Aortic arch calcification: a new predictor for inconclusive Coronary CT angiography and coronary artery disease. (4th February 2022)

• Record Type: Journal Article
• Authors: Paredes Hurtado, N; Carnero Montoro, L; Gonzalez Manzanares, R; Rodriguez Nieto, J; Perea Armijo, J; Gallo Fernandez, I; Pastor Wulf, D; Lopez Baizan, J; Heredia Campos, G; Fernandez Aviles, C; Resua Collado, A; Ruiz Ortiz, M; Espejo Perez, S; Mesa Rubio, MD; Pan Alvarez, M
• Is Part Of: European heart journal. Volume 23(2022)Supplement 1
• Publication Date: 2022-02-04
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeab289.408
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Objective: Coronary CT angiography (CTA) remains as the technique of choice to rule out coronary artery disease (CAD) in symptomatic patients with intermediate-low risk. Despite its sensitivity, numerous artifacts that reduce its accuracy have been described, as well as factors related to CAD. The presence of calcium in the aortic arch (AoA) on the chest radiography (CXR) is an accessible and highly available finding in this patients and to our knowledge it have not been studied at this scenario. Our aim is to evaluate the presence of AoA as a new CTA artifact and predictor of significant coronary lesions. Materials and methods: We conducted an observational descriptive single-center study of patients who underwent CTA to rule out CAD from July 1st to December 31st of 2020. Patients without CXR were excluded. We evaluated the presence of AoA in the postero-anterior CXR. The results of the CTA were classified into 4 categories: absence of lesions, non-significant lesions, significant lesions and inconclusive study due to artifacts. Results: 251 patients were included, mean age 60 ± 12 years, 51% males, 24% diabetics, 57% hypertensive, 13% smokers, 45% dyslipidemic. 18% presented AoA in the CXR. Mean heart rate (HR) was 60 ± 16 bpm. The results of the CTA were: 45% absense of lesions, 26% non-significant lesions, 17% significant lesions and 12% inconclusive due to artifacts. Patients with AoA presented a greater probability of inconclusive CTA and significant coronary lesions both in the univariate analysis and when adjusted for age, sex and HR [OR = 3.2 (1.2-8.1), p = 0.017 ] and [OR = 3.7 (1.5-8.7), p = 0.003] respectively. Conclusions: Calcification of the aortic arch on chest radiography is an independent factor of inconclusive CTA and significant coronary lesions with a 3.2 and 3.7 fold higher risk compared to those who do not present this finding