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Yin K, Chen W, Qin G, Liang J, Bao X, Yu H, Li H, Xu J, Chen X, Wang Y, Savage RH, Schoepf UJ, Mu D, Zhang B. Performance assessment of an artificial intelligence-based coronary artery calcium scoring algorithm in non-gated chest CT scans of different slice thickness. Quant Imaging Med Surg 2024; 14:5708-5720. [PMID: 39144022 PMCID: PMC11320525 DOI: 10.21037/qims-24-247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/05/2024] [Indexed: 08/16/2024]
Abstract
Background The coronary artery calcium score (CACS) has been shown to be an independent predictor of cardiovascular events. The traditional coronary artery calcium scoring algorithm has been optimized for electrocardiogram (ECG)-gated images, which are acquired with specific settings and timing. Therefore, if the artificial intelligence-based coronary artery calcium score (AI-CACS) could be calculated from a chest low-dose computed tomography (LDCT) examination, it could be valuable in assessing the risk of coronary artery disease (CAD) in advance, and it could potentially reduce the occurrence of cardiovascular events in patients. This study aimed to assess the performance of an AI-CACS algorithm in non-gated chest scans with three different slice thicknesses (1, 3, and 5 mm). Methods A total of 135 patients who underwent both LDCT of the chest and ECG-gated non-contrast enhanced cardiac CT were prospectively included in this study. The Agatston scores were automatically derived from chest CT images reconstructed at slice thicknesses of 1, 3, and 5 mm using the AI-CACS software. These scores were then compared to those obtained from the ECG-gated cardiac CT data using a conventional semi-automatic method that served as the reference. The correlations between the AI-CACS and electrocardiogram-gated coronary artery calcium score (ECG-CACS) were analyzed, and Bland-Altman plots were used to assess agreement. Risk stratification was based on the calculated CACS, and the concordance rate was determined. Results A total of 112 patients were included in the final analysis. The correlations between the AI-CACS at three different thicknesses (1, 3, and 5 mm) and the ECG-CACS were 0.973, 0.941, and 0.834 (all P<0.01), respectively. The Bland-Altman plots showed mean differences in the AI-CACS for the three thicknesses of -6.5, 15.4, and 53.1, respectively. The risk category agreement for the three AI-CACS groups was 0.868, 0.772, and 0.412 (all P<0.01), respectively. While the concordance rates were 91%, 84.8%, and 62.5%, respectively. Conclusions The AI-based algorithm successfully calculated the CACS from LDCT scans of the chest, demonstrating its utility in risk categorization. Furthermore, the CACS derived from images with a slice thickness of 1 mm was more accurate than those obtained from images with slice thicknesses of 3 and 5 mm.
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Affiliation(s)
- Kejie Yin
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenping Chen
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guochu Qin
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Liang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xue Bao
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongming Yu
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hui Li
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianhua Xu
- Department of Radiology, Yizheng Hospital of Nanjing Drum Tower Hospital Group, Yizheng, China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, Shanghai, China
| | - Yujie Wang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Rock H. Savage
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - U. Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Dan Mu
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Radiology, Yizheng Hospital of Nanjing Drum Tower Hospital Group, Yizheng, China
| | - Bing Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Hu J, Hao G, Xu J, Wang X, Chen M. Deep learning-based coronary artery calcium score to predict coronary artery disease in type 2 diabetes mellitus. Heliyon 2024; 10:e27937. [PMID: 38496873 PMCID: PMC10944251 DOI: 10.1016/j.heliyon.2024.e27937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background Coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM) patients often presents diffuse lesions, with extensive calcification, and it is time-consuming to measure coronary artery calcium score (CACS). Objectives To explore the predictive ability of deep learning (DL)-based CACS for obstructive CAD and hemodynamically significant CAD in T2DM. Methods 469 T2DM patients suspected of CAD who accepted CACS scan and coronary CT angiography between January 2013 and December 2020 were enrolled. Obstructive CAD was defined as diameter stenosis ≥50%. Hemodynamically significant CAD was defined as CT-derived fractional flow reserve ≤0.8. CACS was calculated with a fully automated method based on DL algorithm. Logistic regression was applied to determine the independent predictors. The predictive performance was evaluated with area under receiver operating characteristic curve (AUC). Results DL-CACS (adjusted odds ratio (OR): 1.005; 95% CI: 1.003-1.006; P < 0.001) was significantly associated with obstructive CAD. DL-CACS (adjusted OR:1.003; 95% CI: 1.002-1.004; P < 0.001) was also an independent predictor for hemodynamically significant CAD. The AUCs, sensitivities, specificities, positive predictive values and negative predictive values of DL-CACS for obstructive CAD and hemodynamically significant CAD were 0.753 (95% CI: 0.712-0.792), 75.9%, 66.5%, 74.8%, 67.8% and 0.769 (95% CI: 0.728-0.806), 80.7%, 62.1%, 59.6% and 82.3% respectively. It took 1.17 min to perform automated measurement of DL-CACS in total, which was significantly less than manual measurement of 1.73 min (P < 0.001). Conclusions DL-CACS, with less time-consuming, can accurately and effectively predict obstructive CAD and hemodynamically significant CAD in T2DM.
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Affiliation(s)
- Jingcheng Hu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jialiang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Meng Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Hussain B, Mahmood A, Flynn MG, Alexander T. Coronary Artery Calcium Scoring in Asymptomatic Patients. HCA HEALTHCARE JOURNAL OF MEDICINE 2023; 4:341-352. [PMID: 37969852 PMCID: PMC10635695 DOI: 10.36518/2689-0216.1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Coronary artery calcium (CAC) scoring is an important prognostic tool for personalized cardiovascular preventive care and has recently been incorporated into American College of Cardiology/American Heart Association guidelines. CAC provides direct visualization and quantification of CAC burden for risk stratification and primary prevention of cardiovascular events in an asymptomatic population. CAC scoring is recommended for individuals with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and selective populations with borderline ASCVD risk. In this review, we outline the interpretation of CAC scores for predicting the risk of cardiovascular events, and we highlight the guidelines for starting statin and potentially starting aspirin therapy. A CAC score of 0 is the strongest negative predictive factor for cardiovascular disease (CVD), and a 0 score can successfully de-risk a patient. On the contrary, higher CAC scores correlate with worse cardiovascular prognostic outcomes. The CAC scan is a widely available and reproducible means for an early look at the atherosclerotic burden, and it can help strategize early interventions. The CAC interpretation and the decision to start treatment need to be personalized based on individual risk factors. We believe the emerging literature supports our contention that the CAC score can be used more broadly to improve the prophylaxis and treatment of a wider range of apparently healthy patients.
