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Influence of the definition of "metabolically healthy obesity" on the progression of coronary artery calcification. PLoS One 2017; 12:e0178741. [PMID: 28575097 PMCID: PMC5456095 DOI: 10.1371/journal.pone.0178741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/18/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Debates whether metabolically healthy obesity (MHO) increases the cardiovascular risk might be due to the metabolic instability of MHO or the absence of a perfect definition of MHO. Therefore, we aimed to investigate the influence of the MHO phenotype on the coronary artery calcium score (CACS) progression according to definition of MHO. METHODS We analyzed a retrospective cohort with a CACS of 0 at baseline and available serial CACS measurements taken ≥ 12 months apart (n = 1,218). Obesity was defined as BMI ≥ 25 kg/m2, and MHO was defined as obesity accompanied by ≤ 1 (MHO class I) or 0 (MHO class II) components of metabolic syndrome (MetS). RESULTS During a median follow-up of 45 months, 32.2% of MHO class I and 10.2% of MHO class II subjects developed MetS. Compared to non-obese/metabolically healthy subjects (reference group), hazard ratios (HR) for development of MetS were 2.174 (95% confidence interval [CI]: 1.513-3.124) and 1.166 (95% CI: 0.434-3.129) for MHO class I and II subjects, respectively. The MHO class I subjects showed a significantly increased risk of CACS progression as compared to the reference group (HR: 1.653; 95% CI: 1.144-2.390), whereas MHO class II subjects did not (HR: 1.195; 95% CI: 0.514-2.778). Among subjects with MHO class I, no significant CACS progression was observed in the subjects who maintained metabolic health during follow-up (HR: 1.448; 95% CI: 0.921-2.278). CONCLUSIONS The risks of metabolic deterioration and CACS progression were significant in subjects with MHO class I, but not in those with MHO class II.
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Lee JH, Kim J, Kim M, Hwang J, Hwang YM, Kang JW, Nam GB, Choi KJ, Kim YH. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation: A comparison of 2 versus 4 frame rate. Medicine (Baltimore) 2017; 96:e7200. [PMID: 28614264 PMCID: PMC5478349 DOI: 10.1097/md.0000000000007200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups.The 4-FPS group showed higher median DAP (599.9 cGy cm; interquartile range [IR], 371.4-1337.5 cGy cm vs. 392.0 cGy cm; IR, 289.7-591.4 cGy cm; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5-34.9 min vs. 15.1 min; IR, 10.7-20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7-2.5 mSv vs. 0.7 mSv; IR, 0.6-1.1 mSv; P < .01) compared with the 2-FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan-Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25).In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional fluoroscopy setting.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chaikriangkrai K, Jhun HY, Palamaner Subash Shantha G, Bin Abdulhak A, Sigurdsson G, Nabi F, Mahmarian JJ, Chang SM. Coronary artery calcium score as a predictor for incident stroke: Systematic review and meta-analysis. Int J Cardiol 2017; 236:473-477. [DOI: 10.1016/j.ijcard.2017.01.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
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Abstract
The coronary artery calcium score plays an Important role In cardiovascular risk
stratification, showing a significant association with the medium- or long-term
occurrence of major cardiovascular events. Here, we discuss the following:
protocols for the acquisition and quantification of the coronary artery calcium
score by multidetector computed tomography; the role of the coronary artery
calcium score in coronary risk stratification and its comparison with other
clinical scores; its indications, interpretation, and prognosis in asymptomatic
patients; and its use in patients who are symptomatic or have diabetes.
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Affiliation(s)
- Priscilla Ornellas Neves
- Full Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at the Hospital Santa Luzia, Brasília, DF, Brazil
| | - Joalbo Andrade
- MD, PhD, Radiologist at the Hospital Santa Luzia, Brasília, DF, Brazil
| | - Henry Monção
- Full Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at the Hospital Santa Luzia, Brasília, DF, Brazil
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Kerut SE, Balart JT, Kerut EK, McMullan MR. Diagnosis of fatty liver by computed tomography coronary artery calcium score. Echocardiography 2017; 34:937-938. [PMID: 28493399 DOI: 10.1111/echo.13545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Nonalcoholic fatty liver disease may range from simple steatosis to fibrosis and cirrhosis. It is associated with the development of coronary artery calcification and appears to be an independent predictor of future adverse cardiovascular events. As the presence of a fatty liver appears to portray an independent increased risk, it may be beneficial to note this on coronary artery calcium scoring reports. Determination of fatty liver is relatively easy to perform. We discuss the method used by the Multi-Ethnic Study of Atherosclerosis (MESA) study for determination of fatty liver from CT coronary artery calcium scoring acquisitions, which may be implemented in clinical analysis.
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Affiliation(s)
- Sarah E Kerut
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John T Balart
- Jefferson Radiology Associates, West Jefferson Medical Center, Marrero, LA, USA
| | | | - Michael R McMullan
- Division of Cardiovascular Diseases, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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206
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Merghani A, Maestrini V, Rosmini S, Cox AT, Dhutia H, Bastiaenan R, David S, Yeo TJ, Narain R, Malhotra A, Papadakis M, Wilson MG, Tome M, AlFakih K, Moon JC, Sharma S. Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile. Circulation 2017; 136:126-137. [PMID: 28465287 DOI: 10.1161/circulationaha.116.026964] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.
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Affiliation(s)
- Ahmed Merghani
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Viviana Maestrini
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Stefania Rosmini
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Andrew T Cox
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Harshil Dhutia
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Rachel Bastiaenan
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Sarojini David
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Tee Joo Yeo
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Rajay Narain
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Aneil Malhotra
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Michael Papadakis
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Mathew G Wilson
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Maite Tome
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Khaled AlFakih
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - James C Moon
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Sanjay Sharma
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.).
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207
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Andreini D, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M, Volpato V, Annoni A, Baggiano A, Formenti A, Mancini ME, Beltrama V, Ditali V, Campari A, Fiorentini C, Bartorelli AL, Pepi M. Atrial Fibrillation: Diagnostic Accuracy of Coronary CT Angiography Performed with a Whole-Heart 230-µm Spatial Resolution CT Scanner. Radiology 2017; 284:676-684. [PMID: 28445682 DOI: 10.1148/radiol.2017161779] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To assess image quality, interpretability, diagnostic accuracy, and radiation exposure of a computed tomography (CT) scanner with 16-cm coverage and 230-µm spatial resolution at coronary artery evaluation in patients with atrial fibrillation (AF) by using invasive coronary angiography (ICA) as the reference method and to compare the results with those obtained in patients with sinus rhythm (SR). Materials and Methods Written informed consent and institutional ethics committee approval were obtained. Between March 2015 and February 2016, 166 consecutive patients were prospectively enrolled (83 with AF, 83 with SR). They underwent ICA and coronary CT angiography performed with a whole-heart CT scanner. Image quality, coronary segment interpretability, effective dose (ED), and diagnostic accuracy were assessed at CT angiography and were compared with those attained with ICA. Diagnostic performance of the groups was compared with the pairwise McNemar test. Results Mean heart rate during scanning was 83 beats per minute ± 21 (standard deviation) in the AF group and 63 beats per minute ± 14 in the SR group (P < .01). Coronary interpretability was 98.5% in the AF group and 98.4% in the SR group (P = .96). In a segment-based analysis, sensitivity and specificity in the detection of coronary stenosis of more than 50% compared with detection of ICA were 96.4% and 98.7%, respectively, in the chronic AF group (P = .98) and 95.6% and 98.1%, respectively, in the SR group (P = .32). In a patient-based analysis, sensitivity and specificity were 95.2% and 97.6%, respectively, in the chronic AF group (P = .95) and 97.8% and 94.7%, respectively, in the SR group (P = .93). Conclusion Whole-heart CT enables evaluation of coronary arteries with high image quality, low radiation exposure, and high diagnostic accuracy in patients with chronic AF, with a diagnostic performance similar to that in patients with SR. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Daniele Andreini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Gianluca Pontone
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Saima Mushtaq
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Edoardo Conte
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Perchinunno
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Guglielmo
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Volpato
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Annoni
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Baggiano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alberto Formenti
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Maria Elisabetta Mancini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Virginia Beltrama
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Ditali
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alessandro Campari
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Cesare Fiorentini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Antonio L Bartorelli
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Mauro Pepi
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
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208
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Lee DY, Kim JH, Park SE, Park CY, Oh KW, Park SW, Rhee EJ, Lee WY. Effects of Low-density Lipoprotein Cholesterol on Coronary Artery Calcification Progression According to High-density Lipoprotein Cholesterol Levels. Arch Med Res 2017; 48:284-291. [DOI: 10.1016/j.arcmed.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/19/2017] [Indexed: 12/19/2022]
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209
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Dorans KS, Wilker EH, Li W, Rice MB, Ljungman PL, Schwartz J, Coull BA, Kloog I, Koutrakis P, D'Agostino RB, Massaro JM, Hoffmann U, O'Donnell CJ, Mittleman MA. Residential proximity to major roads, exposure to fine particulate matter and aortic calcium: the Framingham Heart Study, a cohort study. BMJ Open 2017; 7:e013455. [PMID: 28302634 PMCID: PMC5372069 DOI: 10.1136/bmjopen-2016-013455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Traffic and ambient air pollution exposure are positively associated with cardiovascular disease, potentially through atherosclerosis promotion. Few studies have assessed associations of these exposures with thoracic aortic calcium Agatston score (TAC) or abdominal aortic calcium Agatston score (AAC), systemic atherosclerosis correlates. We assessed whether living close to a major road and residential fine particulate matter (PM2.5) exposure were associated with TAC and AAC in a Northeastern US cohort. DESIGN Cohort study. SETTING Framingham Offspring and Third Generation participants residing in the Northeastern USA. PARTICIPANTS AND OUTCOME MEASURES Among 3506 participants, mean age was 55.8 years; 50% female. TAC was measured from 2002 to 2005 and AAC up to two times (2002-2005; 2008-2011) among participants from the Framingham Offspring or Third Generation cohorts. We first assessed associations with detectable TAC (logistic regression) and AAC (generalised estimating equation regression, logit link). As aortic calcium scores were right skewed, we used linear regression models and mixed-effects models to assess associations with natural log-transformed TAC and AAC, respectively, among participants with detectable aortic calcium. We also assessed associations with AAC progression. Models were adjusted for demographic variables, socioeconomic position indicators and time. RESULTS There were no consistent associations of major roadway proximity or PM2.5 with the presence or extent of TAC or AAC, or with AAC progression. Some estimates were in the opposite direction than expected. CONCLUSIONS In this cohort from a region with relatively low levels of and variation in PM2.5, there were no strong associations of proximity to a major road or PM2.5 with the presence or extent of aortic calcification, or with AAC progression.
