A recent study published in the journal Radiology found that incidental chest computed tomography (CT) findings can help determine who is at risk for future heart attacks and other cardiovascular conditions.

Right now, individuals who have a high risk of cardiovascular events are assessed using risk stratification tools based on age, gender, blood pressure, cholesterol levels, diabetes, smoking status and other risk factors. But many events happen when there are no conventional risk factors present or when the individual's risks are undetected or underdiagnosed.

When radiologists conduct chest CT scans, they are frequently confronted with findings that are unsuspected or unrelated to the CT indication, called incidental findings.
The findings that indicate early signs of atherosclerosis are common and they may play a part in population-based screening to determine individuals at risk for cardiovascular events. But to-date there is no guidance on how to weigh the findings in routine practice.

The researchers at the University Medical Center Utrecht looked at the follow-up data of 10,410 patients who had a diagnostic chest CT scan for non-cardiovascular indications. Throughout a mean follow-up of 3.7 years, 1,148 of the patients had cardiovascular events.

They decided to use chest CT because it has demonstrated itself to offer "robust and strong independent predictors of adverse future cardiovascular events," Dr. Pushpa Jairam, one of the researchers, wrote to DOTmed News.

Jairam believes that there is a need for guidance to distinguish or weigh which of the large amount of incidental findings are prognostically relevant. "The results of this study can be used in the future as a guidance on which cardiovascular incidental findings should be reported (and how they should be assessed) to calculate the 10-year cardiovascular disease risk of an individual," she wrote.

Over 10 million chest CT scans are performed in the U.S. each year. Routine diagnostic clinical CT scans may offer many people the opportunity for a personalized measure of atherosclerotic burden based on readily available imaging data, according to Jairam.

She hopes that the results of her study will make radiologists aware of the fact that in addition to diagnostic purposes, chest CT can also be used for the prediction of certain diseases. She noted that structured reporting of just four incidental cardiovascular CT findings can lead to adequate cardiovascular event risk predication and stratification.

She also hopes that the CT-based cardiovascular disease risk score will be regularly used in daily practice and that reporting of incidental findings will lead to improved patient outcomes. However, she cautioned that a prospective, multicenter trial is needed to validate the impact of these findings.

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