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Oni E, Boakye E, Pressman GS, Dardari Z, Jha K, Szklo M, Budoff M, Nasir K, Hughes TM, Blaha MJ. The Association of Mitral Annular Calcification With Cardiovascular and Noncardiovascular Outcomes: The Multi-Ethnic Study of Atherosclerosis. Am J Cardiol 2024; 225:75-83. [PMID: 38914415 DOI: 10.1016/j.amjcard.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 06/26/2024]
Abstract
Mitral annular calcification (MAC) may be a potential marker of biologic aging. However, the association of MAC with noncardiovascular measures, including bone mineral density (BMD), incident renal failure, dementia, and noncardiovascular mortality, is not well-studied in a multiracial cohort. We used data from 6,814 participants (mean age: 62.2 ± 10.2 years, 52.9% women) without cardiovascular disease at baseline in the Multi-Ethnic Study of Atherosclerosis. MAC was assessed with noncontrast cardiac computed tomography at study baseline. Using multivariable-adjusted linear and logistic regression, we assessed the cross-sectional association of MAC with BMD and walking pace. Furthermore, using Cox proportional hazards, we evaluated the association of MAC with incident renal failure, dementia, and all-cause mortality. In addition, we assessed the association of MAC with cardiovascular and noncardiovascular mortality using competing risks regression. The prevalence of MAC was 9.5% and was higher in women (10.7%) than in men (8.0%). MAC was associated with low BMD (coefficient -0.04, 95% confidence interval [CI] -0.06 to -0.02), with significant interaction by gender (p-interaction = 0.035). MAC was, however, not associated with impaired walking pace (odds ratio 1.09, 95% CI 0.89 to 1.33). Compared with participants without MAC, those with MAC had an increased risk of incident renal failure, albeit nonsignificant (hazard ratio [HR] 1.18, 95% CI 0.95 to 1.45), and a significantly higher hazards of dementia (HR 1.36, 95% CI 1.10 to 1.70). In addition, participants with MAC had a substantially higher risk of all-cause (HR 1.47, 95% CI 1.29 to 1.69), cardiovascular (subdistribution HR 1.39, 95% CI 1.04 to 1.87), and noncardiovascular mortality (subdistribution HR 1.35, 95% CI 1.14 to 1.60) than those without MAC. MAC ≥100 versus <100 was significantly associated with reduced BMD, incident renal failure, dementia, all-cause, cardiovascular, and noncardiovascular mortality. In conclusion, MAC was associated with reduced BMD and dementia and all-cause, cardiovascular, and noncardiovascular mortality in this multiracial cohort. Thus, MAC may be a marker not only for atherosclerotic burden but also for other metabolic and inflammatory factors that increase the risk of noncardiovascular outcomes and death from other causes.
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Affiliation(s)
- Ebenezer Oni
- Division of Cardiology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregg S Pressman
- Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kunal Jha
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Chlorogiannis DD, Pargaonkar S, Apostolos A, Vythoulkas-Biotis N, Kokkinidis DG, Nagraj S. The Predictive Value of Aortic Calcification on Computed Tomography for Major Cardiovascular Events. J Clin Med 2024; 13:4019. [PMID: 39064058 PMCID: PMC11277087 DOI: 10.3390/jcm13144019] [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: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
As the prevalence of cardiovascular disease continues to increase, early identification of patients at high risk of major adverse cardiovascular events (MACE) using reliable diagnostic modalities is important. Transcatheter aortic valve implantation (TAVI) is a minimally invasive percutaneous procedure used to replace the aortic valve with a bioprosthetic one, often without the need for surgery. Extra coronary calcification in the ascending and/or descending thoracic aorta, aortic arch, and abdominal aorta has recently been identified as a method to quantify the extent of atherosclerotic cardiovascular disease. However, its definitive role in the prediction of MACE remains unclear. We performed a comprehensive review to summarize the current literature on the diagnostic and predictive value of thoracic and abdominal aortic calcification, as quantified in computed tomography, for the association, risk stratification, and prediction of MACE and after TAVI procedures. Despite increasing evidence, the predictive role of thoracic calcification still remains unproven, with a need for carefully tailored studies to confirm these findings.
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Affiliation(s)
| | - Sumant Pargaonkar
- Division of Hospital Medicine, Jacobi Medical Center, NYC H+H, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Anastasios Apostolos
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokrateion General Hospital of Athens, 11527 Athens, Greece
| | - Nikolaos Vythoulkas-Biotis
- 3rd Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Thoracic Diseases Hospital of Athens “Sotiria”, 11527 Athens, Greece
| | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sanjana Nagraj
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
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3
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Xian G, Huang R, Xu M, Zhao H, Xu X, Chen Y, Ren H, Xu D, Zeng Q. Noncoding RNA regulates the expression of Krm1 and Dkk2 to synergistically affect aortic valve lesions. Exp Mol Med 2024; 56:1560-1573. [PMID: 38945954 PMCID: PMC11297286 DOI: 10.1038/s12276-024-01256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 07/02/2024] Open
Abstract
Calcific aortic valve disease (CAVD) is becoming an increasingly important global medical problem, but effective pharmacological treatments are lacking. Noncoding RNAs play a pivotal role in the progression of cardiovascular diseases, but their relationship with CAVD remains unclear. Sequencing data revealed differential expression of many noncoding RNAs in normal and calcified aortic valves, with significant differences in circHIPK3 and miR-182-5p expression. Overexpression of circHIPK3 ameliorated aortic valve lesions in a CAVD mouse model. In vitro experiments demonstrated that circHIPK3 inhibits the osteogenic response of aortic valve interstitial cells. Mechanistically, DEAD-box helicase 5 (DDX5) recruits methyltransferase 3 (METTL3) to promote the N6-methyladenosine (m6A) modification of circHIPK3. Furthermore, m6A-modified circHIPK3 increases the stability of Kremen1 (Krm1) mRNA, and Krm1 is a negative regulator of the Wnt/β-catenin pathway. Additionally, miR-182-5p suppresses the expression of Dickkopf2 (Dkk2), the ligand of Krm1, and attenuates the Krm1-mediated inhibition of Wnt signaling. Activation of the Wnt signaling pathway significantly contributes to the promotion of aortic valve calcification. Our study describes the role of the Krm1-Dkk2 axis in inhibiting Wnt signaling in aortic valves and suggests that noncoding RNAs are upstream regulators of this process.
