Introduction: IPF can be associated with a variety of comorbidities, including coronary artery disease (CAD). Significant CAD is associated with worse outcomes in IPF. Diagnosing and treating CAD at an early stage may improve mortality in IPF patients. We sought to determine the predictive ability of coronary calcification, assessed by HRCT scanning of the chest, for significant CAD.
We performed a retrospective review of IPF patients undergoing left heart catheterization(LHC) as part of their evaluation. Patients were categorized as having significant (>50% stenosis), mild (<50% stenosis), or no CAD based on LHC results. The most current available HRCT was assessed for the degree of coronary calcification. Calcification was graded as; 0-no visible calcification, 1-trace calcification, 2-mild calcification, 3-moderate calcification and 4-severe calcification.
Sixty IPF patients qualified for the analysis. LHC demonstrated significant CAD in 26.6% (16/60) of the patients, while 41.6% (25/60) had mild disease and 31.6% (19/60) had no CAD. The median time interval between the LHC and the reviewed HRCT was 41 days. The sensitivity of grade 3 or 4 calcification for significant CAD was 75%, while the specificity was 82%. The sensitivity and specificity of grade 3 or 4 calcification for any CAD was 44% and 89%, respectively.
HRCT is a useful screening tool for the detection of significant CAD in patients with IPF. In addition to parenchymal changes, HRCT degree of coronary calcification should routinely be assessed in patients with IPF.
The early detection of CAD in IPF through routine HRCT may have implications for patient outcomes.
Steven Nathan, No Financial Disclosure Information; No Product/Research Disclosure Information