open access
Correlation between coronary artery calcium score and aorta diameter in population with long-standing hypertension using noncontrast CT scan
Affiliations- Department of Radiology, Al-Yarmook Teaching Hospital, Baghdad, Iraq
- Division of Radiology, Department of Medicine, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
- Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
open access
Abstract
Background: Early detection of aortic aneurysms is challenging in hypertensive patients due to the high risk of life-threatening ruptures. Limited studies on the relationship between coronary artery calcium and aortic diameter are present. This study evaluated the correlation between coronary artery calcium score (CACS) and maximal thoracic and abdominal aortic diameters in hypertensive patients, using a noncontrast CT scan.
Material and methods: We prospectively enrolled 180 hypertensive patients older than 45 who had no aortic aneurysm or heart disease. We split the study population into five classes according to CACS (0, 1–10, 10–100, 100–400, and > 400). We calculated coronary artery calcium and maximal diameters of the ascending thoracic aorta (ATAMAX), descending thoracic aorta (DTAMAX), and abdominal aorta (AAMAX) using native computed tomography imaging.
Results: Coronary artery calcium score was high in patients with high abdominal aorta diameter but not with the high diameters of the thoracic aorta. The cut-off point of the abdominal aorta’s maximum diameter was 34 mm, so AAMAX > 34 mm is predictive of a diagnosis of CACS category five (CACS > 400). There were no differences in ascending and descending thoracic aorta measurements between patients with a coronary artery calcium score of more than 400 (category 5) and the rest.
Conclusion: Screening for an abdominal aortic aneurysm is essential in hypertensive patients as the coronary artery calcium score is associated significantly with increased abdominal aorta diameter. However, the necessity for thoracic aortic aneurysm screening is not apparent in these patients as no significant association is found between CACS and thoracic aorta diameter.
Abstract
Background: Early detection of aortic aneurysms is challenging in hypertensive patients due to the high risk of life-threatening ruptures. Limited studies on the relationship between coronary artery calcium and aortic diameter are present. This study evaluated the correlation between coronary artery calcium score (CACS) and maximal thoracic and abdominal aortic diameters in hypertensive patients, using a noncontrast CT scan.
Material and methods: We prospectively enrolled 180 hypertensive patients older than 45 who had no aortic aneurysm or heart disease. We split the study population into five classes according to CACS (0, 1–10, 10–100, 100–400, and > 400). We calculated coronary artery calcium and maximal diameters of the ascending thoracic aorta (ATAMAX), descending thoracic aorta (DTAMAX), and abdominal aorta (AAMAX) using native computed tomography imaging.
Results: Coronary artery calcium score was high in patients with high abdominal aorta diameter but not with the high diameters of the thoracic aorta. The cut-off point of the abdominal aorta’s maximum diameter was 34 mm, so AAMAX > 34 mm is predictive of a diagnosis of CACS category five (CACS > 400). There were no differences in ascending and descending thoracic aorta measurements between patients with a coronary artery calcium score of more than 400 (category 5) and the rest.
Conclusion: Screening for an abdominal aortic aneurysm is essential in hypertensive patients as the coronary artery calcium score is associated significantly with increased abdominal aorta diameter. However, the necessity for thoracic aortic aneurysm screening is not apparent in these patients as no significant association is found between CACS and thoracic aorta diameter.
Keywords
aorta; coronary artery calcium; CT scan
About this articleTitle
Correlation between coronary artery calcium score and aorta diameter in population with long-standing hypertension using noncontrast CT scan
Journal
Issue
Article type
Original paper
Pages
164-169
Published online
2022-12-05
Page views
3312
Article views/downloads
538
DOI
Bibliographic record
Arterial Hypertension 2022;26(4):164-169.
Keywords
aorta
coronary artery calcium
CT scan
Authors
Sarab Hilal Abdulhussein
Muna Abdul Ghani Zghair
Qays Ahmed Hassan
References (21)- Isselbacher EM, Preventza O, Hamilton Black J, et al. Writing Committee Members, IRAD Investigators. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg. 2001; 33(6): 1185–1192.
- Bergersen L, Kiernan MS, McFarlane G, et al. Prevalence of abdominal aortic aneurysms in patients undergoing coronary artery bypass. Ann Vasc Surg. 1998; 12(2): 101–105.
- Benzaquen BS, Garzon P, Eisenberg MJ. Screening for abdominal aortic aneurysms during cardiac catheterization. J Invasive Cardiol. 2001; 13(2): 100–106.
- Madaric J, Vulev I, Bartunek J, et al. Frequency of abdominal aortic aneurysm in patients >60 years of age with coronary artery disease. Am J Cardiol. 2005; 96(9): 1214–1216.
- Guo D, Hasham S, Kuang SQ, et al. Familial Thoracic Aortic Aneurysms and Dissections. Circulation. 2001; 103(20): 2461–2468.
- Rumberger JA, Simons DB, Fitzpatrick LA, et al. Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study. J Am Coll Cardiol. 1992; 20(5): 1118–1126.
- Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998; 31(1): 126–133.
- Wayhs R, Zelinger A, Raggi P. High coronary artery calcium scores pose an extremely elevated risk for hard events. J Am Coll Cardiol. 2002; 39(2): 225–230.
- Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010; 56(22): 1864–1894.
- Cho IJ, Jang SY, Chang HJ, et al. Aortic aneurysm screening in a high-risk population: a non-contrast computed tomography study in korean males with hypertension. Korean Circ J. 2014; 44(3): 162–169.
- Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv. 2010; 76(2): E43–E86.
- Callister TQ, Cooil B, Raya SP, et al. Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology. 1998; 208(3): 807–814.
- Budoff MJ, Achenbach S, Blumenthal RS, et al. American Heart Association Committee on Cardiovascular Imaging and Intervention, American Heart Association Council on Cardiovascular Radiology and Intervention, American Heart Association Committee on Cardiac Imaging, Council on Clinical Cardiology. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006; 114(16): 1761–1791.
- Janowitz WR, Agatston AS, Kaplan G, et al. Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. Am J Cardiol. 1993; 72(3): 247–254.
- Pletcher MJ, Tice JA, Pignone M, et al. Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med. 2004; 164(12): 1285–1292.
- Hertzer NR, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984; 199(2): 223–233.
- Brown P, Pattenden R, Vernooy C, et al. Selective management of abdominal aortic aneurysms in a prospective measurement program. J Vasc Surg. 1996; 23(2): 213–222.
- Agmon Y, Khandheria BK, Meissner I, et al. Is aortic dilatation an atherosclerosis-related process? Clinical, laboratory, and transesophageal echocardiographic correlates of thoracic aortic dimensions in the population with implications for thoracic aortic aneurysm formation. J Am Coll Cardiol. 2003; 42(6): 1076–1083.
- Nataatmadja M, West M, West J, et al. Abnormal extracellular matrix protein transport associated with increased apoptosis of vascular smooth muscle cells in marfan syndrome and bicuspid aortic valve thoracic aortic aneurysm. Circulation. 2003; 108 Suppl 1: II329–II334.
- Tadros TM, Klein MD, Shapira OzM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation. 2009; 119(6): 880–890.
- Renapurkar RD, Setser RM, O'Donnell TP, et al. Aortic volume as an indicator of disease progression in patients with untreated infrarenal abdominal aneurysm. Eur J Radiol. 2012; 81(2): e87–e93.