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Affiliation(s)
- Kirsten S Dorans
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elissa H Wilker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary B Rice
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Petter L Ljungman
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brent A Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ralph B D'Agostino
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Joseph M Massaro
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, Massachusetts, USA
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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210
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6083] [Impact Index Per Article: 869.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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211
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Lee DH, Youn HJ, Jung HO, Chang K, Choi YS, Jung JI. The cardiovascular risk factors associated with the plaque pattern on coronary computed tomographic angiography in subjects for health check-up. Clin Hypertens 2017; 23:6. [PMID: 28265463 PMCID: PMC5333424 DOI: 10.1186/s40885-017-0062-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although it is known that coronary computed tomographic angiography (CCTA) offers highly negative predictive value to exclude obstructive coronary lesions, the plaque pattern on CCTA has not been fully understood. The purpose of this study was to explore the difference of the plaque patterns on CCTA and to assess the cardiovascular risks in healthy subjects. METHODS A total of 3914 subjects (mean age: 55 ± 10 years, M : F = 2649 : 1265) who underwent CCTA for health check-up between January 2009 and December 2012 were enrolled. According to coronary artery calcium score (CACS) and plaque pattern on CCTA, subjects were categorized into four groups (group 1: normal; group 2: "non-calcified" plaque; group 3: "calcified" plaque; group 4: mixed plaque). We analyzed cardiovascular risks and Framingham risk score (FRS) among the groups. RESULTS The incidence of each group was group 1 in 55.0% (2152/3914), group 2 in 5.1% (200/3914), group 3 in 8.2% (319/3914), and group 4 in 7.2% (280/3914), respectively. There was no difference of FRS among the groups (6.4 ± 6.4%; 6.5 ± 4.6%; 8.2 ± 5.8%; 7.7 ± 5.7% p = 0.086). In multivariate analysis, HbA1c (OR = 2.285; 95%CI = 1.029 - 5.071; p = 0.042) in group 2; age (OR = 1.115; 95%CI = 1.034 - 1.202; p = 0.005) and smoking status (OR = 3.386; 95%CI = 1.124 - 10.202; p = 0.030) in group 3; and age (OR = 1.054; 95%CI = 1.011 - 1.099; p = 0.014) and hypertension (OR = 3.087; 95%CI = 1.536 - 6.202; p = 0.001) in group 4 were independent factors. CONCLUSIONS Our data suggest that more individualized therapy for reduction of cardiovascular risks associated with plaque pattern on CCTA could be considered in healthy subjects.
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Affiliation(s)
- Dong-Hyeon Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Hae-Ok Jung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Jung Im Jung
- Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
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212
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Martinez CH, Freeman CM, Nelson JD, Murray S, Wang X, Budoff MJ, Dransfield MT, Hokanson JE, Kazerooni EA, Kinney GL, Regan EA, Wells JM, Martinez FJ, Han MK, Curtis JL. GDF-15 plasma levels in chronic obstructive pulmonary disease are associated with subclinical coronary artery disease. Respir Res 2017; 18:42. [PMID: 28245821 PMCID: PMC5331711 DOI: 10.1186/s12931-017-0521-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/13/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15), a cytokine associated with cardiovascular mortality, increases during chronic obstructive pulmonary disease (COPD) exacerbations, but any role in stable COPD is unknown. We tested associations between GDF-15 and subclinical coronary atherosclerosis, assessed by coronary artery calcium (CAC) score, in COPD subjects free of clinical cardiovascular disease (CVD). METHODS Cross-sectional analysis of COPD participants (GOLD stages 2-4) in the COPDGene cohort without CVD at enrollment, using baseline CAC (from non-EKG-gated chest computed tomography) and plasma GDF-15 (by custom ELISA). We used multinomial logistic modeling of GDF-15 associations with CAC, adjusting for demographics, baseline risk (calculated using the HEART: Personal Heart Early Assessment Risk Tool (Budoff et al. 114:1761-1791, 2006) score), smoking history, measures of airflow obstruction, emphysema and airway disease severity. RESULTS Among 694 participants with COPD (47% women, mean age 63.6 years) mean GDF-15 was 1,304 pg/mL, and mean CAC score was 198. Relative to the lower GDF-15 tertile, higher tertiles showed bivariate association with increasing CAC score (mid tertile odds ratio [OR] 1.80, 95% confidence interval [CI] 1.29, 2.51; higher tertile OR 2.86, CI 2.04, 4.02). This association was maintained after additionally adjusting for baseline CVD risk, for co-morbidities and descriptors of COPD severity and impact, markers of cardiac stress (N-terminal pro-B-type natriuretic peptide, troponin T) and of inflammation (Interleukin-6), and in subgroup analysis excluding men, diabetics, current smokers or those with limited ambulation. CONCLUSIONS In ever-smokers with COPD free of clinical CVD, GDF-15 contributes independently to subclinical coronary atherosclerosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT00608764 . Registered 28 January 2008.
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Affiliation(s)
- Carlos H Martinez
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Christine M Freeman
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA.,Research Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Joshua D Nelson
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Xin Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mark T Dransfield
- The Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Medical Service, Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - John E Hokanson
- School of Public Health, University of Colorado, Aurora, CO, USA
| | - Ella A Kazerooni
- Radiology Department, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gregory L Kinney
- School of Public Health, University of Colorado, Aurora, CO, USA
| | - Elizabeth A Regan
- National Jewish Health & Research Center, Denver, CO, USA.,Pulmonary & Critical Care Medicine Division, Department of Medicine, University of Colorado, Denver, CO, USA
| | - J Michael Wells
- The Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Medical Service, Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - Fernando J Martinez
- Pulmonary & Critical Care Medicine Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - MeiLan K Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA
| | - Jeffrey L Curtis
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA. .,Graduate Program in Immunology, University of Michigan, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA. .,Medical Service, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105-2303, USA.
