초록접수 현황
| 14F-143 | 구연 발표 |
Computed Tomographic Quantification of Thoracic Aortic Wall Calcification as a Prognostic Value in Patients Undergoing Coronary Artery Bypass Grafting
오세진, 최재성, 진광남¹, 문현종, 성용원, 이정상
서울대학교 의과대학 보라매병원 흉부외과학 교실, 서울대학교 의과대학 보라매병원 영상의학과 교실¹
Background : Thoracic aortic wall calcification is associated with coronary and valvular calcification, and has been recognized as an independent predictor of increased prevalence of cardiovascular events. Moreover, there have been several previous reports that demonstrated the significant correlation between severe thoracic aortic wall calcification and cardiovascular risk factors in a large population based cohort. The aim of this study was to evaluate the prognostic value of computed tomographic (CT) measurement of thoracic aortic wall calcification for the postoperative outcomes in patients who underwent coronary artery bypass grafting (CABG).
Methods : A total of 100 patients (mean age; 66.2±8.9yrs, M:F=61:39) who underwent isolated CABG between 2009 and 2013 were included in the present study. We retrospectively reviewed the medical records and preoperative chest CT angiography or total aorta CT angiography. Using dedicated calcium measuring software, we measured thoracic aortic calcification score (TACS) on non-contrast CT images (1.2mm slice thickness, detection range; above the left main coronary artery to the bottom of both ventricles, calcification; structures with attenuation >130 HU). High TACS was defined as ≥75th percentile value. Body surface area (BSA) was used for analysis as a covariate to avoid the variation of scoring according the patient’s height. Postoperative clinical outcome variables including mortality, stroke, acute renal failure, low cardiac output requiring intra-aortic balloon pump (IABP), perioperative myocardial infarction, pulmonary complication, repeated revascularization, and atrial fibrillation were analyzed.
Results : Preoperative BMI and left ventricular ejection fraction (EF) on echocardiography were 24.2 Kg/m2 and 55.8 %. Twenty six patients had the left main coronary artery disease on preoperative coronary angiography. There were two operative deaths, and postoperative complications were developed in 26 patients. The Mean TACS was 3892.4 ± 5580.0 (range; 8-30361), and the Median and 75th percentile value of TACS were 1965.0 and 5408.8, respectively. The number of patients with high TACS was 25. Univariate analysis showed that age, preoperative use of IABP, peripheral arteriopathy, and high score of TACS ≥75th percentile value were significant variables for the outcomes. Multivariate analysis revealed that preoperative use of IABP (odds ratio of 3.6, P = 0.048), peripheral arteriopathy (odds ratio of 3.6, P = 0.047) and high score of TACS ≥ 75th percentile value (odds ratio of 3.3, P = 0.011) were independent risk factors of postoperative mortality and cardiovascular complications.
Conclusion : Severe degree of thoracic aortic wall calcification is strongly correlated with the poor postoperative clinical outcomes. Therefore, preoperative CT quantification of thoracic aortic wall calcification may be a useful option to predict the early postoperative prognosis in patients undergoing isolated CABG.
Methods : A total of 100 patients (mean age; 66.2±8.9yrs, M:F=61:39) who underwent isolated CABG between 2009 and 2013 were included in the present study. We retrospectively reviewed the medical records and preoperative chest CT angiography or total aorta CT angiography. Using dedicated calcium measuring software, we measured thoracic aortic calcification score (TACS) on non-contrast CT images (1.2mm slice thickness, detection range; above the left main coronary artery to the bottom of both ventricles, calcification; structures with attenuation >130 HU). High TACS was defined as ≥75th percentile value. Body surface area (BSA) was used for analysis as a covariate to avoid the variation of scoring according the patient’s height. Postoperative clinical outcome variables including mortality, stroke, acute renal failure, low cardiac output requiring intra-aortic balloon pump (IABP), perioperative myocardial infarction, pulmonary complication, repeated revascularization, and atrial fibrillation were analyzed.
Results : Preoperative BMI and left ventricular ejection fraction (EF) on echocardiography were 24.2 Kg/m2 and 55.8 %. Twenty six patients had the left main coronary artery disease on preoperative coronary angiography. There were two operative deaths, and postoperative complications were developed in 26 patients. The Mean TACS was 3892.4 ± 5580.0 (range; 8-30361), and the Median and 75th percentile value of TACS were 1965.0 and 5408.8, respectively. The number of patients with high TACS was 25. Univariate analysis showed that age, preoperative use of IABP, peripheral arteriopathy, and high score of TACS ≥75th percentile value were significant variables for the outcomes. Multivariate analysis revealed that preoperative use of IABP (odds ratio of 3.6, P = 0.048), peripheral arteriopathy (odds ratio of 3.6, P = 0.047) and high score of TACS ≥ 75th percentile value (odds ratio of 3.3, P = 0.011) were independent risk factors of postoperative mortality and cardiovascular complications.
Conclusion : Severe degree of thoracic aortic wall calcification is strongly correlated with the poor postoperative clinical outcomes. Therefore, preoperative CT quantification of thoracic aortic wall calcification may be a useful option to predict the early postoperative prognosis in patients undergoing isolated CABG.
책임저자: 최재성
서울시립보라매병원 흉부외과, 서울대학교 의과대학 흉부외과학 교실
연락처 : 오세진, Tel: 02-870-2295 , E-mail : wpwnn@hanmail.net
