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Ghazy T, Vondran M, Irqsusi M, Moscoso-Ludueña M, Lackner HK, Mahlmann A, Rastan AJ. Preoperative Chest Computed Tomography Screening Reduces the Perioperative Stroke Rate in Patients at Risk of Aortic Calcification. J Pers Med 2024; 14:1005. [PMID: 39338258 PMCID: PMC11432762 DOI: 10.3390/jpm14091005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/05/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVES We evaluated the effect of preoperative chest computed tomography (CT) screening on the perioperative stroke rate in cardiosurgical patients at risk of aortic calcification. METHODS Between May 2019 and April 2020, 129 patients at risk of aortic calcification underwent non-contrast chest CT screening before their procedure. They were assigned to Group 1 and compared with a historical Group 2, who were treated the previous year without a preoperative CT scan. The primary endpoint was to determine postoperative stroke occurrence. The secondary outcomes were the rate reintubation/tracheostomy, the length of hospital stay, and any change in surgical strategy based on the CT findings. RESULTS Groups 1 and 2 comprised 129 and 261 patients, respectively. Group 1 had a lower left ventricular ejection fraction, less carotid stenosis, a history of carotid endarterectomy, and a longer cross-clamp time. The surgical strategy was changed for 6 patients in Group 1. Group 1 had a significantly lower stroke rate. No significant differences were observed in reintubation and tracheostomy rates, or length of hospital stay. Lack of CT screening, age, aortic valve surgery, aortic surgery, and rethoracotomy were identified as independent risk factors for a stroke. CONCLUSIONS Preoperative non-contrast chest CT screening of patients at risk of aortic calcification reduces postoperative stroke through adaptation of the surgical approach and should be used routinely in these patients.
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Affiliation(s)
- Tamer Ghazy
- Department of Cardiac and Thoracic-Vascular Surgery, University Hospital Gießen and Marburg, Philipps University of Marburg, 35043 Marburg, Germany
| | - Maximillian Vondran
- Department of Cardiac and Vascular Surgery, Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg-Western Pommerania, 17495 Carlsburg, Germany
| | - Marc Irqsusi
- Department of Cardiac and Thoracic-Vascular Surgery, University Hospital Gießen and Marburg, Philipps University of Marburg, 35043 Marburg, Germany
| | - Martin Moscoso-Ludueña
- Department of Cardiac and Vascular Surgery, Heart and Vascular Center Rotenburg, 36199 Rotenburg an der Fulda, Germany
| | - Helmut Karl Lackner
- Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Adrian Mahlmann
- Centre for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholische Krankenhaus Hagen gem. GmbH, 58099 Hagen, Germany
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ardawan J Rastan
- Department of Cardiac and Thoracic-Vascular Surgery, University Hospital Gießen and Marburg, Philipps University of Marburg, 35043 Marburg, Germany
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2
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Terriaca S, Ferlosio A, Scioli MG, Coppa F, Bertoldo F, Pisano C, Belmonte B, Balistreri CR, Orlandi A. miRNA Regulation of Cell Phenotype and Parietal Remodeling in Atherosclerotic and Non-Atherosclerotic Aortic Aneurysms: Differences and Similarities. Int J Mol Sci 2024; 25:2641. [PMID: 38473887 DOI: 10.3390/ijms25052641] [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: 02/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Aortic aneurysms are a serious health concern as their rupture leads to high morbidity and mortality. Abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) exhibit differences and similarities in their pathophysiological and pathogenetic features. AAA is a multifactorial disease, mainly associated with atherosclerosis, characterized by a relevant inflammatory response and calcification. TAA is rarely associated with atherosclerosis and in some cases is associated with genetic mutations such as Marfan syndrome (MFS) and bicuspid aortic valve (BAV). MFS-related and non-genetic or sporadic TAA share aortic degeneration with endothelial-to-mesenchymal transition (End-Mt) and fibrosis, whereas in BAV TAA, aortic degeneration with calcification prevails. microRNA (miRNAs) contribute to the regulation of aneurysmatic aortic remodeling. miRNAs are a class of non-coding RNAs, which post-transcriptionally regulate gene expression. In this review, we report the involvement of deregulated miRNAs in the different aortic remodeling characterizing AAAs and TAAs. In AAA, miRNA deregulation appears to be involved in parietal inflammatory response, smooth muscle cell (SMC) apoptosis and aortic wall calcification. In sporadic and MFS-related TAA, miRNA deregulation promotes End-Mt, SMC myofibroblastic phenotypic switching and fibrosis with glycosaminoglycan accumulation. In BAV TAA, miRNA deregulation sustains aortic calcification. Those differences may support the development of more personalized therapeutic approaches.
