title: Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?
abstract: OBJECTIVE
  Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings.
  
  
  METHODS
  A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification.
  
  
  RESULTS
  During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).
  
  
  CONCLUSIONS
  Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans.
  
  
  CONCLUSIONS
  • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, pjairam@umcutrecht.nl.
authors.forename: Pushpa M
authors.initials: PM
authors.lastname: Jairam
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Ivana
authors.initials: I
authors.lastname: Isgum
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D014057:Tomography, X-Ray Computed / Q000379:methods*