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Sin HK, Wong PN, Lo KY, Lo MW, Chan SF, Lo KC, Wong YY, Ho LY, Kwok WT, Chan KC, Wong AKM, Mak SK. An echocardiography-derived calcium score as a predictor of major adverse cardiovascular events in peritoneal dialysis patients-A prospective cohort study. Nephrology (Carlton) 2021; 27:181-189. [PMID: 34536257 DOI: 10.1111/nep.13977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND An echocardiography-derived calcium score (ECS) has been shown to predict cardiovascular (CV) mortality in the general population but has not been utilized in the dialysis population. METHODS We conducted a prospective cohort study including 125 prevalent PD patients. Two blinded and independent echocardiographers determined the ECS for each subject at baseline. The primary outcome was the three-point major adverse cardiovascular events (MACE) which is a composite outcome comprising CV death, non-fatal myocardial infarction and non-fatal stroke. The secondary outcome was all-cause mortality. RESULTS The mean age was 61 ± 13 years. The median follow-up duration was 40 months (range 1-50). Seventy six (60.8%) of the subjects had diabetes mellitus (DM). The median duration of dialysis was 32 (IQR 16-54) months. The incidences of MACE and all-cause mortality were 13.0 per 100 patient-years and 18.3 per 100 patient-years. Multivariate Cox regression analysis identified the following three independent predictors of MACE: ECS (HR 1.253/unit increase in ECS, 95% CI 1.014-1.547, p = .036), DM (HR 2.467, 95% CI 1.014-6.005, p = .047) and pre-existing cardiovascular disease (CVD) (HR 2.441, 95% CI 1.261-4.728, p = .008); and the following two predictors of all-cause mortality: pre-existing CVD (HR 2.156, 95% CI 1.251-3.714, p = .006) and serum albumin (HR 0.887/g/L increase in serum albumin, 95% CI 0.839-0.937, p < .001). CONCLUSION The ECS appears to be a significant predictor of MACE in PD patients independently of DM and pre-existing CVD.
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Affiliation(s)
- Ho-Kwan Sin
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Ping-Nam Wong
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Kin-Yee Lo
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Man-Wai Lo
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Shuk-Fan Chan
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Kwok-Chi Lo
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Yuk-Yi Wong
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Lo-Yi Ho
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Wing-Tung Kwok
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Kai-Chun Chan
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
| | | | - Siu-Ka Mak
- Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong
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Hardas S, Titar P, Zanwar I, Phalgune DS. Correlation between echocardiographic calcium score and coronary artery lesion severity on invasive coronary angiography. Indian Heart J 2021; 73:307-312. [PMID: 34154747 PMCID: PMC8322811 DOI: 10.1016/j.ihj.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/13/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The direct correlation between Echocardiographic non-coronary calcium score (ECS) and lesion severity on invasive coronary angiography (ICA) is not reported. The aim of the present study was to find the correlation between ECS and Gensini score. METHODS One hundred seventy patients aged ≥18 years posted for clinically indicated ICA were included. All the patients underwent standard transthoracic echocardiography. ECS and Gensisni scores were calculated. The primary outcome measure was to find a correlation of ECS with Gensini score, whereas the secondary outcome measure was to correlate ECS with traditional risk factors for coronary artery disease. The Chi-square/Fisher exact test was used to compare qualitative variables. Spearman's correlation analysis was used for assessing the correlation between ECS score and the Gensini score. Receiver-operating characteristic curve analysis was performed to detect the cut-off value of the ECS score. RESULTS The correlation of total ECS with Gensini score was positive and statistically significant (r = 0.550, p-value < 0.0001). As ECS increased, the Gensini score increased. ECS value of >1 detected CAD with 56.5% sensitivity, 79.5% specificity. Eight-nine percent of patients who had ECS >1, had Gensini score ≥18, whereas 44.3% of patients who had ECS ≤1, had Gensini score ≥18. The patients with ECS >1 had significantly higher Gensini scores than the patients with ECS ≤1. CONCLUSIONS The correlation of total ECS with Gensini score was positive and statistically significant.
