in cardiac disease-free individuals. Atherosclerosis. 2016;245:22–7 Elsevier Ireland Ltd.CrossRef

27.

Ong K-L, McClelland RL, Rye K-A, Cheung BMY, Post WS, Vaidya D, et al. The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2014;236:257–62. https://doi.org/10.1016/j.atherosclerosis.2014.07.015 Elsevier Ltd.CrossRefPubMedPubMedCentral

28.

Yeboah J, Carr JJ, Terry JG, Ding J, Zeb I, Liu S, et al. Computed tomography-derived cardiovascular risk markers, incident cardiovascular events, and all-cause mortality in nondiabetics: The Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol. 2014;21:1233–41.CrossRef

29.

Youssef G, Guo M, McClelland RL, Shavelle DM, Nasir K, Rivera J, et al. Risk factors for the development and progression of thoracic aorta calcification: The Multi-Ethnic Study of Atherosclerosis. Acad Radiol Elsevier USA. 2015;22:1536–45.CrossRef

30.

Kim J, Budoff MJ, Nasir K, Wong ND, Yeboah J, Al-Mallah MH, et al. Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2017;257:1–8 Elsevier Ireland Ltd Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021915016315337.CrossRef

31.

Mahabadi AA, Lehmann N, Möhlenkamp S, Pundt N, Dykun I, Roggenbuck U, et al. Noncoronary measures enhance the predictive value of cardiac CT above traditional risk factors and CAC score in the general population. JACC Cardiovasc Imaging. 2016;9:1177–85 Elsevier Inc. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1936878X16304089.CrossRef

32.

Hoffmann U, Massaro JM, D’Agostino RB, Kathiresan S, Fox CS, O’Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study. J Am Heart Assoc. 2016;5:1–11. https://doi.org/10.1161/JAHA.115.003144.CrossRef

33.

•• Bos D, Leening MJG, Kavousi M, Hofman A, Franco OH, Van Der Lugt A, et al. Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality: The Rotterdam Study. Circ Cardiovasc Imaging. 2015;8:1–9 The only analysis of the presence of calcium in the aortic arch and its predictive value for mortality.

34.

Cho IJ, Chang HJ, Cho I, Heo R, Lee SE, Shim CY, et al. Association of thoracic aorta calcium score with exercise blood pressure response and clinical outcomes in elderly individuals: differential impact of aorta calcification compared with coronary artery calcification. J Am Heart Assoc John Wiley and Sons Inc 2016;5

35.

Katz R, Budoff MJ, O’Brien KD, Wong ND, Nasir K. The metabolic syndrome and diabetes mellitus as predictors of thoracic aortic calcification as detected by non-contrast computed tomography in the Multi-Ethnic Study of Atherosclerosis. Diabet Med. 2016;33:912–9.CrossRef

36.

•• Tesche C, De Cecco CN, Stubenrauch A, Jacobs BE, Varga-Szemes A, Litwin SE, et al. Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease. Radiol Med. 2017;122:113–20 Springer Milan The only analysis of the presence of calcium in the aortic root and its predictive value for CAC and obstructive CAD.CrossRef

37.

Hoffmann U, Massaro JM, D’Agostino RB, Kathiresan S, Fox CS, O’Donnell CJ. Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study. J Am Heart Assoc [Internet]. 2016;5:1–11. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.115.003144.

38.

Elias-Smale SE, Odink AE, Wieberdink RG, Hofman A, Hunink MGM, Krestin GP, et al. Carotid, aortic arch and coronary calcification are related to history of stroke: the Rotterdam study. Atherosclerosis. 2010;212:656–60 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021915010004934.CrossRef

39.

Saboo SS, Abbara S, Rybicki FJ, Chatzizisis YS. Quantification of aortic calcification – How and why should we do it? Atherosclerosis. 2015;240:469–71 Elsevier Ireland Ltd.CrossRef

40.

•• Mori S, Takaya T, Kinugasa M, Ito T, Takamine S, Fujiwara S, et al. Three-dimensional quantification and visualization of aortic calcification by multidetector-row computed tomography: a simple approach using a volume-rendering method. Atherosclerosis. Elsevier; 2015 [cited 2019 Jul 2];239:622–8. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0021915014016633 Focus on advanced techniques to measure TAC by CT.CrossRef

41.

Liyanage L, Lee NJ, Cook T, Herrmann HC, Jagasia D, Litt H, et al. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis. Int J Card Imaging. 2016;32:173–9 Springer Netherlands.CrossRef

42.

Heuvelmans MA, Vonder M, Rook M, Groen HJM, De Bock GH, Xie X, et al. Screening for early lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease (the big-3) using low-dose chest computed tomography: Current evidence and technical considerations. J Thorac Imaging. 2019:160–9 Lippincott Williams and Wilkins.CrossRef

Title: Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography
Authors: Jesiana Ferreira Pedrosa
Sandhi Maria Barreto
Márcio Sommer Bittencourt
Antonio Luiz Pinho Ribeiro
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Coronary Heart Disease
Computed Tomography
Computed Tomography
Arterial Occlusive Disease
Published in: Current Atherosclerosis Reports / Issue 12/2019
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-019-0811-9

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