Key result
Unrequested non-vascular chest CT findings, particularly moderate pleural effusion, predict ~177% higher cardiovascular risk.
Why the study?
Routine chest CT examinations contain many findings unrelated to the diagnostic question, and the prognostic significance of unrequested non-vascular findings for future cardiovascular events was unclear.
Do unrequested non-vascular findings on routine chest CT predict future cardiovascular events in patients scanned for non-cardiovascular reasons?
Cohort (n=10,410)
Yes
Do unrequested non-vascular findings on routine chest CT predict future cardiovascular events in patients scanned for non-cardiovascular reasons?
Common non-vascular findings on routine chest CT, such as pleural effusions and ground glass opacities, are predictive of future cardiovascular events.
Answers are grounded in this paper and cite their sources.
Incidental non-vascular CT findings may aid CV risk assessment; leaves open whether reporting alters outcomes in non-cardiac scans.
BACKGROUND: Routine computed tomography (CT) examinations contain an abundance of findings unrelated to the diagnostic question. Those with prognostic significance may contribute to early detection and treatment of disease, irrelevant findings can be ignored. We aimed to assess the association between unrequested chest CT findings in lungs, mediastinum and pleura and future cardiovascular events. METHODS: Multi-center case-cohort study in 5 tertiary and 3 secondary care hospitals involving 10410 subjects who underwent routine chest CT for non-cardiovascular reasons. 493 cardiovascular hospitalizations or deaths were recorded during an average follow-up time of 17.8 months. 1191 patients were randomly sampled to serve as a control subcohort. Hazard ratios and annualized event rates were calculated. RESULTS: Abnormalities in the lung (26-44%), pleura (14-15%) and mediastinum (20%) were common. Hazard ratios after adjustment for age and sex were for airway wall thickening 2.26 (1.59-3.22), ground glass opacities 2.50 (1.72-3.62), consolidations 1.97 (1.12-3.47), pleural effusions 2.77 (1.81-4.25) and lymph-nodes 2.04 (1.40-2.96). Corresponding annual event rates were 5.5%, 6.0%, 3.8%, 10.2% and 4.4%. CONCLUSIONS: We have identified several common chest CT findings that are predictive for future risk of cardiovascular events and found that other findings have little utility for this. The added value of the non-vascular predictors to established vascular calcifications on CT remains to be determined.
No takes yet. Share an insight, caveat, or question.
Jong et al. (2011) conducted a cohort in Cardiovascular disease risk (n=10,410). Unrequested non-vascular chest CT findings (e.g., pleural effusion) vs. Absence of the specific CT abnormality was evaluated on Cardiovascular hospitalization or death (HR 2.77, 95% CI 1.81-4.25). Unrequested non-vascular chest CT findings, particularly moderate pleural effusion, significantly predicted future cardiovascular events (HR 2.77) compared to patients without these abnormalities.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: