Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome: Part I Cardiovascular Findings.

There are physiological consequences of overeating that can lead to increased morbidity and mortality. The purpose of this review article is to acquaint the reader with the current state of the art in the non-cardiac-gated, noncontrast chest computed tomographic (NCCT) imaging biomarkers of the metabolic syndrome and their prognostic significance found in the lower neck and chest. NCCT imaging biomarkers associated with metabolic syndrome in the chest include premature coronary artery calcification, acceleration of large vessel arterial and valvular calcifications associated with atherosclerosis, and pulmonary arterial enlargement from pulmonary hypertension associated with sleep apnea. These easily identified imaging biomarkers have prognostic implications for major adverse cardiac events (MACE). These NCCT chest-imaging biomarkers are likely targets for artificial intelligence algorithms to harvest for longitudinal assessment of their individual and multifactorial contributions to chronic disease, MACE, and mortality. Early recognition and treatment of these common disorders may help improve patient outcomes and quality of life while decreasing medical costs.

[1]  S. Grundy,et al.  Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International As , 2009, Circulation.

[2]  S. Abbara Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups , 2008 .

[3]  Harry J de Koning,et al.  Lung cancer screening CT-based prediction of cardiovascular events. , 2013, JACC. Cardiovascular imaging.

[4]  E. V. van Beek,et al.  Validation of an imaging based cardiovascular risk score in a Scottish population. , 2018, European journal of radiology.

[5]  D. Grobbee,et al.  Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events. , 2014, Radiology.

[6]  M. P. Hayball,et al.  Impact of motion artefact on the measurement of coronary calcium score. , 2000, The British journal of radiology.

[7]  P. Araoz,et al.  Imaging of chronic thromboembolic pulmonary hypertension. , 2005, Seminars in roentgenology.

[8]  Maurice B. Bizino,et al.  MR of multi-organ involvement in the metabolic syndrome. , 2015, Magnetic resonance imaging clinics of North America.

[9]  J. Schwimmer Definitive diagnosis and assessment of risk for nonalcoholic fatty liver disease in children and adolescents. , 2007, Seminars in liver disease.

[10]  T. Brady,et al.  Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden: from the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial. , 2009, American heart journal.

[11]  K. Yaffe,et al.  Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis , 2017, JAMA neurology.

[12]  Atul Padole,et al.  Submillisievert chest CT with filtered back projection and iterative reconstruction techniques. , 2014, AJR. American journal of roentgenology.

[13]  A. Marotta,et al.  Gender‐specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea , 2014, Journal of sleep research.

[14]  S. Ng,et al.  Effects of heart rate on motion artifacts of the aorta on non-ECG-assisted 0.5-sec thoracic MDCT. , 2005, AJR. American journal of roentgenology.

[15]  T. Lehtimäki,et al.  Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study. , 2015, European heart journal cardiovascular Imaging.

[16]  I. Amat-Santos,et al.  Coronary artery and aortic valve calcification evaluated with cardiac computed tomography in patients with chest pain: Prognostic value in clinical practice. , 2016, International journal of cardiology.

[17]  D. Levy,et al.  Mitral Annular Calcification Predicts Cardiovascular Morbidity and Mortality: The Framingham Heart Study , 2003, Circulation.

[18]  F. Lopez‐Jimenez,et al.  Abnormal cardiac structure and function in the metabolic syndrome: a population-based study. , 2008, Mayo Clinic proceedings.

[19]  E. Bleecker,et al.  Plasma interleukin-6 concentrations, metabolic dysfunction, and asthma severity: a cross-sectional analysis of two cohorts. , 2016, The Lancet. Respiratory medicine.

[20]  M. Budoff,et al.  Risk stratification of non-contrast CT beyond the coronary calcium scan. , 2012, Journal of cardiovascular computed tomography.

[21]  J. Austin,et al.  Aortic valve calcification as an incidental finding at CT of the elderly: severity and location as predictors of aortic stenosis. , 2006, AJR. American journal of roentgenology.

[22]  Ming-Ting Wu,et al.  Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: concordance study with dedicated cardiac CT. , 2008, AJR. American journal of roentgenology.

[23]  Umaira Ikram,et al.  Relationship of Coronary Calcium on Standard Chest CT Scans With Mortality. , 2016, JACC. Cardiovascular imaging.

[24]  W. Mali,et al.  The association of incidentally detected heart valve calcification with future cardiovascular events , 2010, European Radiology.

