Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct

INTRODUCTION

The degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone.

METHODS

Per-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25-99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25-49%, 50-69%, 70-89%, and 90-99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models.

RESULTS

The frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25-49%:6%; 50-69%:30%; 70-89%:54%; 90-99%:91%, p ​< ​0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p ​< ​0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p ​< ​0.05) with a similar trend with 70-89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP.

CONCLUSIONS

Semiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct.

Association of the new visceral adiposity index with coronary artery calcification and arterial stiffness in Korean population

BACKGROUND AND AIMS

The new visceral adiposity index (NVAI) is an indirect marker of visceral adipose tissue recently developed using a Korean population. Here we examined the association of NVAI with coronary artery calcification and arterial stiffness in asymptomatic Korean patients.

METHODS AND RESULTS

We analyzed data from 60,938 asymptomatic Korean adults. Odds ratios and 95% confidence intervals (CIs) for coronary artery calcification score (CACS) > 100 and brachial-ankle pulse wave velocity (baPWV) ≥14 m/s were calculated across NVAI tertiles using multiple logistic regression analysis. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to assess the ability of NVAI to predict moderate to high risk of cardiovascular disease. The prevalence of moderate and high risk of cardiovascular disease increased significantly as the NVAI tertile increased. The odds ratio (95% CI) of the highest NVAI tertile for CACS >100 was 5.840 (5.101-6.686) for men and 18.916 (11.232-31.855) for women, after adjusting for confounders. All NVAI AUC values were significantly higher than the AUC values for other visceral adiposity markers.

CONCLUSIONS

This study provides the evidence that NVAI is independently and positively associated with coronary calcification and arterial stiffness in asymptomatic Korean adults.

Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium)

Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.

Effect of radiomics from different virtual monochromatic images in dual-energy spectral CT on the WHO/ISUP classification of clear cell renal cell carcinoma

AIM

To investigate the effect of radiomics obtained from different virtual monochromatic images (VMIs) in dual-energy spectral computed tomography (CT) on the World Health Organization/International Association for Urological Pathology (WHO/ISUP) classification of clear cell renal cell carcinoma (ccRCC).

MATERIALS AND METHODS

A retrospective study of 99 ccRCC patients who underwent contrast-enhanced dual-energy CT was undertaken. ccRCC was confirmed at surgery or biopsy and graded according to the WHO/ISUP pathological grading criteria as low grade (n=68, grade I and II) or high grade (n=31, grade III and IV). Radiomics risk scores (RRSs) for differentiating high and low grades of ccRCC were constructed from 11 sets of VMI in (40-140 keV, 10 keV interval) the cortical phase. Receiver operating characteristic (ROC) curves were drawn and the area under the curves (AUCs) was calculated to evaluate the discriminatory power of RRS for each VMI. The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of each model and the decision curve was used to analyse its net benefit to patients.

RESULTS

The AUC values for distinguishing low-from high-grade ccRCC with RRS of 40-140 keV VMIs were all >0.920. The Hosmer-Lemeshow test showed that the p-values of RRS of VMIs were >0.05, suggesting good fits. In the decision curve analysis, RRS from the 40-140 keV VMIs had similar decision curves and provided better net benefits than considering all patients either as high-grade or low-grade.

CONCLUSIONS

The RRS obtained from multiple VMIs in dual-energy spectral CT have high diagnostic efficiencies for distinguishing between low- and high-grade ccRCC with no significant differences between different VMIs.

Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea

BACKGROUND

The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets.

METHODS

This study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived.

RESULTS

The combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets.

CONCLUSIONS

Smoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.

[Research progress in studies on tooth development based on diphyodont mammals]

For decades, the molecular and cellular mechanisms that govern tooth development have been extensively investigated. However, most of the studies are based on mice, whose teeth are quite different from human teeth in morphological and developmental aspects. Mice are not the ideal model for understanding the development of permanent teeth as they have only one set of dentition. Thus, using of diphyodont mammals is a better model to study the deciduous and permanent tooth development and to understand the process of tooth replacement. Several diphyodont mammal models have been established including minipig, ferret, house shrew and rabbit. Studies based on the diphyodont mammals have characterized the morphological changes involved in tooth replacement and molecular mechanisms of tooth replacement. However, few developmental stages were studied on ferret due to the presence of seasonal estrus and the difficulty to obtain ferret embryos at the correct stage. The house shrew is limited as a model because their deciduous tooth germs become vestigial in the embryonic period. The main disadvantage of the rabbit is an incomplete dentition with the lack of canines. Compared to the above mentioned animal models, the miniature pig has proven to be a valuable animal model for diphyodont development due to its dentition similarities, including the morphology, number and size of teeth, to human's, and particularly its heterodont dentition consisting of incisors, canines, premolars and molars. The present article reviews the current knowledge on the development of the primary and successional teeth in minipig modle and briefly summarizes the studies based on other diphyodont mammal models.

Natural killer cell-derived exosome-entrapped paclitaxel can enhance its anti-tumor effect

OBJECTIVE

To study the effectiveness of natural killer cell-derived exosome (NK-Exos)-entrapped paclitaxel (PTX-NK-Exos) in enhancing its anti-tumor effect.

MATERIALS AND METHODS

The NK-Exos were isolated through ultra-high-speed centrifugation, and the PTX-NK-Exos system was constructed via electroporation. The morphology, particle size, Zeta potential and entrapment rate of PTX-NK-Exos were evaluated using transmission electron microscope (TEM), dynamic light scattering (DLS), Western blotting and high-performance liquid chromatography (HPLC), respectively. The uptake of Exos in human breast cancer MCF-7 cells was observed under a laser confocal microscope. Moreover, the effect of PTX-NK-Exos on MCF-7 cell viability was determined through methyl thiazolyl tetrazolium (MTT) assay, flow cytometry and 4',6-diamidino-2-phenylindole (DAPI) staining. The effects of PTX-NK-Exos on messenger ribonucleic acid (mRNA) and protein expressions of B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax) and Caspase-3 in MCF-7 cells were detected using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blotting, respectively.

RESULTS

The NK-Exos were successfully isolated via ultra-high-speed centrifugation, and they had uniform particle size and high expression of markers for Exos. MCF-7 cells could take up Exos. The PTX-NK-Exos drug delivery system was successfully prepared using electroporation. In PTX group and NK-Exos group, the proliferation of MCF-7 cells declined, the nuclear apoptosis was evident and the apoptosis rate of MCF-7 cells rose compared with those in Control group. In PTX group and PTX-NK-Exos group, the migration of MCF-7 cells declined compared with that in Control group. According to the results of qRT-PCR and Western blotting, PTX-NK-Exos exerted an anti-tumor effect through inducing the up-regulation of Bax and Caspase-3 in the apoptotic signaling pathway in tumor cells.

CONCLUSIONS

Exos isolated through ultra-high-speed centrifugation can be used to prepare the PTX-NK-Exos drug delivery system through electroporation. Drug-loaded Exos can effectively inhibit proliferation and induce apoptosis of tumor cells, thereby exerting an anti-tumor effect.