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Affiliation(s)
- Sonia Terriaca
- Anatomic Pathology, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Maria Giovanna Scioli
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Francesca Coppa
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Fabio Bertoldo
- Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy
| | - Calogera Pisano
- Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
- Azienda sanitaria Provinciale di Catania (ASP), 95124 Catania, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
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3
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Saud A, Ali N, Gali F, Qassam H, Hadi NR. The effect of evolocumab alone and in combination with atorvastatin on atherosclerosis progression and TLRs expression. J Med Life 2023; 16:759-765. [PMID: 37520489 PMCID: PMC10375357 DOI: 10.25122/jml-2021-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/29/2021] [Indexed: 08/01/2023] Open
Abstract
Evolocumab, a PCSK-9 inhibitor, is known for its ability to reduce low-density lipoprotein cholesterol (LDL-C). This study aimed to investigate the effects of evolocumab, alone or in combination with atorvastatin, on the progression of atherosclerosis. Fifty male domestic rabbits were randomly assigned to five groups: control, high cholesterol diet, evolocumab vehicle (dimethyl sulfoxide, DMSO), evolocumab alone, and evolocumab plus atorvastatin. Serum levels of interleukin 10 (IL-10), IL-17, IL-1β, intracellular adhesion molecule (ICAM), and vascular adhesion molecule (VCAM) were measured. Toll-like receptor (TLR) expression on monocytes was evaluated using flow cytometry. Histopathological examination and measurement of intimal thickness (IT) were also conducted. The results revealed that the evolocumab produced a statistically significant (p<0.05) reduction in lipid profile at 5 weeks, with the peak effect occurring at 10 weeks. Furthermore, the inhibitor reduced TLRs at 10 weeks to 10.83±1.8 and intimal thickness to 160.66±9.45. IL-17, IL-1β, ICAM, and VCAM were significantly reduced by evolocumab treatment, with the improvement of the histopathological changes in the aortic wall. The combination of evolocumab and atorvastatin caused a more statistically significant reduction in TLRs at 10 weeks to 5.08±1.2 and intimal thickness to 121.79±5.3. IL-17, IL-1β, ICAM, and VCAM were significantly (p<0.05) reduced by the combination, and the histopathological changes in the aortic wall were significantly improved. In conclusion, evolocumab delays the progression of atherosclerosis by modulating inflammatory pathways.
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Affiliation(s)
- Ali Saud
- Department of Pharmacology and Therapeutics, College of Medicine, University of Kufa, Najaf, Iraq
| | - Nabeel Ali
- Department of Pharmacology, College of Medicine, University of Basra, Basra, Iraq
| | - Fadhil Gali
- Department of Pharmacology &Therapeutics, Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Heider Qassam
- Department of Pharmacology &Therapeutics, Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Najah Rayish Hadi
- Department of Pharmacology &Therapeutics, Faculty of Medicine, University of Kufa, Najaf, Iraq
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4
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Sayanthan S, Allison MA, Budoff MJ, Rye KA, Ong KL. Relationship of fibroblast growth factor 21 with the prevalence and progression of vascular and valvular calcification: Multi-ethnic study of atherosclerosis. Int J Cardiol 2023; 370:388-395. [PMID: 36306948 DOI: 10.1016/j.ijcard.2022.10.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Elevated circulating levels of fibroblast growth factor 21 (FGF21) are associated with cardiovascular disease (CVD). Therefore, we investigated the relationship of plasma FGF21 with calcification at different vascular and valvular sites. METHODS A total of 5786 participants, free of clinically apparent CVD at baseline and with valid data on plasma FGF21 and calcification (Agatston score, volume and density) at coronary arteries, thoracic arteries, mitral and aortic valves, and aortic valve ring, were included in the analysis. Vascular calcification was measured at 2-3 follow-up visits. RESULTS At baseline, higher FGF21 levels were associated with prevalent descending thoracic aortic calcification (DTAC) (prevalence ratio = 1.06 [95% CI 1.01-1.11] per SD increase in log-transformed unit, P = 0.016). Among participants without prevalent calcification, higher FGF21 levels were associated with incident DTAC (relative risk [RR] = 1.13 [95% CI 1.04-1.22], P = 0.002). Among all participants, higher FGF21 levels were also associated with the progression of DTAC score and volume (RR = 1.07 [95% CI 1.03-1.12] and 1.08 [95% CI 1.03-1.12] respectively, both P < 0.01). No significant association of FGF21 was found for prevalence (prevalence ratio = 0.89-1.05), incidence (RR = 0.97-1.16) and progression of calcification (RR = 0.94-1.14) at the other sites. CONCLUSION Higher FGF21 levels were associated with the presence, incidence and progression of DTAC. However, the magnitude of this association was similar to those of the non-significant associations of FGF21 levels with calcifications at other sites. Further research is needed to assess the potential of FGF21 as a biomarker for vascular calcification.
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Affiliation(s)
- Shoban Sayanthan
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, United States
| | - Kerry-Anne Rye
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kwok Leung Ong
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia.