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Affiliation(s)
- Gaopeng Xian
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Rong Huang
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Minhui Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Hengli Zhao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Xingbo Xu
- Department of Cardiology, University Medical Center of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Yangchao Chen
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Hao Ren
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China.
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515, Guangzhou, China.
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
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Rezaeian P, Backlund JYC, Zaveri M, Nakanishi R, Matsumoto S, Alani A, Razipour A, Lachin JM, Budoff M. Epicardial and intra-thoracic adipose tissue and cardiovascular calcifications in type 1 diabetes (T1D) in epidemiology of diabetes Interventions and Complications (EDIC): A pilot study. Am J Prev Cardiol 2024; 18:100650. [PMID: 38584607 PMCID: PMC10995972 DOI: 10.1016/j.ajpc.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Coronary artery, aortic valve, and descending aorta calcification (CAC, AVC, DAC) are manifestations of atherosclerosis, and cardiac epicardial adipose tissue (EAT) indicates heart adiposity. This study explored the association between cardiac adipose tissue and cardiovascular calcification in participants with long-standing T1D. Methods EAT and intra-thoracic adipose tissue (IAT) were measured in 100 T1D subjects with cardiac computed tomography (CT) scans in the EDIC study. Volume analysis software was used to measure fat volumes. Spearman correlations were calculated between CAC, AVC, DAC with EAT, and IAT. Associations were evaluated using multiple linear and logistic regression models. Results Participants ranged in age from 32 to 57. Mean EAT, and IAT were 38.5 and 50.8 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6 %, 4.7 %, and 26.8 %, respectively. CAC was positively correlated with age (p-value = 0.0001) and EAT (p-value = 0.0149) but not with AVC and DAC; IAT was not associated with calcified lesions. In models adjusted for age and sex, higher levels of EAT and IAT were associated with higher CAC (p-value < 0.0001 for both) and higher AVC (p-values of 0.0111 and 0.0053, respectively), but not with DAC. The associations with CAC remained significant (p-value < 0.0001) after further adjustment for smoking, systolic blood pressure, BMI, and LDL, while the associations with AVC did not remain significant. Conclusion In participants with T1D, higher EAT and IAT levels are correlated with higher CAC scores. EAT and IAT were not independently correlated with DAC or AVC.
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Affiliation(s)
- Panteha Rezaeian
- Torrance Memorial Physician Network-Cedars-Sinai Health System affiliate, Torrance, CA, USA
| | - Jye-Yu C Backlund
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Mohammed Zaveri
- Department of Medicine Emanate Health Medical Group, West Covina, CA, USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Suguru Matsumoto
- Department of Cardiology, Kouiki Monbetsu Hospital, Hokkaido, Japan
| | - Anas Alani
- Department of Cardiology, University of Loma Linda, Loma Linda, CA, USA
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John M Lachin
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Matthew Budoff
- Lindquist Research Institute, Harbor-UCLA Medical Center, 1124W Carson St, Torrance, CA 90502, USA
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Paknahad M, Shahidi S, Abbasi R, Paknahad M. Evaluation of the Prevalence of Atherosclerosis Within the Course of Internal Carotid Artery in Cone Beam Computed Tomography Images. Indian J Otolaryngol Head Neck Surg 2022; 74:5242-5251. [PMID: 36742500 PMCID: PMC9895759 DOI: 10.1007/s12070-020-01958-y] [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: 05/22/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to retrospectively evaluate the gender-related and age-related prevalence and severity of calcifications within the segments of the internal carotid artery in cone beam computed tomography (CBCT). By using a documented visual scale, out of 400 CBCT examinations a total of 304 CBCT scans of adult patients over 40 years old were evaluated as to the prevalence and severity of intracranial calcifications within the segments of the internal carotid artery. Calcifications were found in 117 CBCT scans. These calcifications were detected along the extracranial (C1: 53%), petrous (C2: 22.2%), Lacerum (C3:27%), cavernous (C4: 94%), and ophthalmic-clinoid (C5/C6: 65%) segments. The Friedman test showed significant differences in the severity of calcifications among the internal carotid artery segments. The McNemar test showed no significant differences between calcifications on the right or left side segments. The Chi square test showed no significant differences in the prevalence of calcifications between men and women; it also showed that the prevalence of calcifications increased with increase in age (P < 0.05). In this study, the frequency and severity of calcifications decreased throughout the C4, C5/C6, and C1 segments in a descending order; moreover, an increased incidence of calcifications by increase in age was documented irrespective of gender.
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Affiliation(s)
- Maryam Paknahad
- Oral and Dental Disease Research Center, Oral and Maxillofacial Radiology Department, Dental School, Shiraz University of Medical Sciences, Zand Street, Shiraz, 7144833586 Iran
| | - Shoaleh Shahidi
- Biomaterials Research Center, Oral and Maxillofacial Radiology Department, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roshanak Abbasi
- Student Research Committee, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Paknahad
- Radiology Department, Medical School, Fasa University of Medical Sciences, Fasa, Iran
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6
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Boakye E, Dardari Z, Obisesan OH, Osei AD, Wang FM, Honda Y, Dzaye O, Osuji N, Carr JJ, Howard-Claudio CM, Wagenknecht L, Konety S, Coresh J, Matsushita K, Blaha MJ, Whelton SP. Sex-and race-specific burden of aortic valve calcification among older adults without overt coronary heart disease: The Atherosclerosis Risk in Communities Study. Atherosclerosis 2022; 355:68-75. [PMID: 35718559 PMCID: PMC11309802 DOI: 10.1016/j.atherosclerosis.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS The prevalence of aortic valve calcification (AVC) increases with age. However, the sex-and race-specific burden of AVC and associated cardiovascular risk factors among adults ≥75 years are not well studied. METHODS We calculated the sex-and race-specific burden of AVC among 2283 older Black and White adults (mean age:80.5 [SD:4.3] years) without overt coronary heart disease from the Atherosclerosis Risk in Communities Study who underwent non-contrast cardiac-gated CT-imaging at visit 7 (2018-2019). Using Poisson regression with robust variance, we calculated the adjusted prevalence ratios (aPR) of the association of AVC with cardiovascular risk factors. RESULTS The overall AVC prevalence was 44.8%, with White males having the highest prevalence at 58.2%. The prevalence was similar for Black males (40.5%), White females (38.9%), and Black females (36.8%). AVC prevalence increased significantly with age among all race-sex groups. The probability of any AVC at age 80 years was 55.4%, 40.0%, 37.3%, and 36.2% for White males, Black males, White females, and Black females, respectively. Among persons with prevalent AVC, White males had the highest median AVC score (100.9 Agatston Units [AU]), followed by Black males (68.5AU), White females (52.3AU), and Black females (46.5AU). After adjusting for cardiovascular risk factors, Black males (aPR:0.53; 95%CI:0.33-0.83), White females (aPR:0.68; 95%CI:0.61-0.77), and Black females (aPR:0.49; 95%CI:0.31-0.77) had lower AVC prevalence compared to White males. In addition, systolic blood pressure, non-HDL-cholesterol, and lipoprotein (a) were independently associated with AVC, with no significant race/sex interactions. CONCLUSIONS AVC, although highly prevalent, was not universally present in this cohort of older adults. White males had ∼50-60% higher prevalence than other race-sex groups. Moreover, cardiovascular risk factors measured in older age showed significant association with AVC.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | | | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yasuyuki Honda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - John Jeffery Carr
- Department of Radiology, Vanderbilt University Medical Centre, Nashville, TN, USA
| | | | - Lynne Wagenknecht
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suma Konety
- Division of Cardiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA.
