Incidental findings on cardiac computed tomography in incident hemodialysis patients

The predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study

Bernard Jaar, Lili Zhang, Svetlana V. Chembrovich, Stephen M Sozio, Tariq Shafi, Julia J. Scialla, Gordon F. Tomaselli, Joao Lima, Wen Hong Linda Kao, Rulan S. Parekh, Lucy Ann Meoni

Research output: Contribution to journalArticle

Abstract

Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics. Methods. We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules. Results: Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules. Conclusions: We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.

Original languageEnglish (US)
Article number68
JournalBMC Nephrology
Volume15
Issue number1
DOIs
StatePublished - May 1 2014

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Incidental Findings
Chronic Kidney Failure
Renal Dialysis
Tomography
Lung
Odds Ratio
Confidence Intervals
Cardiovascular Diseases
Research
Radiology
Lung Diseases
Blood Vessels
Chronic Disease
Cohort Studies
Obesity
Cross-Sectional Studies
Logistic Models
Smoking
Prospective Studies

Keywords

  • Cardiac
  • Computed tomography
  • Hemodialysis
  • Incidental findings
  • Prevalence
  • Pulmonary nodule

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

Cite this

Incidental findings on cardiac computed tomography in incident hemodialysis patients : The predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study. / Jaar, Bernard; Zhang, Lili; Chembrovich, Svetlana V.; Sozio, Stephen M; Shafi, Tariq; Scialla, Julia J.; Tomaselli, Gordon F.; Lima, Joao; Kao, Wen Hong Linda; Parekh, Rulan S.; Meoni, Lucy Ann.

In: BMC Nephrology, Vol. 15, No. 1, 68, 01.05.2014.

Research output: Contribution to journalArticle

Jaar, Bernard ; Zhang, Lili ; Chembrovich, Svetlana V. ; Sozio, Stephen M ; Shafi, Tariq ; Scialla, Julia J. ; Tomaselli, Gordon F. ; Lima, Joao ; Kao, Wen Hong Linda ; Parekh, Rulan S. ; Meoni, Lucy Ann. / Incidental findings on cardiac computed tomography in incident hemodialysis patients : The predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study. In: BMC Nephrology. 2014 ; Vol. 15, No. 1.
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abstract = "Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics. Methods. We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules. Results: Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8{\%} of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2{\%} of all findings), and 41.3{\%} of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8{\%} and 15.3{\%} of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95{\%} Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95{\%} CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95{\%} CI 1.19, 3.40); but not with the presence of pulmonary nodules. Conclusions: We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.",
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AU - Jaar, Bernard

AU - Zhang, Lili

AU - Chembrovich, Svetlana V.

AU - Sozio, Stephen M

AU - Shafi, Tariq

AU - Scialla, Julia J.

AU - Tomaselli, Gordon F.

AU - Lima, Joao

AU - Kao, Wen Hong Linda

AU - Parekh, Rulan S.

AU - Meoni, Lucy Ann

PY - 2014/5/1

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N2 - Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics. Methods. We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules. Results: Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules. Conclusions: We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.

AB - Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics. Methods. We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules. Results: Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules. Conclusions: We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.

KW - Cardiac

KW - Computed tomography

KW - Hemodialysis

KW - Incidental findings

KW - Prevalence

KW - Pulmonary nodule

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