Association of calcium density in the thoracic aorta with risk factors and clinical events

CRAIEM, DAMIAN; CASCIARO, MARIANO; PASCANER, ARIEL; SOULAT, GILLES; GUILENEA, FEDERICO; SIRIEIX, MARIE-EMMANUELLE; SIMON, ALAIN; MOUSSEAUX, ELIE

EUROPEAN RADIOLOGY

SPRINGER

Lugar: Berlin; Año: 2020

0938-7994

Objectives In the ascending aorta, calcification density was independently and inversely associated with cardiovascular disease(CVD) risk prediction. Until now, the density of thoracic aorta calcium (TAC) was estimated as the Agatston score divided by thecalcium area (DAG). We thought to analyze TAC density in a full Hounsfield unit (HU) range and to study its association withTAC volume, traditional risk factors, and CVD events.Methods Non-enhanced CT images of 1426 patients at intermediate risk were retrospectively reviewed. A calcium density scorewas estimated as the average of the maximum HU attenuation in all calcified plaques of the entire thoracic aorta (DAV).Results During a mean 4.0 years follow-up, there were 26 events for a total of 674 patients with TAC > 0. TAC volume and DAVwere positively correlated (R = 0.72). The median DAV value was 457 HU (IQ 323?603 HU) and was exponentially related toDAG (R = 0.86). DAV was inversely associated with systolic pressure (p < 0.05), pulse pressure (p < 0.01), hypertension (p < 0.05),and 10-year FRS (p < 0.001) after adjusting for TAC volume. When TAC volume and DAV were included in a logistic model, asignificant improvement was shown in CVD risk estimation beyond coronary artery calcium (CAC) (AUC = 0.768 vs 0.814,p < 0.05). In multivariable Cox models, TAC volume and DAV showed an independent association with CVD.Conclusions In intermediate risk patients, TAC density was inversely associated with several risk factors after adjustment forTAC volume. A significant improvement was observed over CAC when TAC volume and density were added into the riskprediction model.