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213
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Kwon CH, Kang JG, Lee HJ, Kim NH, Sung JW, Cheong E, Sung KC. Absence of association between gallstone and coronary artery calcification. Atherosclerosis 2017; 258:51-55. [PMID: 28192729 DOI: 10.1016/j.atherosclerosis.2017.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Gallstone has been suggested to be associated with cardiovascular disease (CVD). Coronary artery calcification (CAC) is an excellent value to predict future CVD. The aim of this study was to evaluate the association between gallstone and CAC. METHODS Data were analyzed from an occupational cohort of 46,893 subjects (37,557 men and 9336 women) between 2011 and 2014. Participants with cancer or CVD histories or missing data at baseline were excluded from the study. Gallstone was diagnosed by ultrasound-documentation. Multivariate logistic analysis was conducted to examine the relationship between gallstone and CAC. RESULTS The total population who had gallstone was 1426 (3.1%). In multivariate analysis, odds ratios (OR) for gallstone were not different according to CAC score groups in men and women. In addition, gallstone was not associated with higher OR for CAC in men and women. CONCLUSIONS Gallstone was not associated with CAC in both Korean men and women.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Gyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Gangnam CHA Medical Center, CHA University, School of Medicine, Seoul, Republic of Korea
| | - Joo-Wook Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - EunSun Cheong
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Sasaki T, Kobayashi K, Kita S, Kojima K, Hirano H, Shen L, Takenaka F, Kumon H, Matsuura E. In vivo distribution of single chain variable fragment (scFv) against atherothrombotic oxidized LDL/β2-glycoprotein I complexes into atherosclerotic plaques of WHHL rabbits: Implication for clinical PET imaging. Autoimmun Rev 2017; 16:159-167. [DOI: 10.1016/j.autrev.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/05/2016] [Indexed: 12/17/2022]
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215
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Petri N, Gassenmaier T, Allmendinger T, Flohr T, Voelker W, Bley TA. Influence of cardiac motion on stent lumen visualization in third generation dual-source CT employing a pulsatile heart model. Br J Radiol 2017; 90:20160616. [DOI: 10.1259/bjr.20160616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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216
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Nicoll R, Henein M. Arterial calcification: A new perspective? Int J Cardiol 2017; 228:11-22. [DOI: 10.1016/j.ijcard.2016.11.099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
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217
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Canceled coronary computed tomography angiography: Downstream testing and outcomes. Int J Cardiol 2017; 227:457-461. [DOI: 10.1016/j.ijcard.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023]
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218
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Budoff MJ, Li D, Kazerooni EA, Thomas GS, Mieres JH, Shaw LJ. Diagnostic Accuracy of Noninvasive 64-row Computed Tomographic Coronary Angiography (CCTA) Compared with Myocardial Perfusion Imaging (MPI): The PICTURE Study, A Prospective Multicenter Trial. Acad Radiol 2017; 24:22-29. [PMID: 27771227 DOI: 10.1016/j.acra.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Although multiple studies have shown excellent accuracy statistics for noninvasive angiography by coronary computed tomographic angiography (CCTA), most studies comparing nuclear imaging to CCTA were performed on patients already referred for cardiac catheterization, introducing referral and selection bias. This prospective trial evaluated the diagnostic accuracy of 64-row CCTA to detect obstructive coronary stenosis compared to myocardial perfusion imaging (MPI), using quantitative coronary angiography (QCA) as a reference standard. MATERIALS AND METHODS Twelve sites prospectively enrolled 230 patients (49% male, 57.8 years) with chest pain. All patients underwent MPI and CCTA (Lightspeed VCT/Visipaque 320, GE Healthcare, Milwaukee, WI, USA) prior to invasive coronary angiography (ICA). All patients were evaluated, and those found to have either an abnormal MPI or CCTA were clinically referred for ICA. CCTAs were graded on a 15-segment American Heart Association model by three blinded readers for presence of obstructive stenosis (>50% or >70%); MPI was graded by two blinded readers using a 17-segment model for estimation of the % myocardium ischemic or with stress defects. ICAs were independently graded for % stenosis by QCA. The efficacies of MPI and CCTA were assessed including all vessel segments for per-patient and per-vessel analyses. RESULTS The prevalence of stenosis ≥50% by ICA was 52.1% (25 of 48). The sensitivity of CCTA was significantly higher than nuclear imaging (92.0% vs 54.5%, P < 0.001), with similar specificity (87.0% vs 78.3%) when obstructive disease was defined as ≥50%. CCTA provided superior sensitivity (92.6% vs 59.3%, P < 0.001) and similar specificity (88.9% vs 81.5%) using QCA stenosis ≥70%. For ≥50% stenosis, the computed tomographic angiography odds ratio for ICA disease was 51.75 (95% CI = 8.50-314.94, P < 0.001). For summed stress score ≥5%, the odds ratio for ICA CAD was 12.73 (95% CI = 2.43-66.55, P < 0.001). Using receiver operating characteristic curve analysis, CCTA was better at classifying obstructive coronary artery disease when compared to MPI (area = 0.85 vs 0.71, P < 0.0001). CONCLUSIONS This study represents one of the first prospective multicenter, controlled clinical trials comparing 64-row CCTA to MPI in the same patients, demonstrating superior diagnostic accuracy of CCTA over myocardial perfusion single photon emission computed tomography (MPS) to reliably detect >50% and >70% stenosis in stable chest pain patients.
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Affiliation(s)
- Matthew J Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California.
| | - Dong Li
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California
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Plasma phylloquinone, menaquinone-4 and menaquinone-7 levels and coronary artery calcification. J Nutr Sci 2016; 5:e48. [PMID: 28620475 PMCID: PMC5465808 DOI: 10.1017/jns.2016.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/17/2016] [Accepted: 05/11/2016] [Indexed: 01/07/2023] Open
Abstract
Vitamin K is considered to be involved in the pathological mechanisms of coronary artery calcification (CAC). Correlation between CAC and plasma vitamin K levels was studied. A total of 103 patients, with at least one coronary risk factor, were studied. CAC was measured using 64-slice multislice computed tomography (MSCT) and divided into three groups: none (CAC score = 0; n 25), mild to moderate (0 < CAC score < 400; n 52) and severe (CAC score > 400; n 26). Phylloquinone (PK) and menaquinone (MK)-4 and MK-7 were measured by HPLC-tandem MS. Mean age of patients was 64 (sd 13) years, of which 57 % were male. Median CAC score was 57·2. Median levels of PK, MK-4 and MK-7 were 1·33, 0 and 6·99 ng/ml, showing that MK-7 was the dominant vitamin K in this population. MK-7 showed a significant inverse correlation with uncarboxylated osteocalcin (ucOC, P = 0·014), protein induced by vitamin K absence of antagonist-2 (PIVKA-2, P = 0·013), intact parathyroid hormone (P = 0·007) and bone-specific alkaline phosphatase (P = 0·018). CAC showed an inverse correlation with total circulating uncarboxylated matrix Gla protein (t-ucMGP, P = 0·018) and Hb (P = 0·05), and a positive correlation with age (P < 0·001), creatinine, collagen type 1 cross-linked N-terminal telopeptide (NTX, P = 0·03), pulse wave velocity (P < 0·001) and osteoprotegerin (P < 0·001). However, CAC did not have a significant correlation with plasma levels of PK, MK-4 or MK-7. In conclusion, plasma MK-7, MK-4 or PK level did not show significant correlation with CAC despite the association between plasma vitamin K levels and vitamin K-dependent proteins such as ucOC or PIVKA-2.
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Key Words
- BAP, bone-specific alkaline phosphatase
- CAC, coronary artery calcification
- Coronary artery calcification
- MGP, matrix Gla protein
- MK, menaquinone
- Matrix Gla protein
- NTX, N-terminal telopeptide
- OC, osteocalcin
- OPG, osteoprotegerin
- Osteocalcin
- PIVKA-2, protein induced by vitamin K absence of antagonist-2
- PK, phylloquinone
- PTH, parathyroid hormone
- PWV, pulse wave velocity
- Vitamin K
- t-ucMGP, total circulating uncarboxylated matrix Gla protein
- ucOC, uncarboxylated osteocalcin
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Farhan Khan M, Brackett D, Ashcroft I, Tuck C, Wildman R. A Novel Approach to Design Lesion-Specific Stents for Minimum Recoil. J Med Device 2016. [DOI: 10.1115/1.4034880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Stent geometries are obtained by topology optimization for minimized compliance under different stenosis levels and plaque material types. Three levels of stenosis by cross-sectional area, i.e., 30%, 40%, and 50% and three different plaque material properties, i.e., calcified, cellular, and hypocellular, were studied. The raw optimization results were converted to clear design concepts and their performance was evaluated by implanting them in their respective stenosed artery types using finite element analysis. The results were compared with a generic stent in similar arteries, which showed that the new designs showed less recoil. This work provides a concept that stents could be tailored to specific lesions in order to minimize recoil and maintain a patent lumen in stenotic arteries.
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Affiliation(s)
- Muhammad Farhan Khan
- Mem. ASME Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG72RD, UK e-mail:
| | - David Brackett
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG72RD, UK e-mail:
| | - Ian Ashcroft
- Professor Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG72RD, UK e-mail:
| | - Christopher Tuck
- Professor Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG72RD, UK e-mail:
| | - Ricky Wildman
- Professor Department of Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG72RD, UK e-mail:
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Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, Ungprasert P, Sigurdsson G, Nabi F, Mahmarian JJ, Chang SM. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. Ann Emerg Med 2016; 68:659-670. [DOI: 10.1016/j.annemergmed.2016.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/24/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
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Theofanidis D, Gibbon B. Nursing interventions in stroke care delivery: An evidence-based clinical review. JOURNAL OF VASCULAR NURSING 2016; 34:144-151. [DOI: 10.1016/j.jvn.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022]
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Yahagi K, Kolodgie FD, Lutter C, Mori H, Romero ME, Finn AV, Virmani R. Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus. Arterioscler Thromb Vasc Biol 2016; 37:191-204. [PMID: 27908890 DOI: 10.1161/atvbaha.116.306256] [Citation(s) in RCA: 321] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 11/21/2016] [Indexed: 12/25/2022]
Abstract
The continuing increase in the prevalence of diabetes mellitus in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes mellitus-associated progression of atherosclerosis are not fully understood, at clinical and pathological levels, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes mellitus generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes mellitus. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes mellitus and type 2 diabetes mellitus, suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid, and other arterial beds is also more extensive. Although the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes mellitus such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes mellitus include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of type 1 diabetes mellitus- and type 2 diabetes mellitus-associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.
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Affiliation(s)
- Kazuyuki Yahagi
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Frank D Kolodgie
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Christoph Lutter
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Hiroyoshi Mori
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Maria E Romero
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Aloke V Finn
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.)
| | - Renu Virmani
- From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
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Impact of Advanced Modeled Iterative Reconstruction on Coronary Artery Calcium Quantification. Acad Radiol 2016; 23:1506-1512. [PMID: 27742177 DOI: 10.1016/j.acra.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the influence of advanced modeled iterative reconstruction (ADMIRE) on the coronary artery calcium (CAC) scores by computed tomography (CT). MATERIALS AND METHODS Sixty patients underwent CAC imaging with dual-source 192-slice CT. Agatston, volume and mass score were calculated from filtered back projection (FBP) and iterative reconstructions with different levels of ADMIRE. Friedman test and Wilcoxon rank sum test were used for multiple comparisons of CAC values and the difference ratio among different ADMIRE groups using FBP as reference. RESULTS The median Agatston score (range) using FBP was 115 (0.1-3047) and significantly decreased with incremental ADMIRE levels 1-5: 96 (0.1-2813), 91 (0-2764), 87 (0-2699), 80 (0-2590), 70 (0-2440); all P < 0.001. In comparison with FBP Agatston, volume and mass scores significantly decreased with increasing ADMIRE levels 1-5 (P < 0.001): from -12% to -39%, from -14% to -41%, and from -13% to -40%, respectively. In four patients with low calcium burden, the use of ADMIRE 2 or higher resulted in the disappearance of calcium that was detectable using FBP or ADMIRE 1. The decrease of CAC in high-level ADMIRE resulted in a reassignment to a lower Agatston risk group in 27%. CONCLUSIONS ADMIRE causes a substantial reduction of the CAC scores measured by cardiac CT, which leads to an underestimation of cardiovascular risk scores in some patients.
