Yeqing Zhu1,2, Yong Wang1,3, William E Gioia4, Rowena Yip1, Artit C Jirapatnakul1, Michael S Chung1, David F Yankelevitz1, Claudia I Henschke5. 1. Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA. 2. Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. 3. Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China. 4. Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA. Claudia.Henschke@mountsinai.org.
Abstract
OBJECTIVES: To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers. METHODS: We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants. RESULTS: Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR10 years = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR10 packyears = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR10 years = 2.17), CAC (HR = 1.09) and BMI (HR = 1.06). CONCLUSIONS: AVC scores on LDCT should be documented, especially in lung cancer screening program. KEY POINTS: • LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.
OBJECTIVES: To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers. METHODS: We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants. RESULTS:Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR10 years = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR10 packyears = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR10 years = 2.17), CAC (HR = 1.09) and BMI (HR = 1.06). CONCLUSIONS:AVC scores on LDCT should be documented, especially in lung cancer screening program. KEY POINTS: • LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.
Authors: Javier J Zulueta; Juan P Wisnivesky; Claudia I Henschke; Rowena Yip; Ali O Farooqi; Dorothy I McCauley; Mildred Chen; Daniel M Libby; James P Smith; Mark W Pasmantier; David F Yankelevitz Journal: Chest Date: 2011-10-20 Impact factor: 9.410
Authors: Caroline Chiles; Fenghai Duan; Gregory W Gladish; James G Ravenel; Scott G Baginski; Bradley S Snyder; Sarah DeMello; Stephanie S Desjardins; Reginald F Munden Journal: Radiology Date: 2015-03-09 Impact factor: 11.105
Authors: David Messika-Zeitoun; Lawrence F Bielak; Patricia A Peyser; Patrick F Sheedy; Stephen T Turner; Vuyisile T Nkomo; Jerome F Breen; Joseph Maalouf; Christopher Scott; A Jamil Tajik; Maurice Enriquez-Sarano Journal: Arterioscler Thromb Vasc Biol Date: 2006-12-21 Impact factor: 8.311
Authors: David S Owens; Ronit Katz; Junichiro Takasu; Richard Kronmal; Matthew J Budoff; Kevin D O'Brien Journal: Am J Cardiol Date: 2010-03-01 Impact factor: 2.778
Authors: Marie-Annick Clavel; David Messika-Zeitoun; Philippe Pibarot; Shivani R Aggarwal; Joseph Malouf; Phillip A Araoz; Hector I Michelena; Caroline Cueff; Eric Larose; Romain Capoulade; Alec Vahanian; Maurice Enriquez-Sarano Journal: J Am Coll Cardiol Date: 2013-09-24 Impact factor: 24.094
Authors: Helmut Baumgartner; Judy Hung; Javier Bermejo; John B Chambers; Thor Edvardsen; Steven Goldstein; Patrizio Lancellotti; Melissa LeFevre; Fletcher Miller; Catherine M Otto Journal: J Am Soc Echocardiogr Date: 2017-04 Impact factor: 5.251
Authors: Rowena Yip; Artit Jirapatnakul; Minxia Hu; Xiangmeng Chen; Dan Han; Teng Ma; Yeqing Zhu; Mary M Salvatore; Laurie R Margolies; David F Yankelevitz; Claudia I Henschke Journal: Transl Lung Cancer Res Date: 2021-02