Validation of a standardized semiquantitative template for reporting cardiac abnormalities on thoracic CT examinations of patients with non-cardiac disease
Principal Investigator
Name
Alexander Bankier
Degrees
MD, PhD
Institution
University of Massachusetts Medical School
Position Title
Professor of Radiology
Email
About this CDAS Project
Study
NLST
(Learn more about this study)
Project ID
NLST-506
Initial CDAS Request Approval
May 1, 2019
Title
Validation of a standardized semiquantitative template for reporting cardiac abnormalities on thoracic CT examinations of patients with non-cardiac disease
Summary
Background
Cardiovascular diseases are currently the leading cause of mortality in the US. Recent studies suggest that thoracic computed tomography (CT) can play an important role in identifying patients at risk for cardiovascular disease.
Currently, the overall use of CT constantly increases, and this trend is reinforced by the introduction of CT lung cancer screening into clinical practice. Patients eligible for CT lung cancer screening share cigarette smoking as major risk factor for cardiovascular disease with the patient population at large.
Thus, we have an ample opportunity for further investigating the role of CT in potentially decreasing the number of events caused by cardiovascular disease. In this context, we developed a semi-quantitative standardized reporting template for cardiovascular CT findings detected on non-cardiac CT examinations. This template includes semiquantitative scores for aortic wall calcifications, coronary calcifications, and aortic and mitral valve calcifications as well as measurements of the heart and of the large thoracic vessels (aorta and pulmonary trunk).
Research purpose
The purpose of this project is to validate the prognostic value of our template for reporting cardiovascular abnormalities on thoracic CT examinations in patients from the NLST trial and to relate the results from this template to outcome
Methods
We will perform a retrospective case-control study based on the NLST data. We will select all patients who died from a coronary heart disease for which an initial chest CT examination is available (210 patients according to a previously published study: Chiles C et al, Radiology. 2015 Jul; 276(1): 82–90). We will then match this population of patients (according to gender, age and ethnicity) to a population of patients who were still alive at the end of the trial, and to a population of patients who died from a non-coronary heart disease cause.
Then, two radiologists will independently review the initial chest CTs of all included patients. For each examination, they will record the different parameters making up the standardized reporting template which include the following items previously shown to be independently related to cardiovascular events: coronary artery calcifications, mitral and aortic valve calcifications, aortic wall calcifications, heart and thoracic aorta diameters.
Based on this cardiovascular assessment, several multi parametric quantitative disease severity scores will weigh the individual score components and we will relate the respective component combinations to either positive (fatal cardiovascular event) or negative (no fatal cardiovascular event).
The scoring method which shows the strongest correlation to mortality caused by cardiovascular events will be determined.
Expected results
The cardiovascular abnormalities as assessed by our weighted semi-quantitative standardized template is related to mortality caused by cardiovascular events in a high-risk population.
This finding will support the clinical relevance of our template, legitimize its diffusion, and encourage the use of this simple but comprehensive scoring system in clinical practice.
Cardiovascular diseases are currently the leading cause of mortality in the US. Recent studies suggest that thoracic computed tomography (CT) can play an important role in identifying patients at risk for cardiovascular disease.
Currently, the overall use of CT constantly increases, and this trend is reinforced by the introduction of CT lung cancer screening into clinical practice. Patients eligible for CT lung cancer screening share cigarette smoking as major risk factor for cardiovascular disease with the patient population at large.
Thus, we have an ample opportunity for further investigating the role of CT in potentially decreasing the number of events caused by cardiovascular disease. In this context, we developed a semi-quantitative standardized reporting template for cardiovascular CT findings detected on non-cardiac CT examinations. This template includes semiquantitative scores for aortic wall calcifications, coronary calcifications, and aortic and mitral valve calcifications as well as measurements of the heart and of the large thoracic vessels (aorta and pulmonary trunk).
Research purpose
The purpose of this project is to validate the prognostic value of our template for reporting cardiovascular abnormalities on thoracic CT examinations in patients from the NLST trial and to relate the results from this template to outcome
Methods
We will perform a retrospective case-control study based on the NLST data. We will select all patients who died from a coronary heart disease for which an initial chest CT examination is available (210 patients according to a previously published study: Chiles C et al, Radiology. 2015 Jul; 276(1): 82–90). We will then match this population of patients (according to gender, age and ethnicity) to a population of patients who were still alive at the end of the trial, and to a population of patients who died from a non-coronary heart disease cause.
Then, two radiologists will independently review the initial chest CTs of all included patients. For each examination, they will record the different parameters making up the standardized reporting template which include the following items previously shown to be independently related to cardiovascular events: coronary artery calcifications, mitral and aortic valve calcifications, aortic wall calcifications, heart and thoracic aorta diameters.
Based on this cardiovascular assessment, several multi parametric quantitative disease severity scores will weigh the individual score components and we will relate the respective component combinations to either positive (fatal cardiovascular event) or negative (no fatal cardiovascular event).
The scoring method which shows the strongest correlation to mortality caused by cardiovascular events will be determined.
Expected results
The cardiovascular abnormalities as assessed by our weighted semi-quantitative standardized template is related to mortality caused by cardiovascular events in a high-risk population.
This finding will support the clinical relevance of our template, legitimize its diffusion, and encourage the use of this simple but comprehensive scoring system in clinical practice.
Aims
Specific Aim 1: To apply a standardized template for reporting cardiovascular abnormalities on thoracic CT examinations in a patient cohort at high risk for cardiovascular disease.
Specific Aim 2: To validate the results from the application of this template to the outcome "occurring or non-occurring death from cardiovascular disease"
Collaborators
Constance de Margerie-Mellon, MD, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, USA
Antonio Monteiro Filho, MD, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, USA
Rachael Kirkbride, MD, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, USA
Alexander A. Bankier, MD, PhD, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, USA