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
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Ogunmoroti O, Osibogun O, Ferraro RA, Ndunda PM, Larson NB, Decker PA, Bielinski SJ, Blumenthal RS, Budoff MJ, Michos ED. Hepatocyte growth factor is associated with greater risk of extracoronary calcification: results from the multiethnic study of atherosclerosis. Open Heart 2022; 9:e001971. [PMID: 35641100 PMCID: PMC9157354 DOI: 10.1136/openhrt-2022-001971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatocyte growth factor (HGF) is a biomarker with potential for use in the diagnosis, treatment and prognostication of cardiovascular disease (CVD). Elevated HGF is associated with calcification in the coronary arteries. However, knowledge is limited on the role HGF may play in extracoronary calcification (ECC). This study examined whether HGF is associated with ECC in the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta and descending thoracic aortic (DTAC). METHODS At baseline, adults aged 45-84 years, free of CVD, in the Multi-Ethnic Study of Atherosclerosis had HGF and ECC measured by ELISA and cardiac CT scan, respectively. ECC measurements were repeated after an average of 2.4 years of follow-up. Prevalent ECC was defined as Agatston score >0 at baseline. Incident ECC was defined as Agatston score >0 at follow-up among participants with Agatston score=0 at baseline. We used Poisson and linear mixed-effects regression models to estimate the association between HGF and ECC, adjusted for sociodemographic and CVD risk factors. RESULTS Of 6648 participants, 53% were women. Mean (SD) age was 62 (10) years. Median (IQR) of HGF was 905 (757-1087) pg/mL. After adjustment for CVD risk factors, the highest HGF levels (tertile 3) were associated with greater prevalence and extent of AVC, MAC and DTAC at baseline compared with the lowest tertile (tertile 1). Additionally, the risk of incident AVC and MAC increased by 62% and 45%, respectively, in demographic-adjusted models. However, the associations were not statistically significant in fully adjusted models. The highest HGF levels were also associated with 10% and 13% increase in MAC and DTAC progression, respectively, even after adjustment for CVD risk factors. CONCLUSION Higher HGF levels were significantly associated with a greater risk of calcification at some extracoronary sites, suggesting an alternate biological pathway that could be targeted to reduce CVD risk.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Richard A Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Ndunda
- Division of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Nicholas B Larson
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Paul A Decker
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Suzette J Bielinski
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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8
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Guzzetti E, Oh JK, Shen M, Dweck MR, Poh KK, Abbas AE, Mando R, Pressman GS, Brito D, Tastet L, Pawade T, Falconi ML, de Arenaza DP, Kong W, Tay E, Pibarot P, Song JK, Clavel MA. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis. Eur Heart J Cardiovasc Imaging 2022; 23:717-726. [PMID: 34172988 PMCID: PMC9016361 DOI: 10.1093/ehjci/jeab116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Sex-specific thresholds of aortic valve calcification (AVC) have been proposed and validated in Caucasians. Thus, we aimed to validate their accuracy in Asians. METHODS AND RESULTS Patients with calcific aortic stenosis (AS) from seven international centres were included. Exclusion criteria were ≥moderate aortic/mitral regurgitation and bicuspid valve. Optimal AVC and AVC-density sex-specific thresholds for severe AS were obtained in concordant grading and normal flow patients (CG/NF). We included 1263 patients [728 (57%) Asians, 573 (45%) women, 837 (66%) with CG/NF]. Mean gradient was 48 (26-64) mmHg and peak aortic velocity 4.5 (3.4-5.1) m/s. Optimal AVC thresholds were: 2145 Agatston Units (AU) in men and 1301 AU in women for Asians; and 1885 AU in men and 1129 AU in women for Caucasians. Overall, accuracy (% correctly classified) was high and comparable either using optimal or guidelines' thresholds (2000 AU in men, 1200 AU in women). However, accuracy was lower in Asian women vs. Caucasian women (76-78% vs. 94-95%; P < 0.001). Accuracy of AVC-density (476 AU/cm2 in men and 292 AU/cm2 in women) was comparable to absolute AVC in Caucasians (91% vs. 91%, respectively, P = 0.74), but higher than absolute AVC in Asians (87% vs. 81%, P < 0.001). There was no interaction between AVC/AVC-density and ethnicity (all P > 0.41) with regards to AS haemodynamic severity. CONCLUSION AVC thresholds defining severe AS are comparable in Asian and Caucasian populations, and similar to those proposed in the guidelines. However, accuracy of AVC to identify severe AS in Asians (especially women) is sub-optimal. Therefore, the use of AVC-density is preferable in Asians.