LINC00511 can promote the proliferation, migration and invasion of esophageal cancer cells through regulating microRNA-150-5p

OBJECTIVE

The aim of this study was to investigate the potential role of LINC00511 in esophageal cancer (ECa), and to explore its underlying mechanism through in vitro cell experiments.

PATIENTS AND METHODS

LINC00511 expression in ECa was analyzed by GEPIA database and verified by real-time fluorescence quantitative polymerase chain reaction (qPCR). The bioinformatics website was used to analyze the miRNAs that can bind to LINC00511, and the regulatory relationship between them was verified through Luciferase assay, qPCR as well as Western blotting analysis. Then, the impacts of LINC00511 and microRNA-150-5p on the proliferation or invasiveness of ECa cell lines Kyse30 and ECA109 were investigated by cell counting kit-8 (CCK-8) test and transwell experiment, respectively. Meanwhile, cell cycle and apoptosis were detected by flow cytometry.

RESULTS

Analysis results of the GEPIA database revealed that LINC00511 had a significant high expression in ECa tissue samples in comparison with normal control ones, which is consistent with qPCR results. Meanwhile, a significant negative correlation was found between LINC00511 and microRNA-150-5p. In brief, LINC00511 was able to bind to microRNA-150-5p and inhibited its expression. Besides, overexpression of LINC00511 enhanced ECa cell proliferation and migration, accelerated cell cycle, and suppressed cell apoptosis, while transfection with microRNA-150-5p mimics caused the opposite effects.

CONCLUSIONS

This study shows for the first time that LINC00511 modulates the progression of ECa by binding to microRNA-150-5p.

Independent association of serum uric acid levels with arterial stiffness in the absence of established cardiovascular disorders

BACKGROUND

The impact of serum uric acid (SUA) on atherosclerosis has been suspected to be epiphenomenal owing to its close relationship with metabolic abnormalities. The aim of the present study was to evaluate the association between SUA levels and arterial stiffness in the absence of established cardiovascular (CV) disorders.

METHODS

The relationship between SUA levels and brachial-ankle pulse wave velocity (baPWV) was examined in 353 asymptomatic adults (57 ± 8 years, 11.9% men) without established CV disorders defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥ 90 mmHg; total cholesterol ≥240 mg/dL; low-density lipoprotein cholesterol ≥160 mg/dL; high-density lipoprotein cholesterol <40 mg/dL; fasting glucose ≥126 mg/dL; body mass index ≥25.0 kg/m² ; current smoking; and history of medication for hypertension, diabetes, and dyslipidemia. Subjects were stratified into four groups based on the quartiles of their SUA levels.

RESULTS

Mean baPWV was significantly different in all groups: group I, 1320 ± 195 cm/s; group II, 1336 ± 195 cm/s; group III, 1404 ± 199 cm/s; and group IV, 1483 ± 248 cm/s (P < .001). SUA levels were significantly correlated with baPWV (r = .364) (P < .001). Multivariate linear regression analysis showed that SUA (β: 32.93; 95% confidence interval [CI]: 18.99-54.87), together with age (β: 11.44; 95% CI: 9.36-13.53) and systolic BP (β: 8.98; 95% CI: 6.80-11.16), was significantly associated with baPWV (P < .001).

CONCLUSIONS

High SUA levels have an independent association with increased arterial stiffness even in subjects without established CV disorders.

Minimization of Torque Deviation of Cylinder Deactivation Engine through 48V Mild-Hybrid Starter-Generator Control

Cylinder deactivation (CDA) is an effective technique to improve fuel economy in spark ignition (SI) engines. This technique enhances volumetric efficiency and reduces throttling loss. However, practical implementation is restricted due to torque fluctuations between individual cylinders that cause noise, vibration, and harshness (NVH) issues. To ease torque deviation of the CDA, we propose an in-cylinder pressure based 48V mild-hybrid starter-generator (MHSG) control strategy. The target engine realizes CDA with a specialized engine configuration of separated intake manifolds to independently control the airflow into the cylinders. To handle the complexity of the combined CDA and mild-hybrid system, GT-POWER simulation environment was integrated with a SI turbulent combustion model and 48V MHSG model with actual part specifications. The combustion model is essential for in-cylinder pressure-based control; thus, it is calibrated with actual engine experimental data. The modeling results demonstrate the precise accuracy of the engine cylinder pressures and of quantities such as MAF, MAP, BMEP, and IMEP. The proposed control algorithm also showed remarkable control performance, achieved by instantaneous torque calculation and dynamic compensation, with a 99% maximum reduction rate of engine torque deviation under target CDA operations.

Computed tomography angiography-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement

AIMS

Recovery of left ventricular ejection fraction (LVEF) after aortic valve replacement has prognostic importance in patients with aortic stenosis (AS). The mechanism by which myocardial fibrosis impacts LVEF recovery in AS is not well characterized. We sought to evaluate the predictive value of extracellular volume fraction (ECV) quantified by cardiac CT angiography (CTA) for LVEF recovery in patients with AS after transcatheter aortic valve replacement (TAVR).

METHODS AND RESULTS

In 109 pre-TAVR patients with LVEF <50% at baseline echocardiography, CTA-derived ECV was calculated as the ratio of change in CT attenuation of the myocardium and the left ventricular (LV) blood pool before and after contrast administration. Early LVEF recovery was defined as an absolute increase of ≥10% in LVEF measured by post-TAVR follow-up echocardiography within 6 months of the procedure. Early LVEF recovery was observed in 39 (36%) patients. The absolute increase in LVEF was 17.6 ± 8.8% in the LVEF recovery group and 0.9 ± 5.9% in the no LVEF recovery group (P < 0.001). ECV was significantly lower in patients with LVEF recovery compared with those without LVEF recovery (29.4 ± 6.1% vs. 33.2 ± 7.7%, respectively, P = 0.009). In multivariable analysis, mean pressure gradient across the aortic valve [odds ratio (OR): 1.07, 95% confidence interval (CI): 1.03-1.11, P: 0.001], LV end-diastolic volume (OR: 0.99, 95% CI: 0.98-0.99, P: 0.035), and ECV (OR: 0.92, 95% CI: 0.86-0.99, P: 0.018) were independent predictors of early LVEF recovery.

CONCLUSION

Increased myocardial ECV on CTA is associated with impaired LVEF recovery post-TAVR in severe AS patients with impaired LV systolic function.

Association of High-Density Calcified 1K Plaque With Risk of Acute Coronary Syndrome

Importance

Plaque morphologic measures on coronary computed tomography angiography (CCTA) have been associated with future acute coronary syndrome (ACS). However, the evolution of calcified coronary plaques by noninvasive imaging is not known.

Objective

To ascertain whether the increasing density in calcified coronary plaque is associated with risk for ACS.

