title: Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events.
abstract: BACKGROUND
  There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events.
  
  
  OBJECTIVE
  To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events.
  
  
  METHODS
  One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis.
  
  
  RESULTS
  Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events.
  
  
  CONCLUSIONS
  Patients with increased thoracic AWTmax on chest MDCT could be considered at risk for CCV disease.
authors.affiliation: Servizio di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Milan, Italy silvia.3soldi@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tresoldi
authors.affiliation: Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Unità di Radiologia, Ospedale San Carlo Borromeo, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zoffoli
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Munari
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Primolevo
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Cornalba
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media
keywords: Aorta; atherosclerosis; cardiovascular diseases; cerebrovascular insufficiency; multidetector computed tomography (MDCT); risk factors