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Tang MM, Zhao ST, Li RQ, Hou W. Therapeutic mechanisms of ginseng in coronary heart disease. Front Pharmacol 2023; 14:1271029. [PMID: 37854713 PMCID: PMC10579605 DOI: 10.3389/fphar.2023.1271029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
Coronary heart disease (CHD) is the most common clinical manifestation of cardiovascular disease. It is characterized by myocardial ischemia, which is caused by coronary atherosclerosis. CHD is a significant global health problem with increasing prevalence every year because of significant changes in the lifestyles and diets. Ginseng is a traditional Chinese medicinal herb that has been used in food preparations and traditional medicine for several centuries. Several studies have demonstrated that ginseng improved cardiac function by normalizing blood glucose levels and decreasing blood pressure, oxidative stress, platelet aggregation, and lipid dysregulation in vivo. This review describes the current understanding of the mechanisms by which ginseng alleviates CHD, and provides a reference for the clinical development and application of ginseng as an alternative therapy for CHD.
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Affiliation(s)
| | | | | | - Wei Hou
- Institute of Special Animal and Plant Sciences, Chinese Academy of Agricultural Sciences, Changchun, China
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Honaryar MK, Allodji R, Jimenez G, Lapeyre M, Panh L, Camilleri J, Broggio D, Ferrières J, De Vathaire F, Jacob S. Early Development of Atherosclerotic Plaques in the Coronary Arteries after Radiotherapy for Breast Cancer (BACCARAT Study). J Cardiovasc Dev Dis 2023; 10:299. [PMID: 37504555 PMCID: PMC10380516 DOI: 10.3390/jcdd10070299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Background-Radiotherapy (RT) for breast cancer (BC) can lead to an increased risk of coronary artery disease several years after RT. The aim of this study was to evaluate the development of overall, non-calcified and calcified atherosclerotic plaques over 2 years after BC for RT and associations with cardiac exposure. Methods-The study included 101 left- or right-sided BC patients treated with RT without chemotherapy. A coronary CT angiography was performed before and 2 years after RT. Plaque development thorough the entire coronary network was defined as an increased number of plaques. Cardiac exposure was quantified with mean doses to the heart, left ventricle, and coronary arteries. Logistic regression models were used to assess association with doses. Results-At inclusion, 37% of patients had plaques, increasing to 42% two years after RT. Overall plaque development was observed in seven patients: five with calcified plaque development and four with non-calcified plaque development. The risk of overall plaque development was significantly associated with doses to the Left Main and Circumflex coronary arteries (OR at 1 Gy = 2.32, p = 0.03 and OR at 1 Gy = 2.27, p = 0.03, respectively). Specific analyses for calcified and non-calcified plaque development showed similar results. Conclusion-Our study suggests an association between coronary arteries exposure and the risk of developing both calcified and non-calcified atherosclerotic plaques over 2 years after BC RT. Trial registration number: NCT02605512.
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Affiliation(s)
| | - Rodrigue Allodji
- INSERM U 1018, CESP, Radiation Epidemiology Team, 94800 Villejuif, France
- Gustave Roussy, Research Department, 94800 Villejuif, France
- University Paris-Saclay, 94800 Villejuif, France
| | - Gaelle Jimenez
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, 31076 Toulouse, France
| | - Mathieu Lapeyre
- Department of Radiology, Clinique Pasteur, 31076 Toulouse, France
| | - Loic Panh
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Jeremy Camilleri
- Department of Radiology, Clinique Pasteur, 31076 Toulouse, France
| | - David Broggio
- Department of Dosimetry, PSE-SANTE/SDOS/LEDI, Institute for Radiation Protection and Nuclear Safety (IRSN), 92260 Fontenay-aux-Roses, France
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Rangueil University Hospital, 31400 Toulouse, France
| | - Florent De Vathaire
- INSERM U 1018, CESP, Radiation Epidemiology Team, 94800 Villejuif, France
- Gustave Roussy, Research Department, 94800 Villejuif, France
- University Paris-Saclay, 94800 Villejuif, France
| | - Sophie Jacob
- Laboratory of Epidemiology, PSE-SANTE/SESANE/LEPID, Institute for Radiation Protection and Nuclear Safety (IRSN), 92260 Fontenay-aux-Roses, France
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Nafakhi H, Elwali HQ, Al-Sharea KMK, Al-Mosawi AA. Relationship of cardiovascular risk factors, pericardial fat, and carotid thickness with coronary plaque type in patients with diabetes mellitus. J Diabetes Metab Disord 2023; 22:713-719. [PMID: 37255796 PMCID: PMC10225442 DOI: 10.1007/s40200-023-01190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/01/2023]
Abstract
Background There is paucity of data on the potential predictors of coronary plaque types among patients with diabetes mellitus(DM). Aims To assess the association of cardiovascular risk factors, pericardial fat volume (PFV) assessed by multi-detector CT(MDCT)angiography, and internal carotid intima media thickness with coronary atherosclerotic plaque types in patients with type 2 DM. Patients and methods Patients with suspected coronary artery disease who underwent 64-slice MDCT angiography were enrolled in this retrospective study. Results A total of 784 patients were enrolled in this study, 198 of whom had DM and 586 of whom did not. The prevalence of calcified and mixed plaques was significantly higher in the DM group than without DM group, while no significant difference was found in the distribution of non-calcified plaque between groups. There was significant association between smoking [OR(CI) = 4(2-10),P = 0.001] and increased age[OR(CI) = 1.1(1-1.3),P = 0.023] and calcified plaque presence. Regarding mixed and non-calcified plaque, increased PFV[OR(CI) = 1.1(1-1.3),P = 0.001] and positive family history[OR(CI) = 4(2-12),P = 0.049] showed a significant association with coronary mixed plaque presence while no significant association was observed between cardiovascular risk factors, PFV, and internal carotid intima media thickness and non-calcified plaque presence in patients with DM. Conclusion Increased PFV showed significant and independent association with mixed coronary plaques development, which suggests that PFV may be used as an imaging marker for early detection of increased risk for future coronary events in patients with DM.
