Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial
© 2023. The Author(s)..
OBJECTIVES: Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality.
METHODS: In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach.
RESULTS: Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality.
CONCLUSIONS: Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile.
KEY POINTS: • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
European radiology - 33(2023), 5 vom: 28. Mai, Seite 3115-3123 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mascalchi, Mario [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiovascular disease |
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| Anmerkungen: |
Date Completed 25.04.2023 Date Revised 02.11.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00330-023-09504-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM353609005 |
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| 041 | |a eng | ||
| 100 | 1 | |a Mascalchi, Mario |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 25.04.2023 | ||
| 500 | |a Date Revised 02.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a OBJECTIVES: Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality | ||
| 520 | |a METHODS: In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach | ||
| 520 | |a RESULTS: Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality | ||
| 520 | |a CONCLUSIONS: Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile | ||
| 520 | |a KEY POINTS: • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiovascular disease | |
| 650 | 4 | |a Cause of death | |
| 650 | 4 | |a Lung neoplasm | |
| 650 | 4 | |a Pulmonary emphysema | |
| 650 | 4 | |a Smokers | |
| 700 | 1 | |a Romei, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Marzi, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Diciotti, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Picozzi, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Pistelli, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Zappa, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Paci, Eugenio |e verfasserin |4 aut | |
| 700 | 1 | |a Carozzi, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Gorini, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Falaschi, Fabio |e verfasserin |4 aut | |
| 700 | 1 | |a Deliperi, Anna Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Camiciottoli, Gianna |e verfasserin |4 aut | |
| 700 | 1 | |a Carrozzi, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Puliti, Donella |e verfasserin |4 aut | |
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