Small whole heart volume predicts cardiovascular events in patients with stable chest pain: insights from the PROMISE trial
- 26 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 31 (8), 6200-6210
- https://doi.org/10.1007/s00330-021-07695-2
Abstract
Objectives The size of the heart may predict major cardiovascular events (MACE) in patients with stable chest pain. We aimed to evaluate the prognostic value of 3D whole heart volume (WHV) derived from non-contrast cardiac computed tomography (CT). Methods Among participants randomized to the CT arm of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), we used deep learning to extract WHV, defined as the volume of the pericardial sac. We compared the WHV across categories of cardiovascular risk factors and coronary artery disease (CAD) characteristics and determined the association of WHV with MACE (all-cause death, myocardial infarction, unstable angina; median follow-up: 26 months). Results In the 3798 included patients (60.5 ± 8.2 years; 51.5% women), the WHV was 351.9 ± 57.6 cm3/m2. We found smaller WHV in no- or non-obstructive CAD, women, people with diabetes, sedentary lifestyle, and metabolic syndrome. Larger WHV was found in obstructive CAD, men, and increased atherosclerosis cardiovascular disease (ASCVD) risk score (p < 0.05). In a time-to-event analysis, small WHV was associated with over 4.4-fold risk of MACE (HR (per one standard deviation) = 0.221; 95% CI: 0.068–0.721; p = 0.012) independent of ASCVD risk score and CT-derived CAD characteristics. In patients with non-obstructive CAD, but not in those with no- or obstructive CAD, WHV increased the discriminatory capacity of ASCVD and CT-derived CAD characteristics significantly. Conclusions Small WHV may represent a novel imaging marker of MACE in stable chest pain. In particular, WHV may improve risk stratification in patients with non-obstructive CAD, a cohort with an unmet need for better risk stratification. Key Points • Heart volume is easily assessable from non-contrast cardiac computed tomography. • Small heart volume may be an imaging marker of major adverse cardiac events independent and incremental to traditional cardiovascular risk factors and established CT measures of CAD. • Heart volume may improve cardiovascular risk stratification in patients with non-obstructive CAD.Keywords
Funding Information
- National Heart, Lung, and Blood Institute (R01HL098237, U01HL092040, R01HL098305, U01HL092022, R01HL098235, R01HL098236)
- American Heart Association (18UNPG34030172, 13FTF16450001)
- Office of AIDS Research (5P30AI060354-14)
This publication has 36 references indexed in Scilit:
- 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromesEuropean Heart Journal, 2019
- Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest PainJAMA Cardiology, 2018
- Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjectsJournal of Cardiovascular Computed Tomography, 2017
- Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)Circulation, 2017
- Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest PainCell Metabolism, 2017
- Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin TherapyJACC: Cardiovascular Imaging, 2017
- Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure – The Multi-Ethnic Study of AtherosclerosisJournal of Cardiovascular Computed Tomography, 2016
- Epicardial and paracardial adipose tissue volume and attenuation – Association with high-risk coronary plaque on computed tomographic angiography in the ROMICAT II trialAtherosclerosis, 2016
- Mortality Risk in Symptomatic Patients With Nonobstructive Coronary Artery DiseaseJournal of the American College of Cardiology, 2011
- Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS)American Heart Journal, 2006