Buckens Constantinus F, de Jong Pim A, Verkooijen Helena M, Verhaar Harald J, Mali Willem P, van der Graaf Yolanda
Radiology Department, University Medical Center Utrecht, Heidelberglaan 100, E01.132, 3508 GA, Utrecht, The Netherlands,
Int J Cardiovasc Imaging. 2015 Feb;31(2):437-45. doi: 10.1007/s10554-014-0567-9. Epub 2014 Dec 2.
Osteoporosis and cardiovascular disease often coexist. Vertebral fractures incidentally imaged in the course of routine care might be able to contribute to the prediction of cardiovascular events. Following a case-cohort design, 5,679 patients undergoing chest CT were followed for a median duration of 4.4 years. Cases were defined as patients who subsequently developed a cardiovascular event (n = 493). The presence and severity of vertebral fractures, as well as aortic, coronary and valvular calcifications on CT were investigated. Cases were more likely to be male (69 vs 60 %) and older (66 vs 61 years old). Prevalent vertebral fractures conferred an elevated risk of cardiovascular events after adjustment for age and gender [hazard ratio (HR) of 1.28, 95 % confidence interval (CI) 1.07 to 1.54]. This effect remained moderate after correction for cardiovascular calcifications (HR 1.20, CI 0.99-1.44). However, in terms of discrimination, vertebral fractures did not have substantial incremental prognostic value after correction (C-index was 0.683 vs 0.682 for models with and without vertebral fractures respectively). Prevalent vertebral fractures on routine clinical chest CT are related to future cardiovascular events but do not have additional prognostic value to models that already include age, gender and cardiovascular calcifications.
骨质疏松症和心血管疾病常常并存。在常规护理过程中偶然成像的椎体骨折可能有助于预测心血管事件。采用病例队列设计，对5679例接受胸部CT检查的患者进行了为期4.4年的中位随访。病例定义为随后发生心血管事件的患者（n = 493）。研究了椎体骨折的存在和严重程度，以及CT上的主动脉、冠状动脉和瓣膜钙化情况。病例组男性比例更高（69%对60%）且年龄更大（66岁对61岁）。在调整年龄和性别后，现患椎体骨折使心血管事件风险升高[风险比（HR）为1.28，95%置信区间（CI）为1.07至1.54]。在校正心血管钙化后，这种效应仍为中等程度（HR 1.20，CI 0.99 - 1.44）。然而，在鉴别能力方面，校正后椎体骨折没有显著的增量预后价值（有和无椎体骨折模型的C指数分别为0.683和0.682）。常规临床胸部CT上的现患椎体骨折与未来心血管事件相关，但对于已经包含年龄、性别和心血管钙化的模型没有额外的预后价值。
