The role of cardiothoracic ratio in predicting coronary artery atherosclerosis in young adult patients

Year 2024, Volume: 5 Issue: 3, 182 - 187, 28.06.2024

Semih Sağlık

https://doi.org/10.47582/jompac.1491752

Abstract

Aims: This study aimed to determine the role of cardiothoracic ratio in predicting coronary atherosclerosis in young adult patients.
Methods: In this single-center retrospective study, young adult patients who underwent coronary computed tomography angiography (CTA) with suspicion of coronary artery disease between October 2022 and May 2024 were included. Demographic and clinical histories of all patients were determined from the medical record system. Coronary artery calcium scores (CACSc) and cardiothoracic ratios (CTR) of the patients in question were calculated and recorded from the coronary CTA images.
Result: A total of 264 young adult patients under the age of 45, with an average age of 42.2±3.1 years, were included in this study. The patients included in the study were divided into two groups according to the presence of atherosclerotic calcific plaque in coronary CTA. Smoking history, hyperlipidemia, hypertension and diabetes mellitus history were significantly different in the two patient groups (for all, p<0.05). In univariate regression analysis, hyperlipidemia, diabetes mellitus, hypertension, smoking history and high CTR values were determined as risk factors for coronary atherosclerotic calcific plaque.
Conclusion: Our findings show that the risk of coronary atherosclerosis is high in young adult patients with CTR values above 0.5150.

Keywords

Cardiothoracic ratio, Coronary Artery Calcium Score, Atherosclerotic Plaque, Coronary Computed Tomography Angiography

Genç erişkin hastalarda koroner arter aterosklerozunu öngörmede kardiyotorasik oranın rolü

Abstract

Amaç: Bu çalışmada, genç erişkin hastalarda koroner atherosklerozu tahmin etmede kardiyotorasik oranın rolünün belirlenmesi amaçlanmıştır.
Hastalar ve Yöntemler: Bu tek merkezli retrospektif çalışmada Ekim 2022-Mayıs 2024 tarihleri arasında koroner arter hastalığı şüphesi ile koroner bilgisayarlı tomografi anjiyografi (CTA) çekimi yapılan genç erişkin hasta dâhil edilmiştir. Tüm hastaların demografik ve klinik özgeçmişleri tıbbı kayıt sisteminden belirlendi. Söz konusu hastaların koroner arter kalsiyum skorları (CACSc) ve kardiyotorasik oranları (CTR) koroner CTA görüntüleri üzerinden hesaplanıp kayıt altına alındı.
Bulgular: Bu çalışmaya, yaş ortalaması 42,2±3,1 yıl olan 45 yaş altı toplam 264 genç erişkin hasta dahil edildi. Çalışmaya dahil edilen hastalar coroner CTA’da aterosklerotik kalsifik plak varlığına göre iki gruba ayrıldı. Sigara kullanım öyküsü, hyperlipidemia, hipertansiyon ve diabetes mellitus öyküsü iki hasta grubunda anlamlı derecede farklıydı (hepsi için, p<0.05). Tek değişkenli regrasyon analizde hyperlipidemia, diabetes mellitus, hipertansiyon, sigara kullanım öyküsü ve yüksek CTR değerleri koroner aterosklerotik kalsifik plak için risk faktörleri olarak belirlendi. Çok değişkenli regresyon analizde ise sigara kullanım öyküsü (p=0.001, OR: 1.55; 95% confidence interval (CI), 0.819-2.93) ve 0.5150 üstündeki CTR değerleri (p <0.001, OR: 45.8; 95% confidence interval (CI), 14.5-144.4) koroner aterosklerotik kalsifik plak ile bağımsız olarak ilişkili oldukları belirlendi.
Sonuç: Bulgularımız, CTR değerleri 0.5150 üzerinde olan genç yetişkin hastalarda koroner atheroskleroz riskinin yüksek olduğunu göstermektedir.