Design, Setting, and Participants

This multicenter case-control cohort study included individuals enrolled in ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a nested case-control study of patients drawn from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, which included 13 study sites in 8 countries. Patients who experienced core laboratory-verified ACS after baseline CCTA (n = 189) and control individuals who did not experience ACS after baseline CCTA (n = 189) were included. Patients and controls were matched 1:1 by propensity scores for age; male sex; presence of hypertension, hyperlipidemia, and diabetes; family history of premature coronary artery disease (CAD); current smoking status; and CAD severity. Data were analyzed from November 2018 to March 2019.

Exposures

Whole-heart atherosclerotic plaque volume was quantitated from all coronary vessels and their branches. For patients who underwent invasive angiography at the time of ACS, culprit lesions were coregistered to baseline CCTA lesions by a blinded independent reader. Low-density plaque was defined as having less than 130 Hounsfield units (HU); calcified plaque, as having more than 350 HU and subcategorized on a voxel-level basis into 3 strata: 351 to 700 HU, 701 to 1000 HU, and more than 1000 HU (termed 1K plaque).

Main Outcomes and Measures

Association between calcium density and future ACS risk.

Results

A total of 189 patients and 189 matched controls (mean [SD] age of 59.9 [9.8] years; 247 [65.3%] were male) were included in the analysis and were monitored during a mean (SD) follow-up period of 3.9 (2.5) years. The overall mean (SD) calcified plaque volume (>350 HU) was similar between patients and controls (76.4 [101.6] mm3 vs 99.0 [156.1] mm3; P = .32), but patients who experienced ACS exhibited less 1K plaque (>1000 HU) compared with controls (3.9 [8.3] mm3 vs 9.4 [23.2] mm3; P = .02). Individuals within the highest quartile of 1K plaque exhibited less low-density plaque, as a percentage of total plaque, when compared with patients within the lower 3 quartiles (12.6% [10.4%] vs 24.9% [20.6%]; P < .001). For 93 culprit precursor lesions detected by CCTA, the volume of 1K plaque was lower compared with the maximally stenotic lesion in controls (2.6 [7.2] mm3 vs 7.6 [20.3] mm3; P = .01). The per-patient and per-lesion results were similar between the 2 groups when restricted to myocardial infarction cases.

Conclusions and Relevance

Results of this study suggest that, on a per-patient and per-lesion basis, 1K plaque was associated with a lower risk for future ACS and that measurement of 1K plaque may improve risk stratification beyond plaque burden.

Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events

BACKGROUND

The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE).

METHODS

The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted.

RESULTS

The study population comprised 1166 patients (age 60.5 ​± ​9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P ​< ​0.001.

CONCLUSIONS

Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.

Age- and sex-related features of atherosclerosis from coronary computed tomography angiography in patients prior to acute coronary syndrome: results from the ICONIC study

AIMS

Although there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS).

METHODS AND RESULTS

Within the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (<65 vs. ≥ 65 years old) for analysis. Older patients had higher total plaque volume than younger patients. Within specific subtypes of plaque volume, however, only calcified plaque volume was higher in older patients (135.9 ± 163.7 vs. 63.8 ± 94.2 mm3, P < 0.0001, respectively). Although no sex-related differences were recorded for calcified plaque volume, females had lower fibrous and fibrofatty plaque volume than males (Fibrofatty volume 29.6 ± 44.1 vs. 75.3 ± 98.6 mm3, P = 0.0001, respectively). No sex-related differences in the prevalence of qualitative high-risk plaque features were found, even after separate analyses considering age were performed.

CONCLUSION

Our data underline the importance of age- and sex-related differences in coronary atherosclerosis presentation, which should be considered during CCTA-based atherosclerosis quantification.

Atherogenic index of plasma and coronary artery calcification progression beyond traditional risk factors according to baseline coronary artery calcium score

This study aimed to evaluate the association between the atherogenic index of plasma (AIP), which has been suggested as a novel marker for atherosclerosis, and coronary artery calcification (CAC) progression according to the baseline coronary artery calcium score (CACS). We included 12,326 asymptomatic Korean adults who underwent at least two CAC evaluations from December 2012 to August 2016. Participants were stratified into four groups according to AIP quartiles, which were determined by the log of (triglyceride/high-density lipoprotein cholesterol). Baseline CACSs were divided into three groups: 0, 1 − 100, and > 100. CAC progression was defined as a difference ≥ 2.5 between the square roots (√) of the baseline and follow-up CACSs (Δ√transformed CACS). Annualized Δ√transformed CACS was defined as Δ√transformed CACS divided by the inter-scan period. During a mean 3.3-year follow-up period, the overall incidence of CAC progression was 30.6%. The incidences of CAC progression and annualized Δ√transformed CACS were markedly elevated with increasing AIP quartile in participants with baseline CACSs of 0 and 1 − 100, but not in those with a baseline CACS > 100. The AIP level was associated with the annualized Δ√transformed CACS in participants with baseline CACSs of 0 (β = 0.016; P < 0.001) and 1 − 100 (β = 0.035; P < 0.001), but not in those with baseline CACS > 100 (β = 0.032; P = 0.385). After adjusting for traditional risk factors, the AIP was significantly associated with CAC progression in those with baseline CACS ≤ 100. The AIP has value for predicting CAC progression in asymptomatic adults without heavy baseline CAC.

Lrp6 Dynamic Expression in Tooth Development and Mutations in Oligodontia

Genes associated with the WNT pathway play an important role in the etiology of tooth agenesis. Low-density lipoprotein receptor-related protein 6 encoding gene (LRP6) is a recently defined gene that is associated with autosomal dominant inherited tooth agenesis. Here, we aimed to identify novel LRP6 mutations in patients with tooth agenesis and investigate the significance of Lrp6 during tooth development. Using whole-exome sequencing, we identified 4 novel LRP6 heterozygous mutations (c.2292G>A, c.195dup, c.1095dup, and c.1681C>T) in 4 of 77 oligodontia patients. Notably, a patient who carried a nonsense LRP6 mutation (c.2292G>A; p.W764*) presented a hypohidrotic ectodermal dysplasia phenotype. Preliminary functional studies, including bioinformatics analysis and TOP-/FOP-flash reporter assays, demonstrated that the activation of WNT/β-catenin signaling was compromised as a consequence of LRP6 mutations. RNAscope in situ hybridization revealed dynamic and special changes of Lrp6 expression during murine tooth development from E11.5 to E16.5. It was noteworthy that Lrp6 was specifically expressed in the epithelium at E11.5 to E13.5 but was expressed in both dental epithelium and dental papilla from E14.5 and persisted in both tissues at later stages. Our study broadens the mutation spectrum of human tooth agenesis and is the first to identify a LRP6 mutation in patients with hypohidrotic ectodermal dysplasia and reveal the dynamic expression pattern of Lrp6 during tooth development. Information from this study is conducive to understanding the functional significance of Lrp6 on the biological process of tooth development.

The change of serum serotonin levels between acute coronary syndrome and chronic stable angina undergoing percutaneous coronary intervention

Background

Activated platelets release serotonin (5-hydroxytryptamine, 5HT) causing vasoconstriction and aggregation of platelets in patients with acute coronary syndrome (ACS). It can lead to undergo percutaneous coronary intervention (PCI). We investigated the serial changes of serotonin level in patients with ACS and chronic stable angina (CSA) treated with PCI.