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Affiliation(s)
- Hussein Nafakhi
- Internal medicine department, Medicine College, University of Kufa, P.O. 21, Kufa, Najaf, Iraq
| | | | - Kareem M Khalaf Al-Sharea
- Diabetes and endocrine center, Al-Sader teaching medical city, Najaf health directorate, Najaf, Iraq
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Limpijankit T, Jongjirasiri S, Meemook K, Unwanatham N, Thakkinstian A, Laothamatas J. Predictive values of coronary artery calcium and arterial stiffness for long-term cardiovascular events in patients with stable coronary artery disease. Clin Cardiol 2022; 46:171-183. [PMID: 36448219 PMCID: PMC9933115 DOI: 10.1002/clc.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subclinical atherosclerosis detected by increased coronary artery calcium (CAC) or arterial stiffness as reflected by cardio-ankle vascular index (CAVI) has been associated with major adverse cardiovascular events (MACEs). However, comparative data from these two assessments in the same population are still limited. METHODS From 2005 to 2013, patients with stable coronary artery disease (CAD), both asymptomatic and symptomatic who underwent both coronary computed tomography and CAVI were enrolled and followed for occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke) until December 2019. A cause-specific hazard model was applied to assess the associations of CAC score, and CAVI with long-term MACEs. RESULTS A total of 8687 patients participated. Of them, CAC scores were 0, 1-99, 100-399, and ≥400 in 49.7%, 31.9%, 12.3%, and 6.1%, respectively. Arterial stiffness (CAVI ≥ 9.0) was associated with the magnitude of CAC in 23.8%, 36.3%, 44.5%, and 56.2%, respectively. During an average of 9.9 ± 2.4 years follow-up, MACEs occurred in 8.0% (95% CI: 7.4%, 8.6%) of subjects. After adjusting for covariables, CAC scores of 100-399 and ≥400, and CAVIs of ≥9.0 were found to independently predict the occurrence of MACEs with the hazard ratios (95% CI) of 1.70 (1.13, 1.98), 1.87 (1.33, 2.63), and 1.27 (1.06, 1.52), respectively. Other risk predictors were hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy. CONCLUSIONS A CAC score ≥100 or a CAVI ≥ 9.0 predicts the long-term occurrence of MACEs in both asymptomatic and symptomatic patients with stable CAD. These two noninvasive tests can be used as screening tools to guide treatment for the prevention of future CV events.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Sutipong Jongjirasiri
- Department of Radiology, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Krissada Meemook
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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Ban X, Li Z, Duan Y, Xu K, Xiong J, Tu Y. Advanced Imaging Modalities Provide New Insights into Coronary Artery Calcification. Eur J Radiol 2022; 157:110601. [DOI: 10.1016/j.ejrad.2022.110601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/07/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
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Tiller NB, Kinninger A, Abbasi A, Casaburi R, Rossiter HB, Budoff MJ, Adami A. Physical Activity, Muscle Oxidative Capacity, and Coronary Artery Calcium in Smokers with and without COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:2811-2820. [PMID: 36353139 PMCID: PMC9639376 DOI: 10.2147/copd.s385000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Severe chronic obstructive pulmonary disease (COPD) is partly characterized by diminished skeletal muscle oxidative capacity and concurrent dyslipidemia. It is unknown whether such metabolic derangements increase the risk of cardiovascular disease. This study explored associations among physical activity (PA), muscle oxidative capacity, and coronary artery calcium (CAC) in COPDGene participants. Methods Data from current and former smokers with COPD (n = 75) and normal spirometry (n = 70) were retrospectively analyzed. Physical activity was measured for seven days using triaxial accelerometry (steps/day and vector magnitude units [VMU]) along with the aggregate of self-reported PA amount and PA difficulty using the PROactive D-PPAC instrument. Muscle oxidative capacity (k) was assessed via near-infrared spectroscopy, and CAC was assessed via chest computerized tomography. Results Relative to controls, COPD patients exhibited higher CAC (median [IQR], 31 [0–431] vs 264 [40–799] HU; p = 0.003), lower k (mean ± SD = 1.66 ± 0.48 vs 1.25 ± 0.37 min−1; p < 0.001), and lower D-PPAC total score (65.2 ± 9.9 vs 58.8 ± 13.2; p = 0.003). Multivariate analysis—adjusting for age, sex, race, diabetes, disease severity, hyperlipidemia, smoking status, and hypertension—revealed a significant negative association between CAC and D-PPAC total score (β, −0.05; p = 0.013), driven primarily by D-PPAC difficulty score (β, −0.03; p = 0.026). A 1 unit increase in D-PPAC total score was associated with a 5% lower CAC (p = 0.013). There was no association between CAC and either k, steps/day, VMU, or D-PPAC amount. Conclusion Patients with COPD and concomitantly elevated CAC exhibit greater perceptions of difficulty when performing daily activities. This may have implications for exercise adherence and risk of overall physical decline.
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Affiliation(s)
- Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - April Kinninger
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Asghar Abbasi
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Richard Casaburi
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Harry B Rossiter
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Correspondence: Harry B Rossiter, Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA, Tel +1 310-222-8200, Email
| | - Matthew J Budoff
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alessandra Adami
- Department of Kinesiology, University of Rhode Island, Kingston, RI, USA
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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Harnessing imaging biomarkers to refine individualized cardiovascular disease risk: a case-based discussion. Coron Artery Dis 2022; 33:574-579. [PMID: 35942620 DOI: 10.1097/mca.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditional models of cardiovascular risk assessment rely on population-level risk factors and may not accurately capture individualized risk. Imaging biomarkers such as plaque characterization and pericoronary fat inflammation may offer refined risk prediction and allow physicians to personalize care-plans for cardiovascular disease prevention. The integration of plaque morphology and pericoronary inflammation into clinical care is highlighted using a case-based discussion. This article reviews the existing body of evidence supporting the use of novel biomarkers in an individualized comprehensive risk assessment algorithm.
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Moradi M, Rafiei E, Rasti S, Haghbin H. Coronary artery calcification-does it predict the CAD-RADS category? Emerg Radiol 2022; 29:969-977. [PMID: 35922681 PMCID: PMC9362466 DOI: 10.1007/s10140-022-02082-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/28/2022] [Indexed: 12/20/2022]
Abstract
Purpose Coronary calcium scores (CCSs) in cardiac-gated computed tomography (CCT) are diagnostic for coronary artery disease (CAD). This study aims to investigate if CCSs can foretell CAD-reporting and data system (CAD-RADS) without performing computed tomography angiography (CTA). Methods Profiles of 544 patients were studied who had gone through CCT and CTA; the number of calcified regions of interest (ROIs), the Agatston, area, volume, and mass CCSs were calculated. Among the CAD-RADS categories (1 to 5), the mean values were compared for each CCS separately. A cut-offfor each CCS was declared using ROC curve analysis, more than which could predict significant CAD (CAD-RADS 3 to 5). Also, logistic regression models indicated the most probable CAD-RADS category based on the CCSs. P < 0.05 was considered significant. Results Among 53% male and 47% female participants with a mean (SD) age of 62.57 (0.84) years, numbers of calcified ROIs were significantly different between each pair of CAD-RADS categories. While other CCSs did not show a significant difference between CAD-RADS 1 and 2 or 2 and 3. All CCSs were significantly different between the non-significant and significant CAD groups; cut-offs for the number of calcified ROIs, the Agatston, area, volume, and mass scores were 9, 128, 44mm2, 111mm3, and 22 mg, respectively. Formulae A and B predicted the most probable CAD-RADS category (accuracy: 79%) and the probability of significant/non-significant CAD (accuracy: 81%), respectively. Conclusion CCSs could predict CAD-RADS with an accuracy of 80%. Further studies are needed to introduce more predictive calcium indices.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, 8174673461, Isfahan, Iran
| | - Ebrahim Rafiei
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, 8174673461, Isfahan, Iran
| | - Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, 8174673461, Isfahan, Iran.
