Relationship between Abdominal Aortic Calcification by Plain Lateral Lumbar X-ray and CT-based Coronary Artery Calcification in Chronic Kidney Disease Patients
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Abstract
Background : The presence and severity of cardiovascular calcifications strongly predict cardiovascular mortality in patients with chronic kidney disease (CKD). Most studies examining calcification in CKD patients use computed tomographic (CT)-based techniques to detect coronary artery calcification (CAC); which is relatively expensive. This study focuses on testing whether lateral abdominal radiographs, which are widely available, less costly, could be used instead of CT imaging.
Methods : A cross-sectional study was done in pre-dialysis CKD patients in Bhumibol Adulyadej Hospital, Royal Thai Air Force. All participants were investigated by CT-based CAC scores and lateral plain film of the lumbosacral (LS) region to detect abdominal aortic calcification (AAC) scores within 3 months following enrolment. Medical data were collected from patients and medical records.
Results : A total of 70 patients (44 males, 26 females), aged 70.59+10.16 years were enrolled in this study. There was a significant association between CT-based CAC scores and plain film-based AAC scores. The correlation coefficient (r) between CAC scores and 4 scales AAC, 8 scales AAC and 24 scales AAC was 0.399 (p=0.001), 0.364 (p=0.002) and 0.385 (p=0.001), respectively. The CAC scores > 400, which is considered to be a good predictor of cardiovascular mortality, was chosen to be tested with various AAC scores. It was shown that CAC scores > 400 has strong correlation with AAC > 2 in 4 scales AAC (sensitivity = 93.5 %, specificity = 59 %, area under the curve (AUC) = 0.783), AAC > 3 in 8 scales AAC (sensitivity = 83.9 %, specificity = 64.1 %, AUC = 0.766), and
AAC > 4 in 24 scales AAC (sensitivity = 87.1 %, specificity = 71.8 %, AUC = .799). There was also a good correlation between each AAC scales.
Conclusion : Abdominal aortic calcification detected by lateral abdominal radiographs could be used instead of CT-based coronary calcification scores. Prognostic value of the abdominal aortic calcification in this population should be determined in large scale, prospective cohort studies.
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