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000274082 1001_ $$0P:(DE-He78)eba11eff7c9c475da132d5343d569759$$aMascalchi, Mario$$b0$$eFirst author$$udkfz
000274082 245__ $$aPulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial.
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000274082 500__ $$a#EA:C020# / 2023 May;33(5):3115-3123
000274082 520__ $$aCardiovascular 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.In 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.Pulmonary 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.Moderate-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.• 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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000274082 650_7 $$2Other$$aCardiovascular disease
000274082 650_7 $$2Other$$aCause of death
000274082 650_7 $$2Other$$aLung neoplasm
000274082 650_7 $$2Other$$aPulmonary emphysema
000274082 650_7 $$2Other$$aSmokers
000274082 7001_ $$aRomei, Chiara$$b1
000274082 7001_ $$aMarzi, Chiara$$b2
000274082 7001_ $$aDiciotti, Stefano$$b3
000274082 7001_ $$aPicozzi, Giulia$$b4
000274082 7001_ $$aPistelli, Francesco$$b5
000274082 7001_ $$aZappa, Marco$$b6
000274082 7001_ $$aPaci, Eugenio$$b7
000274082 7001_ $$aCarozzi, Francesca$$b8
000274082 7001_ $$aGorini, Giuseppe$$b9
000274082 7001_ $$aFalaschi, Fabio$$b10
000274082 7001_ $$aDeliperi, Anna Lisa$$b11
000274082 7001_ $$aCamiciottoli, Gianna$$b12
000274082 7001_ $$aCarrozzi, Laura$$b13
000274082 7001_ $$aPuliti, Donella$$b14
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