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5
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miR-424/322 protects against abdominal aortic aneurysm formation by modulating the Smad2/3/runt-related transcription factor 2 axis. MOLECULAR THERAPY. NUCLEIC ACIDS 2022; 27:656-669. [PMID: 35036072 PMCID: PMC8752907 DOI: 10.1016/j.omtn.2021.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
Rupture of abdominal aortic aneurysms (AAAs) is one of the leading causes of sudden death in the elderly population. The osteogenic transcription factor runt-related gene (RUNX) encodes multifunctional mediators of intracellular signal transduction pathways in vascular remodeling and inflammation. We aimed to evaluate the roles of RUNX2 and its putative downstream target miR-424/322 in the modulation of several AAA progression-related key molecules, such as matrix metalloproteinases and vascular endothelial growth factor. In the GEO database, we found that male patients with AAAs had higher RUNX2 expression than did control patients. Several risk factors for aneurysm induced the overexpression of MMPs through RUNX2 transactivation, and this was dependent on Smad2/3 upregulation in human aortic smooth muscle cells. miR-424 was overexpressed through RUNX2 after angiotensin II (AngII) challenge. The administration of siRUNX2 and miR-424 mimics attenuated the activation of the Smad/RUNX2 axis and the overexpression of several AAA progression-related molecules in vitro. Compared to their littermates, miR-322 KO mice were susceptible to AngII-induced AAA, whereas the silencing of RUNX2 and the administration of exogenous miR-322 mimics ameliorated the AngII-induced AAA in ApoE KO mice. Overall, we established the roles of the Smad/RUNX2/miR-424/322 axis in AAA pathogenesis. We demonstrated the therapeutic potentials of miR-424/322 mimics and RUNX2 inhibitor for AAA progression.
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Larsen AI. Aortic calcification; from innocent bystander to independent predictor; the delicate balance in biology; da aaaCapo: Editorial accompanying ‘Abdominal aortic calcification – from ancient friend to modern foe’. Eur J Prev Cardiol 2022; 28:e20-e24. [PMID: 32674591 DOI: 10.1177/2047487320937130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Norway
- Department of Clinical Science, University of Bergen, Norway
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7
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Murzi M. Aortic screening is mandatory in minimally invasive valve surgery. Eur J Cardiothorac Surg 2021; 59:1208-1209. [PMID: 34125880 DOI: 10.1093/ejcts/ezab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michele Murzi
- Heart Hospital, Department of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, Massa, Italy
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Jan YT, Tsai PS, Longenecker CT, Lin DC, Yun CH, Sung KT, Liu CC, Kuo JY, Hung CL, Wu TH, Lin JL, Hou CJY, Tsai CT, Chien CY, So A. Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines. Diagnostics (Basel) 2021; 11:diagnostics11061027. [PMID: 34205037 PMCID: PMC8226485 DOI: 10.3390/diagnostics11061027] [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: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.
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Affiliation(s)
- Ya-Ting Jan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Pei-Shan Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | | | - Dao-Chen Lin
- Division of Endocrine and metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Kuo-Tzu Sung
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chuan-Chuan Liu
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
- Health Evaluation Center, MacKay Memorial Hospital, Taipei 104, Taiwan
- Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu City 306, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan;
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Cheng-Ting Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chen-Yen Chien
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104, Taiwan
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Aaron So
- Imaging Program, Lawson Health Research Institute, London, ON N6C 2R5, Canada;
- Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada
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9
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Segmental Evaluation of Thoracic Aortic Calcium and Their Relations with Cardiovascular Risk Factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cells 2021; 10:cells10051243. [PMID: 34070075 PMCID: PMC8158124 DOI: 10.3390/cells10051243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022] Open
Abstract
Thoracic aortic calcium (TAC) appears to be a subclinical marker of cardiovascular disease (CVD) and to predict cardiovascular (CV) mortality. However, studies on TAC use tomographic scans obtained for coronary artery calcium (CAC) score, which does not include the aortic arch. This study evaluates TAC prevalence in aortic arch (AAC), ascending (ATAC) and descending thoracic aorta (DTAC) and verify whether they are associated with the same CV risk factors. Cross-sectional analysis, including 2427 participants (mean age 55.6 ± 8.7; 54.1% women) of the ELSA-Brasil cohort. Nonenhanced ECG-gated tomographies were performed in 2015–2016. Multivariable logistic regression estimated the CV risk factors associated with calcium in each segment. Overall prevalence of ATAC, AAC and DTAC was, 23.1%, 62.1%, and 31.2%, respectively. About 90.4% of the individuals with TAC had AAC and only 19.5% had calcium in all segments. In the multivariable analysis, increasing age, lower levels of schooling, current smoking, higher body mass index, and hypertension remained associated with calcium in all segments. No sex or race/ethnicity differences were found in any aortic segment. Diabetes and dyslipidemia were associated with ATAC and DTAC, but not with AAC, suggesting that AAC may reflect an overlap of mechanisms that impact vascular health, including atherosclerosis.
