ArticleEuropean radiology2023
Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial.
Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- The Use of Computed Tomography Densitometry for the Assessment of Emphysema in Clinical Trials: A Position Paper from the Fleischner Society.American journal of respiratory and critical care medicine · 2025Pooled it
- Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial.European radiology · 2024Trial
- Pulmonary vascular volume heterogeneity in association with emphysema: a multicenter study based on non-contrast chest CT.European radiology · 2026Article
- Association Between Emphysema and Coronary Artery Calcium on Low-Dose CT in Urban Chinese Adults: Does Lifestyle Matter?Healthcare (Basel, Switzerland) · 2026Article
- The impact of chest computed tomography-defined emphysema on extrapulmonary metastases in patients with lung cancer.BMC medical imaging · 2026Article
- Comparative lobe-specific histomorphometric evaluation of pulmonary architecture, fibrosis, and alveolar macrophage distribution in swine raised under different management systems.Veterinary world · 2026Article
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- Article
- The association and impact of radiographic, pathological emphysema and spirometric airway obstruction on patients with resectable lung adenocarcinoma.Respiratory research · 2025Article
- Quantitatively Assessed Emphysema Severity on HRCT Independently Predicts Coronary Artery Disease in COPD: A Retrospective Cohort Study.International journal of chronic obstructive pulmonary disease · 2025Article
- Is Type and Grade of Emphysema Important for Bone Mineral Density and Aortic Calcifications?Journal of clinical medicine · 2024Article
- How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?European respiratory review : an official journal of the European Respiratory Society · 2024Review
- Cardiac troponin I as predictor for cardiac and other mortality in the German randomized lung cancer screening trial (LUSI).Scientific reports · 2024Article
- The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer.ERJ open research · 2023Article
- Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed.Diagnostics (Basel, Switzerland) · 2023Review
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Authors and funding
15 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesCardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality.
methodsIn this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach.
resultsPulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality.
conclusionsModerate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile. KEY POINTS: • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
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