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225
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Tongut A, Özyedek Z, Çerezci İ, Erentürk S, Hatemi AC. Prevalence of congenital coronary artery anomalies as shown by multi-slice computed tomography coronary angiography: a single-centre study from Turkey. J Int Med Res 2016; 44:1492-1505. [PMID: 27856928 PMCID: PMC5536768 DOI: 10.1177/0300060516667118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective Coronary artery anomaly (CAA) is a remarkable etiological factor for sudden cardiac death in young adults. The incidence of CAA is unknown, with most reliable data available based on postmortem/angiography investigations. This study aimed to assess the prevalence of different forms of coronary anomalies, and to investigate the relationships between demographic data and occurrence of CAA. Methods A total of 2401 consecutive patients (1805 men; mean age, 56 ± 11.7 years), who were referred between January 2005 and December 2008 for noninvasive multi-slice computed tomography (MSCT) imaging, were retrospectively analysed. Results A total of 225 cases (191 men; mean age, 55.9 ± 12) of CAAs were identified (9.37%). Because 11 patients had multiple muscular bridges of the coronary arteries, 236 coronary artery anomalies were found in these 225 patients. Cases were classified into three groups: group 1, coronary anomalies of origin and distribution (n = 36, 1.5%); group 2, anomalies of intrinsic coronary arterial anatomy (n = 180, 7.49%); and group 3, anomalies of coronary termination (n = 9, 0.4%). Conclusion The prevalence of CAA was 9.37% in our single-centre study, which is consistent with previous research. A minimally invasive tool, such as MSCT angiography, should be used to identify CAA.
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Affiliation(s)
- Aybala Tongut
- 1 Kartal Kosuyolu Heart Center, Pediatric Cardiovascular Surgery Clinic, Istanbul, Turkey
| | - Zeki Özyedek
- 2 Maçka Emar Advanced Medical Imaging Center, Istanbul, Turkey
| | - İsmail Çerezci
- 2 Maçka Emar Advanced Medical Imaging Center, Istanbul, Turkey
| | - Selim Erentürk
- 3 Department of Cardiovascular Surgery, Institute for Cardiology, Istanbul University, Istanbul, Turkey
| | - Ali Can Hatemi
- 1 Kartal Kosuyolu Heart Center, Pediatric Cardiovascular Surgery Clinic, Istanbul, Turkey.,3 Department of Cardiovascular Surgery, Institute for Cardiology, Istanbul University, Istanbul, Turkey
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226
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Hatemi AC, Tongut A, Özyedek Z, Çerezci İ, Özgöl İ, Perk Gürün H. Association between ascending aortic diameter and coronary artery dilation: a demographic data analysis. J Int Med Res 2016; 44:1349-1358. [PMID: 28322097 PMCID: PMC5536746 DOI: 10.1177/0300060516666623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Coronary artery dilations (CDs), a subgroup of coronary artery anomalies (CAAs), are relatively rare but important cardiac pathologies. They are considered to be linked to coronary atherosclerosis in most cases. Methods The demographic data, multi-slice computed tomographic coronary angiography data, coronary calcium score, and ascending aortic diameter (AAD) of 1538 patients were reviewed. In total, 197 (12.8%) patients (166 men, 31 women; age 15 – 84 years; mean 55.78 ± 12.32 years) with CAAs were identified, and 81 (5.3%) patients (70 men, 11 women; age 27 – 80 years; mean 56.63 ± 12.06 years) had CDs. Multiple regression and correlation analyses were performed in all 1538 patients to predict the association between the AAD and the presence of CD and thus their correlation with atherosclerosis. Results The AAD was significantly larger in patients with than without CAAs and CDs. Male sex was significantly more prevalent in patients with CAAs and CDs. According to the multiple logistic regression model, male sex increased the risk of CD by 2.650 and the risk of CAA by 2.017, while hyperlipidaemia decreased the risk of CAA by 0.681. While a moderately weak correlation between the AAD and age was observed in patients with CDs, no correlation was found between the AAD and coronary calcium score. Conclusion Although the natural history and physiopathology of CDs is not yet fully understood, the present study shows an association between the AAD and the presence of CDs but a lack of association between atherosclerosis and CDs.
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Affiliation(s)
- Ali Can Hatemi
- 1 Istanbul University, Institute for Cardiology, Department of Cardiovascular Surgery, Istanbul, Turkey.,2 Kartal Koşuyolu Heart Center, Pediatric Cardiovascular Surgery Clinic, Istanbul
| | - Aybala Tongut
- 2 Kartal Koşuyolu Heart Center, Pediatric Cardiovascular Surgery Clinic, Istanbul
| | - Zeki Özyedek
- 3 Macka Emar Advanced Medical Imaging Center, Istanbul, Turkey
| | - İsmail Çerezci
- 3 Macka Emar Advanced Medical Imaging Center, Istanbul, Turkey
| | - İlhan Özgöl
- 1 Istanbul University, Institute for Cardiology, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Hande Perk Gürün
- 4 Marmara University, Marmara Faculty of Medicine, Department of Public Health, Istanbul, Turkey
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Herrmann JL, Goldberg LA, Khan AM, Partington SL, Brothers JA, Mascio CE, Spray TL, Kim YY, Fuller S. A Comparison of Perioperative Management of Anomalous Aortic Origin of a Coronary Artery Between an Adult and Pediatric Cardiac Center. World J Pediatr Congenit Heart Surg 2016; 7:721-726. [DOI: 10.1177/2150135116668333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) presents in varying age-groups. Assuming management algorithms differ between pediatric and adult institutions, we compared the perioperative management of patients with AAOCA at two such centers. Methods: A retrospective review was conducted at a pediatric and an adult institution of patients 14 years or older who underwent surgical repair of AAOCA between January 2000 and May 2014. Results: Twenty patients from the pediatric center (median age: 16.5 years, range: 14-18 years) and nine patients from the adult center (median age: 40 years, range: 37-52 years) were included. An anomalous aortic origin of a right coronary artery was the most frequent pathology at each institution. Chest pain was the most common presenting symptom at both institutions. Preoperative echocardiography was performed in 95% patients at the pediatric center and in 100% of patients at the adult center. Cardiac catheterization was utilized more frequently at the adult center, and cardiac magnetic resonance imaging more commonly employed at the pediatric center. Isolated coronary unroofing was performed in 19 of 20 cases at the pediatric center and in only 2 (22%) cases at the adult institution, both by congenitally trained cardiac surgeons. More concomitant cardiac procedures were performed at the adult center with associated longer operative times and hospital stays. Conclusion: Management strategies for AAOCA vary depending on both patient-specific factors and expertise of the managing team. Further studies are needed to optimally standardize diagnostic and treatment pathways regardless of location venue.