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Affiliation(s)
- Suhas Hardas
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Pritam Titar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Ishwar Zanwar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
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Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque. J Hypertens 2020; 39:1210-1220. [PMID: 33323910 DOI: 10.1097/hjh.0000000000002773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. MATERIALS AND METHODS We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. RESULTS Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. CONCLUSION Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. VIDEO ABSTRACT Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
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Desai MY, Cremer PC, Schoenhagen P. Thoracic Aortic Calcification: Diagnostic, Prognostic, and Management Considerations. JACC Cardiovasc Imaging 2019; 11:1012-1026. [PMID: 29976300 DOI: 10.1016/j.jcmg.2018.03.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.
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Affiliation(s)
- Milind Y Desai
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Paul C Cremer
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cardiovascular Section, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study. J Hypertens 2019; 37:1183-1190. [PMID: 30882598 DOI: 10.1097/hjh.0000000000002052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed. METHODS In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography. RESULTS cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m in men and ≥47 g/m in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m in men and <47 g/m in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42. CONCLUSION Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.
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Banchhor SK, Londhe ND, Araki T, Saba L, Radeva P, Khanna NN, Suri JS. Calcium detection, its quantification, and grayscale morphology-based risk stratification using machine learning in multimodality big data coronary and carotid scans: A review. Comput Biol Med 2018; 101:184-198. [DOI: 10.1016/j.compbiomed.2018.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023]
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Hirschberg K, Reinhart M, Mereles D, Uhlmann L, André F, Riffel J, Ochs M, Katus HA. Echocardiographic calcification score in patients with low/intermediate cardiovascular risk. Clin Res Cardiol 2018; 108:194-202. [PMID: 30083858 DOI: 10.1007/s00392-018-1343-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk. METHODS Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan-Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality. RESULTS An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7-15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3-5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2-3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3-5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9-5.4); p < 0.001]. CONCLUSIONS We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.
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Affiliation(s)
- Kristof Hirschberg
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Manuel Reinhart
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marco Ochs
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Izquierdo-Gómez MM, Hernández-Betancor I, García-Niebla J, Marí-López B, Laynez-Cerdeña I, Lacalzada-Almeida J. Valve Calcification in Aortic Stenosis: Etiology and Diagnostic Imaging Techniques. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5178631. [PMID: 28812017 PMCID: PMC5546080 DOI: 10.1155/2017/5178631] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/20/2017] [Indexed: 12/30/2022]
Abstract
Aortic stenosis is the most common valvulopathy in the Western world. Its prevalence has increased significantly in recent years due to population aging; hence, up to 8% of westerners above the age of 84 now have severe aortic stenosis (Lindroos et al., 1993). This causes increased morbidity and mortality and therein lies the importance of adequate diagnosis and stratification of the degree of severity which allows planning the best therapeutic option in each case. Long understood as a passive age-related degenerative process, it is now considered a rather more complex entity involving mechanisms and factors similar to those of atherosclerosis (Stewart et al., 1997). In this review, we summarize the pathophysiological mechanisms underlying the onset and progression of the disease and analyze the current role of cardiac imaging techniques for diagnosis.
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Affiliation(s)
| | | | - Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, El Hierro, Spain
| | - Belén Marí-López
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
