title: Prediction of coronary artery disease by a systemic atherosclerosis score index derived from whole-body MR angiography.
abstract: BACKGROUND
  Whole-body magnetic resonance angiography (WB-MRA) has shown its potential for the non-invasive assessment of nearly the entire arterial vasculature within one examination. Since the presence of extra-cardiac atherosclerosis is associated with an increased risk of coronary events, our goal was to establish the relationship between WB-MRA findings, including a systemic atherosclerosis score index, and the presence of significant coronary artery disease (CAD).
  
  
  METHODS
  WB-MRA was performed on a 1.5T scanner in 50 patients scheduled to undergo elective cardiac catheterization for suspected CAD. In each patient, 40 extra-cardiac vessel segments were evaluated and assigned scores according to their luminal narrowing. The atherosclerosis score index (ASI) was generated as the ratio of summed scores to analyzable segments.
  
  
  RESULTS
  ASI was higher in patients with significant (> 50% stenosis) CAD (n = 27) vs. patients without CAD (n = 22; 1.56 vs. 1.28, p = 0.004). ASI correlated with PROCAM (R = 0.57, p < 0.001) and Framingham (R = 0.36, p = 0.01) risk scores as estimates of the 10-year risk of coronary events. A ROC derived ASI of > 1.54 predicted significant CAD with a sensitivity of 59%, specificity of 86% and a positive predictive value of 84%. Logistic regression revealed ASI > 1.54 as the strongest independent predictor for CAD with a 11-fold increase in likelihood to suffer from significant coronary disease. On the contrary, while 15/27 (55%) of patients with CAD exhibited at least one extra-cardiac stenosis > 50%, only 3/22 (14%) of those patients without CAD did (p = 0.003). The likelihood for an extra-cardiac stenosis when CAD is present differed between vascular territories and ranged from 15% for a carotid stenosis to 44% for a stenosis in the lower extremities.
  
  
  CONCLUSIONS
  This study provides important new evidence for the close association of extra-cardiac and coronary atherosclerosis. The novel findings that a WB-MRA derived systemic atherosclerosis score index is not only associated with established cardiovascular risk scores but is also predictive of significant CAD suggest its potential prognostic implications and underline the importance to screen for coronary disease in patients with extra-cardiac manifestations of atherosclerosis.
authors.affiliation: Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany. stephanie.lehrke@med.uni-heidelberg.de
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lehrke
authors.forename: Benjamin
authors.initials: B
authors.lastname: Egenlauf
authors.forename: Henning
authors.initials: H
authors.lastname: Steen
authors.forename: Dirk
authors.initials: D
authors.lastname: Lossnitzer
authors.forename: Grigorius
authors.initials: G
authors.lastname: Korosoglou
authors.forename: Constanze
authors.initials: C
authors.lastname: Merten
authors.forename: Boris T
authors.initials: BT
authors.lastname: Ivandic
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
mesh_terms: D000842:Ankle / Q000098:blood supply; D050197:Atherosclerosis / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D006328:Cardiac Catheterization; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D051598:Whole Body Imaging / Q000379:methods*