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Affiliation(s)
- Jeremy L. Herrmann
- Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leah A. Goldberg
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail M. Khan
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Partington
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julie A. Brothers
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L. Spray
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Budoff MJ, Raggi P, Beller GA, Berman DS, Druz RS, Malik S, Rigolin VH, Weigold WG, Soman P. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology. JACC Cardiovasc Imaging 2016; 9:176-92. [PMID: 26846937 DOI: 10.1016/j.jcmg.2015.11.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/06/2015] [Indexed: 12/21/2022]
Abstract
Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - George A Beller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center and the Cedars-Sinai Heart Institute, Los Angeles, California
| | - Regina S Druz
- Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, Uniondale, New York
| | - Shaista Malik
- Department of Medicine, University of California, Irvine, California
| | - Vera H Rigolin
- Department of Medicine/Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wm Guy Weigold
- Cardiology Division, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Zhou C, Chan HP, Hadjiiski LM, Chughtai A, Wei J, Kazerooni EA. Coronary artery analysis: Computer-assisted selection of best-quality segments in multiple-phase coronary CT angiography. Med Phys 2016; 43:5268. [PMID: 27782685 DOI: 10.1118/1.4961740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The authors are developing an automated method to identify the best-quality coronary arterial segment from multiple-phase coronary CT angiography (cCTA) acquisitions, which may be used by either interpreting physicians or computer-aided detection systems to optimally and efficiently utilize the diagnostic information available in multiple-phase cCTA for the detection of coronary artery disease. METHODS After initialization with a manually identified seed point, each coronary artery tree is automatically extracted from multiple cCTA phases using our multiscale coronary artery response enhancement and 3D rolling balloon region growing vessel segmentation and tracking method. The coronary artery trees from multiple phases are then aligned by a global registration using an affine transformation with quadratic terms and nonlinear simplex optimization, followed by a local registration using a cubic B-spline method with fast localized optimization. The corresponding coronary arteries among the available phases are identified using a recursive coronary segment matching method. Each of the identified vessel segments is transformed by the curved planar reformation (CPR) method. Four features are extracted from each corresponding segment as quality indicators in the original computed tomography volume and the straightened CPR volume, and each quality indicator is used as a voting classifier for the arterial segment. A weighted voting ensemble (WVE) classifier is designed to combine the votes of the four voting classifiers for each corresponding segment. The segment with the highest WVE vote is then selected as the best-quality segment. In this study, the training and test sets consisted of 6 and 20 cCTA cases, respectively, each with 6 phases, containing a total of 156 cCTA volumes and 312 coronary artery trees. An observer preference study was also conducted with one expert cardiothoracic radiologist and four nonradiologist readers to visually rank vessel segment quality. The performance of our automated method was evaluated by comparing the automatically identified best-quality segments identified by the computer to those selected by the observers. RESULTS For the 20 test cases, 254 groups of corresponding vessel segments were identified after multiple phase registration and recursive matching. The AI-BQ segments agreed with the radiologist's top 2 ranked segments in 78.3% of the 254 groups (Cohen's kappa 0.60), and with the 4 nonradiologist observers in 76.8%, 84.3%, 83.9%, and 85.8% of the 254 groups. In addition, 89.4% of the AI-BQ segments agreed with at least two observers' top 2 rankings, and 96.5% agreed with at least one observer's top 2 rankings. In comparison, agreement between the four observers' top ranked segment and the radiologist's top 2 ranked segments were 79.9%, 80.7%, 82.3%, and 76.8%, respectively, with kappa values ranging from 0.56 to 0.68. CONCLUSIONS The performance of our automated method for selecting the best-quality coronary segments from a multiple-phase cCTA acquisition was comparable to the selection made by human observers. This study demonstrates the potential usefulness of the automated method in clinical practice, enabling interpreting physicians to fully utilize the best available information in cCTA for diagnosis of coronary disease, without requiring manual search through the multiple phases and minimizing the variability in image phase selection for evaluation of coronary artery segments across the diversity of human readers with variations in expertise.
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Affiliation(s)
- Chuan Zhou
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
| | - Heang-Ping Chan
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
| | - Lubomir M Hadjiiski
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
| | - Aamer Chughtai
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
| | - Jun Wei
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
| | - Ella A Kazerooni
- Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904
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Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT versus First-Generation 64-Slice Dual-Source CT. Sci Rep 2016; 6:34795. [PMID: 27752040 PMCID: PMC5067634 DOI: 10.1038/srep34795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/19/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to compare the image quality and radiation dose of coronary computed tomography angiography (CCTA) from prospectively triggered 128-slice CT (128-MSCT) versus dual-source 64-slice CT (DSCT). The study was approved by the Medical Ethics Committee at Tongji Medical College of Huazhong University of Science and Technology. Eighty consecutive patients with stable heart rates lower than 70 bpm were enrolled. Forty patients were scanned with 128-MSCT, and the other 40 patients were scanned with DSCT. Two radiologists independently assessed the image quality in segments (diameter >1 mm) according to a three-point scale (1: excellent; 2: moderate; 3: insufficient). The CCTA radiation dose was calculated. Eighty patients with 526 segments in the 128-MSCT group and 544 segments in the DSCT group were evaluated. The image quality 1, 2 and 3 scores were 91.6%, 6.9% and 1.5%, respectively, for the 128-MSCT group and 97.6%, 1.7% and 0.7%, respectively, for the DSCT group, and there was a statistically significant inter-group difference (P ≤ 0.001). The effective doses were 3.0 mSv in the 128-MSCT group and 4.5 mSv in the DSCT group (P ≤ 0.001). Compared with DSCT, CCTA with prospectively triggered 128-MSCT had adequate image quality and a 33.3% lower radiation dose.
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Ishiba H, Sumida Y, Kataoka S, Kuroda M, Akabame S, Tomiyasu K, Tanaka M, Arai M, Taketani H, Seko Y, Okajima A, Hara T, Umemura A, Nishikawa T, Yamaguchi K, Moriguchi M, Mitsuyoshi H, Yasui K, Itoh Y. Association of coronary artery calcification with liver fibrosis in Japanese patients with non-alcoholic fatty liver disease. Hepatol Res 2016; 46:1107-1117. [PMID: 26853695 DOI: 10.1111/hepr.12665] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/20/2016] [Accepted: 01/30/2016] [Indexed: 12/12/2022]
Abstract
AIMS Cardiovascular events are the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD), but their relationship remains unclear. This study examined the association between coronary atherosclerosis and liver fibrosis, represented by the coronary artery calcification (CAC) score and non-invasive fibrosis markers, respectively. METHODS Among 698 patients with chest pain or electrocardiographic abnormalities who underwent coronary computed tomography (CT) between April 2006 and March 2010, those with known liver disorders or history of emergency coronary angioplasty were excluded, leaving 366 patients for this study. Diagnosis of NAFLD was based on abdominal CT and history of alcohol consumption. Subjects with CAC of 100 AU or more were categorized into the high-risk group for cardiovascular events. Patient records were examined for clinical parameters including CAC score and non-invasive fibrosis marker FIB-4 index. RESULTS Ninety-four patients (25.7%) had NAFLD. In this group, univariate analysis identified old age, high diastolic blood pressure, high liver to spleen ratio and high FIB-4 index as risk factors for cardiovascular events and multivariate analysis identified age of 66 years or older and FIB-4 index of 2.09 or more as the significant risk factors. For the observation period until August 2014, the cumulative proportion of PCI performance was significantly higher in patients with FIB-4 of 2.09 or more than those with FIB-4 of less than 2.09. CONCLUSION The progression of arteriosclerosis and that of liver fibrosis may be associated in NAFLD patients. The FIB-4 index can be easily determined and thus can be a useful marker for predicting cardiovascular events in NAFLD patients.
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Affiliation(s)
- Hiroshi Ishiba
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Yoshio Sumida
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine.
| | - Seita Kataoka
- Department of Gastroenterology, Kyoto Yamashiro General Medical Center
| | - Masaaki Kuroda
- Department of Gastroenterology, Kyoto Yamashiro General Medical Center
| | - Satoshi Akabame
- Department of Cardiology, Kyoto Yamashiro General Medical Center
| | | | - Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Arai
- Department of Gastroenterology, Kyoto Yamashiro General Medical Center
| | - Hiroyoshi Taketani
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Yuya Seko
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Akira Okajima
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Tasuku Hara
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Atsushi Umemura
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Taichiro Nishikawa
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Kanji Yamaguchi
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Michihisa Moriguchi
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Hironori Mitsuyoshi
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Kohichiroh Yasui
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
| | - Yoshito Itoh
- Departments of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
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Zhu L, Liu J, Gao C, Zhao W, Que J, Wang X, Qi D, Liu J, Xiao W, Yan J, Li W, Zhang Y, Yang H. Comparison of coronary plaque, coronary artery calcification and major adverse cardiac events in Chinese outpatients with and without type 2 diabetes. SPRINGERPLUS 2016; 5:1678. [PMID: 27733980 PMCID: PMC5042911 DOI: 10.1186/s40064-016-3373-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 09/23/2016] [Indexed: 01/15/2023]
Abstract
Objective Diabetes substantially increases the risk of cardiovascular disease (CAD) and is associated with an increased risk of CAD mortality. The purpose of this study was to investigate the differences in coronary artery plaque, coronary artery calcification (CAC) measured in outpatients with and without type 2 diabetes, and the occurrence rate of a major adverse cardiac event (MACE) throughout follow-up with the same patients. Methods Five hundred eighty-eight outpatients with suspected CAD comprising 208 diabetic and 380 non-diabetic patients were enrolled in this study. Coronary artery plaque and CAC scores were detected and measured by dual-source computed tomography. The major MACE during the follow-up period (4.0–20 months) was recorded and its relationship to type 2 diabetes and CAC was investigated. Results The diabetes group had higher CAC scores in the left anterior descending, left circumflex, and right coronary arteries and total CAC burden than the group without diabetes. The diabetes group had more diseased coronary segments and more obstructed vessels than the non-diabetes group. Logistic regression analysis demonstrated that diabetes is positively associated with mixed coronary plaque and non-calcified plaque. All patients in the diabetes group and all patients with higher CACs in both groups had a higher incidence rate of MACEs. Conclusion Patients with type 2 diabetes have a higher prevalence of obstructive CAD, higher CAC scores, and a higher incidence rate of MACEs than those without diabetes. Diabetes and higher CAC scores were the important predictors of the occurrence of MACEs throughout follow-up with patients.