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Gaibazzi N, Rigo F, Facchetti R, Carerj S, Giannattasio C, Moreo A, Mureddu GF, Salvetti M, Grolla E, Faden G, Cesana F, Faggiano P. Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:991-1000. [PMID: 26358694 DOI: 10.1093/ehjci/jev222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS According to recent data, more accurate selection of patients undergoing coronary angiography for suspected coronary artery disease (CAD) is needed. From the Active PREvention Study multicentre prospective study, we further analyse whether carotid intima-media thickness (cIMT), carotid plaques (cPL), and echocardiographic cardiac calcium score (eCS) have incremental discriminatory and reclassification predictive value for CAD over clinical risk score in subjects undergoing coronary angiography, specifically depending on their low, intermediate, or high class of clinical risk. METHODS AND RESULTS In eight centres, 445 subjects without history of prior CAD but with chest pain of recent onset and/or a positive/inconclusive stress test for ischaemia prospectively underwent clinically indicated elective coronary angiography after cardiac and carotid ultrasound assessments with measurements of cIMT, cPL, and eCS. The study population was divided into subjects at low (10%), intermediate (10-20%), and high (>20%) Framingham risk score (FRS). Ultrasound parameters were tested for their incremental value to predict CAD over FRS, in each pre-test risk category. No significant difference could be appreciated between the discrimination value of FRS and Diagnostic Imaging for Coronary Artery Disease score for the presence of CAD. eCS or cPL demonstrated significant incremental prediction over FRS, consistently in the three FRS categories (P < 0.01); this applied to both discrimination and reclassification, with the exception of high-risk subjects, in whom cPL was apparently not incremental over FRS, and eCS was only of borderline significance for better discrimination. CONCLUSIONS Ultrasound eCS and cPL assessments were significant predictors of angiographic CAD in patients without prior CAD but with signs or symptoms suspect for CAD, independently and incrementally to FRS, across all pre-test risk probability strata, although in high-risk subjects, only eCS maintained an incremental value. The use of cIMT was not significantly incrementally useful in any FRS risk category.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Via Gramsci, 14, Parma 43124, Italy
| | | | - Rita Facchetti
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
| | | | | | - Antonella Moreo
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
| | | | | | | | | | - Francesca Cesana
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
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Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease. J Hypertens 2015; 33:1291-300. [DOI: 10.1097/hjh.0000000000000543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prognostic Value of Echocardiographic Calcium Score in Patients With a Clinical Indication for Stress Echocardiography. JACC Cardiovasc Imaging 2015; 8:389-396. [DOI: 10.1016/j.jcmg.2014.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/28/2014] [Indexed: 01/15/2023]
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12
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Gaibazzi N, Baldari C, Faggiano P, Albertini L, Faden G, Pigazzani F, Rossi C, Reverberi C. Cardiac calcium score on 2D echo: correlations with cardiac and coronary calcium at multi-detector computed tomography. Cardiovasc Ultrasound 2014; 12:43. [PMID: 25352208 PMCID: PMC4219088 DOI: 10.1186/1476-7120-12-43] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/09/2014] [Indexed: 01/01/2023] Open
Abstract
Background To test the hypothesis that a semi-quantitative echocardiographic calcium score (eCS) significantly correlates with cardiac calcium measured by coronary computed tomography angiography (CCTA) and, secondarily, severe coronary artery calcifications and stenosis. Methods This is a retrospective, observational study, conducted in a tertiary centre. eCS was compared with CCTA scores of non-coronary cardiac calcium (nCACS), coronary cardiac calcium (CACS) and number of diseased coronary vessels, in 141 subjects without known coronary artery disease (CAD), who underwent both echocardiography and CCTA for clinical reasons. Results Age, prevalence of hypertension and all measures of calcium (eCS, nCACS and CACS) differed significantly between the no-CAD and CAD subgroups. eCS was positively correlated with nCACS (Spearman rho = 0.64, p < 0.0001), CACS (rho = 0.46, p < 0.01) and weakly with the number of diseased coronary vessels (rho = 0.28, p < 0.05). eCS and nCACS had similar area under the curve (AUC) for the prediction of severe CACS (≥400) (0.77, 95% CI 0.68-0.86 and 0.79, 95% CI 0.72-0.88) or obstructive CAD (0.63, 95% CI 0.54-0.72 and 0.63, 95% CI 0.55-0.73). Conclusions eCS, a calcium score easily obtainable during standard echocardiography, is moderately to strongly correlated with nCACS by CCTA. The full eCS score correlates with nCACS better than its single components. It correlates with CACS and predicts severe coronary calcification (CACS > 400), a known predictor of cardiovascular morbidity and mortality. The eCS also predicts obstructive CAD, incrementally to age and clinical variables, although for this purpose CACS remains the most accurate score.
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Affiliation(s)
- Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43123 Parma, Italy.
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Ultrasound carotid intima-media thickness, carotid plaque and cardiac calcium incrementally add to the Framingham Risk Score for the prediction of angiographic coronary artery disease: a multicenter prospective study. Int J Cardiol 2014; 177:708-10. [PMID: 25449491 DOI: 10.1016/j.ijcard.2014.09.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022]
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Gaibazzi N, Sicari R, Agricola E, Cioffi G, Mazzone C, Albertini L, Faden G, Molinaro S, Regazzoli D, Di Lenarda A, Faggiano P. Cardiac calcification at transthoracic echocardiography predicts stress echo results: a multicentre study. Int J Cardiol 2014; 174:393-5. [PMID: 24768381 DOI: 10.1016/j.ijcard.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy.
