Key result
Higher chest CT aortic arch calcification is linked to ~94% higher cardiovascular mortality risk.
Why the study?
Vascular calcification, especially aortic arch calcification, is an independent predictor of mortality in hemodialysis patients, but chest X-ray may underestimate calcium deposition, necessitating evaluation of chest CT-assessed AoAC for prognostic value.
Does higher chest CT-estimated aortic arch calcification score predict increased cardiovascular and all-cause mortality in maintenance hemodialysis patients?
Cohort (n=205)
No
Does higher chest CT-estimated aortic arch calcification score predict increased cardiovascular and all-cause mortality in maintenance hemodialysis patients?
Hazard Ratio: 1.935 (95% CI 1.148–3.263)
p-value: p=0.013
Aortic arch calcification score quantified by routine, non-contrast chest CT is a strong and independent predictor of both long-term cardiovascular and all-cause mortality in maintenance hemodialysis patients.
May support opportunistic CT-based risk stratification in hemodialysis; leaves open whether scoring improves outcomes or warrants practice change.
Background Cardiovascular complications are the leading cause of death in hemodialysis patients, and vascular calcification, particularly aortic arch calcification (AoAC), is an independent predictor of cardiovascular and all-cause mortality. However, chest X-ray, a commonly used method for assessing AoAC may underestimate calcium deposition. This study aimed to evaluate the prognostic value of AoAC assessed by chest computed tomography (CT) for predicting cardiovascular and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A retrospective cohort study was conducted, including 205 hemodialysis patients who underwent chest CT scans between January and December 2019. Patients were followed up until August 31, 2024, with a median follow-up duration of 61 months. AoAC scores (AoACS) were calculated using the Agatston-type method. Cox proportional hazards models and Kaplan-Meier survival analysis were used for statistical evaluation. Results Higher AoACS was associated with increased mortality risk and significantly reduced cardiovascular and overall survival rates ( p < 0.001). Multivariable analysis revealed that log(AoACS + 1) was independently associated with cardiovascular mortality (HR 1.935, 95%CI 1.148–3.263, p = 0.013) and all-cause mortality (HR 1.641, 95%CI 1.156–2.329, p < 0.006). Diabetes and serum albumin levels were also independent predictors of mortality. Conclusions AoACS derived from routine chest CT is a novel and promising marker for risk stratification in MHD patients. Trial Registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2500098576) on March 11, 2025.
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Gao et al. (2026) conducted a cohort in Maintenance hemodialysis (MHD) (n=205). Chest CT-estimated aortic arch calcification score (AoACS) vs. Lower or zero aortic arch calcification scores was evaluated on Cardiovascular mortality (HR 1.935, 95% CI 1.148-3.263, p=0.013). Higher chest CT-estimated aortic arch calcification score (log-transformed) was independently associated with a near 2-fold increased risk of cardiovascular mortality (HR 1.935).
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