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Affiliation(s)
- Lijie Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Jingjing Liu
- Cardio-Pulmonary Function Department, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China ; Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
| | - Wenli Zhao
- Cardiac Catheterization Room, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jing Que
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Jun Liu
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Wentao Xiao
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Juanjuan Yan
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - Wentao Li
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
| | - You Zhang
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
| | - Honghui Yang
- Department of Cardiology, Zhengzhou University People's Hospital, 7 Wei Wu Road, Zhengzhou, 450003 China
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Mangold S, Wichmann JL, Schoepf UJ, Caruso D, Tesche C, Steinberg DH, Varga-Szemes A, Stubenrauch AC, Bayer RR, Biancalana M, Nikolaou K, De Cecco CN. Diagnostic accuracy of coronary CT angiography using 3 rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population. Eur Radiol 2016; 27:2298-2308. [PMID: 27682312 DOI: 10.1007/s00330-016-4601-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/15/2016] [Accepted: 09/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients. METHODS We retrospectively analyzed 76 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography. Prospectively ECG-triggered acquisition was performed with automated tube voltage selection (ATVS). Patients were dichotomized based on body mass index in groups A (<30 kg/m2, n = 37) and B (≥30 kg/m2, n = 39) and based on tube voltage in groups C (<120 kV, n = 46) and D (120 kV, n = 30). Coronary arteries were assessed for significant stenoses (≥50 % luminal narrowing) and diagnostic accuracy was calculated. RESULTS Per-patient overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 96.9 %, 95.5 %, 93.9 %, 97.7 % and 96.1 %, respectively. Sensitivity and NPV were lower in groups B and D compared to groups A and C, but no statistically significant differences were observed (group A vs. B: sensitivity, 100.0 % vs. 93.3 %, p = 0.9493; NPV, 100 % vs. 95.5 %, p = 0.9812; group C vs. D: sensitivity, 100.0 % vs. 92.3 %, p = 0.8462; NPV, 100.0 % vs. 94.1 %, p = 0.8285). CONCLUSION CCTA using 3rd-generation DSCT and (ATVS) provides high diagnostic accuracy in both non-obese and obese patients. KEY POINTS • Coronary CTA provides high diagnostic accuracy in non-obese and obese patients. • Diagnostic accuracy between obese and non-obese patients showed no significant difference. • <120 kV studies were performed in 44 % of obese patients. • Current radiation dose-saving approaches can be applied independent of body habitus.
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Affiliation(s)
- Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA. .,Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Cardiology, Heart Centre Munich-Bogenhausen, Munich, Germany
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Andrew C Stubenrauch
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Richard R Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew Biancalana
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
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234
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Association between nonalcoholic fatty liver disease and coronary artery calcification in postmenopausal women. Menopause 2016; 22:1323-7. [PMID: 26154274 PMCID: PMC4666010 DOI: 10.1097/gme.0000000000000503] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Cardiovascular disease is a leading cause of death in postmenopausal women, and nonalcoholic fatty liver disease (NAFLD) has been known to be associated with cardiovascular disease. However, little information regarding the relationship between NAFLD and coronary artery calcification (CAC) in postmenopausal women is available. The aim of this study was to investigate the association between NAFLD and CAC in postmenopausal women. Methods: Among 4,377 participants who underwent cardiac computed tomography in a health promotion center, 919 postmenopausal women were enrolled. Anthropometric profiles and multiple cardiovascular risk factors were measured. NAFLD was measured by ultrasonography, and CAC was evaluated by cardiac computed tomography. Odds ratios and 95% CI for the presence of CAC, by severity of fatty liver disease, were estimated using logistic regression. Results: Women were stratified into three groups by severity of NAFLD. There were significant differences in cardiovascular parameters among the groups, and prevalence of CAC significantly increased with severity of NAFLD. On logistic regression analysis after adjustment for multiple risk factors, the odds ratios for the prevalence of CAC were as follows (P < 0.05): no NAFLD, 1.0; mild NAFLD, 1.34 (95% CI, 0.92-2.16); moderate to severe NAFLD, 1.83 (95% CI, 1.06-3.16). However, this association was attenuated after adjustment for insulin resistance (P = 0.16). Conclusions: There is a significant correlation between NAFLD and prevalence of CAC, but NAFLD is not an independent factor for coronary atherosclerosis in postmenopausal women.
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235
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Predictive ability of the pooled cohort risk assessment for the incidence and progression of coronary artery calcification. Coron Artery Dis 2016; 27:504-10. [DOI: 10.1097/mca.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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236
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The role of angiographic follow-up after percutaneous coronary intervention. Int J Cardiol 2016; 222:911-920. [PMID: 27526358 DOI: 10.1016/j.ijcard.2016.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 01/22/2023]
Abstract
In the early days of coronary angioplasty, follow-up coronary angiography was often performed to assess restenosis. Angiographic restenosis has been shown to be associated with worse clinical outcomes, though the exact causality has yet to be determined. Numerous studies have repeatedly demonstrated that routine follow-up coronary angiography increases the incidence of target lesion revascularization without a clear reduction in mortality or myocardial infarction. Despite the lack of proven benefit of angiographic follow-up, routine follow-up coronary angiography is still being performed in certain countries and facilities. There are several factors that might explain the lack of benefit of angiographic follow-up: 1) lower incidence of stent failure in the current drug-eluting stent era has attenuated the net clinical benefit of follow-up angiography. 2) Angiographic restenosis might not lead to myocardial ischemia. 3) Patients that do have functionally significant restenosis are often referred for coronary angiography due to clinical indications such as intractable angina. 4) Absence of restenosis at the time of follow-up angiography does not exclude future restenosis. The absence of proven benefit in unselected populations does not necessarily preclude the presence of benefit in selected population, and there may be a subgroup of patients who can benefit from angiographic follow-up such as those with a large myocardial ischemic territory or those at very high risk of restenosis. Until there is more clinical evidence with respect to follow-up angiography, the decision of whether or not to perform it routinely in selected high-risk population should entail an in-depth discussion with the patient.
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237
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Ditah C, Otvos J, Nassar H, Shaham D, Sinnreich R, Kark JD. Small and medium sized HDL particles are protectively associated with coronary calcification in a cross-sectional population-based sample. Atherosclerosis 2016; 251:124-131. [DOI: 10.1016/j.atherosclerosis.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 01/21/2023]
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238
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Chang CC, Hsu CY, Huang PH, Chiang CH, Huang SS, Leu HB, Huang CC, Chen JW, Lin SJ. Association of Serum Bilirubin with SYNTAX Score and Future Cardiovascular Events in Patients Undergoing Coronary Intervention. ACTA CARDIOLOGICA SINICA 2016; 32:412-9. [PMID: 27471354 DOI: 10.6515/acs20150708c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bilirubin has emerged as an important endogenous antioxidant molecule, and increasing evidence shows that bilirubin may protect against atherosclerosis. The SYNTAX score has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether serum bilirubin levels are associated with SYNTAX scores and whether they could be used to predict future cardiovascular events in patients undergoing coronary intervention. METHODS Serum bilirubin levels and other blood parameters in patients with at least 12-h fasting states were determined. The primary endpoint was any composite cardiovascular event within 1 year, including death, nonfatal myocardial infarction, and target-vessel revascularization. RESULTS In total, 250 consecutive patients with stable coronary artery disease (mean age 70 ± 13) who had received coronary intervention were enrolled. All study subjects were divided into two groups: group 1 was defined as high SYNTAX score (> 22), and group 2 was defined as low SYNTAX score (≤ 22). Total bilirubin levels were significantly lower in the high SYNTAX score group than in the low SYNTAX score group (0.51 ± 0.22 vs. 0.72 ± 0.29 mg/dl, p < 0.001). By multivariate analysis, serum total bilirubin levels were identified as an independent predictor for high SYNTAX score (adjusted odds ratio: 0.28, 95% confidence interval 0.04-0.42; p = 0.004). Use of the Kaplan-Meier analysis demonstrated a significant difference in 1-year cardiovascular events between high (> 0.8 mg/dl), medium (> 0.5, ≤ 0.8 mg/dl), and low (≤ 0.5 mg/dl) bilirubin levels (log-rank test p = 0.011). CONCLUSIONS Serum bilirubin level is associated with SYNTAX score and predicts future cardiovascular events in patients undergoing coronary intervention.
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Affiliation(s)
- Chun-Chin Chang
- Division of Cardiology, Department of Medicine; ; Cardiovascular Research Center
| | - Chien-Yi Hsu
- Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei; ; Department of Medicine, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Chia-Hung Chiang
- Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine; ; Healthcare and Management Center, Taipei Veterans General Hospital; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine; ; Healthcare and Management Center, Taipei Veterans General Hospital; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine; ; Department of Medical Education; ; Cardiovascular Research Center; ; Institute of Pharmacology
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine; ; Division of Clinical Research; ; Cardiovascular Research Center; ; Institute of Pharmacology
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine; ; Department of Medical Research; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei
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Patient-Specific Computational Models of Coronary Arteries Using Monoplane X-Ray Angiograms. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:2695962. [PMID: 27403203 PMCID: PMC4925948 DOI: 10.1155/2016/2695962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
Coronary artery disease (CAD) is the most common type of heart disease in western countries. Early detection and diagnosis of CAD is quintessential to preventing mortality and subsequent complications. We believe hemodynamic data derived from patient-specific computational models could facilitate more accurate prediction of the risk of atherosclerosis. We introduce a semiautomated method to build 3D patient-specific coronary vessel models from 2D monoplane angiogram images. The main contribution of the method is a robust segmentation approach using dynamic programming combined with iterative 3D reconstruction to build 3D mesh models of the coronary vessels. Results indicate the accuracy and robustness of the proposed pipeline. In conclusion, patient-specific modelling of coronary vessels is of vital importance for developing accurate computational flow models and studying the hemodynamic effects of the presence of plaques on the arterial walls, resulting in lumen stenoses, as well as variations in the angulations of the coronary arteries.