[25]  D. Torigian,et al.  Tongue fat and its relationship to obstructive sleep apnea. , 2014, Sleep.

[26]  C. Fox,et al.  Axial area and anteroposterior diameter as estimates of left atrial size using computed tomography of the chest: comparison with 3-dimensional volume. , 2010, Journal of cardiovascular computed tomography.

[27]  P. Śliwiński,et al.  Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study. , 2016, Polskie Archiwum Medycyny Wewnetrznej.

[28]  R. Günther,et al.  MDCT detection of mitral valve calcification: prevalence and clinical relevance compared with echocardiography. , 2007, AJR. American journal of roentgenology.

[29]  Filippo Cademartiri,et al.  Under-reporting of cardiovascular findings on chest CT , 2016, La radiologia medica.

[30]  S. Achenbach,et al.  Detecting human coronary inflammation by imaging perivascular fat , 2017, Science Translational Medicine.

[31]  S. Moebus,et al.  Noncoronary Measures Enhance the Predictive Value of Cardiac CT Above Traditional Risk Factors and CAC Score in the General Population. , 2016, JACC. Cardiovascular imaging.

[32]  M. Budoff,et al.  Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium: The Multi-Ethnic Study of Atherosclerosis (MESA). , 2017, Atherosclerosis.

[33]  A. Yan,et al.  Prognostic value of visually detected coronary artery calcification on unenhanced non-gated thoracic computed tomography for prediction of non-fatal myocardial infarction and all-cause mortality. , 2017, Journal of cardiovascular computed tomography.

[34]  Klaus Mann,et al.  Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. , 2010, Journal of the American College of Cardiology.

[35]  Wolfgang Kratzer,et al.  Prevalence of non-alcoholic fatty liver and characteristics in overweight adolescents in the general population , 2007, European Journal of Epidemiology.

[36]  A. Leung,et al.  Left Atrium Maximal Axial Cross-Sectional Area is a Specific Computed Tomographic Imaging Biomarker of World Health Organization Group 2 Pulmonary Hypertension , 2017, Journal of thoracic imaging.

[37]  M. Criqui,et al.  Comparison of ordinal versus Agatston coronary calcification scoring for cardiovascular disease mortality in community-living individuals , 2014, The International Journal of Cardiovascular Imaging.

[38]  Diagnostic accuracy of standard axial 64-slice chest CT compared to cardiac MRI for the detection of cardiomyopathies. , 2016, The British journal of radiology.

[39]  G. Lip,et al.  Mitral annular calcification predicts cardiovascular morbidity and mortality in middle-aged patients with atrial fibrillation: the Belgrade Atrial Fibrillation Study. , 2011, Chest.

[40]  M. Whooley,et al.  Mitral annular calcium, inducible myocardial ischemia, and cardiovascular events in outpatients with coronary heart disease (from the Heart and Soul Study). , 2012, The American journal of cardiology.

[41]  M. Budoff,et al.  2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. , 2017, Journal of cardiovascular computed tomography.

[42]  U. Hoffmann,et al.  Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection. , 2018, Radiology.

[43]  L. Edwards,et al.  Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality , 2014, Thorax.

[44]  M. Budoff,et al.  2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary , 2010 .

[45]  Raúl San José Estépar,et al.  Automated Agatston score computation in a large dataset of non ECG-gated chest computed tomography , 2016, 2016 IEEE 13th International Symposium on Biomedical Imaging (ISBI).

[46]  Raúl San José Estépar,et al.  Cardiac Morphometry on Computed Tomography and Exacerbation Reduction with &bgr;‐Blocker Therapy in Chronic Obstructive Pulmonary Disease , 2017, American journal of respiratory and critical care medicine.

[47]  H. Minuk,et al.  Metabolic syndrome. , 2005, Journal of insurance medicine.

[48]  G. Boysen,et al.  European Guidelines on Cardiovascular Disease Prevention , 2009, International journal of stroke : official journal of the International Stroke Society.

[49]  Udo Hoffmann,et al.  Reference Values for Normal Pulmonary Artery Dimensions by Noncontrast Cardiac Computed Tomography: The Framingham Heart Study , 2012, Circulation. Cardiovascular imaging.

[50]  R. Sacco,et al.  Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study. , 2008, JACC. Cardiovascular imaging.

[51]  T. Miyati,et al.  Measurement of gantry rotation time in modern ct , 2014, Journal of applied clinical medical physics.