Methods

From July 2009 to April 2010, 123 consecutive patients who have undergone PCI for either ACS (n=63) or CSA (n=60) were enrolled. After the loading dose of aspirin 300mg and clopidogrel 600mg before PCI, maintenance once daily dose of 100mg and 75mg have been given from the day after PCI in all patients. Serum serotonin level (SERO) were serially measured at baseline, pre-, post-PCI, 90 min, 6 hours, 12 hours, 24 hours and 48 hours to compare between ACS and CSA groups. All demographic, biochemical variables, and clinical events were also collected for comparison in each group.

Results

SERO at post-PCI (55.2±120.0 vs 20.1±24.0, p=0.03) and peak level (94.0±170.9 vs 38.8±72.3, p=0.02) were significantly higher in ACS group. SERO after 90 min (34.4±66.1 vs 28.7±38.2, p=0.8), 6 hours (23.9±38.3 vs 10.1±10.0, p=0.34), 24 hours (55.8±108.5 vs 37.2±88.2, p=0.39) and 48 hours (43.5±122.9 vs 25.2±65.5, p=0.53) tended to be higher in ACS group than CSA group without statistical significance. SERO rebounded at 24 hours post-PCI and dropped at 48 hours.

Conclusions

SERO was more elevated in patients with ACS than those with CSA undergoing PCI, suggesting the need for more potent and sustained platelet inhibition particularly in ACS patients. SERO might be considered as a substitute marker of platelet activation. Triple antiplatelet therapy including selective serotonin receptor antagonist on top of aspirin and clopidogrel could be as an option for ACS patients undergoing PCI

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Hallym University Research Fund 2017 (HURF-2017-84)

MiRNA-93-5p promotes the biological progression of gastric cancer cells via Hippo signaling pathway

OBJECTIVE

To clarify the influence of microRNA-93-5p (miRNA-93-5p) on biological behaviors of gastric cancer (GC) cells and its regulatory effect on Hippo pathway.

MATERIALS AND METHODS

SGC-7901 and HGC-27 cells were used for establishing miRNA-93-5p overexpression and downregulation model through transfection of miRNA-93-5p mimics or inhibitor, respectively. Relative levels of genes in Hippo pathway were determined in GC cells transfected with miRNA-93-5p mimics or inhibitor by quantitative Real-time polymerase chain reaction (qRT-PCR). Regulatory effects of miRNA-93-5p on proliferative, migratory and invasive abilities of GC cells were evaluated by cell counting kit-8 (CCK-8), colony formation and transwell assay, respectively.

RESULTS

MiRNA-93-5p was markedly upregulated by transfection of miRNA-93-5p mimics into SGC-7901 cells, which was downregulated by transfection of miRNA-93-5p inhibitor into HGC-27 cells. Overexpression of miRNA-93-5p accelerated GC cells to proliferate, migrate and invade. Meanwhile, miRNA-93-5p overexpression in GC cells upregulated downstream genes in Hippo pathway, including CDX2, FOXM1 and CTGF.

CONCLUSIONS

MiRNA-93-5p enhances proliferative, migratory and invasive abilities of GC cells by activating Hippo pathway, which may serve as a diagnostic and therapeutic target for GC.

Replacing true unenhanced imaging in renal carcinoma with virtual unenhanced images in dual-energy spectral CT: a feasibility study

AIM

To investigate the clinical value of virtual unenhanced (VNC) spectral computed tomography (CT) images to replace the conventional true unenhanced spectral CT images (TNC) in diagnosing renal carcinoma.

MATERIALS AND METHODS

Fifty-six cases of renal carcinoma confirmed by histopathology underwent conventional plain CT and contrast-enhanced spectral CT at arterial phase (AP) and venous phase (VP). VNC images were generated on an AW4.6 workstation. The CT attenuation, image noise, contrast-to-noise ratio (CNR), and signal-noise-ratio (SNR) of the renal lesions and normal kidneys, long and short axis diameters of the lesion were measured from the three image sets and analysed using one-way analysis of variance (ANOVA). Two radiologists evaluated image quality subjectively using a five-point score, and lesion signature using a three-point score. Image quality scores were compared statistically and tested for consistency.

RESULTS

The two reviewers had good agreement for subjective evaluation (Kappa>0.70) and there was no difference in the quality of the scores among the three image groups. The lesion signature scores were all above the acceptable level. The CNR and SNR values in VNC were significantly higher than in TNC (p<0.05). VNC images had lower renal noise than in TNC (p<0.05). There was no difference in the long and short axis diameters of the lesion among the three image groups. VNC had higher CT attenuation values for the lesion and kidney than TNC (p<0.05), but the differences were <5 HU.

CONCLUSION

VNC images in spectral CT may be used to replace the conventional plain CT to reduce imaging duration and radiation dose in diagnosing renal carcinoma.

LncRNA NEAT1 regulates pulmonary fibrosis through miR-9-5p and TGF-β signaling pathway

OBJECTIVE

Pulmonary fibrosis (PF) is a chronic lung disease with complex pathogenesis and poor prognosis. Studies had demonstrated that long non-coding RNAs (lncRNAs) play an important role in the development of fibrosis. We explored the roles of NEAT1 in PF progression in this study.

PATIENTS AND METHODS

PF tissues and TGF-β1-induced cells were analyzed for the function of NEAT1 in PF progression. qRT-PCR or Western blot was applied to detect NEAT1, miR‑9-5p or protein expressions. PF mice model assay was used to detect the effects of NEAT1 on PF in vivo. Luciferase reporter assay was applied to confirm target relationship between NEAT1 and miR‑9-5p. Correlation of NEAT1 and miR-9-5p was analyzed by Spearman's method.

RESULTS

We observed that NEAT1 was significantly upregulated while miR-9-5p was downregulated in PF tissues and TGF-β1-induced cells. A negative correlation was exhibited of NEAT1 and miR-9-5p expression in PF tissues. Protein level of p-Smad2 was increased in TGF-β1 induced cells. Furthermore, NEAT1 knockdown increased E-cadherin expression, while decreased N-cadherin, Vimentin, Collagen I, Collagen III and α-smooth muscle actin (α-SMA) expressions in TGF-β1-induced cells. Moreover, NEAT1 could directly target miR-9-5p to regulate the PF induced by TGF-β1. The miR-9-5p overexpression inhibited TGF-β1 and p-Smad2 expression, while NEAT1 overexpression attenuated this effect. In addition, NEAT1 inhibition enhanced E-cadherin expression, and reduced TGF-β1, p-Smad2, N-cadherin, Collagen I, Collagen III, α-SMA and Vimentin expression after BLM treatment.

CONCLUSIONS

Taken together, our findings showed that NEAT1 knockdown attenuated PF via the regulatory of miR-9-5p and TGF-β signaling to repress EMT and might provide new therapeutic targets for PF patients.

