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The Prognostic Value of Vascular Diameter Measurements on Routine Chest Computed Tomography in Patients Not Referred for Cardiovascular Indications

Gondrie, Martijn J.A. MD, PhD*†; van der Graaf, Yolanda MD, PhD*; Jacobs, Peter C. MD*†; Buckens, Stan C.F.M. MD*; Mali, Willem P.Th.M. MD, PhDOn Behalf of the PROVIDI Study Group

Journal of Computer Assisted Tomography: November/December 2011 - Volume 35 - Issue 6 - p 734–741
doi: 10.1097/RCT.0b013e318231824a
Original Article

Objectives The aim of the study was to investigate whether diameter measurements of the thoracic aorta and the heart can be used as prognostic markers for future cardiovascular disease.

Methods Following a case-cohort design, a total of 10,410 patients undergoing chest computed tomography were followed up for a mean period of 17 months. The ones with a cardiovascular indication were excluded. Diameter measurements were evaluated with Cox proportional hazard analysis.

Results Five hundred fifteen incident cardiovascular events occurred during follow-up. The heart (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03–1.06) and ascending thoracic (HR, 1.002; 95% CI, 1.001–1.004) diameter showed an exponential prognostic effect beyond a threshold diameter of, respectively, 11 and 30 mm; the descending aortic diameter (HR, 1.04; 95% CI, 1.01–1.13) and cardiothoracic ratio (HR, 1.06; 95% CI, 1.04–1.08) showed linear prognostic effects beyond, respectively, 25 and 0.45 mm.

Conclusion Intrathoracic diameter measurements can be used as markers to predict cardiovascular events in patients not referred for that disease outcome.

From the *Julius Center for Health Sciences and Primary Care and †Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.

Received for publication June 12, 2011; accepted August 5, 2011.

Reprints: Martijn J.A. Gondrie, MD, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA Utrecht, the Netherlands (e-mail:

The PROVIDI Study Group consists of J. Laméris (Department of Radiology, Academic Medical Center, Amsterdam), C. van Kuijk (Department of Radiology, VU University Medical Center Amsterdam), W. ten Hove (Department of Radiology, Gelre Hospitals, Apeldoorn), M. Oudkerk (Department of Radiology, University Medical Center Groningen), Ay L. Oen (Department of Radiology, Elkerliek Hospital, Helmond), J. Wildberger (Department of Radiology, Academic Hospital Maastricht), J. van Heesewijk (Department of Radiology, St Antonius Hospital, Nieuwegein), W. Mali (Department of Radiology, University Medical Center Utrecht), and Y. van der Graaf (Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht).

The study was funded by a program grant from the Netherlands Organization for Scientific Research–Medical Sciences (NWO-MW; grant 40-00812-98-07-005). The funders had no involvement in the study design, data collection, analysis and interpretation, the writing of the report, or the decision to submit the paper for publication.

The authors report no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.