title: Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease.
abstract: OBJECTIVE
  To evaluate the correlation between aortic root calcification (ARC) markers and coronary artery calcification (CAC) derived from coronary artery calcium scoring (CACS) and their ability to predict obstructive coronary artery disease (CAD).
  
  
  METHODS
  We retrospectively analyzed 189 patients (47% male, age 60.3 ± 11.1 years) with an intermediate probability of CAD who underwent clinically indicated CACS and coronary CT angiography (CCTA). ARC markers [aortic root calcium score (ARCS) and volume (ARCV)] were calculated and compared to CAC markers: coronary artery calcium score (CACS), volume (CACV), and mass (CACM). CCTA datasets were visually evaluated for significant CAD (stenosis ≥ 50%) and the ability of ARC markers to predict obstructive CAD was assessed.
  
  
  RESULTS
  ARCS (mean 67.7 ± 189.5) and ARCV (mean 67.3 ± 184.7) showed significant differences between patients with and without CAC (109.4 ± 238.6 vs 9.42 ± 31.4, p < 0.0001; 108.5 ± 232.4 vs 9.9 ± 30.5, p < 0.0001). A strong correlation was found for ARCS and ARCV with CACS, CACM, and CACV (all p < 0.0001). In a multivariate analysis, ARCS (OR 1.09, p = 0.033) and ARCV (OR 1.12, p = 0.046) were independent markers for CAC. Using a receiver-operating characteristics analysis, the AUC to detect severe CAC was 0.71 (p < 0.0001) and 0.71 (p < 0.0001) for ARCS and ARCV, respectively. ARCS (0.67, p < 0.0001) and ARCV (0.68, p < 0.0001) showed discriminatory power for predicting obstructive CAD, yielding sensitivities 61 and 78% and specificities of 62 and 80%, respectively.
  
  
  CONCLUSIONS
  ARC markers are associated with and independently predict the presence of CAC and obstructive CAD. Further testing is required in patients with severe ARC and significant CAD in order to reliably obtain these markers from thoracic-CT or X-ray for proper risk classification.
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.|Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Tesche
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.|Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stubenrauch
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Jacobs
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Akos
authors.initials: A
authors.lastname: Varga-Szemes
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: B Devon
authors.initials: BD
authors.lastname: Ball
authors.affiliation: Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Baquet
authors.affiliation: Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Jochheim
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.|Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA. schoepf@musc.edu.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29403, USA. schoepf@musc.edu.
authors.forename: U Joseph
authors.identifier: http://orcid.org/0000-0002-6164-5641
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*
keywords: Aortic root calcification; Coronary artery calcium score; Coronary artery disease; Coronary computed tomographic angiography