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Affiliation(s)
- Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong 30099, Korea
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI 48073, USA
| | - Ramy Mando
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI 48073, USA
| | - Gregg S Pressman
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Daniel Brito
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mariano Luis Falconi
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Diego Perez de Arenaza
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Jae-Kwan Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul 138736, Korea
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
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9
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Ogunmoroti O, Osibogun O, Mathews L, Esuruoso OA, Ndumele CE, Okunrintemi V, Burke GL, Blumenthal RS, Budoff MJ, Michos ED. Favorable Cardiovascular Health Is Associated With Lower Prevalence, Incidence, Extent, and Progression of Extracoronary Calcification: MESA. Circ Cardiovasc Imaging 2022; 15:e013762. [PMID: 35290079 PMCID: PMC9179934 DOI: 10.1161/circimaging.121.013762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)-measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta-is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated with a lower risk of ECC. METHODS We analyzed data from MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years without cardiovascular disease at baseline. ECC was measured by noncontrast cardiac computed tomography scan at baseline and after an average of 2.4 years. Prevalent ECC was defined as an Agatston score >0 at the baseline scan. Incident ECC was defined as Agatston score >0 at the follow-up scan among participants with Agatston score of 0 at the baseline scan. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) was scored 0 to 2 points, with 2 indicating ideal; 1, intermediate; and 0, poor. The aggregated CVH score was 0 to 14 points (0-8, inadequate; 9-10, average; 11-14, optimal). We used Poisson and linear mixed-effects regression models to examine the association between CVH and ECC adjusted for sociodemographic factors. RESULTS Of 6504 participants, 53% were women with a mean age (SD) of 62 (10) years. Optimal and average CVH scores were associated with lower ECC prevalence, incidence, and extent. For example, optimal CVH scores were associated with 57%, 56%, 70%, and 54% lower risk of incident aortic valve calcification, mitral annulus calcification, ascending thoracic aorta calcification, and descending thoracic aorta calcification, respectively. In addition, optimal and average CVH scores were associated with lower ECC progression at 2 years, although these associations were only significant for mitral annulus calcification and descending thoracic aorta calcification. CONCLUSIONS In this multiethnic cohort, favorable CVH was associated with a lower risk of extracoronary atherosclerosis. These findings emphasize the importance of primordial prevention as an intervention to reduce the burden of cardiovascular disease.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Olatokunbo Osibogun
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami' FL (O. Osibogun)
| | - Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Olumuyiwa A Esuruoso
- Division of General Internal Medicine, Meharry Medical College, Nashville, TN (O.A.E.)
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Victor Okunrintemi
- Division of Cardiovascular Disease, Houston Methodist Hospital, TX (V.O.)
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (G.L.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA (M.J.B.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
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10
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Cardiovascular computed tomography and HIV: The evolving role of imaging biomarkers in enhanced risk prediction. IMAGING 2021. [DOI: 10.1556/1647.2021.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
The treatment of human immunodeficiency virus (HIV) with antiretroviral (ARV) medications has revolutionised the care for these patients. The dramatic increase in life expectancy has brought new challenges in treating diseases of aging in this cohort. Cardiovascular disease (CVD) is now a leading cause of morbidity and mortality with risk matched HIV-positive patients having double the risk of MI compared to HIV-negative patients. This enhanced risk is secondary to the interplay the virus (and accessory proteins), ARV medications and traditional risk factors. The culmination of these factors can lead to a hybrid metabolic syndrome characterised by heightened ectopic fat. Cardiovascular computed tomography (CT) is ideal for quantifying epicardial adipose tissue volumes, hepatosteatosis and cardiovascular disease burden. The CVD risk attributed to disease burden and plaque morphology is well established in general populations but is less clear in HIV populations. The purpose of this review article is to appraise the latest data on CVD development in HIV-positive patients and how the use of cardiovascular CT may be used to enhance risk prediction in this population. This may have important implications on individualised treatment decisions and risk reduction strategies which will improve the care of these patients.
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11
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Xiao F, Zha Q, Zhang Q, Wu Q, Chen Z, Yang Y, Yang K, Liu Y. Decreased Glucagon-Like Peptide-1 Is Associated With Calcific Aortic Valve Disease: GLP-1 Suppresses the Calcification of Aortic Valve Interstitial Cells. Front Cardiovasc Med 2021; 8:709741. [PMID: 34513952 PMCID: PMC8428521 DOI: 10.3389/fcvm.2021.709741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: This study explores the concentration and role of glucagon-like peptide-1 (GLP-1) in calcific aortic valve disease (CAVD). Background: Calcific aortic valve disease is a chronic disease presenting with aortic valve degeneration and mineralization. We hypothesized that the level of GLP-1 is associated with CAVD and that it participates in the calcification of aortic valve interstitial cells (AVICs). Methods: We compared the concentration of GLP-1 between 11 calcific and 12 normal aortic valve tissues by immunohistochemical (IHC) analysis. ELISA was used to measure GLP-1 in serum of the Control (n = 197) and CAVD groups (n = 200). The effect of GLP-1 on the calcification of AVICs and the regulation of calcific gene expression were also characterized. Results: The GLP-1 concentration in the calcific aortic valves was 39% less than that in the control non-calcified aortic valves. Its concentration in serum was 19.3% lower in CAVD patients. Multivariable regression analysis demonstrated that GLP-1 level was independently associated with CAVD risk. In vitro, GLP-1 antagonized AVIC calcification in a dose- and time-dependent manner and it down-regulated RUNX2, MSX2, BMP2, and BMP4 expression but up-regulated SOX9 expression. Conclusions: A reduction in GLP-1 was associated with CAVD, and GLP-1 participated in the mineralization of AVICs by regulating specific calcific genes. GLP-1 warrants consideration as a novel treatment target for CAVD.
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Affiliation(s)
- Fan Xiao
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Zha
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qianru Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qihong Wu
- Department of Vascular and Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhongli Chen
- Department of Vascular and Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Yang
- Department of Endocrinology, The Second People's Hospital of Yunnan Province, Kunming, China
| | - Ke Yang
- Department of Vascular and Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Liu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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12
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Birudaraju D, Cherukuri L, Pranesh S, Budoff MJ. Current methods to assess mitral annular calcification and its risk factors. Expert Rev Cardiovasc Ther 2021; 19:787-800. [PMID: 34348555 DOI: 10.1080/14779072.2021.1964361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenerative mechanism of the fibrous base of the mitral valve. While MAC was originally thought to be an age-related degenerative process, there is evidence that other mechanisms, such as atherosclerosis and abnormal calcium phosphorus metabolism, also contribute to the development of MAC. AREAS COVERED This paper summarizes, existing perception of clinically valid definition of MAC and the pathophysiological processes that lead to the development of MAC and the diagnostic implications of this disease entity. EXPERT OPINION Minimal evidence exists on the natural history and progression of MAC. Characterization of MAC progression and identification of predisposing risk factors can help to validate hypotheses. MAC is most commonly asymptomatic and incidental finding. Echocardiography is the primary imaging modality for identification and characterization of MAC and associated mitral valve (MV) disease. For patients with an indication for MV surgery, computed tomography (CT) is a complementary imaging modality for MAC. MAC is generally recognized by its characteristic density, location, and shape on echocardiography and CT, unusual variants are sometimes confused with other lesions.
