Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD Trial

Published Online:https://doi.org/10.1148/radiol.11110364

A modified coronary artery calcium score at low-dose CT correlates poorly with emphysema extent as quantified with automated CT analysis and percentage predicted forced expiratory volume in 1 second and has the strongest association with cardiovascular events and all-cause mortality in a lung cancer screening population.

Purpose

To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial.

Materials and Methods

In this institutional review board–approved study, both clinical and low-dose CT data were evaluated in a cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and total extent of emphysema. The correlations between mCAC, percentage predicted FEV1, MLA, and emphysema extent were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to assess the relationships between mCAC, FEV1, MLA, and emphysema extent and all-cause mortality and CVEs.

Results

The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score and FEV1 (r = −0.03, P = .4), MLA (r = −0.01, P = .7), or emphysema extent (r = 0.02, P = .6). An mCAC score greater than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73; 95% confidence interval [CI]: 1.05, 13.32; P = .04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P = .03).

Conclusion

mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.

© RSNA, 2011

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110364/-/DC1

References

  • 1 Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag 2008;4(2):315–324.
  • 2 Shemesh J, Henschke CI, Farooqi A, et al.. Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer. Clin Imaging 2006;30(3):181–185.
  • 3 Jacobs PC, Prokop M, van der Graaf Y, et al.. Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers. Atherosclerosis 2010;209(2):455–462.
  • 4 Shemesh J, Henschke CI, Shaham D, et al.. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 2010;257(2):541–548.
  • 5 Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;228(3):826–833.
  • 6 Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291(2):210–215.
  • 7 Wu MT, Yang P, Huang YL, et al.. Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: concordance study with dedicated cardiac CT. AJR Am J Roentgenol 2008;190(4):923–928.
  • 8 Sin DD, Wu LL, Man SFP. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005;127(6):1952–1959.
  • 9 Khot UN, Khot MB, Bajzer CT, et al.. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003;290(7):898–904.
  • 10 Stavem K, Aaser E, Sandvik L, et al.. Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males. Eur Respir J 2005;25(4):618–625.
  • 11 Thurnheer R, Muntwyler J, Stammberger U, et al.. Coronary artery disease in patients undergoing lung volume reduction surgery for emphysema. Chest 1997;112(1):122–128.
  • 12 Alhaj EK, Alhaj NE, Bergmann SR, et al.. Coronary artery calcification and emphysema. Can J Cardiol 2008;24(5):369–372.
  • 13 Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation 2001;104(22):2679–2684.
  • 14 McAllister DA, Maclay JD, Mills NL, et al.. Arterial stiffness is independently associated with emphysema severity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;176(12):1208–1214.
  • 15 Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA 2007;297(9):953–961.
  • 16 Marchianò A, Calabrò E, Civelli E, et al.. Pulmonary nodules: volume repeatability at multidetector CT lung cancer screening. Radiology 2009;251(3):919–925.
  • 17 Sverzellati N, Guerci L, Randi G, et al.. Interstitial lung diseases in a lung cancer screening trial. Eur Respir J 2011;38(2):392–400.
  • 18 Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 1995;152(5 Pt 2):S77–S121.
  • 19 Roca J, Burgos F, Sunyer J, et al.. References values for forced spirometry. Group of the European Community Respiratory Health Survey. Eur Respir J 1998;11(6):1354–1362.
  • 20 Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15(4):827–832.
  • 21 Kuhnigk JM, Dicken V, Zidowitz S, et al.. Informatics in radiology (infoRAD): new tools for computer assistance in thoracic CT. I. Functional analysis of lungs, lung lobes, and bronchopulmonary segments. RadioGraphics 2005;25(2):525–536.
  • 22 Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC. Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 1995;152(2):653–657.
  • 23 Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 1999;74(3):243–252.
  • 24 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307–310.
  • 25 Vehmas T, Hiltunen A, Leino-Arjas P, Piirilä P. Relation between atherosclerotic calcifications detected in chest computed tomography and lung function. [in Spanish]. Arch Bronconeumol 2009;45(8):376–382.
  • 26 Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? the potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003;107(11):1514–1519.
  • 27 Eid AA, Ionescu AA, Nixon LS, et al.. Inflammatory response and body composition in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164(8 Pt 1):1414–1418.
  • 28 Haruna A, Muro S, Nakano Y, et al.. CT scan findings of emphysema predict mortality in COPD. Chest 2010;138(3):635–640.
  • 29 Budoff MJ, Nasir K, McClelland RL, et al.. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2009;53(4):345–352.

Article History

Received February 25, 2011; revision requested April 11; revision received June 28; accepted July 22; final version accepted August 25.
Published online: Feb 2012
Published in print: Feb 2012