| | - Hossein Haghbin
- Department of Statistics, Faculty of Intelligent Systems Engineering and Data Sciences, Persian Gulf University, 7516913817, Bushehr, Iran
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Limpijankit T, Jongjirasiri S, Unwanatham N, Rattanasiri S, Thakkinstian A, Laothamatas J. Causal Relationship of Coronary Artery Calcium on Myocardial Infarction and Preventive Effect of Antiplatelet Therapy. Front Cardiovasc Med 2022; 9:871267. [PMID: 35571181 PMCID: PMC9091507 DOI: 10.3389/fcvm.2022.871267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of coronary artery calcium score (CACS) to guide antiplatelet therapy in order to prevent myocardial infarction (MI) is still uncertain. This study aimed to find the causal relationship of CACS on MI and preventive effect of antiplatelet therapy. Methods From 2005 to 2013, all patients with cardiovascular risk factors or symptoms of suspected CAD underwent coronary computed tomography. CACSs were measured using Agatston method and stratified into 4 groups: 0, 1–99, 100–399, and ≥ 400. Antiplatelet therapy was prescribed following physician discretion. Outcomes of interest were MI and bleeding. A mediation analysis was applied to find association pathways. CACS was considered as an independent variable, whereas antiplatelet therapy was considered as a mediator and MI considered the outcome of interest. Results A total of 7,849 subjects were enrolled. During an average of 9.9 ± 2.4 years follow-up, MI and bleeding events occurred in 2.24% (n = 176) and 2.82% (n = 221) of subjects, respectively. CACSs 100–399 and CAC ≥ 400 were significantly associated with the development of MI [OR 3.14 (1.72, 5.72), and OR 3.22 (1.66, 6.25), respectively, p < 0.001]. Antiplatelet therapy reduced the risk of MI of these corresponding CAC groups with ORs of 0.60 (0.41, 0.78) and 0.56 (0.34, 0.77), p < 0.001]. A risk of bleeding was associated with antiplatelet therapy (only aspirin), anticoagulant, hypertension, male gender and old age. Conclusion CACS was associated with the development of future MI. The preventive effect of antiplatelet therapy was clearly demonstrated in subjects with CACSs equal to or above 100, but this benefit was partially offset by an increased risk of bleeding.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand
- *Correspondence: Thosaphol Limpijankit,
| | - Sutipong Jongjirasiri
- Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand
| | - Jiraporn Laothamatas
- Faculty of Heath Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand
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14
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Han C, Kang KW, Kim TY, Uhm JS, Park JW, Jung IH, Kim M, Bae S, Lim HS, Yoon D. Artificial Intelligence-Enabled ECG Algorithm for the Prediction of Coronary Artery Calcification. Front Cardiovasc Med 2022; 9:849223. [PMID: 35463761 PMCID: PMC9019148 DOI: 10.3389/fcvm.2022.849223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 12/28/2022] Open
Abstract
Coronary artery calcium (CAC), which can be measured in various types of computed tomography (CT) examinations, is a hallmark of coronary artery atherosclerosis. However, despite the clinical value of CAC scores in predicting cardiovascular events, routine measurement of CAC scores is limited due to high cost, radiation exposure, and lack of widespread availability. It would be of great clinical significance if CAC could be predicted by electrocardiograms (ECGs), which are cost-effective and routinely performed during various medical checkups. We aimed to develop binary classification artificial intelligence (AI) models that predict CAC using only ECGs as input. Moreover, we aimed to address the generalizability of our model in different environments by externally validating our model on a dataset from a different institution. Among adult patients, standard 12-lead ECGs were extracted if measured within 60 days before or after the CAC scores, and labeled with the corresponding CAC scores. We constructed deep convolutional neural network models based on residual networks using only the raw waveforms of the ECGs as input, predicting CAC at different levels, namely CAC score ≥100, ≥400 and ≥1,000. Our AI models performed well in predicting CAC in the training and internal validation dataset [area under the receiver operating characteristics curve (AUROC) 0.753 ± 0.009, 0.802 ± 0.027, and 0.835 ± 0.024 for the CAC score ≥100, ≥400, and ≥1,000 model, respectively]. Our models also performed well in the external validation dataset (AUROC 0.718, 0.777 and 0.803 for the CAC score ≥100, ≥400, and ≥1,000 model, respectively), indicating that our model can generalize well to different but plausibly related populations. Model performance in terms of AUROC increased in the order of CAC score ≥100, ≥400, and ≥1,000 model, indicating that higher CAC scores might be associated with more prominent structural changes of the heart detected by the model. With our AI models, a substantial proportion of previously unrecognized CAC can be afforded with a risk stratification of CAC, enabling initiation of prophylactic therapy, and reducing the adverse consequences related to ischemic heart disease.
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Affiliation(s)
- Changho Han
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, South Korea
| | - Ki-Woon Kang
- Division of Cardiology, College of Medicine, Heart Research Institute, Chung-Ang University Hospital, Chung-Ang University, Seoul, South Korea
| | | | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, South Korea.,BUD.on Inc., Seoul, South Korea.,Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
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15
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Saydam CD. Subclinical cardiovascular disease and utility of coronary artery calcium score. IJC HEART & VASCULATURE 2021; 37:100909. [PMID: 34825047 PMCID: PMC8604741 DOI: 10.1016/j.ijcha.2021.100909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
ASCVD are the leading causes of mortality and morbidity among Globe. Evaluation of patients' comprehensive and personalized risk provides risk management strategies and preventive interventions to achieve gain for patients. Framingham Risk Score (FRS) and Systemic Coronary Risk Evaluation Score (SCORE) are two well studied risk scoring models, however, can miss some (20-35%) of future cardiovascular events. To obtain more accurate risk assessment recalibrating risk models through utilizing novel risk markers have been studied in last 3 decades and both ESC and AHA recommends assessing Family History, hs-CRP, CACS, ABI, and CIMT. Subclinical Cardiovascular Disease (SCVD) has been conceptually developed for investigating gradually progressing asymptomatic development of atherosclerosis and among these novel risk markers it has been well established by literature that CACS having highest improvement in risk assessment. This review study mainly selectively discussing studies with CACS measurement. A CACS = 0 can down-stratify risk of patients otherwise treated or treatment eligible before test and can reduce unnecessary interventions and cost, whereas CACS ≥ 100 is equivalent to statin treatment threshold of ≥ 7.5% risk level otherwise statin ineligible before test. Since inflammation, insulin resistance, oxidative stress, dyslipidemia and ongoing endothelial damage due to hypertension could lead to CAC, ASCVD linked with comorbidities. Recent cohort studies have shown a CACS 100-300 as a sign of increased cancer risk. Physical activity, dietary factors, cigarette use, alcohol consumption, metabolic health, family history of CHD, aging, exposures of neighborhood environment and non-cardiovascular comorbidities can determine CACs changes.