[52]  G. Mcneill,et al.  Mitral annulus calcification , 1990, The British journal of clinical practice.

[53]  Shah Ebrahim,et al.  European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) , 2012, International Journal of Behavioral Medicine.

[54]  Kyung Soo Lee,et al.  Coronary calcium screening using low-dose lung cancer screening: effectiveness of MDCT with retrospective reconstruction. , 2008, AJR. American journal of roentgenology.

[55]  Edward Y Lee,et al.  Motion artifact on high-resolution CT images of pediatric patients: comparison of volumetric and axial CT methods. , 2009, AJR. American journal of roentgenology.

[56]  International Association for the Study of Obesity , 2018, The Grants Register 2019.

[57]  H. D. de Koning,et al.  Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population , 2015, The International Journal of Cardiovascular Imaging.

[58]  David F Yankelevitz,et al.  Coronary artery calcification on low-dose computed tomography: comparison of Agatston and Ordinal Scores. , 2015, Clinical imaging.

[59]  T. Nakamoto Sleep-Disordered Breathing-a Real Therapeutic Target for Hypertension, Pulmonary Hypertension, Ischemic Heart Disease, and Chronic Heart Failure? , 2018, Journal of Nippon Medical School = Nippon Ika Daigaku zasshi.

[60]  J. Fahy,et al.  Metabolic consequences of obesity as an “outside in” mechanism of disease severity in asthma , 2016, European Respiratory Journal.

[61]  Rowena Yip,et al.  Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. , 2010, Radiology.

[62]  R. Kronmal,et al.  Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA) , 2018, European heart journal.

[63]  Thin-section CT of lung without ECG gating: 64-detector row CT can markedly reduce cardiac motion artifact which can simulate lung lesions. , 2009, European journal of radiology.

[64]  S. Moebus,et al.  Association of computed tomography-derived left atrial size with major cardiovascular events in the general population: the Heinz Nixdorf Recall Study. , 2014, International journal of cardiology.

[65]  Jeffrey L. Anderson,et al.  ACCF / AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults , 2010 .

[66]  M. Nieuwdorp,et al.  Gut Microbiota and the Gut-Brain Axis: New Insights in the Pathophysiology of Metabolic Syndrome , 2017, Psychosomatic medicine.

[67]  C. Fox,et al.  Simple area-based measurement for multidetector computed tomography to predict left ventricular size , 2010, European Radiology.

[68]  Moyses Szklo,et al.  Coronary calcium as a predictor of coronary events in four racial or ethnic groups. , 2008, The New England journal of medicine.

[69]  R. D'Agostino,et al.  Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study , 2016, Journal of the American Heart Association.

[70]  L. Gesualdo,et al.  Relationship of para- and perirenal fat and epicardial fat with metabolic parameters in overweight and obese subjects , 2018, Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity.

[71]  Mario J. Garcia,et al.  Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. , 2015, Journal of the American College of Cardiology.

[72]  D. Bluemke,et al.  Metabolic Syndrome Is Associated With Impaired Diastolic Function Independently of MRI-Derived Myocardial Extracellular Volume: The MESA Study , 2018, Diabetes.

[73]  Joseph Shemesh,et al.  Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT? , 2016, Annals of translational medicine.

[74]  J. Després,et al.  The 'valvulo-metabolic' risk in calcific aortic valve disease. , 2007, The Canadian journal of cardiology.

[75]  D. Goff,et al.  Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. , 2012, JAMA.

[76]  K. O’Brien Pathogenesis of calcific aortic valve disease: a disease process comes of age (and a good deal more). , 2006, Arteriosclerosis, thrombosis, and vascular biology.

[77]  M. Kalra,et al.  Recent Advances in Computed Tomographic Technology: Cardiopulmonary Imaging Applications , 2017, Journal of thoracic imaging.

[78]  Samuel G Armato,et al.  CT-based pulmonary artery measurements for the assessment of pulmonary hypertension. , 2014, Academic radiology.

[79]  H. Kauczor,et al.  Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics , 2015, European Radiology.

[80]  Scott G. Baginski,et al.  Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods. , 2015, Radiology.

[81]  T. Brady,et al.  Left atrial volume and index by multi-detector computed tomography: comprehensive analysis from predictors of enlargement to predictive value for acute coronary syndrome (ROMICAT study). , 2011, International journal of cardiology.