Prediction of revascularization by coronary CT angiography using a machine learning ischemia risk score

OBJECTIVES

The machine learning ischemia risk score (ML-IRS) is a machine learning-based algorithm designed to identify hemodynamically significant coronary disease using quantitative coronary computed tomography angiography (CCTA). The purpose of this study was to examine whether the ML-IRS can predict revascularization in patients referred for invasive coronary angiography (ICA) after CCTA.

METHODS

This study was a post hoc analysis of a prospective dual-center registry of sequential patients undergoing CCTA followed by ICA within 3 months, referred from inpatient, outpatient, and emergency department settings (n = 352, age 63 ± 10 years, 68% male). The primary outcome was revascularization by either percutaneous coronary revascularization or coronary artery bypass grafting. Blinded readers performed semi-automated quantitative coronary plaque analysis. The ML-IRS was automatically computed. Relationships between clinical risk factors, coronary plaque features, and ML-IRS with revascularization were examined.

RESULTS

The study cohort consisted of 352 subjects with 1056 analyzable vessels. The ML-IRS ranged between 0 and 81% with a median of 18.7% (6.4-34.8). Revascularization was performed in 26% of vessels. Vessels receiving revascularization had higher ML-IRS (33.6% (21.1-55.0) versus 13.0% (4.5-29.1), p < 0.0001), as well as higher contrast density difference, and total, non-calcified, calcified, and low-density plaque burden. ML-IRS, when added to a traditional risk model based on clinical data and stenosis to predict revascularization, resulted in increased area under the curve from 0.69 (95% CI: 0.65-0.72) to 0.78 (95% CI: 0.75-0.81) (p < 0.0001), with an overall continuous net reclassification improvement of 0.636 (95% CI: 0.503-0.769; p < 0.0001).

CONCLUSIONS

ML-IRS from quantitative coronary CT angiography improved the prediction of future revascularization and can potentially identify patients likely to receive revascularization if referred to cardiac catheterization.

KEY POINTS

• Machine learning ischemia risk from quantitative coronary CT angiography was significantly higher in patients who received revascularization versus those who did not receive revascularization. • The machine learning ischemia risk score was significantly higher in patients with invasive fractional flow ≤ 0.8 versus those with > 0.8. • The machine learning ischemia risk score improved the prediction of future revascularization significantly when added to a standard prediction model including stenosis.

Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score: From the CONFIRM registry

BACKGROUND AND AIMS

The Agatston coronary artery calcium score (CACS) may fail to identify small or less dense coronary calcification that can be detected on coronary CT angiography (CCTA). We investigated the prevalence and prognostic importance of subtle calcified plaques on CCTA among individuals with CACS 0.

METHODS

From the prospective multicenter CONFIRM registry, we evaluated patients without known CAD who underwent CAC scan and CCTA. CACS was categorized as 0, 1-10, 11-100, 101-400, and >400. Patients with CACS 0 were stratified according to the visual presence of coronary plaques on CCTA. Plaque composition was categorized as non-calcified (NCP), mixed (MP) and calcified (CP). The primary outcome was a major adverse cardiac event (MACE) which was defined as death and myocardial infarction.

RESULTS

Of 4049 patients, 1741 (43%) had a CACS 0. NCP and plaques that contained calcium (MP or CP) were detected by CCTA in 110 patients (6% of CACS 0) and 64 patients (4% of CACS 0), respectively. During a 5.6 years median follow-up (IQR 5.1-6.2 years), 413 MACE events occurred (13%). Patients with CACS 0 and MP/CP detected by CCTA had similar MACE risk compared to patients with CACS 1-10 (p = 0.868). In patients with CACS 0, after adjustment for risk factors and symptom, MP/CP was associated with an increased MACE risk compared to those with entirely normal CCTA (HR 2.39, 95% CI [1.09-5.24], p = 0.030).

CONCLUSIONS

A small but non-negligible proportion of patients with CACS 0 had identifiable coronary calcification, which was associated with increased MACE risk. Modifying CAC image acquisition and/or scoring methods could improve the detection of subtle coronary calcification.

Atherogenic index of plasma and the risk of advanced subclinical coronary artery disease beyond traditional risk factors: An observational cohort study

BACKGROUND

Atherogenic lipoprotein profile of plasma is an important risk factor for atherosclerosis. The atherogenic index of plasma (AIP) has been suggested as a novel marker for atherosclerosis.

HYPOTHESIS

AIP is a useful marker of advanced subclinical coronary artery disease (CAD) in subjects without overt renal dysfunction.

METHODS

A total of 6928 subjects with estimated glomerular filtration rate > 60 mL/minutes/1.73 m² evaluated by coronary computed tomography angiography (CCTA) for health check-up were included. The relation of AIP to advanced CAD (heavy coronary calcification, defined as coronary artery calcium score [CACS] >100 or obstructive coronary plaque [OCP], defined as plaque with >50% stenosis) was evaluated.

RESULTS

All participants were stratified into four groups based on AIP quartiles. The prevalence of CACS >100 (group I [lowest] 4.7% vs group II 7.0% vs group III 8.8% vs group IV 10.0%) and OCP (group I 3.7% vs group II 6.4% vs group III 8.8% vs group IV 10.9%) (all P < .001) increased with elevating AIP quartiles. Higher AIP (per 0.1 unit increase) was associated with an increased risk of CACS >100 (odds ratio [OR] 1.057, 95% confidence interval (CI) 1.010 to 1.106, P = .017; relative risk (RR) 1.048, 95% CI 1.009-1.089, and P = .015) and OCP (OR 1.079, 95% CI 1.033-1.127, P = .001; RR 1.069, 95% CI 1.031-1.108, P < .001) after adjusting for age > 60 years, male sex, hypertension, diabetes mellitus, dyslipidaemia, obesity, and proteinuria.

CONCLUSION

AIP is independently associated with advanced subclinical CAD beyond traditional risk factors.

Efficient radiation releasing in device-level glass ceramics driven by a blue laser

Ce³⁺ doped M₃Al₅O₁₂ (MAG, M=Lu, Y) glass ceramics (GCs) have been proved to be shapeable phosphors for white lighting driven by a 453 nm laser. Quantitative characterization reflects that the net emission powers of 4 wt% LuAG-doped GC and 4 wt% YAG-doped GC are 59.99 mW and 66.22 mW at the pump power of 117.63 mW, and the quantum yields reach up to 71.1% and 78.0%, respectively. Miniaturization of devices can be achieved for LuAG/YAG-GCs by optimizing sample size and phosphor concentration with maintaining fluorescence intensity of the samples. Presupposed color coordinate trace reveals that the high-brightness white fluorescence can be realized when the appropriate intensity ratio is determined between residual laser and sample emission. The tunable white fluorescence and the efficient radiation releasing illustrate that LuAG/YAG-GCs are potential candidates for application in solid-state laser illumination.