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Affiliation(s)
- Divya Birudaraju
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Lavanya Cherukuri
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Shruthi Pranesh
- Division Of Cardiology, Penn State Holy Spirit Hospital, Harrisburg, Pennsylvania, USA
| | - Matthew J Budoff
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
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13
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Kurasawa S, Hishida M, Imaizumi T, Okazaki M, Nishibori N, Kondo T, Kasuga H, Maruyama S. All-cause and cardiovascular mortality in patients undergoing hemodialysis with aortic sclerosis and mild-to-moderate aortic stenosis: A cohort study. Atherosclerosis 2021; 331:12-19. [PMID: 34256259 DOI: 10.1016/j.atherosclerosis.2021.06.910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Mild-to-moderate aortic stenosis (AS) and aortic sclerosis, a precursor of AS, are associated with mortality in the general population; however, their association in patients undergoing hemodialysis with higher morbidity of AS is unknown. Thus, we investigated the mortality of aortic sclerosis and mild-to-moderate AS in patients undergoing hemodialysis. METHODS This was a retrospective multicenter cohort study of consecutive patients undergoing hemodialysis at nine dialysis facilities who underwent screening echocardiography between January 2008 and December 2019. We investigated the mortality of patients with aortic sclerosis or mild-to-moderate AS using multivariable Cox proportional hazards regression. RESULTS Among 1,878 patients undergoing hemodialysis, those with normal aortic valves, aortic sclerosis, mild AS, moderate AS, severe AS, and prosthetic aortic valves were 844 (45%), 793 (42%), 161 (8.6%), 38 (2.0%), 11 (0.6%), and 31 (1.7%), respectively. After excluding patients with severe AS and prosthetic aortic valves, we performed comparative analysis on 1,836 patients (mean age, 67 years; 66% male). In a median follow-up of 3.6 years, crude death rates (per 100 person-years) were 5.2, 10.6, and 13.0 in patients with normal aortic valves, aortic sclerosis, and mild-to-moderate AS, respectively. Compared with normal aortic valves, both aortic sclerosis and mild-to-moderate AS were associated with all-cause and cardiovascular death: adjusted hazard ratios (95% confidence intervals) were 1.36 (1.13-1.65) and 1.36 (1.02-1.80) for all-cause death; and 1.52 (1.06-2.17) and 1.74 (1.04-2.92) for cardiovascular death, respectively. CONCLUSIONS Aortic sclerosis and mild-to-moderate AS were independent risk factors for all-cause and cardiovascular death in patients undergoing hemodialysis.
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Affiliation(s)
- Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiro Nishibori
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirotake Kasuga
- Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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14
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Blaha MJ, DeFilippis AP. Multi-Ethnic Study of Atherosclerosis (MESA): JACC Focus Seminar 5/8. J Am Coll Cardiol 2021; 77:3195-3216. [PMID: 34167645 DOI: 10.1016/j.jacc.2021.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
The MESA (Multi-Ethnic Study of Atherosclerosis) is a National Heart, Lung, and Blood Institute-sponsored prospective study aimed at studying the prevalence, progression, determinants, and prognostic significance of subclinical cardiovascular disease in a sex-balanced, multiethnic, community-dwelling U.S. cohort. MESA helped usher in an era of noninvasive evaluation of subclinical atherosclerosis presence, burden, and progression for the evaluation of atherosclerotic cardiovascular disease risk, beyond what could be predicted by traditional risk factors alone. Concepts developed in MESA have informed international patient care guidelines, providing new tools to effectively guide public health policy, population screening, and clinical decision-making. MESA is grounded in an open science model that continues to be a beacon for collaborative science. In this review, we detail the original goals of MESA, and describe how the scope of MESA has evolved over time. We highlight 10 significant MESA contributions to cardiovascular medicine, and chart the path forward for MESA in the year 2021 and beyond.
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA; Division of Cardiology. Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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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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16
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Guzzetti E, Annabi MS, Pibarot P, Clavel MA. Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium. Front Cardiovasc Med 2020; 7:570689. [PMID: 33344514 PMCID: PMC7744378 DOI: 10.3389/fcvm.2020.570689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023] Open
Abstract
Aortic stenosis (AS) is a disease of the valve and the myocardium. A correct assessment of the valve disease severity is key to define the need for aortic valve replacement (AVR), but a better understanding of the myocardial consequences of the increased afterload is paramount to optimize the timing of the intervention. Transthoracic echocardiography remains the cornerstone of AS assessment, as it is universally available, and it allows a comprehensive structural and hemodynamic evaluation of both the aortic valve and the rest of the heart. However, it may not be sufficient as a significant proportion of patients with severe AS presents with discordant grading (i.e., an AVA ≤ 1 cm2 and a mean gradient <40 mmHg) which raises uncertainty about the true severity of AS and the need for AVR. Several imaging modalities (transesophageal or stress echocardiography, computed tomography, cardiovascular magnetic resonance, positron emission tomography) exist that allow a detailed assessment of the stenotic aortic valve and the myocardial remodeling response. This review aims to provide an updated overview of these multimodality imaging techniques and seeks to highlight a practical approach to help clinical decision making in the challenging group of patients with discordant low-gradient AS.