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16
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Hayrapetian A, Berenji GR, Nguyen KL, Li Y. 18F-Sodium fluoride uptake is associated with severity of atherosclerotic stenosis in stable ischemic heart disease. J Nucl Cardiol 2021; 28:3058-3066. [PMID: 32676905 PMCID: PMC10163835 DOI: 10.1007/s12350-020-02238-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Increased uptake of 18F-Sodium fluoride (18F-NaF) PET has potential to identify atherosclerotic plaques that are vulnerable to rupture. Whether 18F-NaF PET can evaluate the significance of atherosclerotic plaque in patients with stable coronary artery disease is less clear. We evaluated 18F-NaF PET uptake in coronary arteries in patients without acute coronary artery syndrome to determine the association of 18F-NaF signal uptake with severity of coronary stenosis. METHODS AND RESULTS We retrospectively identified 114 patients who received both regadenoson stress 82Rb myocardial perfusion PET and 18F-NaF PET study with an average interval of 5 months. Out of this cohort, forty-one patients underwent invasive coronary angiography. In a patient-based analysis, patients with ischemic regadenoson stress 82Rb PET had significantly higher coronary 18F-NaF uptake than patients with normal myocardial perfusion (P < .01). Among the 41 patients who underwent coronary angiography, per-vessel 18F-NaF uptake in both obstructive and nonobstructive coronary arteries was significantly higher than in normal coronary arteries (P < .05) regardless of the severity of coronary calcification. There was poor correlation between calcification and 18F-NaF uptake in coronary arteries (r = 0.41) CONCLUSION: Coronary arterial 18F-NaF uptake is associated with coronary stenosis severity in patients with stable coronary artery disease. 18F-NaF PET studies may be useful for characterizing coronary atherosclerotic plaques.
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Affiliation(s)
- Artineh Hayrapetian
- Department of Radiology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Gholam R Berenji
- Department of Radiology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Kim-Lien Nguyen
- Department of Radiology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Divsion of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA
- Department of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yuxin Li
- Department of Radiology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
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Xu J, Liu J, Guo N, Chen L, Song W, Guo D, Zhang Y, Fang Z. Performance of artificial intelligence-based coronary artery calcium scoring in non-gated chest CT. Eur J Radiol 2021; 145:110034. [PMID: 34837795 DOI: 10.1016/j.ejrad.2021.110034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the risk category performance of artificial intelligence-based coronary artery calcium score (AI-CACS) software used in non-gated chest computed tomography (CT) on three types of CT machines, considering the manual method as the standard. METHODS A total of 901 patients who underwent both chest CT and electrocardiogram (ECG)-gated non-contrast-enhanced cardiac CT with the same equipment within a 3-month period were enrolled in the study. AI-CACS software was based on a deep learning algorithm and was trained on multi-vendor, multi-scanner, and multi-hospital anonymized data from the chest CT database. The AI-CACS was automatically obtained from chest CT data by the AI-CACS software, while the manual CACS was obtained from cardiac CT data by the manual method. The correlation of the AI-CACS and manual CACS, concordance rate and kappa value of the risk categories determined by the two methods were calculated. The chi-square test was used to evaluate the differences in risk categories among the three types of CT machines from different manufacturers. The risk category performance of the AI-CACS for dichotomous risk categories bounded by 0, 100 and 400 was assessed. RESULTS The correlation of the AI-CACS with the manual CACS was ρ = 0.893 (p < 0.001). The Bland-Altman plot (AI-CACS minus manual CACS) showed a mean difference of -27.2 and 95% limits of agreement of -290.0 to 235.6. The agreement of risk categories for the CACS was kappa (κ) = 0.679 (p < 0.001), and the concordance rate was 80.6%. The risk categories determined by the AI-CACS software on three types of CT machines were not significantly different (p = 0.7543). As dichotomous risk categories bounded by 0, 100 and 400, the accuracy, kappa value, and area under the curve of the AI-CACS were 88.6% vs. 92.9% vs. 97.9%, 0.77 vs. 0.77 vs. 0.83, and 0.885 vs. 0.964 vs. 0.981, respectively. CONCLUSIONS There was good correlation and agreement between the AI-CACS and manual CACS in terms of the risk category. It is feasible to obtain the CACS using AI software based on non-gated chest CT data in a short time without increasing the radiation dose or economic burden. The AI-CACS software algorithm has good clinical universality and can be applied to CT machines from different manufacturers.
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Affiliation(s)
- Jie Xu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Jia Liu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Ning Guo
- ShuKun (BeiJing) Technology Co., Ltd., Jinhui Bd, Qiyang Rd, 100000 Beijing, China
| | - Linli Chen
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Weixiang Song
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Dajing Guo
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Yu Zhang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China.
| | - Zheng Fang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China.
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Murgia A, Balestrieri A, Crivelli P, Suri JS, Conti M, Cademartiri F, Saba L. Cardiac computed tomography radiomics: an emerging tool for the non-invasive assessment of coronary atherosclerosis. Cardiovasc Diagn Ther 2021; 10:2005-2017. [PMID: 33381440 DOI: 10.21037/cdt-20-156] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the last decades, significant advances have been made in the preventive approaches to cardiovascular disease. Even so, coronary artery disease remains one of the main causes of morbidity and mortality worldwide. Invasive imaging modalities, such as intravascular ultrasound or optical coherence tomography, have played a key role in the comprehension of the pathological processes underlying myocardial infarction and cerebrovascular disease. These imaging techniques have contributed greatly to the identification and phenotyping of the culprit lesion, the so-called vulnerable plaque. Coronary computed tomographic angiography (CCTA) has emerged in more recent years as the non-invasive modality of choice in the study of coronary atherosclerosis, showing in many studies a diagnostic yield comparable to invasive approaches. Moreover, being able to describe extra-luminal characteristics of the affected vessel, CCTA has greatly contributed towards shifting the attention of researchers from the mere quantification of luminal stenosis to the identification of adverse plaque features, which appear to have a stronger prognostic value. However, the identification of some of the hallmarks of vulnerable plaques is qualitative in nature and, therefore, subject to some degree of inter-reader variability. Moreover, CCTA is still unable to identify some fine markers of plaque vulnerability which can be detected by invasive techniques, such as neovascularization and plaque erosion, among others. Nonetheless, radiological images can be viewed as vast 3-D datasets which, via the use of recent technology, allow for the extraction of numerous quantitative features that may be used to accurately phenotype a given lesion. Radiomics is the process of extrapolating innumerable parameters from a given region of interest, with the goal of establishing correlations between quantitative variables and clinical data. These datasets can then be manipulated to create predictive models via the use of automated algorithms in a process called machine learning. As a result of these approaches, radiological images may offer information regarding the characterization of a plaque which can go much beyond the boundaries of what can be qualitatively asserted by the human eye, contributing to expanding the knowledge of the disease and ultimately assist clinical decisions. Thus far, radiomics has found its more consistent area of application in the field of oncology; to present date, the amount of clinical data regarding coronary artery disease is still relatively small, partly due to the technical difficulties associated with the implementation of such techniques to the study of a small and geometrically complex lesion such as the coronary plaque. The present review, after a summary of the imaging modalities most commonly used nowadays in the study of coronary plaques, will provide a perspective on the application of radiomic analysis to coronary artery disease.