Association of Cardiovascular Disease Risk Factor Burden With Progression of Coronary Atherosclerosis Assessed by Serial Coronary Computed Tomographic Angiography

IMPORTANCE

Several studies have reported that the progression of coronary atherosclerosis, as measured by serial coronary computed tomographic (CT) angiography, is associated with the risk of future cardiovascular events. However, the cumulative consequences of multiple risk factors for plaque progression and the development of adverse plaque characteristics have not been well characterized.

OBJECTIVES

To examine the association of cardiovascular risk factor burden, as assessed by atherosclerotic cardiovascular disease (ASCVD) risk score, with the progression of coronary atherosclerosis and the development of adverse plaque characteristics.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study is a subgroup analysis of participant data from the prospective observational Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) study, which evaluated the association between serial coronary CT angiography findings and clinical presentation. The PARADIGM international multicenter registry, which includes 13 centers in 7 countries (Brazil, Canada, Germany, Italy, Portugal, South Korea, and the US), was used to identify 1005 adult patients without known coronary artery disease who underwent serial coronary CT angiography scans (median interscan interval, 3.3 years; interquartile range [IQR], 2.6-4.8 years) between December 24, 2003, and December 16, 2015. Based on the 10-year ASCVD risk score, the cardiovascular risk factor burden was classified as low (<7.5%), intermediate (7.5%-20.0%), or high (>20.0%). Data were analyzed from February 8, 2019, to April 17, 2020.

EXPOSURES

Association of baseline ASCVD risk burden with plaque progression.

MAIN OUTCOMES AND MEASURES

Noncalcified plaque, calcified plaque, and total plaque volumes (mm3) were measured. Noncalcified plaque was subclassified using predefined Hounsfield unit thresholds for fibrous, fibrofatty, and low-attenuation plaque. The percent atheroma volume (PAV) was defined as plaque volume divided by vessel volume. Adverse plaque characteristics were defined as the presence of positive remodeling, low-attenuation plaque, or spotty calcification.

RESULTS

In total, 1005 patients (mean [SD] age, 60 [8] years; 575 men [57.2%]) were included in the analysis. Of those, 463 patients (46.1%) had a low 10-year ASCVD risk score (low-risk group), 373 patients (37.1%) had an intermediate ASCVD risk score (intermediate-risk group), and 169 patients (16.8%) had a high ASCVD risk score (high-risk group). The annualized progression rate of PAV for total plaque, calcified plaque, and noncalcified plaque was associated with increasing ASCVD risk (r = 0.26 for total plaque, r = 0.23 for calcified plaque, and r = 0.11 for noncalcified plaque; P < .001). The annualized PAV progression of total plaque, calcified plaque, and noncalcified plaque was significantly greater in the high-risk group compared with the low-risk and intermediate-risk groups (for total plaque, 0.99% vs 0.45% and 0.58%, respectively; P < .001; for calcified plaque, 0.61% vs 0.23% and 0.36%; P < .001; and for noncalcified plaque, 0.38%vs 0.22% and 0.23%; P = .01). When further subclassified by noncalcified plaque type, the annualized PAV progression of fibrofatty and low-attenuation plaque was greater in the high-risk group (0.09% and 0.02%, respectively) compared with the low- to intermediate-risk group (n = 836; 0.02% [P = .02] and 0.001% [P = .008], respectively). The interval development of adverse plaque characteristics was greater in the high-risk group compared with the low-risk and intermediate-risk groups (for new positive remodeling, 73 patients [43.2%] vs 151 patients [32.6%] and 133 patients [35.7%], respectively; P = .02; for new low-attenuation plaque, 26 patients [15.4%] vs 44 patients [9.5%] and 35 patients [9.4%]; P = .02; and for new spotty calcification, 37 patients [21.9%] vs 52 patients [11.2%] and 54 patients [14.5%]; P = .002). The progression of noncalcified plaque subclasses and the interval development of adverse plaque characteristics did not significantly differ between the low-risk and intermediate-risk groups.

CONCLUSIONS AND RELEVANCE

Progression of coronary atherosclerosis occurred across all ASCVD risk groups and was associated with an increase in 10-year ASCVD risk. The progression of fibrofatty and low-attenuation plaques and the development of adverse plaque characteristics was greater in patients with a high risk of ASCVD.

Machine learning insight into the role of imaging and clinical variables for the prediction of obstructive coronary artery disease and revascularization: An exploratory analysis of the CONSERVE study

BACKGROUND

Machine learning (ML) is able to extract patterns and develop algorithms to construct data-driven models. We use ML models to gain insight into the relative importance of variables to predict obstructive coronary artery disease (CAD) using the Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization (CONSERVE) study, as well as to compare prediction of obstructive CAD to the CAD consortium clinical score (CAD2). We further perform ML analysis to gain insight into the role of imaging and clinical variables for revascularization.

METHODS

For prediction of obstructive CAD, the entire ICA arm of the study, comprising 719 patients was used. For revascularization, 1,028 patients were randomized to invasive coronary angiography (ICA) or coronary computed tomographic angiography (CCTA). Data was randomly split into 80% training 20% test sets for building and validation. Models used extreme gradient boosting (XGBoost).

RESULTS

Mean age was 60.6 ± 11.5 years and 64.3% were female. For the prediction of obstructive CAD, the AUC was significantly higher for ML at 0.779 (95% CI: 0.672-0.886) than for CAD2 (0.696 [95% CI: 0.594-0.798]) (P = 0.01). BMI, age, and angina severity were the most important variables. For revascularization, the model obtained an overall area under the receiver-operation curve (AUC) of 0.958 (95% CI = 0.933-0.983). Performance did not differ whether the imaging parameters used were from ICA (AUC 0.947, 95% CI = 0.903-0.990) or CCTA (AUC 0.941, 95% CI = 0.895-0.988) (P = 0.90). The ML model obtained sensitivity and specificity of 89.2% and 92.9%, respectively. Number of vessels with ≥70% stenosis, maximum segment stenosis severity (SSS) and body mass index (BMI) were the most important variables. Exclusion of imaging variables resulted in performance deterioration, with an AUC of 0.705 (95% CI 0.614-0.795) (P <0.0001).

CONCLUSIONS

For obstructive CAD, the ML model outperformed CAD2. BMI is an important variable, although currently not included in most scores. In this ML model, imaging variables were most associated with revascularization. Imaging modality did not influence model performance. Removal of imaging variables reduced model performance.

64effects of long-term exercise training and detraining on endothelial function and arterial stiffness in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up

Introduction

Exercise training (ET) improves endothelial function and arterial stiffness in patients with cardiovascular disease. However, whether ET improves endothelial function and arterial stiffness in patients with atrial fibrillation (AF) is unclear. If it does, for how long the effects are sustained remains to be determined.

Methods

In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an ET group for 12 months (CT, n = 13), a group with 6-month detraining after a 6-month ET (DT, n = 15), and a medical treatment only group (MT, n = 30). For ET, cycling on a bicycle ergometer was performed in the DT and CT groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warmup at 60% to 70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80% to 90% of the HRpeak, with 3 minutes of active recovery at 60% to 70% of the HRpeak between intervals, ending with a 5-minute cooldown period. Peak exercise oxygen consumption (Vo2), intimal-medial thickness (IMT) of the carotid artery measured on high-resolution ultrasonography, and left ventricular function were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments. In addition, plasma von Willebrand factor (vWF), endothelin-1, nitric oxide, tumour necrosis factor alpha, interleukin-1 beta, interleukin-6, and interleukin-10 levels were measured as indices of endothelial function.

