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Prognostic Value of Vascular Calcifications and Regional Fat Depots Derived From Conventional Chest Computed Tomography

Rodríguez-Granillo, Gastón A., MD, PhD*; Reynoso, Exequiel, MD*; Capuñay, Carlos, MD*; Antoniades, Charalambos, MD, PhD; Shaw, Leslee J., PhD; Carrascosa, Patricia, MD, PhD*

doi: 10.1097/RTI.0000000000000370
Imaging in Cardiac Risk Prediction

Purpose: The prognostic value of vascular calcifications as well as of regional fat depots has been reported separately, in population-based studies, and using gated-computed tomography (CT) examinations. We, therefore, explored the interplay and prognostic value of vascular calcifications and adipose tissue depots assessed during conventional nongated chest CT.

Materials and Methods: We enrolled a consecutive series of 1250 patients aged between 35 and 74 years who underwent clinically indicated chest CT scans. We measured the extent of coronary artery calcification (CAC) using the segment-involvement score (CACSIS), and aortic and valve calcification. Pericardial fat volume (PFV), hepatic fat, and abdominal subcutaneous adipose tissue were also calculated. Patients were followed-up for all-cause mortality.

Results: A total of 577 (46%) patients had presence of CAC in the coronary tree. Over a mean follow-up of 3.7 years, 51 (4%) deaths occurred, 23 (4.1%) in male patients and 28 (4.1%) in female patients. Patients with higher PFV were older (P<0.0001), more frequently male (P<0.0001), had higher abdominal subcutaneous adipose tissue (P<0.0001), hepatic fat (P<0.0001), as well as a larger extent of CAC (P<0.0001), aortic calcium (P<0.0001), and valve calcium (P<0.0001). From a multivariable Cox regression model, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.11), P=0.001, PFV upper tertile (HR, 4.07; 95% CI, 2.09-7.92), P<0.0001, and CACSIS>5 (HR, 2.19; 95% CI, 1.14-4.23; P<0.0001) were independent predictors of all-cause death.

Conclusions: In this relatively large patient cohort undergoing clinically indicated conventional chest CT scans, PFV and coronary calcification were high-risk markers associated with worsening survival.

*Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina

Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK

Division of Cardiology, Emory University, Atlanta, GA

Patricia Carrascosa is Consultant of GE Healthcare. The remaining authors declare no conflicts of interest.

Correspondence to: Gastón A. Rodríguez-Granillo, MD, PhD, Department of Cardiovascular Imaging, Diagnóstico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires B1602ABQ, Argentina (e-mail:

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