Assessment of coronary artery calcium by chest CT compared with EKG-gated cardiac CT in the multicenter AIDS cohort study.
Assessment of coronary artery calcium by chest CT compared with EKG-gated cardiac CT in the multicenter AIDS cohort study.
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DOI：
10.1371/journal.pone.0176557
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Morris A
中科院分区：
文献类型：
--
作者：
Chandra D;Gupta A;Leader JK;Fitzpatrick M;Kingsley LA;Kleerup E;Haberlen SA;Budoff MJ;Witt M;Post WS;Sciurba FC;Morris A
HIV感染者患冠状动脉疾病（CAD）的风险增加。通过评估冠状动脉钙化（CAC）早期检测亚临床CAD可能有助于对这些个体进行风险分层和预防CAD事件。然而，目前量化CAC的标准（即Agatston评分）需要EKG门控心脏CT成像。确定使用非EKG门控胸部CT和韦斯顿评分系统评估CAC是否是HIV感染和未感染个体中Agatston评分的有用替代物。CAC通过韦斯顿和Agatston评分在108名参加多中心艾滋病队列研究的男性中进行评估。参与者年龄为55.2（IQR 50.4; 59.9）岁，62（57.4%）例HIV血清阳性。韦斯顿评分类别的观察者间一致性（rs = 0.94，κ = 90.0%，p<0.001，n = 21）和观察者内一致性（rs = 0.95，κ = 95.2%，p<0.001，n = 97）为极佳。在我们的队列中，韦斯顿评分与Agatston评分（年龄、种族、HDL胆固醇水平，所有p<0.05）相似的CAD风险因素相关。韦斯顿和Agatston评分之间具有良好的相关性（rs = 0.92，p<0.001）和一致性（κw = 0.77，p<0.001）。这项研究是第一个使用胸部CT检查HIV感染者的钙评分，并独立验证韦斯顿评分作为Agatston评分的替代品。在心电图门控心脏CT无法评估冠状动脉钙的临床或研究环境中，应考虑使用胸部CT进行韦斯顿评分。
Individuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging. To determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals. CAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study. Participants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p<0.001, n = 21) and intra-observer agreement (rs = 0.95, κ = 95.2%, p<0.001, n = 97) for category of Weston score were excellent. Weston scores were associated with similar CAD risk factors as Agatston scores (age, race, HDL cholesterol level, all p<0.05) in our cohort. There was excellent correlation (rs = 0.92, p<0.001) and agreement (κw = 0.77, p<0.001) between Weston and Agatston scores. This study is the first to examine calcium scoring using chest CT in HIV-infected individuals and to independently validate the Weston score as a surrogate for the Agatston score. In clinical or research settings where EKG-gated cardiac CT is not feasible for the assessment of coronary calcium, Weston scoring by using chest CT should be considered.