Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events

Abstract

Background

There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events.

Purpose

To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events.

Material and Methods

One hundred and forty-eight non-cardiac patients (78 men; 67±12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWT_ref) and at the maximum AWT (AWT_max). Correlation with clinical CCV patients' history was estimated. The value of AWT_max and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis.

Results

Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥30 kg/m²; 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWT_max and AWT_ref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWT_max median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWT_max was the only independent variable associated to the frequency of CCV events.

Conclusion

Patients with increased thoracic AWT_max on chest MDCT could be considered at risk for CCV disease.

Keywords

Aorta atherosclerosis cardiovascular diseases cerebrovascular insufficiency multidetector computed tomography (MDCT)risk factors

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