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240
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Progression of CAC Score and Risk of Incident CVD. JACC Cardiovasc Imaging 2016; 9:1420-1429. [PMID: 27372023 DOI: 10.1016/j.jcmg.2016.03.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/19/2016] [Accepted: 03/24/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The authors sought to determine the relative contributions of baseline coronary artery calcification (CAC), follow-up CAC, and CAC progression on incident cardiovascular disease (CVD). BACKGROUND Repeat CAC scanning has been proposed as a method to track progression of total atherosclerotic burden. However, whether CAC progression is a useful predictor of future CVD events remains unclear. METHODS This was a prospective observational study of 5,933 participants free of CVD who underwent 2 examinations, including CAC scores, and subsequent CVD event assessment. CAC progression was calculated using the square root method. The primary outcome was total CVD events (CVD death, nonfatal myocardial infarction, nonfatal atherosclerotic stroke, coronary artery bypass surgery, percutaneous coronary intervention). Secondary outcomes included hard CVD events, total coronary heart disease (CHD) events, and hard CHD events. RESULTS CAC was detected at baseline in 2,870 individuals (48%). The average time between scans was 3.5 ± 2.0 years. After their second scan, 161 individuals experienced a total CVD event during a mean follow-up of 7.3 years. CAC progression was significantly associated with total CVD events (hazard ratio: 1.14, 95% confidence interval: 1.01 to 1.30 per interquartile range; p = 0.042) in the model including baseline CAC, but the contribution of CAC progression was small relative to baseline CAC (chi-square 4.16 vs. 65.92). Furthermore, CAC progression was not associated with total CVD events in the model including follow-up CAC instead of baseline CAC (hazard ratio: 1.05, 95% confidence interval: 0.92 to 1.21; p = 0.475). A model that included follow-up CAC alone performed as well as the model that included baseline CAC and CAC progression. CONCLUSIONS Although CAC progression was independently, but modestly, associated with CVD outcomes, this relationship was no longer significant when including follow-up CAC in the model. These findings imply that if serial CAC scanning is performed, the latest scan should be used for risk assessment, and in this context, CAC progression provides no additional prognostic information.
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Dorans KS, Wilker EH, Li W, Rice MB, Ljungman PL, Schwartz J, Coull BA, Kloog I, Koutrakis P, D'Agostino RB, Massaro JM, Hoffmann U, O'Donnell CJ, Mittleman MA. Residential Proximity to Major Roads, Exposure to Fine Particulate Matter, and Coronary Artery Calcium: The Framingham Heart Study. Arterioscler Thromb Vasc Biol 2016; 36:1679-85. [PMID: 27312220 DOI: 10.1161/atvbaha.116.307141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Long-term exposure to traffic and particulate matter air pollution is associated with a higher risk of cardiovascular disease, potentially via atherosclerosis promotion. Prior research on associations of traffic and particulate matter with coronary artery calcium Agatston score (CAC), an atherosclerosis correlate, has yielded inconsistent findings. Given this background, we assessed whether residential proximity to major roadway or fine particulate matter were associated with CAC in a Northeastern US study. APPROACH AND RESULTS We measured CAC ≤2 times from 2002 to 2005 and 2008 to 2011 among Framingham Offspring or Third-Generation Cohort participants. We assessed associations of residential distance to major roadway and residential fine particulate matter (2003 average; spatiotemporal model) with detectable CAC, using generalized estimating equation regression. We used linear mixed effects models to assess associations with loge(CAC). We also assessed associations with CAC progression. Models were adjusted for demographic variables, socioeconomic position markers, and time. Among 3399 participants, 51% had CAC measured twice. CAC was detectable in 47% of observations. At first scan, mean age was 52.2 years (standard deviation 11.7); 51% male. There were no consistent associations with detectable CAC, continuous CAC, or CAC progression. We observed heterogeneous associations of distance to major roadway with odds of detectable CAC by hypertensive status; interpretation of these findings is questionable. CONCLUSIONS Our findings add to prior work and support evidence against strong associations of traffic or fine particulate matter with the presence, extent, or progression of CAC in a region with relatively low levels of and little variation in fine particulate matter.
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Affiliation(s)
- Kirsten S Dorans
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Elissa H Wilker
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Wenyuan Li
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Mary B Rice
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Petter L Ljungman
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Joel Schwartz
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Brent A Coull
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Itai Kloog
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Petros Koutrakis
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Ralph B D'Agostino
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Joseph M Massaro
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Udo Hoffmann
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Christopher J O'Donnell
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Murray A Mittleman
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.).
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242
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Kim WJ, Kwon CH, Han S, Lee WS, Kang JW, Ahn JM, Lee JY, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks. J Korean Med Sci 2016; 31:902-8. [PMID: 27247499 PMCID: PMC4853669 DOI: 10.3346/jkms.2016.31.6.902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022] Open
Abstract
Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P < 0.01). The total CAD prevalence was 6.1%. The occult CAD prevalence in the FRS ≤ 5%, 6%-10%, 11%-20%, and > 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P < 0.001). In multivariate logistic regression analysis adjusting, not only the intermediate and high risk groups but also the low risk (FRS 6%-10%) group had significantly increased odds ratio for occult CAD compared to the very low-risk (FRS ≤ 5%) group (1.89 [95% confidence interval, CI, 1.09-3.29] in FRS 6%-10%; 2.48 [95% CI, 1.47-4.20] in FRS 11%-20%; and 3.10 [95% CI, 1.75-5.47] in FRS > 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.
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Affiliation(s)
- Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Chang Hee Kwon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
| | - Woo Seok Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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243
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O'Rourke C, Shelton G, Hutcheson JD, Burke MF, Martyn T, Thayer TE, Shakartzi HR, Buswell MD, Tainsh RE, Yu B, Bagchi A, Rhee DK, Wu C, Derwall M, Buys ES, Yu PB, Bloch KD, Aikawa E, Bloch DB, Malhotra R. Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation. J Vis Exp 2016. [PMID: 27284788 DOI: 10.3791/54017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in the world. Atherosclerotic plaques, consisting of lipid-laden macrophages and calcification, develop in the coronary arteries, aortic valve, aorta, and peripheral conduit arteries and are the hallmark of cardiovascular disease. In humans, imaging with computed tomography allows for the quantification of vascular calcification; the presence of vascular calcification is a strong predictor of future cardiovascular events. Development of novel therapies in cardiovascular disease relies critically on improving our understanding of the underlying molecular mechanisms of atherosclerosis. Advancing our knowledge of atherosclerotic mechanisms relies on murine and cell-based models. Here, a method for imaging aortic calcification and macrophage infiltration using two spectrally distinct near-infrared fluorescent imaging probes is detailed. Near-infrared fluorescent imaging allows for the ex vivo quantification of calcification and macrophage accumulation in the entire aorta and can be used to further our understanding of the mechanistic relationship between inflammation and calcification in atherosclerosis. Additionally, a method for isolating and culturing animal aortic vascular smooth muscle cells and a protocol for inducing calcification in cultured smooth muscle cells from either murine aortas or from human coronary arteries is described. This in vitro method of modeling vascular calcification can be used to identify and characterize the signaling pathways likely important for the development of vascular disease, in the hopes of discovering novel targets for therapy.
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Affiliation(s)
- Caitlin O'Rourke
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Georgia Shelton
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Joshua D Hutcheson
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Megan F Burke
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Trejeeve Martyn
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Timothy E Thayer
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Hannah R Shakartzi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Mary D Buswell
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Robert E Tainsh
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Binglan Yu
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Aranya Bagchi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - David K Rhee
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Connie Wu
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Matthias Derwall
- Department of Anesthesiology, Uniklinik RWTH Aachen, RWTH Aachen University
| | - Emmanuel S Buys
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Paul B Yu
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Kenneth D Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Elena Aikawa
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Donald B Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Department of Anesthesiology, Uniklinik RWTH Aachen, RWTH Aachen University; Center for Immunology and Inflammatory Diseases and the Division of Rheumatology, Allergy, and Immunology of the Department of Medicine, Massachusetts General Hospital
| | - Rajeev Malhotra
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School;
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244
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Routine Coronary Calcium Scan Can Precisely Measure Vertebral Bone Density Without a Quantitative Calibration Phantom. J Comput Assist Tomogr 2016; 40:126-30. [PMID: 26529677 DOI: 10.1097/rct.0000000000000330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to assess accuracy and precision of quantitative computed tomography (QCT) and phantomless in thoracic bone mineral density (BMD) assessment using coronary artery calcium scan (CACS). METHODS A total of 513 subjects underwent CACS with a calibration phantom. The thoracic spine BMD and concentration of calcium hydroxyapatite in phantom rods, as well CT Hounsfield unit of both, were measured. The thoracic BMD and phantom-rods calcium concentration were obtained using phantomless. The accuracy and precision error of QCT and phantomless were compared. RESULTS The mean biases from true calcium concentration of phantom rods were 2.9% and 3.8% for the QCT and phantomless, respectively (P < 0.001). The biases of thoracic BMD from QCT by phantomless were 3.8% with a similar precision error in both methods. CONCLUSIONS The thoracic BMD can be assessed accurately and precisely using QCT and phantomless with a routine CACS.