Keywords

Kardiyotorasik Oran, Koroner Arter Kalsiyum Skoru, Aterosklerotik Plak, Koroner Bilgisayarlı Tomografi Anjiyografi

References

• Lippi G, Favaloro E, Sanchis-Gomar F. Sudden cardiac andnoncardiac death in sports: epidemiology, causes, pathogenesis,and prevention. Semin Thromb Hemost. 2018:44:780-786.
• Wong ND, Hsu JC, Detrano RC, Diamond G, EisenbergH, Gardin JM. Coronary artery calcium evaluation byelectron beam computed tomography and its relation to newcardiovascular events. Am J Cardiol. 2000:86:495-8.
• Budoff, Matthew J., et al. “Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA).” European heart journal. (2018):2401-2408.
• Garcia-Garcia, Hector M., et al. “Imaging plaques to predict and better manage patients with acute coronary events.” Circulation research 114.12(2014):1904-1917.
• Tang W, Shen X, Li H, et al. The independent and incremental value of ultrasound carotid plaque length to predict the presence and severity of coronary artery disease: analysis from the carotid plaque length prospective registry. Eur Heart J Cardiovasc Imaging. 2020:21(4),389-396.
• Danzer CS. The cardiothoracic ratio. Am J Med Sci. 1919;157, 513–554.
• Kearney MT, Fox KA, Lee AJ, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol. 2002:40,1801-1808
• Gollub MJ, Panu N, Delaney H, et al. Shall we report cardiomegaly at routine computed tomography of the chest? J Comput Assist Tomogr. 2012:36(1):67-71.
• Yotsueda R, Taniguchi M, Tanaka S, et al. Cardiothoracic ratio and all-cause mortality and cardiovascular disease events in hemodialysis patients: The Q-Cohort Study. AJKD. 2017:70,84-92.
• Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. JACC. 1990:15(4),827-832.
• Miller JA. Cardiac dimensions derived fromm helical CT: correlation with plain film radiography. Internet J Radiol. 2000; 2020;1(1).
• Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. JACC. 2018; 72(4)434-447.
• Mortensen MB, Blaha MJ. Is there a role of coronary CTA in primary prevention? Current state and future directions. Curr Atheroscler Rep. 2021;23(8),44.
• Patil VC, Avhad AB, Kulkarni AR, Pandere KA. High-sensitive C-reactive protein in patients with coronary artery disease. J Nat Sci Biol Med. 2020;11(1)39.
• Luo H, Kou T, Yin L. High-Sensitivity C-Reactive Protein to HDL-C Ratio a predictor of coronary artery disease. Int Heart J. 2021; 62(6),1221-1229.
• Liu D, Du C, Shao W, Ma G. Diagnostic role of carotid intima-media thickness for coronary artery disease: a meta-analysis. Biomed Res Int. 2020:9879463. doi: 10. 1155 / 2020/ 9879463
• Bytyçi I, Shenouda R, Wester P, Henein MY. Carotid atherosclerosis in predicting coronary artery disease: a systematic review and meta-analysis. ATVB. 2021;41(4), e224- e237.
• Sang T, Lv N, Dang A, Cheng N, Zhang W. Brachial-ankle pulse wave velocity and prognosis in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis. J Hypertens. 2021;44(9),1175-1185.
• van Hout MJ, Dekkers IA, Westenberg JJ, et al. Normal and reference values for cardiovascular magnetic resonance-based pulse wave velocity in the middle-aged general population. JCMR. 2021;23(1),46.
• Xu C, Tian Q, Yu H, Ge W, Zheng H, Huang D. Predictive value of the ankle-brachial index for all-cause and cardio-cerebrovascular mortality. Angiology. 2023;74(7),649-656.
• Elasan S, Yilmaz O. Cardiothoracic ratio and left ventricular ejection fraction relationship: A meta-analysis study. Saudi Med J. 2023;44(6),529.
• Felker GM, Shaw LK, O’Connor CM. a standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002;39:210–218.