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Affiliation(s)
- Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Quebec, QC, Canada
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Quebec, QC, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Quebec, QC, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Quebec, QC, Canada
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17
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Chen Z, Shen Y, Xue Q, Lin BW, He XY, Zhang YB, Yang Y, Shen WF, Liu YH, Yang K. Clinical Relevance of Plasma Endogenous Tissue-Plasminogen Activator and Aortic Valve Sclerosis: Performance as a Diagnostic Biomarker. Front Cardiovasc Med 2020; 7:584998. [PMID: 33173789 PMCID: PMC7591748 DOI: 10.3389/fcvm.2020.584998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Aortic valve sclerosis (AVSc), a common precursor to calcific aortic valve disease, may progress into advanced aortic stenosis with hemodynamic instability. However, plasma biomarkers of such a subclinical condition remain lacking. Since impaired fibrinolysis featuring dysregulated tissue plasminogen activator (t-PA) is involved in several cardiovascular diseases, we investigated whether endogenous t-PA was also associated with AVSc. Methods: Plasma t-PA levels were measured in 295 consecutive patients undergoing standard echocardiography and Doppler flow imaging. Multiple logistic regression analyses were used to assess the association between t-PA and AVSc. Receiver operating characteristic curve analysis was performed for determining the diagnostic value of t-PA for AVSc. The performance of adding t-PA to clinical signatures of AVSc was evaluated. Concentration of t-PA was assessed in human sclerotic and non-sclerotic aortic valves by histology and immunohistochemistry analysis. Results: Plasma t-PA was higher in patients with AVSc than in non-AVSc counterparts (median, 2063.10 vs. 1403.17 pg/mL, p < 0.01). C-statistics of plasma t-PA for discriminating AVSc was 0.698 (95%CI: 0.639–0.758). The performance of t-PA for identifying AVSc was better among male and non-hypertensive patients [C-statistics (95%CI): 0.712 (0.634–0.790) and 0.805 (0.693–0.916), respectively]. Combination of t-PA and clinical factors improved classification of the patients (category-free NRI: 0.452, p < 0.001; IDI: 0.020, p = 0.012). The concentration of t-PA was three times higher in sclerotic compared to non-sclerotic aortic valves. Conclusion: Elevated circulating t-PA level confers an increased risk for AVSc. Further prospective studies with larger sample size are needed to examine if t-PA could serve as a diagnostic clinical marker for AVSc.
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Affiliation(s)
- Zhongli Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiqi Xue
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Wen Lin
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao Yan He
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Bo Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Yang
- Department of Endocrinology, The Second People's Hospital of Yunnan Province, Kunming, China
| | - Wei Feng Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye Hong Liu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Ke Yang
| | - Ke Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ye Hong Liu
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18
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Huang C, Zhan JF, Chen YX, Xu CY, Chen Y. LncRNA-SNHG29 inhibits vascular smooth muscle cell calcification by downregulating miR-200b-3p to activate the α-Klotho/FGFR1/FGF23 axis. Cytokine 2020; 136:155243. [PMID: 32818704 DOI: 10.1016/j.cyto.2020.155243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vascular calcification (VC) is characterized by mineral accumulation on the walls of arteries and veins, which is a pathological process commonly found in elderly individuals and patients with atherosclerosis, hypertension, and diabetes. Emerging evidence suggests that long non-coding RNAs (lncRNAs) play an important role in VC. However, the role of SNHG29 is less clear. METHODS The expression of SNHG29, miR-200b-3p, α-Klotho, FGFR1 and FGF23 in vascular smooth muscle cells (VSMCs) was quantified by qRT-PCR and western blot assays. β-GP was used to construct an in vitro calcification model, followed by MTT assay to detect cell viability. Calcification was determined by alizarin red S staining and quantified by calcification assay. ALP activity was investigated by ALP staining. The interactions among SNHG29, miR-200b-3p and α-Klotho were verified by luciferase assay. RESULTS In the in vitro calcification model, SNHG29 was downregulated, while miR-200b-3p was upregulated. SNHG29 overexpression and miR-200b-3p knockdown significantly suppressed osteoblast-related factors (RUNX2 and BMP2), accompanied by activation of the α-Klotho/FGFR1/FGF23 axis, further inhibiting the formation of calcified nodules. Moreover, miR-200b-3p overexpression and α-Klotho knockdown reversed the SNHG29 overexpression-induced inhibitory effects on calcified VSMCs. CONCLUSION Our study is the first to demonstrate that SNHG29 could inhibit VSMC calcification by downregulating miR-200b-3p to activate the α-Klotho/FGFR1/FGF23 axis, suggesting SNHG29 as a novel therapeutic target for VC-associated diseases.
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Affiliation(s)
- Chong Huang
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Jin-Feng Zhan
- Physical Examination Center of the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yan-Xia Chen
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Cheng-Yun Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yan Chen
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China.
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19
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Kim AJ, Xu N, Yutzey KE. Macrophage lineages in heart valve development and disease. Cardiovasc Res 2020; 117:663-673. [PMID: 32170926 DOI: 10.1093/cvr/cvaa062] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/29/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Heterogeneous macrophage lineages are present in the aortic and mitral valves of the heart during development and disease. These populations include resident macrophages of embryonic origins and recruited monocyte-derived macrophages prevalent in disease. Soon after birth, macrophages from haematopoietic lineages are recruited to the heart valves, and bone marrow transplantation studies in mice demonstrate that haematopoietic-derived macrophages continue to invest adult valves. During myxomatous heart valve disease, monocyte-derived macrophages are recruited to the heart valves and they contribute to valve degeneration in a mouse model of Marfan syndrome. Here, we review recent studies of macrophage lineages in heart valve development and disease with discussion of clinical significance and therapeutic applications.
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Affiliation(s)
- Andrew J Kim
- Division of Molecular Cardiovascular Biology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 240 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Na Xu
- Division of Molecular Cardiovascular Biology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 240 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Katherine E Yutzey
- Division of Molecular Cardiovascular Biology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 240 Albert Sabin Way, Cincinnati, OH 45229, USA
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20
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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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Affiliation(s)
- Aldrin V Gomes
- Department of Neurobiology, Physiology, and Behavior (A.V.G.).,Department of Physiology and Membrane Biology (A.V.G.), University of California, Davis
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Vuorio A, Watts GF, Kovanen PT. Lipoprotein(a) as a risk factor for calcific aortic valvulopathy in heterozygous familial hypercholesterolemia. Atherosclerosis 2019; 281:25-30. [DOI: 10.1016/j.atherosclerosis.2018.11.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/17/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022]
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23
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Racial Disparities in the Cardiac Computed Tomography Assessment of Coronary Artery Disease: Does Gender Matter. Cardiol Rev 2018; 27:14-22. [PMID: 30520779 DOI: 10.1097/crd.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Coronary heart disease (CHD) represents a significant healthcare burden in terms of hospital resources, morbidity, and mortality. Primary prevention and early detection of risk factors for the development of CHD are pivotal to successful intervention programs and prognostication. Yet, there remains a paucity of evidence regarding differences in the assessment of these risk factors and the tools of assessment among different ethnicities. We conducted a narrative review to assess the utility of cardiac computed tomography, particularly coronary artery calcification (CAC), in different ethnicities. We also looked to see whether age, sex, comorbidities, and genetic background have peculiar influences on CAC. In this review, we highlight some of the pivotal studies regarding the question of CAC in relation to the development of CHD among different ethnicities. We identify several key trends in the literature showing that although African Americans have high rates of CHD, their risk of CAC may be relatively lower compared with other ethnicities. Similarly, South Asian patients may be at a high risk for adverse cardiac events due to elevated CAC. We also note that several studies are limited by small sample size and were based on 1 large cohort study. Future studies should include a large international prospective cohort to truly evaluate the effects of ethnicity on CAC and CHD risk. To appropriately apply CAC in the clinical practice, the variations in its scoring based on a subject's age, sex, comorbidity, and ethnicity should be addressed and interpreted beforehand.