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Ikari Y, Torii S, Shioi A, Okano T. Impact of menaquinone-4 supplementation on coronary artery calcification and arterial stiffness: an open label single arm study. Nutr J 2016; 15:53. [PMID: 27175730 PMCID: PMC4866409 DOI: 10.1186/s12937-016-0175-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/04/2016] [Indexed: 01/07/2023] Open
Abstract
Background Dietary intake of vitamin K has been reported to reduce coronary artery calcification (CAC) and cardiovascular events. However, it is unknown whether supplemental menaquinone (MK)-4 can reduce CAC or arterial stiffness. To study the effect of MK-4 supplementation on CAC and brachial ankle pulse wave velocity (baPWV). Methods This study is a single arm design to take 45 mg/day MK-4 daily as a therapeutic drug for 1 year. Primary endpoint was CAC score determined using 64-slice multislice CT (Siemens), and the secondary endpoint was baPWV measured before and 1 year after MK-4 therapy. Results A total of 26 patients were enrolled. The average age was 69 ± 8 years and 65 % were female. Plasma levels of phylloquinone (PK), MK-7, and MK4 were 1.94 ± 1.38 ng/ml, 14.2 ± 11.9 ng/ml and 0.4 ± 2.0 ng/ml, respectively, suggesting that MK-7 was the dominant vitamin K in the studied population. Baseline CAC and baPWV were 513 ± 773 and 1834 ± 289 cm/s, respectively. At 1 year following MK-4 supplementation, the values were 588 ± 872 (+14 %) and 1821 ± 378 cm/s (−0.7 %), respectively. In patients with high PIVKA-2, −18 % annual reduction of baPWV was observed. Conclusion Despite high dose MK-4 supplementation, CAC increased +14 % annually, but baPWV did not change (−0.7 %). The benefits of MK-4 supplementation were only observed in patients with vitamin K insufficiencies correlated with high PIVKA-2 baseline levels, reducing baPWV but not CAC. Trial registration This study was registered as UMIN 000002760
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Affiliation(s)
- Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
| | - Sho Torii
- Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Atsushi Shioi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-0051, Japan
| | - Toshio Okano
- Department of Hygienic Sciences, Kobe Pharmaceutical University, 4-9-1 Motoyamakitamachi, Higashinadaku, Kobe, 658-0003, Japan
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246
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Correlation between coronary artery calcium score and aortic diameter in a high-risk population of elderly male hypertensive patients. Coron Artery Dis 2016; 25:698-704. [PMID: 25051100 DOI: 10.1097/mca.0000000000000150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies on the relationship between coronary artery calcium and aortic diameter are scarce. The aim of the current study was to evaluate the correlation between coronary artery calcium score (CACS) and maximal thoracic and abdominal aortic diameters in a population of elderly (>65 years) male hypertensive patients at high risk for coronary artery disease. PATIENTS AND METHODS From June 2012 to April 2013, we prospectively enrolled 393 male hypertensive patients older than 65 years of age who had no history of aortic aneurysm. Coronary artery calcium and maximal diameters of the ascending thoracic aorta (ATAmax), descending thoracic aorta (DTAmax), and abdominal aorta (AAmax) were measured using noncontrast computed tomography imaging. Aortic diameters are indexed to body surface area (BSA). Participants were divided into five groups according to CACS (0, 1-10, 10-100, 100-400, and >400). RESULTS The mean ATAmax/BSA, DTAmax/BSA, and AAmax/BSA were 22.0±2.7, 16.3±1.9, and 13.0±2.9 mm, respectively. On multivariate analysis, ATAmax/BSA was associated independently with age, diabetes, and history of aortic valve replacement (all P<0.001). DTAmax/BSA was associated independently with age (P<0.001). However, there were no significant correlations between thoracic aorta diameter and CACS. In contrast, AAmax/BSA was associated independently with CACS as well as age and history of smoking (P=0.014, 0.003, and 0.019, respectively). Abdominal aortic aneurysm (>30 mm) was more prevalent in patients with a CACS of 400 or more compared with the others (14 vs. 3%, P<0.001). CONCLUSION CACS was associated with increased abdominal aorta diameter, but not with thoracic aorta diameter. Therefore, screening for an abdominal aortic aneurysm is warranted in patients with a high risk of coronary artery disease and a high CACS. However, the necessity for thoracic aortic aneurysm screening is not clear in these patients.
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Feldman DI, Cainzos-Achirica M, Billups KL, DeFilippis AP, Chitaley K, Greenland P, Stein JH, Budoff MJ, Dardari Z, Miner M, Blumenthal RS, Nasir K, Blaha MJ. Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA). Clin Cardiol 2016; 39:291-8. [PMID: 27145089 DOI: 10.1002/clc.22530] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described. HYPOTHESIS Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED. METHODS After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up. RESULTS Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED. CONCLUSIONS Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.
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Affiliation(s)
- David I Feldman
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kevin L Billups
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Andrew P DeFilippis
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Cardiology, KentuckyOne Health-Jewish Hospital, University of Louisville, Louisville, Kentucky
| | - Kanchan Chitaley
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James H Stein
- Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew J Budoff
- Department of Internal Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Martin Miner
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:218-25. [PMID: 27103916 PMCID: PMC4826891 DOI: 10.11909/j.issn.1671-5411.2016.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.
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Ko BJ, Chang Y, Jung HS, Yun KE, Kim CW, Park HS, Chung EC, Shin H, Ryu S. Relationship Between Low Relative Muscle Mass and Coronary Artery Calcification in Healthy Adults. Arterioscler Thromb Vasc Biol 2016; 36:1016-21. [PMID: 27034471 DOI: 10.1161/atvbaha.116.307156] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/11/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Sarcopenia or low muscle mass is related to cardiovascular risk factors; however, the association between low muscle mass and subclinical atherosclerosis has been largely unexplored. We investigated whether muscle mass is related to coronary artery calcification (CAC) in a large sample of middle-aged asymptomatic adults. APPROACH AND RESULTS We performed a cross-sectional study of 31 108 asymptomatic adults without cancer, diabetes mellitus, or known cardiovascular disease who underwent a health checkup examination including cardiac tomography estimation of CAC scores between 2012 and 2013. Skeletal muscle mass index (SMI) [SMI (%)=total skeletal muscle mass (kg)/body weight (kg)×100] was estimated using a bioelectrical impedance analyzer. We assessed the relationship between SMI and CAC scores using both multivariate-adjusted Tobit models and multinomial logistic regression models. Of the 31 108 subjects, 3374 subjects (10.9%) had a CAC score 1 to 100, and 628 subjects (2.0%) had a CAC score >100. SMI was inversely associated with CAC score ratios. Specifically, in a multivariable-adjusted model adjusting for potential confounders, CAC score ratios (95% confidence intervals) of SMI for quartiles 1, 2, and 3 compared with quartile 4 were 2.27 (1.70-3.05), 1.46 (1.15-1.85), and 1.24 (0.98-1.55), respectively (P for trend <0.001). Adjusting for insulin resistance reduced the magnitude of the associations, but they remained statistically significant. CONCLUSIONS Relative muscle mass was negatively associated with the prevalence of coronary calcification, supporting low muscle mass as an independent risk factor of coronary heart disease.
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Affiliation(s)
- Byung-Joon Ko
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Yoosoo Chang
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.).
| | - Hyun-Suk Jung
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Kyung Eun Yun
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Chan-Won Kim
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Hye Soon Park
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Eun Chul Chung
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Hocheol Shin
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.)
| | - Seungho Ryu
- From the Center for Cohort Studies, Total Healthcare Center (B.-J.K., Y.C., H.-S.J., K.E.Y., C.-W.K., E.C.C., H.S., S.R.), Department of Occupational and Environmental Medicine (Y.C., S.R.), Department of Radiology (E.C.C.), and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.); and Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (H.S.P.).
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Haarmark C, Andersen KF, Madsen C, Zerahn B. Coronary artery calcium score and N-terminal pro-B-type natriuretic peptide as potential gatekeepers for myocardial perfusion imaging. Clin Physiol Funct Imaging 2016; 37:710-716. [PMID: 27005324 DOI: 10.1111/cpf.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
Myocardial perfusion imaging (MPI) holds an important place as non-invasive risk assessment in patients with intermediate risk of coronary heart disease (CHD). However, as much as 60-70% of MPI scans are normal. This study evaluates the role of coronary artery calcium scoring (CAC score) and NT-proBNP as potential gatekeepers for MPI. Patients with intermediate risk of CHD referred for standard MPI were included. CAC score and NT-proBNP were both assessed at the day of the stress study. Sensitivity, specificity and NPV for prediction of abnormal MPI scans were calculated for CAC, NT-proBNP and the combination hereof. A total of 190 patients were included (mean age 61 ± 12 years, 55% female) of whom 24% had known CHD. In all 30% of the scans were abnormal. CAC score achieved the highest AUC regardless of whether patients with known CHD were included or not [AUC 0·75 95% CI (0·66-0·84) and AUC 0·79 (0·68-0·91)]. As a singular variable, CAC score was the most potent predictor with a sensitivity of 85%, specificity of 39% and NPV 88%. The combination of CAC score<10 and NT-proBNP>26 reached a sensitivity of 98% and NPV 94%, where 8% of scans tentatively could be avoided. In patients referred for MPI with intermediate risk for CHD, a combination of CAC score and NT-proBNP could be used to identify a group of patients where MPI could be averted with a high degree of diagnostic safety.
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Affiliation(s)
- Christian Haarmark
- Department of Clinical Physiology & Nuclear Medicine, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Herlev, Denmark.,Department of Clinical Physiology & Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kim Francis Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Claus Madsen
- Department of Clinical Physiology & Nuclear Medicine, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology & Nuclear Medicine, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Herlev, Denmark
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