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10
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Zhang J, Yang Y, Zhang H, Gao P, Zhang Z, Fu W, Zheng L, Zhao Y. Study on the predictive effect of fibrinogen on vascular calcification. Vascular 2021; 29:952-958. [PMID: 33427123 DOI: 10.1177/1708538120985243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fibrinogen, lipoprotein, and high-density lipoprotein levels were associated with vascular calcification, but their predictive capacity for a vascular calcification was not reported. AIMS The purpose of this study was to evaluate the predictive efficacy of fibrinogen, lipoprotein, and high-density lipoprotein by retrospective analysis of fibrinogen, lipoprotein, and high-density lipoprotein levels in patients with vascular calcification, to explore the effective predictive indexes of vascular calcification, to predict the occurrence and development of vascular calcification, and to provide a simple and effective method for the diagnosis and prevention of vascular calcification.Hypothesis: Fibrinogen is a good prediction of vascular calcification. METHODS Univariate and multivariate analyses were used to assess the effects of fibrinogen, lipoprotein, and high-density lipoprotein on the CV, and the ROC curve of the predictive model was used to assess its predictive effectiveness. We collected the relevant indicators of 462 patients admitted to the Department of Vascular Surgery of the First Hospital of Hebei Medical University from August 2018 to July 2020, including 189 patients with vascular calcification (40.9%) and 273 patients without vascular calcification (59.1%); 75% of the collected data is used for modeling (modeling group) and 25% for verification (verification group). RESULTS Results from the multivariate analysis showed fibrinogen, lipoprotein, and high-density lipoprotein to be independent predictors of vascular calcification. Next, the three-factor models are developed respectively. The area below the ROC curve in the fibrinogen, lipoprotein, and high-density lipoprotein forecast model was 0.8018, 0.7348, and 0.7019, respectively. CONCLUSIONS Fibrinogen is more predictive than high-density lipoprotein and lipoprotein in patients with arteriosclerosis.
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Affiliation(s)
- Jing Zhang
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Yan Yang
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongsong Zhang
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pengju Gao
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Zepeng Zhang
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Wenxiu Fu
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Lihua Zheng
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaheng Zhao
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, China
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11
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Yao H, Sun Z, Zang G, Zhang L, Hou L, Shao C, Wang Z. Epidemiological Research Advances in Vascular Calcification in Diabetes. J Diabetes Res 2021; 2021:4461311. [PMID: 34631895 PMCID: PMC8500764 DOI: 10.1155/2021/4461311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/27/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
Vascular calcification is the transformation of arterial wall mesenchymal cells, particularly smooth muscle cells (SMCs), into osteoblast phenotypes by various pathological factors. Additionally, vascular transformation mediates the abnormal deposition of calcium salts in the vascular wall, such as intimal and media calcification. Various pathological types have been described, such as calcification and valve calcification. The incidence of vascular calcification in patients with diabetes is much higher than that in nondiabetic patients, representing a critical cause of cardiovascular events in patients with diabetes. Because basic research on the clinical transformation of vascular calcification has yet to be conducted, this study systematically expounds on the risk factors for vascular calcification, vascular bed differences, sex differences, ethnic differences, diagnosis, severity assessments, and treatments to facilitate the identification of a new entry point for basic research and subsequent clinical transformation regarding vascular calcification and corresponding clinical evaluation strategies.
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Affiliation(s)
- Haipeng Yao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhen Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guangyao Zang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lina Hou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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12
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Fitzpatrick J, Kim ED, Sozio SM, Jaar BG, Estrella MM, Monroy-Trujillo JM, Parekh RS. Calcification Biomarkers, Subclinical Vascular Disease, and Mortality Among Multiethnic Dialysis Patients. Kidney Int Rep 2020; 5:1729-1737. [PMID: 33102965 PMCID: PMC7569684 DOI: 10.1016/j.ekir.2020.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Vascular calcification and stiffness are associated with higher mortality and cardiovascular disease in hemodialysis patients, but the underlying mechanism is not well elucidated and previous studies have been contradictory. We sought to determine the association of circulating calcification biomarkers with calcification, stiffness, and mortality in a multiethnic incident dialysis population. Methods Among 391 incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, we examined the cross-sectional associations of baseline fibroblast growth factor 23 (FGF23), desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, and osteoprotegerin (OPG) according to total coronary artery calcium score (CAC, using the Agatston calcification criteria) at baseline, vascular stiffness (pulse wave velocity [PWV]) over 4 study visits, and all-cause mortality. Results Patients' mean age was 55 years; 40% were female, 72% were African American, and 58% had diabetes. Higher OPG and FGF23 were associated with a 1.09-fold (per 5-pmol/l increase in OPG; 95% confidence interval [CI]: 1.01-1.17) and 1.12-fold (per increase of 100 log RU/ml in FGF23; 95% CI: 1.02‒1.34) higher prevalence of CAC, independent of demographics, comorbidities, dialysis factors, and serum klotho levels. Higher OPG was associated with higher baseline PWV. Higher FGF23 was associated with lower PWV over follow-up. dp-ucMGP and fetuin-A were not associated with either CAC or vascular stiffness. After adjustment, circulating biomarkers were not associated with mortality risk. Conclusion Several circulating calcification biomarkers were only modestly associated with subclinical cardiovascular disease in an incident multiethnic hemodialysis population; none were associated with mortality. Understanding whether these associations persist in larger, diverse hemodialysis populations is warranted before planning trials.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Franscisco, California, USA.,Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Jose M Monroy-Trujillo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
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13
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Soohoo M, Moradi H, Obi Y, Rhee CM, Gosmanova EO, Molnar MZ, Kashyap ML, Gillen DL, Kovesdy CP, Kalantar-Zadeh K, Streja E. Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes. J Am Heart Assoc 2020; 8:e011869. [PMID: 30885048 PMCID: PMC6475049 DOI: 10.1161/jaha.118.011869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Although studies have shown that statin therapy in patients with non-dialysis-dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end-stage renal disease. Methods and Results In 47 720 veterans who transitioned to end-stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all-cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow-up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean± SD age was 71±11 years, and the cohort included 4% women, 23% blacks, and 66% diabetics. Over 12 months of follow-up, there were 13 411 deaths, with an incidence rate of 35.3 (95% CI , 34.7-35.8) deaths per 100 person-years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12-month all-cause (hazard ratio [95% CI], 0.79 [0.76-0.82]) and cardiovascular (hazard ratio [95% CI ], 0.83 [0.78-0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95% CI ], 0.89 [0.87-0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions Among veterans with non-dialysis-dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end-stage renal disease is associated with favorable early end-stage renal disease outcomes.