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Plazyo O, Liu R, Moazzem Hossain M, Jin JP. Deletion of calponin 2 attenuates the development of calcific aortic valve disease in ApoE -/- mice. J Mol Cell Cardiol 2018; 121:233-241. [PMID: 30053524 DOI: 10.1016/j.yjmcc.2018.07.249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022]
Abstract
Calcific aortic valve disease (CAVD) is a leading cause of cardiovascular mortality and lacks non-surgical treatment. The pathogenesis of CAVD involves perturbation of valvular cells by mechanical stimuli, including shear stress, pressure load and leaflet stretch, of which the molecular mechanism requires further elucidation. We recently demonstrated that knockout (KO) of Cnn2 gene that encodes calponin isoform 2, a mechanoregulated cytoskeleton protein, attenuates atherosclerosis in ApoE KO mice. Here we report that Cnn2 KO also decreased calcification of the aortic valve in ApoE KO mice, an established model of CAVD. Although myeloid cell-specific Cnn2 KO highly effectively attenuated vascular atherosclerosis that shares many pathogenic processes with CAVD, it did not reduce aortic valve calcification in ApoE KO mice. Indicating a function in the pathogenesis of CAVD, calponin 2 participates in myofibroblast differentiation that is a leading step in the development of CAVD. The aortic valves of ApoE KO mice exhibited increased expression of calponin 2 and smooth muscle actin (SMA), a hallmark of myofibroblasts. The expression of calponin 2 increased during myofibroblast-like differentiation of primary sheep aortic valve interstitial cells and during the osteogenic differentiation of mouse myofibroblasts. Cnn2 KO attenuated TGFβ1-induced differentiation of myofibroblasts in culture as shown by the lower expression of SMA and less calcification than that of wild type (WT) cells. These findings present calponin 2 as a novel molecular target for the treatment and prevention of CAVD.
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Affiliation(s)
- Olesya Plazyo
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | - Rong Liu
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | - M Moazzem Hossain
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | - J-P Jin
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA.
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Abstract
Purpose of Review This review highlights recent findings regarding genetics of coronary artery calcification (CAC), a marker of subclinical atherosclerosis burden, that is a precursor of clinical coronary artery disease. Recent findings CAC quantity is heritable. Genome wide association studies of common single nucleotide polymorphisms have identified genomic regions explaining ~2.4% of CAC heritability. Low frequency and rare variants explain additional variation in CAC. Evidence suggests that there may be different genetic etiologies for variation in CAC progression than for cross-sectional measures of CAC. Studies integrating multiple -omics data are providing new insights into the pathobiology of subclinical coronary atherosclerosis. Summary The future is promising for innovative studies utilizing whole genome sequencing data as well as other -omics such as epigenomic modifications of genes and gene expression. These studies may provide multiple sources of data pointing to the same gene or pathway, thus providing greater confidence in findings.
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Affiliation(s)
- Lawrence F Bielak
- University of Michigan, Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Patricia A Peyser
- University of Michigan, Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Alqahtani F, Aljohani S, Amin AH, Al-Hijji M, Ali OO, Holmes DR, Alkhouli M. Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States. Mayo Clin Proc 2018; 93:607-617. [PMID: 29506780 DOI: 10.1016/j.mayocp.2017.11.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR). PATIENTS AND METHODS Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs). RESULTS Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001). CONCLUSIONS African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Sami Aljohani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Ali Hama Amin
- Division of Cardiology, West Virginia University, Morgantown, WV
| | | | - Oluseun O Ali
- Novant Health Heart & Vascular Institute, Charlotte, NC
| | | | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, WV; Department of Cardiology, Mayo Clinic, Rochester, MN.
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Bellasi A, Di Lullo L, Raggi P. Cardiovascular calcification: The emerging role of micronutrients. Atherosclerosis 2018; 273:119-121. [PMID: 29705018 DOI: 10.1016/j.atherosclerosis.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Antonio Bellasi
- Department of Nephrology and Dialysis, Sant'Anna Hospital, ASST-Lariana, Como, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, Colleferro, Italy
| | - Paolo Raggi
- Mazankowski Alberta Heart Hospital, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Abstract
PURPOSE OF REVIEW This review aims to highlight the past and more current literature related to the multifaceted pathogenic programs that contribute to calcific aortic valve disease (CAVD) with a focus on the contribution of developmental programs. RECENT FINDINGS Calcification of the aortic valve is an active process characterized by calcific nodule formation on the aortic surface leading to a less supple and more stiffened cusp, thereby limiting movement and causing clinical stenosis. The mechanisms underlying these pathogenic changes are largely unknown, but emerging studies have suggested that signaling pathways common to valvulogenesis and bone development play significant roles and include Transforming Growth Factor-β (TGF-β), bone morphogenetic protein (BMP), Wnt, Notch, and Sox9. This comprehensive review of the literature highlights the complex nature of CAVD but concurrently identifies key regulators that can be targeted in the development of mechanistic-based therapies beyond surgical intervention to improve patient outcome.
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29
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Affiliation(s)
- Isabella Albanese
- Division of Cardiology and Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kashif Khan
- Division of Cardiology and Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bianca Barratt
- Division of Cardiology and Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hamood Al-Kindi
- Division of Cardiology and Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Adel Schwertani
- Division of Cardiology and Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Small A, Kiss D, Giri J, Anwaruddin S, Siddiqi H, Guerraty M, Chirinos JA, Ferrari G, Rader DJ. Biomarkers of Calcific Aortic Valve Disease. Arterioscler Thromb Vasc Biol 2017; 37:623-632. [PMID: 28153876 PMCID: PMC5364059 DOI: 10.1161/atvbaha.116.308615] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/23/2017] [Indexed: 01/08/2023]
Abstract
Calcific aortic valve disease (CAVD) is a highly prevalent cardiovascular disorder accounting for a rising economic and social burden on aging populations. In spite of continuing study on the pathophysiology of disease, there remain no medical therapies to prevent the progression of CAVD. The discovery of biomarkers represents a potentially complementary approach in stratifying risk and timing of intervention in CAVD and has the advantage of providing insight into causal factors for the disease. Biomarkers have been studied extensively in atherosclerotic cardiovascular disease, with success as additive for clinical and scientific purposes. Similar research in CAVD is less robust; however, the available studies of biomarkers in CAVD show promise for enhanced clinical decision making and identification of causal factors for the disease. This comprehensive review summarizes available established and novel biomarkers in CAVD, their contributions toward an understanding of pathophysiology, their potential clinical utility, and provides an outline to direct future research in the field.
