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01-11-2019 | Computed Tomography | Cardiac

Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study

Authors: Borek Foldyna, Parastou Eslami, Jan-Erik Scholtz, Kristin Baltrusaitis, Michael T. Lu, Joseph M. Massaro, Ralph B. D’Agostino Sr, Maros Ferencik, Hugo J. W. L. Aerts, Christopher J. O’Donnell, Udo Hoffmann

Published in: European Radiology | Issue 11/2019

Abstract

Objectives

To investigate the association between directly measured density and morphology of coronary artery calcium (CAC) with cardiovascular disease (CVD) events, using computed tomography (CT).

Methods

Framingham Heart Study (FHS) participants with CAC in noncontrast cardiac CT (2002–2005) were included and followed until 2016. Participants with known CVD or uninterpretable CT scans were excluded. We assessed and correlated (Spearman) CAC density, CAC volume, and the number of calcified segments. Moreover, we counted morphology features including shape (cylindrical, spherical, semi-tubular, and spotty), location (bifurcation, facing pericardium, or facing myocardium), and boundary regularity. In multivariate Cox regression analyses, we associated all CAC characteristics with CVD events (CVD-death, myocardial infarction, stroke).

Results

Among 1330 included participants (57.8 ± 11.7 years; 63% male), 73 (5.5%) experienced CVD events in a median follow-up of 9.1 (7.8–10.1) years. CAC density correlated strongly with CAC volume (Spearman’s ρ = 0.75; p < 0.001) and lower number of calcified segments (ρ = − 0.86; p < 0.001; controlled for CAC volume). In the survival analysis, CAC density was associated with CVD events independent of Framingham risk score (HR (per SD) = 2.09; 95%CI, 1.30–3.34; p = 0.002) but not after adjustment for CAC volume (p = 0.648). The extent of spherically shaped and pericardially sided calcifications was associated with fewer CVD events accounting for the number of calcified segments (HR (per count) = 0.55; 95%CI, 0.31–0.98; p = 0.042 and HR = 0.66; 95%CI, 0.45–0.98; p = 0.039, respectively).

Conclusions

Directly measured CAC density does not predict CVD events due to the strong correlation with CAC volume. The spherical shape and pericardial-sided location of CAC are associated with fewer CVD events and may represent morphological features related to stable coronary plaques.

Key Points

• Coronary calcium density may not be independently associated with cardiovascular events.

• Coronary calcium density correlates strongly with calcium volume.

• Spherical shape and pericardial-sided location of CAC are associated with fewer CVD events.

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Title: Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study
Authors: Borek Foldyna
Parastou Eslami
Jan-Erik Scholtz
Kristin Baltrusaitis
Michael T. Lu
Joseph M. Massaro
Ralph B. D’Agostino Sr
Maros Ferencik
Hugo J. W. L. Aerts
Christopher J. O’Donnell
Udo Hoffmann
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Arterial Occlusive Disease
Published in: European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06223-7

ACC 2024 Congress

Springer Medicine

Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

ACC 2024 Congress

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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