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Affiliation(s)
- Melissa Soohoo
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA.,2 Nephrology Section Tibor Rubin Veterans Affairs Medical Center Long Beach CA
| | - Hamid Moradi
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA.,2 Nephrology Section Tibor Rubin Veterans Affairs Medical Center Long Beach CA
| | - Yoshitsugu Obi
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA
| | - Connie M Rhee
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA
| | - Elvira O Gosmanova
- 3 Nephrology Section Stratton Veterans Affairs Medical Center Albany NY.,4 Division of Nephrology Department of Medicine Albany Medical College Albany NY
| | - Miklos Z Molnar
- 5 Division of Transplant Surgery Methodist University Hospital Transplant Institute Memphis TN.,6 Department of Surgery University of Tennessee Health Science Center Memphis TN.,7 Department of Medicine University of Tennessee Health Science Center Memphis TN.,8 Department of Transplantation and Surgery Semmelweis University Budapest Hungary
| | - Moti L Kashyap
- 9 Atherosclerosis Research Center Gerontology Section, Geriatric, Rehabilitation Medicine and Extended Care Health Care Group Veterans Affairs Medical Center Long Beach CA
| | - Daniel L Gillen
- 10 Department of Medicine University of California Irvine CA
| | - Csaba P Kovesdy
- 11 Nephrology Section Memphis Veterans Affairs Medical Center Memphis TN.,12 Division of Nephrology University of Tennessee Health Science Center Memphis TN
| | - Kamyar Kalantar-Zadeh
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA.,2 Nephrology Section Tibor Rubin Veterans Affairs Medical Center Long Beach CA
| | - Elani Streja
- 1 Harold Simmons Center for Kidney Disease Research and Epidemiology Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA.,2 Nephrology Section Tibor Rubin Veterans Affairs Medical Center Long Beach CA
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14
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Karger AB, Steffen BT, Nomura SO, Guan W, Garg PK, Szklo M, Budoff MJ, Tsai MY. Association Between Homocysteine and Vascular Calcification Incidence, Prevalence, and Progression in the MESA Cohort. J Am Heart Assoc 2020; 9:e013934. [PMID: 32013703 PMCID: PMC7033888 DOI: 10.1161/jaha.119.013934] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background While elevated homocysteine has been associated with calcification in several studies, its importance as a cardiovascular risk factor remains unclear. This study examines the relationship between homocysteine and vascular and valve calcification in the MESA (Multi-ethnic Study of Atherosclerosis) cohort. Methods and Results MESA participants with baseline homocysteine measurements and cardiac computed tomography scans were included (N=6789). Baseline and follow-up assessment of vascular (coronary artery [CAC], descending thoracic aorta [DTAC]) and valve (aortic valve [AVC], mitral annular [MAC]) calcification was performed. Prevalence ratio/relative risk regression was used to assess the relationship of homocysteine with prevalent and incident calcification, and multivariable logistic regression was used to assess associations between homocysteine and calcification progression. Elevated homocysteine was associated with greater relative risk of prevalent and incident CAC and incident DTAC. We also identified a strong association between elevated homocysteine and CAC and DTAC progression. Elevated homocysteine was found to confer a >2-fold increased risk of severe CAC progression (defined as ΔCAC ≥100/year) and an ≈1.5-fold increased risk for severe DTAC progression (defined as ΔDTAC ≥100/year). Conclusions To our knowledge, this is the first study demonstrating an association between elevated homocysteine and both incidence and progression of coronary and extra-coronary vascular calcification. Our findings suggest a potential role for elevated homocysteine as a risk factor for severe vascular calcification progression. Future studies are warranted to further assess the utility of homocysteine as a biomarker for vascular calcification incidence and progression. Clinical Trial Registration https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.
