OʼHare Phoebe E, Ayres Jonny F, OʼRourke Rachael L, Slaughter Richard E, Marshall Henry M, Bowman Rayleen V, Fong Kwun M, Yang Ian A
From the *School of Medicine, The University of Queensland; Departments of †Medical Imaging, and ‡Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
J Comput Assist Tomogr. 2014 Sep-Oct;38(5):753-9. doi: 10.1097/RCT.0000000000000119.
This cross-sectional study assessed the prognostic implications of computed tomography (CT) coronary artery calcification (CAC), independent of emphysema, in patients with chronic obstructive pulmonary disease (COPD).
Coronary artery calcification and emphysema were assessed on noncontrast, ungated chest CT scans of patients with COPD using the validated CAC ordinal visual scale (CAC OVS; range, 0-12) and visual CT emphysema index.
A total of 200 CT images were analyzed. All-cause mortality was associated with CAC OVS greater than 4 (hazard ratio, 2.03; 95% confidence interval, 1.08-3.82; P = 0.028) and with moderate to severe CT emphysema index (hazard ratio, 4.34; 95% confidence interval, 1.53-12.33; P = 0.006). Increased emphysema severity, myocardial infarction, hypertension, and male sex independently correlated with CAC OVS greater than 4.
Coronary artery calcification severity and emphysema severity on CT images are related and are strongly as well as independently associated with prognosis in patients with moderate to severe COPD. The potential to use CAC OVS on unenhanced nongated CT as a screening tool for coronary artery disease and as a prognostic marker in patients with COPD needs further investigation in prospective studies.
本横断面研究评估了慢性阻塞性肺疾病（COPD）患者中计算机断层扫描（CT）冠状动脉钙化（CAC）独立于肺气肿的预后意义。
使用经过验证的CAC序数视觉量表（CAC OVS；范围为0 - 12）和视觉CT肺气肿指数，对COPD患者的非增强、非门控胸部CT扫描进行冠状动脉钙化和肺气肿评估。
共分析了200张CT图像。全因死亡率与CAC OVS大于4相关（风险比，2.03；95%置信区间，1.08 - 3.82；P = 0.028），也与中度至重度CT肺气肿指数相关（风险比，4.34；95%置信区间，1.53 - 12.33；P = 0.006）。肺气肿严重程度增加、心肌梗死、高血压和男性性别与CAC OVS大于4独立相关。
CT图像上的冠状动脉钙化严重程度和肺气肿严重程度相关，并且与中度至重度COPD患者的预后密切且独立相关。在未增强的非门控CT上使用CAC OVS作为冠状动脉疾病筛查工具以及COPD患者预后标志物的潜力，需要在前瞻性研究中进一步探究。
