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Lung-cancer screening can spot people at high risk for aortic stenosis

Annals of Internal Medicine

Reuters Health – 09/06/2021 – Lung-cancer screening using low-dose computed tomography (LDCT) can also pick up aortic-valve calcification (AVC) and identify people at risk for aortic stenosis, new research shows.

During LDCT lung-cancer screening, “evaluation of aortic-valve calcium deposits that correspond with severity of aortic stenosis would be beneficial. This is not time consuming and could be valuable and important for patients as an additional finding,” Dr. Marcin Fijalkowski told Reuters Health by email.

Dr. Fijalkowski and colleagues at the Medical University of Gdansk, in Poland, assessed the usefulness of LDCT lung-cancer screening to determine the degree of AVC in 6,631 adults aged 50 to 80 years with a smoking history of 30 or more pack-years. They set a calcium score of 900 as the cutoff point indicating a positive test result that would trigger referral for echocardiogram.

Any degree of AVC was revealed in 869 (13.1%) individuals; 68 (7.8%) of these individuals had a calcium score of 900 or greater and were referred for echocardiography.

Among the 54 individuals who had echocardiography, 13 were diagnosed with severe aortic stenosis, 20 with moderate aortic stenosis and 16 with mild aortic stenosis. More than half of the patients with aortic stenosis were unaware of their valvular heart disease, including those with severe aortic stenosis.

Based on these findings, the researchers propose that AVC assessment become a routine procedure in the LDCT protocol for lung-cancer screening.

In their Annals of Internal Medicine report, they note that lung cancer and cardiovascular events have the same modifiable risk factors, “so people screened for lung cancer could also be diagnosed with cardiovascular diseases.”

However, cardiology societies do not yet recognize LDCT as a diagnostic tool for aortic stenosis, the researchers add.

They say the chief limitation of their study is the small number of patients, which prevented them from defining an exact cutoff point for each stage of aortic stenosis and estimating the correlations between LDCT and echocardiographic findings.

Also, the choice of an aortic-valve calcium score of 900 to select patients for additional diagnostic work-up was arbitrary; future studies are required to identify the optimal cutoff value.

Despite these limitations and caveats, “we conclude that LDCT is a useful diagnostic tool for identifying persons at high risk for clinically significant aortic stenosis and that the degree of AVC should be routinely assessed in all persons undergoing LDCT lung cancer screening.”

The study had no direct financial support and the authors have no relevant disclosures.

SOURCE: https://bit.ly/3z7RDIu Annals of Internal Medicine, online June 7, 2021.

By Megan Brooks

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