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Affiliation(s)
- Amy B Karger
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Brian T Steffen
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Sarah O Nomura
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Weihua Guan
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN
| | - Parveen K Garg
- Division of Cardiology University of Southern California Los Angeles CA
| | - Moyses Szklo
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center at Harbor-UCLA Torrance CA
| | - Michael Y Tsai
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
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15
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Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography. Curr Atheroscler Rep 2019; 21:51. [DOI: 10.1007/s11883-019-0811-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Yang CJ, Tsai SH, Wang JC, Chang WC, Lin CY, Tang ZC, Hsu HH. Association between acute aortic dissection and the distribution of aortic calcification. PLoS One 2019; 14:e0219461. [PMID: 31295298 PMCID: PMC6622544 DOI: 10.1371/journal.pone.0219461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Aortic calcification (AC) is associated with increased risks of cardiovascular events and mortality. Numerous studies have explored the association between calcification and abdominal artery aneurysm. However, evidence regarding the association between AC and acute aortic dissection (AAD) is limited. We aimed to evaluate the association between AC-related variables and the development of intimal tear (IT) in patients with AAD. Methods We conducted a retrospective observational study involving 64 patients with type A AAD and 32 patients with type B AAD from February, 2011 to January, 2017 at a tertiary referral medical center in Taiwan. We used the default analysis module “calcification score analysis” to calculate all the calcification variables, including AC scores and volume. Results We identified an association between AC and AAD. Patients with AAD had a greater AC volume in the aortic arch and greater AC scores for both the ascending aorta and the aortic arch than did patients without AAD. However, hypertension and coronary artery disease, rather than AC remained to be the independent risk factor for AAD in multivariate analysis. Patients with type A AAD had greater mean and cumulative AC volumes in the aortic arch, greater cumulative AC volumes in the whole aorta and higher cumulative AC scores in the aortic arch than did patients with type B AAD. ACs were superimposed on ITs in nearly half of the patients with AAD. In patients with type A AAD, AC was more commonly located distal to the IT and farther from the IT. Conclusions We identified the associations between AC-related variables and the location of IT in patients with AAD. However, AC was not an independent risk factor for AAD. The distribution of AC was different between patients with type A and type B AAD.
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Affiliation(s)
- Chih-Jen Yang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (SHT); (HHH)
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Yuan Lin
- Division of Cardiovascular surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Zun-Cheng Tang
- Department of Biological Imaging and Radiological Science, National Yang-Ming University, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (SHT); (HHH)
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17
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Dudink EAMP, Peeters FECM, Altintas S, Heckman LIB, Haest RJ, Kragten H, Kietselaer BLJH, Wildberger J, Luermans JGLM, Weijs B, Crijns HJGM. Agatston score of the descending aorta is independently associated with coronary events in a low-risk population. Open Heart 2018; 5:e000893. [PMID: 30564374 PMCID: PMC6269642 DOI: 10.1136/openhrt-2018-000893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/03/2018] [Accepted: 11/10/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives A standard coronary artery calcium scan includes part of the aorta. This additional information is often not included in routine analyses. We aimed to determine the feasibility of assessing the Agatston score of the descending aorta calcification (DAC) on standard coronary calcium scans and the association of this score with coronary events in a low-risk study population. Methods Between January 2008 and March 2011, 390 consecutive patients who were referred for cardiac CT as part of work-up for pulmonary vein isolation (n=115) or assessment of presence of coronary artery disease (n=275) were included. At baseline, all patients were free of a history of cardiovascular disease. Two independent observers determined the Agatston score of the ascending aorta and descending aorta. Results A total of 16 patients (4.1%) developed coronary events (acute coronary syndrome (n=6) and symptomatic significant coronary artery disease requiring treatment (n=10)) during a follow-up of 67±12 months, with more events in patients with calcifications in the descending aorta than in those without (8.4% vs 3.7 %; p=0.08). Multivariable Cox regression, corrected for Framingham Risk Score (FRS) and coronary Agatston score (CAC), revealed that DAC was independently associated with coronary events (per 100 units; HR: 1.06, 95% CI 1.02 to 1.09; p=0.001). DAC furthermore increased the identification of patients that will experience a coronary event (area under the curve: 0.68 for FRS only, 0.75 for FRS+CAC and 0.78 for FRS+CAC+DAC). Conclusions The Agatston score of the descending aorta could be included in the standard analysis of cardiac CT scans of low-risk patients since it holds valuable information for the prediction of coronary events.
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Affiliation(s)
- Elton A M P Dudink
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Frederique E C M Peeters
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Sibel Altintas
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Rutger J Haest
- Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands
| | - Hans Kragten
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bas L J H Kietselaer
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joachim Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Bob Weijs
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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18
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Murzi M, Cerillo AG, Gasbarri T, Margaryan R, Kallushi E, Farneti P, Solinas M. Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years. Interact Cardiovasc Thorac Surg 2017; 24:363-368. [PMID: 28040754 DOI: 10.1093/icvts/ivw370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Methods Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. Results The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P = 0.004), mitral valve replacement (OR = 3.9; P = 0.05), emergent procedure (OR = 3.4; P = 0.014) and conversion to sternotomy (OR = 3.7; P = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P = 0.001), active endocarditis (OR = 5.8; P = 0.07) and hypercholesterolaemia (OR = 2.4; P = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P = 0.033). Conclusions Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.
