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Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease

  • Tesche, Christian1, 2
  • De Cecco, Carlo N.1, 3
  • Stubenrauch, Andrew1
  • Jacobs, Brian E.1
  • Varga-Szemes, Akos1
  • Litwin, Sheldon E.4, 1
  • Ball, B. Devon1
  • Baquet, Moritz5
  • Jochheim, David5
  • Ebersberger, Ullrich1, 2
  • Bayer, Richard R. 2nd4
  • Hoffmann, Ellen2
  • Steinberg, Daniel H.4
  • Schoepf, U. Joseph1, 4
  • 1 Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29403, USA , Charleston (United States)
  • 2 Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Englschalkinger Strasse 77, Munich, 81925, Germany , Munich (Germany)
  • 3 University of Rome “Sapienza”, Department of Radiological Sciences, Oncology and Pathology, Piazzale Aldo Moro 5, Rome, 00185, Italy , Rome (Italy)
  • 4 Medical University of South Carolina, Division of Cardiology, Department of Medicine, 25 Courtenay Drive, Charleston, SC, 29403, USA , Charleston (United States)
  • 5 Hospital of the Ludwig-Maximilians-University, Department of Cardiology, Marchioninistrasse 15, Munich, 81377, Germany , Munich (Germany)
Published Article
La radiologia medica
Springer Milan
Publication Date
Nov 14, 2016
DOI: 10.1007/s11547-016-0707-5
Springer Nature


ObjectiveTo evaluate the correlation between aortic root calcification (ARC) markers and coronary artery calcification (CAC) derived from coronary artery calcium scoring (CACS) and their ability to predict obstructive coronary artery disease (CAD).MethodsWe retrospectively analyzed 189 patients (47% male, age 60.3 ± 11.1 years) with an intermediate probability of CAD who underwent clinically indicated CACS and coronary CT angiography (CCTA). ARC markers [aortic root calcium score (ARCS) and volume (ARCV)] were calculated and compared to CAC markers: coronary artery calcium score (CACS), volume (CACV), and mass (CACM). CCTA datasets were visually evaluated for significant CAD (stenosis ≥ 50%) and the ability of ARC markers to predict obstructive CAD was assessed.ResultsARCS (mean 67.7 ± 189.5) and ARCV (mean 67.3 ± 184.7) showed significant differences between patients with and without CAC (109.4 ± 238.6 vs 9.42 ± 31.4, p < 0.0001; 108.5 ± 232.4 vs 9.9 ± 30.5, p < 0.0001). A strong correlation was found for ARCS and ARCV with CACS, CACM, and CACV (all p < 0.0001). In a multivariate analysis, ARCS (OR 1.09, p = 0.033) and ARCV (OR 1.12, p = 0.046) were independent markers for CAC. Using a receiver-operating characteristics analysis, the AUC to detect severe CAC was 0.71 (p < 0.0001) and 0.71 (p < 0.0001) for ARCS and ARCV, respectively. ARCS (0.67, p < 0.0001) and ARCV (0.68, p < 0.0001) showed discriminatory power for predicting obstructive CAD, yielding sensitivities 61 and 78% and specificities of 62 and 80%, respectively.ConclusionARC markers are associated with and independently predict the presence of CAC and obstructive CAD. Further testing is required in patients with severe ARC and significant CAD in order to reliably obtain these markers from thoracic-CT or X-ray for proper risk classification.

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