Should we report incidental aortic calcification on chest CT imaging?
Jul 30, 2024
auto_awesome
In this discussion, Professor Marc Dweck, a cardiovascular expert from The University of Edinburgh, dives into the significance of incidental aortic calcification found in chest CT scans. The conversation highlights how these findings can refine cardiovascular risk assessments and the need for integrating them into clinical guidelines. They also explore advancements in imaging techniques, the correlation between aortic calcification and cardiovascular events, and the role of AI in identifying these incidental findings. A vital listen for those interested in heart health!
Advanced imaging techniques, including incidental thoracic aortic calcification detection, could significantly enhance cardiovascular risk assessment beyond traditional methods.
Integrating calcification scoring into clinical guidelines presents challenges, requiring robust observational data and clear communication strategies for treatment implications.
Deep dives
Limitations of Traditional Risk Scoring
Traditional risk factor scoring mechanisms for predicting cardiovascular events, such as heart attacks and strokes, have notable limitations. While effective at the population level, they often fail to accurately assess individual risk, as many patients experiencing their first myocardial infarction do not present with high-risk scores. This means that both low-risk individuals can suffer from serious cardiovascular events and high-risk individuals can remain asymptomatic. The introduction of advanced imaging techniques presents an opportunity to better guide preventative therapies by refining risk assessment beyond simple clinical factors.
Thoracic Aortic and Coronary Calcium Scoring
The incidental detection of thoracic aortic calcification alongside coronary artery calcification offers a compelling method for predicting cardiovascular events, as revealed in recent studies. Both types of calcification were found to be independently associated with cardiovascular events, with coronary artery calcification serving as a slightly more powerful predictor. However, thoracic aortic calcification also exhibited value in lower-risk individuals, highlighting the systemic nature of atherosclerosis. This suggests that employing both measures could enhance overall risk assessment strategies in clinical practice.
Integrating Imaging Findings into Clinical Guidelines
To effectively integrate findings from thoracic and coronary calcification scoring into clinical guidelines, several challenges must be addressed. Convincing the medical community of the value of these imaging techniques requires more observational data to reinforce their significance. Moreover, establishing systematic approaches to communicate imaging results and their implications for treatment decisions is crucial. This includes determining appropriate thresholds for initiating preventative therapies, such as statins and aspirin, based on calcification results to ensure that these findings lead to actionable clinical outcomes.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Professor Marc Dweck from The University of Edinburgh. They discuss a study in Heart that tested the predictive power of thoracic aortic calcium calcium for predicting future vascular events.
Editorial: Future applications of incidental detection of thoracic and coronary calcium for atherosclerotic cardiovascular disease events prediction - https://heart.bmj.com/content/110/14/929