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Affiliation(s)
- Michele Murzi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Alfredo G Cerillo
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Tommaso Gasbarri
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Rafik Margaryan
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Enkel Kallushi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Pierandrea Farneti
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Marco Solinas
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
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19
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Kälsch H, Lehmann N, Moebus S, Hoffmann B, Stang A, Jöckel KH, Erbel R, Mahabadi AA. Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.116.005093. [PMID: 28360229 PMCID: PMC5533012 DOI: 10.1161/jaha.116.005093] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Thoracic aortic calcification (TAC) and coronary artery calcification (CAC) are markers of subclinical atherosclerosis and are associated with incident major cardiovascular events. We investigated major determinants for incidence and progression of TAC and the association between TAC and CAC incidence and progression. Methods and Results In a population‐based cohort study, 3270 participants (aged 45–74 years, 53.1% women) received cardiac computed tomography at baseline and after a mean follow‐up of 5.1±0.3 years for quantification of calcification of the ascending (ATAC) and descending thoracic aorta (DTAC) and CAC. Multivariable relative risk regression analysis was used to investigate associations of cardiovascular risk factors with incident TAC, of baseline TAC with incident CAC, and of baseline CAC with incident TAC. Of 1243 participants with baseline TAC of 0, 517 (41.6%) revealed incident TAC after 5 years. Incidence of descending TAC was higher (34.5%) than ascending TAC (23.3%). Incident TAC after 5 years was associated with age (relative risk 1.26 [95% CI 1.21–1.33], per 5 years), blood pressure (relative risk 1.06 [95% CI 1.03–1.10], per 10 mm Hg), low‐density lipoprotein cholesterol (relative risk 1.08 [95% CI 1.04–1.12], per 20 mg/dL), and smoking (relative risk 1.28 [95% CI 1.07–1.53]). Among the 1185 participants without CAC at baseline, the risk of developing CAC was 28.3% when baseline TAC was present compared with 22.2% among those without baseline TAC (excess risk 6.1% [95% CI 1.2–11.0%]). The point estimate of excess risk for incident CAC was higher for ascending TAC (10.8% [95% CI 4.8–16.7%]) and low for descending TAC (1.8% [95% CI −3.2% to 6.7%]). Excess risk for developing ascending and descending TAC with present baseline CAC was 16.4% (95% CI 12.7–20.0%) and 15.6% (95% CI 10.8–20.4%), respectively. Conclusion TAC and CAC share similar major determinants for incident calcification. Participants with TAC, especially ascending TAC, are at elevated risk for development of CAC.
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Affiliation(s)
- Hagen Kälsch
- Department of Cardiology and Vascular Medicine, West-German Heart and Vessel Center Essen, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Barbara Hoffmann
- IUF-Leibniz Research Institute for Environmental Medicine and University of Düsseldorf, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vessel Center Essen, University Duisburg-Essen, Essen, Germany
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20
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Hyperphosphatemia and hs-CRP Initiate the Coronary Artery Calcification in Peritoneal Dialysis Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2520510. [PMID: 28321403 PMCID: PMC5340948 DOI: 10.1155/2017/2520510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/11/2017] [Accepted: 01/29/2017] [Indexed: 12/21/2022]
Abstract
Background. Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly. Methods. Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients. Results. 70 patients recruited to our study were split into a noninitiation group (n = 37) and an initiation group (n = 33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments. Conclusions. Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients.
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21
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Guo J, Fujiyoshi A, Willcox B, Choo J, Vishnu A, Hisamatsu T, Ahuja V, Takashima N, Barinas-Mitchell E, Kadota A, Evans RW, Miura K, Edmundowicz D, Masaki K, Shin C, Kuller LH, Ueshima H, Sekikawa A. Increased Aortic Calcification Is Associated With Arterial Stiffness Progression in Multiethnic Middle-Aged Men. Hypertension 2017; 69:102-108. [PMID: 27821619 PMCID: PMC5145727 DOI: 10.1161/hypertensionaha.116.08459] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 09/23/2016] [Accepted: 10/12/2016] [Indexed: 01/11/2023]
Abstract
Arterial stiffness is established as an independent predictor of cardiovascular morbidity and mortality. The objective was to prospectively evaluate association of aortic calcification burden with progression of arterial stiffness in population-based samples of healthy middle-aged men from ERA JUMP cohort (Electron-Beam Computed Tomography and Risk Factor Assessment in Japanese and US Men in the Post-World War II Birth Cohort). Men (n=635) aged 40 to 49 years (207 white American, 45 black American, 142 Japanese American, and 241 Japanese in Japan) were examined at baseline and 4 to 7 years later. Aortic calcification was evaluated from level of aortic arch to iliac bifurcation. Arterial stiffness progression was measured as annual change in brachial-ankle pulse wave velocity. Multivariable-adjusted general linear models were applied to investigate associations of longitudinal change in aortic calcification with arterial stiffness progression in participants overall, as well as in subgroups without or with prevalent aortic calcification at baseline. Annual change in aortic calcification was positively and significantly associated with arterial stiffness progression. In participants with annual changes in aortic calcium score of ≤0, 1 to 10, 11 to 100, and >100, the adjusted means (SD) for the annual change in brachial-ankle pulse wave velocity were 3.8 (2.2), 7.2 (2.2), 12.2 (1.8), and 15.6 (2.6) cm/s, respectively (P for trend <0.01) adjusted for baseline aortic calcification, arterial stiffness, and standard cardiovascular risk factors. Arterial stiffness was associated with the incidence of aortic calcification over the follow-up period among participants without aortic calcification (n=297) and with an increase in aortic calcification among participants with prevalent aortic calcification at baseline (n=388). Our findings suggest aortic calcification may be causally linked to arterial stiffness.
