Harlianto Netanja I, Mohamed Hoesein Firdaus A A, Mali Willem P T H, Hol Marjolein E, Hazenberg Constantijn E V B, van Herwaarden Joost A, Foppen Wouter, de Jong Pim A
Department of Radiology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands.
Department of Vascular Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
Int J Cardiovasc Imaging. 2025 Jun 2. doi: 10.1007/s10554-025-03435-5.
Thoracic aortic calcifications (TAC) are a common finding in medical imaging. We assessed the association between TAC on chest radiographs and major adverse limb events (MALE), other cardiovascular outcomes, and mortality in cardiovascular disease patients. A total of 4680 patients were included from the prospective Utrecht Cardiovascular Cohort-Second Manifestation of ARTerial disease cohort. TAC severity was classified based on chest radiographs by certified readers as mild, moderate, and severe. Multivariate cox proportional hazard models were utilized to assess associations between TAC and incident MALE defined as major amputation, peripheral revascularization or thrombolysis in the lower limb. Secondary endpoints included major adverse cardiovascular events (MACE: stroke, myocardial infarction, and vascular death), and all-cause mortality. A total of 4680 patients were included. TAC was present in 1789 (38%) patients. After a median follow-up of 11.8 years (interquartile range: 7.6-15.7 years), 426 MALE, 992 MACE, and 1387 deaths occurred. TAC presence was associated with incident MALE after adjustments, (hazard ratio (HR):2.14;95%CI:1.73-2.65) and this risk increased with TAC severity (HR: 1.97; 95%CI:1.51-2.57, HR: 2.04; 95%CI:1.56-2.68, and HR: 2.71; 95%CI: 2.02-3.65). Moreover, TAC was associated with incident MACE (HR:1.22;95%CI:1.06-1.40), ischemic stroke (HR: 1.45; 95%CI: 1.11-1.91), and vascular death (HR: 1.35; 95%CI: 1.13-1.63). TAC was only associated with all-cause mortality (HR:1.34;95%CI:1.18-1.52) in patients who experienced a previous cardiovascular event. In cardiovascular disease patients, TAC on chest radiographs is associated with an increased risk for incident MALE. In addition, we found that TAC was associated with incident ischemic stroke, MACE and all-cause mortality.
胸主动脉钙化（TAC）是医学影像检查中常见的表现。我们评估了胸部X线片上的TAC与主要不良肢体事件（MALE）、其他心血管结局以及心血管疾病患者死亡率之间的关联。前瞻性乌得勒支心血管队列研究——动脉疾病的第二次表现队列共纳入了4680例患者。由经过认证的阅片者根据胸部X线片将TAC严重程度分为轻度、中度和重度。采用多变量Cox比例风险模型评估TAC与定义为下肢大截肢、外周血管重建或溶栓的新发MALE之间的关联。次要终点包括主要不良心血管事件（MACE：中风、心肌梗死和血管性死亡）以及全因死亡率。共纳入4680例患者。1789例（38%）患者存在TAC。中位随访11.8年（四分位间距：7.6 - 15.7年）后，发生了426例MALE、992例MACE和1387例死亡。调整后，TAC的存在与新发MALE相关（风险比（HR）：2.14；95%置信区间：1.73 - 2.65），且这种风险随TAC严重程度增加（HR：1.97；95%置信区间：1.51 - 2.57，HR：2.04；95%置信区间：1.56 - 2.68，以及HR：2.71；95%置信区间：2.02 - 3.65）。此外，TAC与新发MACE（HR：1.22；95%置信区间：1.06 - 1.40）、缺血性中风（HR：1.45；95%置信区间：1.11 - 1.91）和血管性死亡（HR：1.35；95%置信区间：1.13 - 1.63）相关。仅在既往有心血管事件的患者中，TAC与全因死亡率相关（HR：1.34；95%置信区间：1.18 - 1.52）。在心血管疾病患者中，胸部X线片上的TAC与新发MALE风险增加相关。此外，我们发现TAC与新发缺血性中风、MACE和全因死亡率相关。