Results

The 6-month ET increased peak Vo2 (CT: 29.0 ± 6.5 ml/[kg·min] and DT: 26.0 ± 8.2 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p = 0.04) and decreased plasma vWF levels (CT: 103.7 ± 30.7 IU/dL and DT: 106.0 ± 31.2 IU/dL vs. MT: 145.0 ± 47.7 IU/dL, p = 0.01). Detraining significantly reduced the ET-induced increase in Vo2 and decreased the vWF to baseline level, although continuous ET maintained changes in Vo2 (CT: 28.1 ± 5.3 ml/[kg·min] and DT: 22.4 ± 6.6 ml/[kg·min] vs. MT: 21.5 ± 4.8 ml/[kg·min], p = 0.043) and in vWF (CT: 84.3 ± 39.1 IU/dL vs. DT: 122.2 ± 27.5 IU/dL and MT: 135.9 ± 50.4 IU/dL, p = 0.014). However, carotid arterial IMT, and resting left ventricular systolic and diastolic functions showed no significant changes, with no inter-group differences after 6 months of training and 6 months of continuous training or detraining.

Conclusions

The decreased vWF level suggested that ET can be a strong non-pharmacologic option to improve endothelial function in patients with AF. However, it can rapidly lose its effects after detraining. Therefore, physicians should encourage their patients to participate in a continuous exercise program to sustain its benefits in terms of improved exercise capacity and endothelial function in patients with AF.

63Effects of exercise-based cardiac rehabilitation and detraining on exercise capacity and cardiac function in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up

Introduction

We aimed to determine whether maximal exercise capacity, left ventricular function, and quality of life (QoL) scores are sustained in patients with atrial fibrillation (AF) after termination of training following exercise-based cardiac rehabilitation (ECR).

Methods

In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an exercise training group for 12 months (ECR, n = 13), a group with 6-month detraining after a 6-month exercise training (DT, n = 15), and a medical treatment only group (MT, n = 30). For exercise training, cycling on a bicycle ergometer was performed in the DT and ECR groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warm-up at 60%–70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80%–90% of the HRpeak, with 3 minutes of active recovery at 60%–70% of the HRpeak between intervals, ending with a 5-minute cool-down period. Peak exercise oxygen consumption (Vo2), left ventricular function, plasma lipid level, N-terminal pro B-type natriuretic peptide level, and QoL score were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments.

Results

Six months of exercise training increased the peak Vo2 (ECR: 28.2 ± 7.0 ml/[kg·min] and DT: 28.0 ± 8.3 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p= 0.047) and QoL scores (36-Item Short-form Health Survey) and decreased the total cholesterol level (ECR: 146.8 ± 43.8 mg/dl and DT: 140.6 ± 22.4 vs. MT: 182 ± 44.2 mg/dl, p = 0.008). Detraining resulted in an increase in QoL score and a decrease in total cholesterol level (ECR: 142.8 ± 21.4 mg/dl and DT: 151.8 ± 39.8 vs. MT: 176.8 ± 34.2 mg/dl, p = 0.017). However, the exercise training-induced increase in peak Vo2 reverted to the baseline level after detraining (ECR: 27.1 ± 5.1 ml/kg/min vs. DT: 24.4 ± 7.2 ml/[kg·min] and MT: 21.5 ± 4.86 ml/[kg·min], p = 0.017). The resting left ventricular systolic and diastolic functions were not significantly different, with no inter-group difference after 6 months of training and 6 months of continuous training or detraining.

Conclusions

As the QoL scores are maintained despite peak Vo2 being lowered by detraining after an exercise training period in patients with AF, physicians should encourage patients’ participation in a continuous exercise program to sustain the improvement in both the QoL score and peak Vo2 with exercise training. Further studies with larger sample sizes are needed to observe the long-term effects of exercise training and detraining.

Triglyceride glucose index is an independent predictor for the progression of coronary artery calcification in the absence of heavy coronary artery calcification at baseline

BACKGROUND

Data on the relationship between the triglyceride glucose (TyG) index and coronary artery calcification (CAC) progression is limited. This longitudinal study evaluated the association of TyG index with CAC progression in asymptomatic adults.

METHODS

We enrolled 12,326 asymptomatic Korean adults who had at least two CAC evaluations. The TyG index was determined using ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). CAC progression was defined as a difference ≥ 2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualized Δ√transformed CACS was defined as Δ√transformed CACS divided by the inter-scan period.

RESULTS

During a mean 3.3 years, the overall incidence of CAC progression was 30.6%. The incidence of CAC progression (group I [lowest]: 22.7% versus [vs.] group II: 31.7% vs. group III [highest]: 37.5%, P < 0.001) and annualized Δ√transformed CACS (group I: 0.46 ± 1.44 vs. group II: 0.71 ± 2.02 vs. group III: 0.87 ± 1.75, P < 0.001) were markedly elevated with increasing TyG index tertiles. Multivariate linear regression analysis showed that TyG index was associated with annualized Δ√transformed CACS (β = 0.066, P = 0.036). In multivariate logistic regression analysis, the TyG index was significantly associated with CAC progression in baseline CACS ≤ 100.

CONCLUSION

The TyG index is an independent predictor of CAC progression, especially in adults without heavy baseline CAC.

First-principles calculations of oxygen octahedral distortions in LaAlO3/SrTiO3(001) superlattices

The size, shape and connectivity of oxide octahedra are essential for understanding and controlling the emergent functional properties of ABO₃ perovskites. Using first-principles calculations, we systematically studied the oxygen octahedral rotation and deformation in LaAlO₃/SrTiO₃(001) superlattices. Superlattices with electron- or hole-doped interfaces, or both, are compared. The results showed that there are at least three different types of oxygen octahedral distortions in these superlattices, which is more than what had previously been reported in the literature. We demonstrate that interfacial oxygen octahedral coupling and hole-doping, in addition to epitaxial strain, are the key factors underlying the formation of multiple types of oxygen octahedral rotations in these systems. We confirm that oxygen octahedral rotations and deformations play an essential role in insulator-metal transitions. Furthermore, octahedral distortion leads to ferroelectricity like dipole formation with the polarization vector always pointing to the positively charged interfaces.

Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry

Background

Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography–determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP.

Methods and Results

Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher‐ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78–0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52–0.67]; Duke coronary artery disease score, 0.74 [0.68–0.79]; ML model 1, 0.62 [0.55–0.69]; ML model 2, 0.73 [0.67–0.80]; all P<0.001; statistical model, 0.81 [0.75–0.87], P=0.128).

Conclusions

Based on a ML framework, quantitative atherosclerosis characterization has been shown to be the most important feature when compared with clinical, laboratory, and qualitative measures in identifying patients at risk of RPP.

Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry

OBJECTIVE

Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes.

RESEARCH DESIGN AND METHODS

Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization.

RESULTS

MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7-11.6] and 3.9 [95% CI 2.8-5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21-3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%.

CONCLUSIONS

For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.

Epithelial Wnt10a Is Essential for Tooth Root Furcation Morphogenesis

WNT10A (Wingless-type MMTV integration site family, member 10A) plays a crucial role in tooth development, and patients with biallelic WNT10A mutation and mice lacking Wnt10a show taurodontism. However, whether epithelial or mesenchymal WNT10A controls the initiation of the root furcation formation remains unclear, and the functional significance of WNT10A in regulating root morphogenesis has not been clarified. Here, we investigated how Wnt10a affects tooth root development by generating different tissue-specific Wnt10a conditional knockout mice. Wnt10a knockout in the whole tissue (EIIa-Cre;Wnt10a^flox/flox) and in dental epithelium (K14-Cre;Wnt10a^flox/flox) led to an absence of or apically located root furcation in molars of mice, a phenotype that resembled taurodontism. An RNAscope analysis showed that the dynamic epithelial and mesenchymal Wnt10a expression pattern occurred during root development. Immunofluorescent staining of E-cadherin and EdU revealed decreased epithelial cell proliferation at the cervical region of the molar in K14-Cre;Wnt10a^flox/flox mice at postnatal day 0 (PN0), just before the initiation of root morphogenesis. Interestingly, we found increased pulpal mesenchymal cell proliferation in the presumptive root furcating region of the molar in K14-Cre;Wnt10a^flox/flox mice at PN4 and PN7. RNA-seq indicated that among the Wnt ligands with high endogenous expression levels in molars, Wnt4 was increased after epithelial knockout of Wnt10a. The RNAscope assay confirmed that the expression of Wnt4 and Axin2 in the dental papilla of the presumptive root furcating region, where dental pulp overgrowth occurred, was increased in K14-Cre;Wnt10a^flox/flox molars. Furthermore, after suppression of the elevated Wnt4 level in K14-Cre;Wnt10a^flox/flox molars by Wnt4 shRNA adenovirus and kidney capsule grafts, the root furcation defect was partially rescued. Taken together, our study provides the first in vivo evidence that epithelial Wnt10a guides root furcation formation and plays a crucial role in controlling the organized proliferation of adjacent mesenchymal cells by regulating proper Wnt4 expression during root furcation morphogenesis.

P2534Prevalence and risk factors of acquired LQTS among pregnancy: a single-center study

Background

Prolonged QT intervals have been observed in pregnant women, especially those with twin pregnancy, which predisposes them to a high risk of ventricular arrhythmias.

Purpose

To evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized parturient women with single and twin pregnancy and search for potential risk factors.

Methods

Information about age-matched parturient women with single and twin pregnancy were retrospectively collected in our hospital from January 2016 to June 2018. The prevalence of aLQTS was evaluated. The common risk factors for corrected QT (QTc) prolongation were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in such population.

Results

Totally 293 parturient women (147 twin pregnancy, 50.17%) were included. The prevalence of aLQTS was 72.70% in all cases, 53.15% in the single pregnancy, 93.20% in the twin pregnancy. The proportion of severely prolonged QTc was 36.18% in all cases, 8.22% in the single pregnancy and 63.95% in the twin pregnancy. The QTc interval was much longer in the twin pregnancy than in the single pregnancy with significant difference. Differences in systolic blood pressure, diastolic blood pressure, total cholesterol, serum uric acid, fetal weight, QRS, RV5+SV1, Tp-Te, Tp-Te/QT have been revealed to be statistically significant between the QTc-prolongation group and the QTc-normal group. The incidence of gestational hypertension and twin pregnancy in the QTc-prolongation group were more prevalent than in the QTc-normal group with significant difference. In the multivariable logistic regression analysis, gestational hypertension, twin pregnancy, increase of diastolic blood pressure, high total cholesterol, high serum uric acid, and heavy fetal weight were identified to be associated with QTc prolongation in parturient women.

Table 1. Risk factors significantly correlated with QTc prolongation in parturient women Index P value OR (95% CI) DBP (mmHg) 0.033* 1.052 (1.004 to 1.101) TC (mmol/L) 0.001** 1.442 (1.165 to 1.785) UA (μmol/L) 0.007** 1.004 (1.001 to 1.008) Fetal weight (g) <0.001** 1.001 (1.001 to 1.001) Hypertention (%) 0.029* 2.561 (1.099 to 5.967) Twin (%) <0.001** 12.618 (6.145 to 25.909)

Conclusion

To our knowledge, this is the first clinical study to evaluate the prevalence of aLQTS between single and twin pregnancy. The prevalence of aLQTS is much higher in the parturient women, particularly in twin pregnancy.

The association between progression of coronary artery calcium and colorectal adenoma: A retrospective follow-up study of asymptomatic Koreans

The potential relationship between coronary artery calcium (CAC) and colorectal adenoma has been widely indicated. This study aimed to investigate the relationship between the risk of colorectal adenoma and CAC progression in asymptomatic Korean adults who underwent serial assessments by colonoscopy and CAC scan.A total of 754 asymptomatic participants, who had undergone serial CAC scans and colonoscopies for screening, were enrolled. Changes in CAC were assessed according to the absolute change between baseline and follow-up results. CAC progression was defined using Multi-Ethnic Study of Atherosclerosis method. Risk for adenoma at follow-up colonoscopy was determined using hazard ratio (HR) by Cox regression. The area under the receiver operating characteristic (ROC) curve was measured.The mean follow-up duration was 3.4 ± 2.5 years. CAC progression was found in 215 participants (28.5%). Participants with adenoma at index colonoscopy showed a higher rate of CAC progression than those without (38.8% vs 23.6%, P < .01). In participants with adenoma at index colonoscopy, CAC progression significantly increased the cumulative risk for adenoma at follow-up colonoscopy (HR = 1.48, 95% confidence interval [CI] 1.06-2.06, log-rank P = .021). In multivariate analysis, male sex (HR = 2.57, 95% CI 1.22-5.42, P = .013), ≥3 adenomas at index colonoscopy (HR = 2.60, 95% CI 1.16-5.85, P = .021), and CAC progression (HR = 2.74, 95% CI 1.48-5.08, P = .001) increased the risk of adenoma at follow-up colonoscopy. In participants without adenoma at index colonoscopy, neither baseline CAC presence nor CAC progression increased the risk of adenoma at follow-up colonoscopy. The interaction between CAC progression and adenoma at index colonoscopy was significant in multivariable model (P = .005). In the ROC analysis, AUC of CAC progression for adenoma at follow-up colonoscopy was 0.625 (95% CI 0.567-0.684, P < .001) in participants with adenoma at index colonoscopy.Participants with CAC progression, who are at high risk of coronary atherosclerosis, may need to be considered for follow-up evaluation of colorectal adenoma, especially those with adenoma at index colonoscopy.