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Affiliation(s)
- Jingchuan Guo
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Akira Fujiyoshi
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Bradley Willcox
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Jina Choo
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Abhishek Vishnu
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Takashi Hisamatsu
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Vasudha Ahuja
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Naoyuki Takashima
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Emma Barinas-Mitchell
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Aya Kadota
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Rhobert W Evans
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Katsuyuki Miura
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Daniel Edmundowicz
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Kamal Masaki
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Chol Shin
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Lewis H Kuller
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Hirotsugu Ueshima
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.)
| | - Akira Sekikawa
- From the Department of Epidemiology, University of Pittsburgh, PA (J.G., A.V., V.A., E.B.-M., R.W.E., L.H.K., A.S.); Department of Public Health (A.F., N.T., A.K., K.M.) and Center for Epidemiologic Research in Asia (A.K., K.M., H.U.), Shiga University of Medical Science, Japan; Department of Research, Kuakini Medical Center, Honolulu, HI (B.W.); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.W., K.M.); College of Nursing, Korea University, Seoul, South Korea (J.C.); Department of Environmental Medicine and Public Health, Shimane University, Japan (T.H.); Department of Cardiology, Temple University Hospital, Philadelphia, PA (D.E.); Department of Geriatric Medicine, Kuakini Medical Center, Honolulu, Hawaii (K.M.); and Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea (C.S.).
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22
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Criqui MH, Aboyans V, Allison MA, Denenberg JO, Forbang N, McDermott MM, Wassel CL, Wong ND. Peripheral Artery Disease and Aortic Disease. Glob Heart 2016; 11:313-326. [PMID: 27741978 PMCID: PMC5119538 DOI: 10.1016/j.gheart.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 01/14/2023] Open
Abstract
We reviewed published MESA (Multi-Ethnic Study of Atherosclerosis) study articles concerning peripheral arterial disease, subclavian stenosis (SS), abdominal aortic calcium (AAC), and thoracic artery calcium (TAC). Important findings include, compared to non-Hispanic whites, lower ankle-brachial index (ABI) and more SS in African Americans, and higher ABI and less SS in Hispanic and Chinese Americans. Abnormal ABI and brachial pressure differences were associated with other subclinical cardiovascular disease (CVD) measures. Both very high and low ABI independently predicted increased CVD events. Looking at aortic measures, TAC and AAC were significantly associated with other subclinical CVD measures. Comparisons of AAC with coronary artery calcium (CAC) showed that both were less common in ethnic minority groups. However, although CAC was much more common in men than in women in multivariable analysis, this was not true of AAC. Also, when AAC and CAC were adjusted for each other in multivariable analysis, there was a stronger association for AAC than for CAC with CVD and total mortality.
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Affiliation(s)
- Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm 1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Nketi Forbang
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Colchester, VT, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA
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23
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Ferreira Botelho MP, Koktzoglou I, Collins JD, Giri S, Carr JC, Gupta N, Edelman RR. MR imaging of iliofemoral peripheral vascular calcifications using proton density-weighted, in-phase three-dimensional stack-of-stars gradient echo. Magn Reson Med 2016; 77:2146-2152. [PMID: 27297954 DOI: 10.1002/mrm.26295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 11/08/2022]
Abstract
PURPOSE The presence of vascular calcifications helps to determine percutaneous access for interventional vascular procedures and has prognostic value for future cardiovascular events. Unlike CT, standard MRI techniques are insensitive to vascular calcifications. In this prospective study, we tested a proton density-weighted, in-phase (PDIP) three-dimensional (3D) stack-of-stars gradient-echo pulse sequence with approximately 1 mm3 isotropic spatial resolution at 1.5 Tesla (T) and 3T to detect iliofemoral peripheral vascular calcifications and correlated MR-determined lesion volumes with CT angiography (CTA). METHODS The study was approved by the Institutional Review Board. The prototype PDIP stack-of-stars pulse sequence was applied in 12 patients with iliofemoral peripheral vascular calcifications who had undergone CTA. RESULTS Vascular calcifications were well visualized in all subjects, excluding segments near prostheses or stents. The location, size, and shape of the calcifications were similar to CTA. Quantitative analysis showed excellent correlation (r2 = 0.84; P < 0.0001) between MR- and CT-based measures of calcification volume. In one subject in whom three pulse sequences were compared, PDIP stack-of-stars outperformed cartesian 3D gradient-echo and point-wise encoding time reduction with radial acquisition (PETRA). CONCLUSION In this pilot study, a PDIP 3D stack-of-stars gradient-echo pulse sequence with high spatial resolution provided excellent image quality and accurately depicted the location and volume of iliofemoral vascular calcifications. Magn Reson Med 77:2146-2152, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Marcos P Ferreira Botelho
- Radiology, Northwestern Medicine, Chicago, Illinois, USA.,Radiology, Northshore University HealthSystem, Evanston, Illinois, USA
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Evanston, Illinois, USA.,Radiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - James C Carr
- Radiology, Northwestern Medicine, Chicago, Illinois, USA
| | - NavYash Gupta
- Surgery, Northshore University HealthSystem, Evanston, Illinois, USA
| | - Robert R Edelman
- Radiology, Northwestern Medicine, Chicago, Illinois, USA.,Radiology, Northshore University HealthSystem, Evanston, Illinois, USA
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