• Chareonthaitawee P, Christian TF, Hirose K, Gibbons RJ, Rumberger JA. Relation of initial infarct size to extent of left ventricular remodeling in the year after acute myocardial infarction. J Am Coll Cardiol. 1995;25:567-573.
• Truszkiewicz K, Poręba R, Gać P. Radiological cardiothoracic ratio in evidence-based medicine. J Clin Med. 2021;10(9),2016.
• Hsu HJ, Wu IW, Hsu KH, Sun CY, Chen CY, Lee CC. Vitamin D deficiency, cardiothoracic ratio, and long-term mortality in hemodialysis patients. Sci Rep. 2020;10(1)7533.
• Ito K, Ookawara S, Ueda Y, et al. A higher cardiothoracic ratio is associated with 2-year mortality after hemodialysis initiation. Nephron Extra. 2015;5(3),100-110.
• Eslami V, Abrishami A, Zarei E, Khalili N, Baharvand Z, Sanei-Taheri M. The association of CT-measured cardiac indices with lung involvement and clinical outcome in patients with COVID-19. Acad Radiol. 2021;28(1),8-17.
• Wilhelmsen L. Cardiothoracic ratio and relative heart volume as predictors of coronary heart disease mortality. Eur Heart J. 1998;19(6),826-827.
• Treasure CB, Klein JL, Vita JA, et al. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels. Circulation. 1993;87(1),86-93.
• Gao P, Wen X, Ou Q, Zhang J. Which one of LDL-C/HDL-C ratio and non-HDL-C can better predict the severity of coronary artery disease in STEMI patients. BMC Cardiovasc Disord.2022;22(1),318.
• Rodgers JL, Jones J, Bolleddu SI, et al. Cardiovascular Risks Associated with Genderand Aging. J Cardiovasc Dev Dis.2019; 1;6(2).
• Zeitouni M, Clare RM, Chiswell K, et al. Risk factor burden and long‐term prognosis of patients with premature coronary artery disease. J Am Heart Assoc. 2020;9(24), e017712.
• Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. NEJM. 1997;336(18),1276-1282.
• Javaid A, Mitchell JD, Villines TC. Predictors of coronary artery calcium and long‐term risks of death, myocardial infarction, and stroke in young adults. J Am Heart Assoc. 2021;10(22), e022513.
• Loria CM, Liu K, Lewis CE, et al. Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA study. J Am Coll Cardiol. 2007;49:2013-2020.
• Budoff M, Backlund JYC, et al. The association of coronary artery calcification with subsequent incidence of cardiovascular disease in type 1 diabetes: the DCCT/EDIC trials. J Am Coll Cardiol Img. 2019;12(7 Part 2)1341-1349.
• Goldberg RB, Stone NJ, Grundy SM. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol in Diabetes. Diabetes care.2020;43(8),1673-1678.
• Nezarat N, Budoff MJ, Luo Y, et al. Presence, characteristics, and volumes of coronary plaque determined by computed tomography angiography in young type 2 diabetes mellitus. Am J Cardiol. 2017;119(10),1566-1571.
• Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25),e1082-e1143.
• De Ferranti SD, Steinberger J, Ameduri R, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association. Circulation. 2019;139(13),e603-e634.
• Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical
• Practice Guidelines. Circulation. 2019;140(11),e596-e646. Stone NJ, Smith Jr SC, Orringer CE, et al. Managing atherosclerotic cardiovascular risk in young adults: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(8),819-836.
• Gaeta G, Cuomo S, Capozzi G,et al. Lipoprotein(a) levels are increased in healthy young subjects with parental history of premature myocardial infarction. Nutr Metab Cardiovasc Dis. 2008;18:492–496.
• Boren J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020;41(24),2313-2330.
• Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108:364-369
• Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000;342(7),454-460.
• Kang J, Chang Y, Kim S, Sung KC, Shin H, Ryu S. Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atheroscler. 2019;282,188-195.