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Affiliation(s)
| | | | - Paola Crivelli
- Department of Radiology, University of Sassari, Sassari SS, Italy
| | - Jasjit S Suri
- Stroke and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | - Maurizio Conti
- Department of Radiology, University of Sassari, Sassari SS, Italy
| | | | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari CA, Italy
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Anand A, Pavithra R, Sangeetha T, Velayuthaprabhu S. A literature survey on the biomarkers of cardiovascular disease. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2021; 7:141. [DOI: 10.4103/ijam.ijam_80_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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20
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Mukai H, Dai L, Chen Z, Lindholm B, Ripsweden J, Brismar TB, Heimbürger O, Barany P, Qureshi AR, Söderberg M, Bäck M, Stenvinkel P. Inverse J-shaped relation between coronary arterial calcium density and mortality in advanced chronic kidney disease. Nephrol Dial Transplant 2020; 35:1202-1211. [PMID: 30534995 DOI: 10.1093/ndt/gfy352] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The coronary artery calcium (CAC) score from cardiac computed tomography (CT) is a composite of CAC volume and CAC density. In the general population, CAC volume is positively and CAC density inversely associated with cardiovascular disease (CVD) events, implying that decreased CAC density reflects atherosclerotic plaque instability. We analysed associations of CAC indices with mortality risk in patients with end-stage renal disease [chronic kidney disease Stage 5 (CKD5)]. METHODS In 296 CKD5 patients undergoing cardiac CT (median age 55 years, 67% male, 19% diabetes, 133 dialysed), the Framingham risk score (FRS), presence of CVD and protein-energy wasting (PEW; subjective global assessment) and high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at baseline. During follow-up for a median of 35 months, 51 patients died and 75 patients underwent renal transplantation. All-cause mortality risk was analysed with competing-risk regression models. Vascular calcification was analysed in biopsies of the arteria epigastrica inferior in 111 patients. RESULTS Patients in the middle tertile of CAC density had the highest CAC score, CAC volume, age, CVD, PEW, FRS, hsCRP and IL-6. In competing risk analysis, the middle {subhazard ratio [sHR] 10.7 [95% confidence interval (CI) 2.0-57.3]} and high [sHR 8.9 (95% CI 1.5-51.8)] tertiles of CAC density associated with increased mortality, independent of CAC volume. The high tertile of CAC volume, independent of CAC density, associated with increased mortality [sHR 8.9 (95% CI 1.5-51.8)]. Arterial media calcification was prominent and associated with CAC volume and CAC density. CONCLUSIONS In CKD5, mortality increased linearly with higher CAC score and CAC volume whereas for CAC density an inverse J-shaped pattern was observed, with the crude mortality rate being highest for the middle tertile of CAC density. CAC volume and CAC density were associated with the extent of arterial media calcification.
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Affiliation(s)
- Hideyuki Mukai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Lu Dai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Zhimin Chen
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Jonaz Ripsweden
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Torkel B Brismar
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Magnus Söderberg
- Department of Pathology, Drug Safety and Metabolism, AstraZeneca, Mölndal, Sweden
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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Henein MY, Vancheri S, Bajraktari G, Vancheri F. Coronary Atherosclerosis Imaging. Diagnostics (Basel) 2020; 10:E65. [PMID: 31991633 PMCID: PMC7168918 DOI: 10.3390/diagnostics10020065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 02/05/2023] Open
Abstract
Identifying patients at increased risk of coronary artery disease, before the atherosclerotic complications become clinically evident, is the aim of cardiovascular prevention. Imaging techniques provide direct assessment of coronary atherosclerotic burden and pathological characteristics of atherosclerotic lesions which may predict the progression of disease. Atherosclerosis imaging has been traditionally based on the evaluation of coronary luminal narrowing and stenosis. However, the degree of arterial obstruction is a poor predictor of subsequent acute events. More recent techniques focus on the high-resolution visualization of the arterial wall and the coronary plaques. Most acute coronary events are triggered by plaque rupture or erosion. Hence, atherosclerotic plaque imaging has generally focused on the detection of vulnerable plaque prone to rupture. However, atherosclerosis is a dynamic process and the plaque morphology and composition may change over time. Most vulnerable plaques undergo progressive transformation from high-risk to more stable and heavily calcified lesions, while others undergo subclinical rupture and healing. Although extensive plaque calcification is often associated with stable atherosclerosis, the extent of coronary artery calcification strongly correlates with the degree of atherosclerosis and with the rate of future cardiac events. Inflammation has a central role in atherogenesis, from plaque formation to rupture, hence in the development of acute coronary events. Morphologic plaque assessment, both invasive and non-invasive, gives limited information as to the current activity of the atherosclerotic disease. The addition of nuclear imaging, based on radioactive tracers targeted to the inflammatory components of the plaques, provides a highly sensitive assessment of coronary disease activity, thus distinguishing those patients who have stable disease from those with active plaque inflammation.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden; (M.Y.H.); (G.B.)
- Departments of Fluid Mechanics, Brunel University, Middlesex, London UB8 3PH, UK
- Molecular and Nuclear Research Institute, St George’s University, London SW17 0RE, UK
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden; (M.Y.H.); (G.B.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
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Strauss HW, Nakahara T, Narula N, Narula J. Vascular Calcification: The Evolving Relationship of Vascular Calcification to Major Acute Coronary Events. J Nucl Med 2019; 60:1207-1212. [PMID: 31350320 DOI: 10.2967/jnumed.119.230276] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022] Open
Abstract
Calcification in a coronary artery is accepted as definite evidence of coronary atherosclerosis. The extent and density of calcification, as combined in the Agatston score, is associated with the risk of a patient experiencing a major acute coronary event. Atherosclerosis occurs because damaged endothelial cells allow low-density lipoprotein cholesterol (LDLc) to leak into subintimal tissue. Proteoglycans in subendothelial collagen have a high affinity for LDLc, retaining the lipoprotein cholesterol complex. As the endothelial damage is repaired, the subintimal LDLc is trapped. Retained LDLc induces an inflammatory response in the overlying endothelium, causing the endothelium to express chemotactic peptides. Chemotactic peptides attract circulating monocytes, which follow the concentration gradient, enter the tissue, and become tissue macrophages to phagocytize and digest the irritating LDLc in the atheroma. In the process of digesting LDLc, enzymes in the macrophages oxidize the LDLc complex. Oxidized LDL is toxic to macrophages; when present in sufficient quantity, it may cause death of macrophages, contributing to inflammation in the atheroma. In a necrotic inflammatory lesion, the regulatory mechanisms that control tissue concentrations of calcium and phosphorus are lost, allowing the solubility product of calcium phosphate to be exceeded, resulting in the formation of microscopic calcium-phosphate crystals. With ongoing inflammation, additional calcium-phosphate crystals are formed, which may aggregate. When these aggregated calcium phosphate crystals exceed 1 mm, the lesions become visible on clinical CT as coronary calcifications. Serial gated CT scans of the heart have demonstrated that once formed, CT-visible calcifications do not decrease significantly in size but may increase.