| | - Rosa Sicari
- CNR Institute of Clinical Physiology, Pisa, Italy
| | | | - Giovanni Cioffi
- Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy
| | | | - Lisa Albertini
- Cardiology Department, Parma University Hospital, Parma, Italy
| | | | | | - Damiano Regazzoli
- Division of noninvasive Cardiology, IRCCS Ospedale San Raffaele, Milano
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Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease. Int J Cardiol 2014; 172:364-7. [DOI: 10.1016/j.ijcard.2014.01.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/27/2013] [Accepted: 01/12/2014] [Indexed: 11/21/2022]
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Lazaros G, Toutouzas K, Drakopoulou M, Boudoulas H, Stefanadis C, Rajamannan N. Aortic sclerosis and mitral annulus calcification: a window to vascular atherosclerosis? Expert Rev Cardiovasc Ther 2014; 11:863-77. [DOI: 10.1586/14779072.2013.811978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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In the search of coronary calcium. Int J Cardiol 2013; 167:310-7. [DOI: 10.1016/j.ijcard.2012.06.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/23/2012] [Accepted: 06/09/2012] [Indexed: 01/07/2023]
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Yousry M, Rickenlund A, Petrini J, Gustavsson T, Prahl U, Liska J, Eriksson P, Franco-Cereceda A, Eriksson MJ, Caidahl K. Real-time imaging required for optimal echocardiographic assessment of aortic valve calcification. Clin Physiol Funct Imaging 2012; 32:470-5. [PMID: 23031068 PMCID: PMC3549484 DOI: 10.1111/j.1475-097x.2012.01153.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 06/25/2012] [Indexed: 11/30/2022]
Abstract
Introduction Aortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored. Methods Two-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1–5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted. Results Visual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P<0·001) compared to evaluation of stop frames by visual assessment (r = 0·66, P<0·001) or the GSMn score (r = 0·64, P<0·001). High inter- and intra-observer correlations were observed for real-time visual score (both intraclass correlation coefficient = 0·93). Conclusion Real-time evaluation of the level of AVC is superior to using stop frames assessed either visually or by dedicated computer grey scale measurement software.
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Affiliation(s)
- Mohamed Yousry
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Lacalzada J, de la Rosa A, Jiménez JJ, Juárez R, Barragán A, Blanco G, Iribarren JL, Bonilla JA, Laynez I. Prognostic value of echocardiographic-derived calcium index in coronary artery disease diagnosed by 64-multidetector computed tomography. Echocardiography 2012; 29:1120-7. [PMID: 22672409 DOI: 10.1111/j.1540-8175.2012.01755.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine whether echocardiographic calcium index (ECI) calculated using transthoracic echocardiography (TTE) predicts coronary ischemic events. We also wished to determine coronary artery calcium score (CACS), the presence of obstructive coronary artery disease (CAD) and plaque composition, all of which were assessed by multidetector computed tomography (MDCT). METHODS We carried out a prospective cohort study of 82 consecutive outpatients with chest pain and low-moderate risk of CAD, referred for noninvasive coronariography by MDCT. ECI was blindly assessed by TTE and correlated with subsequent cardiovascular events during a follow up period of 36 months. RESULTS ECI values of ≥7 had a sensitivity of 77.3%, a specificity of 90%, positive predictive value of 73.9%, and negative predictive value of 91.5% with respect to future coronary ischemic events. In addition, patients with ECI ≥ 7 showed a greater presence of severe calcified and obstructive CAD and a linear increase of obstructed vessels and mixed and calcified plaques, with a linear trend according to ECI values. CONCLUSION ECI values of ≥7 determine poor CAD prognosis in relation to ischemic events. Furthermore, ECI ≥ 7 may serve as a marker of content of coronary artery calcium, intraluminal obstruction, and plaque composition. Therefore, ECI seems to provide prognostic information as well as information about the characteristics of the plaque of atheroma.
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Affiliation(s)
- Juan Lacalzada
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
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Abu Assi E, Vidal Pérez R, González-Juanatey J. Aportaciones de las técnicas de imagen cardíaca en la valoración del paciente de alto riesgo cardiovascular. Rev Clin Esp 2009. [DOI: 10.1016/s0014-2565(09)73257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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