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Affiliation(s)
- H William Strauss
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Takehiro Nakahara
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Navneet Narula
- Department of Pathology, New York University School of Medicine, New York, New York; and
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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23
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García-Gómez MC, Vilahur G. Osteoporosis and vascular calcification: A shared scenario. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 32:33-42. [PMID: 31221532 DOI: 10.1016/j.arteri.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/11/2019] [Indexed: 12/12/2022]
Abstract
Osteoporosis is a systemic skeletal disease, characterised by low bone mass and deterioration in the micro-architecture of bone tissue, which causes increased bone fragility and consequently greater susceptibility to fractures. It is the most frequent metabolic bone disease in our population, and fractures resulting from osteoporosis are becoming more common. Furthermore, vascular calcification is a recognised risk factor of cardiovascular morbidity and mortality that historically has been considered a passive and degenerative process. However, it is currently recognised as an active process, which has histopathological characteristics, mineral composition and initiation and development mechanisms characteristic of bone formation. Paradoxically, patients with osteoporosis frequently show vascular calcifications. Traditionally, they have been considered as independent processes related to age, although more recent epidemiological studies have shown that there is a close relationship between the loss of bone mass and vascular calcification, regardless of age. In fact, both conditions share risk factors and pathophysiological mechanisms. These include the relationship between proteins of bone origin, such as osteopontin and osteoprotegerin (OPG), with vascular pathology, and the intercellular protein system RANK/RANKL/OPG and the Wnt signalling pathway. The mechanisms linked in both pathologies should be considered in clinical decisions, given that treatments for osteoporosis could have unforeseen effects on vascular calcification, and vice versa. In short, a better understanding of the relationship between both entities can help in proposing strategies to reduce the increasing prevalence of vascular calcification and osteoporosis in the aging population.
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Affiliation(s)
| | - Gemma Vilahur
- Programa ICCC-Institut de Recerca Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España; CIBERCV Instituto de Salud Carlos III, Madrid, España.
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24
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Roth L, Van der Donckt C, Emini Veseli B, Van Dam D, De Deyn PP, Martinet W, Herman AG, De Meyer GRY. Nitric oxide donor molsidomine favors features of atherosclerotic plaque stability and reduces myocardial infarction in mice. Vascul Pharmacol 2019; 118-119:106561. [PMID: 31085310 DOI: 10.1016/j.vph.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/19/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Nitric oxide (NO) donors are commonly used for the prevention and treatment of ischemic heart disease. Besides their effects on the heart, NO donors may also prevent hypoxic brain damage and exert beneficial effects on atherosclerosis by favoring features of plaque stability. We recently described that apolipoprotein E (ApoE) deficient mice with a mutation in the fibrillin-1 (Fbn1) gene (ApoE-/-Fbn1C1039G+/-) develop accelerated atherosclerosis, plaque rupture, myocardial infarction, cerebral hypoxia and sudden death. In the present study, we evaluated the effects of chronic treatment with the NO donor molsidomine on atherosclerotic plaque stability, cardiac function, neurological symptoms and survival in the ApoE-/-Fbn1C1039G+/- mouse model. Female ApoE-/-Fbn1C1039G+/- mice were fed a Western diet (WD). After 8 weeks of WD, the mice were divided into two groups receiving either molsidomine via the drinking water (1 mg/kg/day; n = 34) or tap water (control; n = 36) until 25 weeks of WD. Survival tended to increase after molsidomine treatment (68% vs. 58% in controls). Importantly, atherosclerotic plaques of molsidomine-treated mice had a thicker fibrous cap (11.1 ± 1.2 vs. 8.1 ± 0.7 μm) and showed an increased occurrence of plaque macrocalcifications (30% vs. 0%), indicative of a more stable phenotype. Molsidomine also improved cardiac function, as fractional shortening was increased (40 ± 2% vs. 27 ± 2%) combined with a decreased end diastolic (3.1 ± 0.2 vs. 3.9 ± 0.2 mm) and end systolic diameter (1.9 ± 0.1 vs. 2.9 ± 0.2 mm). Furthermore, perivascular fibrosis (23 ± 2 vs. 30 ± 2%) and the occurrence of myocardial infarctions (12% vs. 36%) was significantly reduced. Track width, a measure of the animal's hind limb base of support and representative of hypoxic brain damage, was also normalized as a result of molsidomine treatment (2.54 ± 0.04 vs. 2.91 ± 0.09 cm in controls). These findings demonstrate that the NO donor molsidomine improves cardiac function, reduces neurological symptoms and enhances atherosclerotic plaque stability.
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Affiliation(s)
- Lynn Roth
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | | | - Besa Emini Veseli
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Peter P De Deyn
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands; Department of Neurology, Memory Clinic of Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Lindendreef 1, 2020 Antwerp, Belgium
| | - Wim Martinet
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Arnold G Herman
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium.
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25
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Lee JH, Kang EJ, Bae WY, Kim JK, Choi JH, Kim CH, Kim SJ, Jo KS, Kim MS, Koh TK. Carotid Arterial Calcium Scoring Using Upper Airway Computed Tomography in Patients with Obstructive Sleep Apnea: Efficacy as a Clinical Predictor of Cerebrocardiovascular Disease. Korean J Radiol 2019; 20:631-640. [PMID: 30887745 PMCID: PMC6424829 DOI: 10.3348/kjr.2018.0550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/16/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jae Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Eun Ju Kang
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Woo Yong Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea.
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jae Hyung Choi
- Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
| | - Chul Hoon Kim
- Department of Oral and Maxillofacial Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Sang Joon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Kyoo Sang Jo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Moon Sung Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Tae Kyung Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Mary's Medical Center, Busan, Korea
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26
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Bartoli-Leonard F, Wilkinson FL, Schiro A, Inglott FS, Alexander MY, Weston R. Suppression of SIRT1 in Diabetic Conditions Induces Osteogenic Differentiation of Human Vascular Smooth Muscle Cells via RUNX2 Signalling. Sci Rep 2019; 9:878. [PMID: 30696833 PMCID: PMC6351547 DOI: 10.1038/s41598-018-37027-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022] Open
Abstract
Vascular calcification is associated with significant morbidity and mortality within diabetes, involving activation of osteogenic regulators and transcription factors. Recent evidence demonstrates the beneficial role of Sirtuin 1 (SIRT1), an NAD+ dependant deacetylase, in improved insulin sensitivity and glucose homeostasis, linking hyperglycaemia and SIRT1 downregulation. This study aimed to determine the role of SIRT1 in vascular smooth muscle cell (vSMC) calcification within the diabetic environment. An 80% reduction in SIRT1 levels was observed in patients with diabetes, both in serum and the arterial smooth muscle layer, whilst both RUNX2 and Osteocalcin levels were elevated. Human vSMCs exposed to hyperglycaemic conditions in vitro demonstrated enhanced calcification, which was positively associated with the induction of cellular senescence, verified by senescence-associated β-galactosidase activity and cell cycle markers p16 and p21. Activation of SIRT1 by SRT1720 reduced Alizarin red staining by a third, via inhibition of the RUNX2 pathway and prevention of senescence. Conversely, inhibition of SIRT1 via Sirtinol and siRNA increased RUNX2 by over 50%. These findings demonstrate the key role that SIRT1 plays in preventing calcification in a diabetic environment, through the inhibition of RUNX2 and senescence pathways, suggesting a downregulation of SIRT1 may be responsible for perpetuating vascular calcification in diabetes.
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Affiliation(s)
- F Bartoli-Leonard
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - F L Wilkinson
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - A Schiro
- Vascular Unit, Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - F Serracino Inglott
- Vascular Unit, Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Y Alexander
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - R Weston
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK.
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27
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Ramanathan R, Gram JB, Sidelmann JJ, Dey D, Kusk MW, Nørgaard BL, Sand NPR. Sex difference in fibrin clot lysability: Association with coronary plaque composition. Thromb Res 2018; 174:129-136. [PMID: 30597343 DOI: 10.1016/j.thromres.2018.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/21/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fibrin clot lysability is associated with development of cardiovascular disease (CVD). We evaluated sex-differences in fibrin clot lysability and the association with coronary plaque composition determined by computed tomography angiography (CTA). METHODS Middle-aged citizens without known CVD were randomly selected from a national registry. A coronary CTA assessed volumes of calcified-, non-calcified-, low-density non-calcified-, and total- plaque using a validated plaque quantification software. A non-enhanced cardiac CT scan assessed the Agatston score. Fibrin structure properties were determined using turbidimetric methods. Plasma concentrations of C-reactive protein and fibrinogen were assessed. RESULTS 138 individuals (71 women) participated. Men more frequently had coronary plaques compared to women, P < 0.05. Coronary plaque features were comparable between men and women, P > 0.05. Women with total plaque volume > 0 mm3 had lower fibrin clot lysability compared to women with total plaque volume = 0 mm3, adjusted difference [95% confidence interval] 10.28 [1.42-19.15], P = 0.02, and a fibrinogen-dependent lower fibrin clot lysability compared to men with and without coronary plaques, 6.82 [-2.67-16.31], P = 0.16, and 8.73 [-0.43-17.89], P = 0.06, respectively. Fibrinogen correlated with all the coronary plaque features (correlation coefficient r = 0.42-0.57) only in women with total plaque volume > 0 mm3, all P < 0.01. CONCLUSION Asymptomatic women with coronary plaques assessed by coronary CTA have reduced fibrin clot lysability compared to both women without coronary plaques and men, suggesting a sex-dependent link between coronary atherosclerosis and fibrin clot lysability.
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Affiliation(s)
- Ramshanker Ramanathan
- Department of Cardiology, Hospital of South West Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Denmark; Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, and Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark.
| | - Jørgen B Gram
- Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, and Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Johannes J Sidelmann
- Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, and Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA
| | - Martin W Kusk
- Department of Radiology, Hospital of South West Denmark, Esbjerg, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
| | - Niels Peter R Sand
- Department of Cardiology, Hospital of South West Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Denmark
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Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6528238. [PMID: 30306089 PMCID: PMC6165606 DOI: 10.1155/2018/6528238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.
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Association of Exercise Capacity, Cardiac Function, and Coronary Artery Calcification with Components for Metabolic Syndrome. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4619867. [PMID: 30402479 PMCID: PMC6193328 DOI: 10.1155/2018/4619867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/20/2018] [Indexed: 12/26/2022]
Abstract
Purpose The purpose of this study was to investigate the association of exercise capacity, cardiac function, and coronary artery calcification (CAC) with components of metabolic syndrome in Korean adults. Method Medical records of healthy adults who underwent exercise tolerance test (ETT), coronary CT angiography (CTA), and echocardiography of the heart for cardiac health check-up were retrospectively reviewed. Patients who had a history of severe cardiovascular disease or could not perform ETT due to other musculoskeletal problems were excluded. Subjects were classified into groups based on the number of components for metabolic syndrome: no component (Group 1, n=90), 1, 2 components (Group 2, n=321), and 3 or more components (Group 3, n=154). Exercise capacity was assessed using the symptom-limited ETT, and CAC score was obtained using the coronary CTA and Agatston score. Cardiac structure and function were assessed using echocardiography. Results A total of 565 patients (mean (SD) age 59.5 (9.1), 340 men, 225 women) were selected. Exercise capacity was significantly lower in Group 3 than in the other groups (p<0.05). The CAC score was significantly higher in Group 3 than in the other groups (p<0.05). Compared to the other groups, echocardiography findings in Group 3 showed a greater hypertrophy of the left ventricle and reduction in the diastolic function (p<0.05). Exercise capacity, CAC score, cardiac structure, and function were different between the 3 groups, where a tendency to worsen was observed from Group 1 to Group 3. Conclusion Metabolic syndrome decreases exercise capacity of the patient and contributes to CAC, thereby increasing the risk for cardiovascular diseases and deterioration in cardiac structure and function. Therefore, early detection of metabolic syndrome and subsequently the prevention and management of heart disease are necessary.
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Thomas IC, Forbang NI, Criqui MH. The evolving view of coronary artery calcium and cardiovascular disease risk. Clin Cardiol 2018; 41:144-150. [PMID: 29356018 DOI: 10.1002/clc.22842] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022] Open
Abstract
Calcification of the coronary artery is a complex pathophysiologic process that is intimately associated with atherosclerosis. Extensive investigation has demonstrated the value of identifying and quantifying coronary artery calcium (CAC) in atherosclerotic cardiovascular disease (CVD) prognostication. However, over the last several years, an increasing body of evidence has suggested that CAC has underappreciated aspects that modulate, and at times attenuate, future CVD risk. The most commonly used measure of CAC, the Agatston unit, effectively models both higher density and higher area of CAC as risk factors for future CVD events. Recent findings from the Multi-Ethnic Study of Atherosclerosis (MESA) have challenged this assumption, demonstrating that higher density of CAC is protective for coronary heart disease and CVD events. Statins may be associated with an increase in CAC, an unexpected finding given their clear benefits in the prevention and treatment of CVD. Studies utilizing intracoronary ultrasound and coronary computed tomography angiography have demonstrated that calcified atherosclerotic plaque-as compared with noncalcified or sparsely calcified plaque-is associated with fewer CVD events. These studies lend support to the often-asserted (but as yet unvalidated) view that calcification may play a role in plaque stabilization. Furthermore, vascular calcification, though a surrogate for atherosclerotic plaque burden, may also possess identifiable aspects that can refine CVD risk assessment.
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Affiliation(s)
- Isac C Thomas
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego.,Division of Preventive Medicine, Department of Family and Public Health, University of California San Diego
| | - Nketi I Forbang
- Division of Preventive Medicine, Department of Family and Public Health, University of California San Diego
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family and Public Health, University of California San Diego
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