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Affiliation(s)
- Aeron Small
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel Kiss
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jay Giri
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Saif Anwaruddin
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hasan Siddiqi
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marie Guerraty
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Julio A Chirinos
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Giovanni Ferrari
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J Rader
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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31
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Hung TC, Wang KT, Yun CH, Kuo JY, Hou CJY, Liu CY, Wu TH, Bezerra HG, Cheng HY, Hung CL, Yeh HI. Value of serum N-terminal B-type natriuretic peptide in asymptomatic structural heart disease in Taiwanese population: Comparisons with current ESC Guidelines. Int J Cardiol 2017; 231:195-200. [DOI: 10.1016/j.ijcard.2016.12.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/27/2016] [Indexed: 12/22/2022]
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[Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 87:108-115. [PMID: 27389533 DOI: 10.1016/j.acmx.2016.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022] Open
Abstract
OBJETIVE The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. METHODS In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. RESULTS The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects without CAC, while those with CAC 1-99, 100-399, and >400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. CONCLUSION Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.
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Rezaeian P, Miller PE, Haberlen SA, Razipour A, Bahrami H, Castillo R, Witt MD, Kingsley L, Palella FJ, Nakanishi R, Matsumoto S, Alani A, Jacobson LP, Post WS, Budoff MJ. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study. J Cardiovasc Comput Tomogr 2016; 10:229-236. [PMID: 26949197 DOI: 10.1016/j.jcct.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC). METHODS We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). The associations between HIV infection and the presence of each type of ECC (score > 0) were evaluated by multivariable logistic regression. We also evaluated the association of ECC with inflammatory biomarker levels and coronary plaque morphology. RESULTS Among HIV+ and HIV- men, the age-standardized prevalences were 15% for TAC (HIV+ 14%/HIV- 16%), 10% for AVC (HIV+ 11%/HIV- 8%), 24% for AVRC (HIV+ 23% HIV- 24%), and 5% for MAC (HIV+ 7%/HIV- 3%). After adjustment, HIV+ men had 3-fold greater odds of MAC compared to HIV- men (OR = 3.2, 95% CI: 1.5-6.7), and almost twice the odds of AVC (1.8, 1.1-2.9). HIV serostatus was not associated with TAC or AVRC. AVRC was associated with higher Il-6 and sCD163 levels. TAC was associated with higher ICAM-1, TNF-α RII, and Il-6 levels. AVC and AVRC calcification were associated with presence of non-calcified plaque in HIV+ but not HIV- men. CONCLUSION HIV infection is an independent predictor of MAC and AVC. Whether these calcifications predict mortality in HIV+ patients deserves further investigation.
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Affiliation(s)
- Panteha Rezaeian
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA.,Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - P Elliott Miller
- Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Aryabod Razipour
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Hossein Bahrami
- Division of Cardiology and Stanford Cardiovascular Institute, Stanford University; Stanford, CA
| | - Romeo Castillo
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA
| | - Mallory D Witt
- Division of HIV Medicine- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Rine Nakanishi
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Suguru Matsumoto
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Anas Alani
- Division of Cardiology, University of Florida; Gainesville, FL
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Matthew J Budoff
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
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Youssef G, Guo M, McClelland RL, Shavelle DM, Nasir K, Rivera J, Carr JJ, Wong ND, Budoff MJ. Risk Factors for the Development and Progression of Thoracic Aorta Calcification: The Multi-Ethnic Study of Atherosclerosis. Acad Radiol 2015; 22:1536-45. [PMID: 26403646 PMCID: PMC4636912 DOI: 10.1016/j.acra.2015.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 05/11/2015] [Accepted: 08/23/2015] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Vascular calcification independently predicts cardiovascular disease (CVD), and computed tomography (CT) is a useful tool to evaluate and quantify not only coronary but also thoracic aortic calcification (TAC). Previous TAC progression reports were limited to dialysis and renal transplant patients. This is the first study to evaluate TAC progression in a large multiethnic cohort without clinically evident CVD at entry. METHODS Non-contrast-enhanced cardiac CTs were obtained in 5886 of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants (mean age, 62 years; 48% males; 40% white, 27% black, 21% Hispanic, and 12% Chinese). Baseline and follow-up TAC scores were derived. RESULTS Overall, 4308 (73%) participants had no detectable baseline TAC. Mean follow-up duration was 2.4 ± 0.8 years, during which 12% developed TAC. The overall incidence rate was 4.8%/year and was greater with age across gender and ethnic groups; TAC incidence was significantly lower in blacks than whites. After adjustment for follow-up duration, regression analyses showed age, systolic blood pressure, antihypertensives, and smoking were associated with incident TAC. A total of 1578 (27%) participants had TAC at baseline with a positive association between average annual TAC change and baseline age. Although the overall median change was 32.9 (-1.4 to 112.2) Agatston units, 27% showed an annual score change of ≥100 and blacks showed the lowest median across ethnic groups; 22.7 (-3 to 86.8). Age, systolic blood pressure, lipid-lowering medication, diabetes, and smoking were associated with TAC progression. CONCLUSIONS In MESA, traditional CV risk factors were related to both TAC incidence and progression. Blacks had the lowest incidence and median change across ethnic groups, consistent with previous findings for coronary calcification.
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Affiliation(s)
- George Youssef
- Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502
| | - Mengye Guo
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Khurram Nasir
- Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Juan Rivera
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; South Beach Preventive Cardiology, Miami, Florida
| | - J Jeffrey Carr
- Department of Radiology, Wake Forest University, Winston-Salem, North Carolina
| | - Nathan D Wong
- Division of Radiology, University of California, Irvine, Irvine, California
| | - Matthew J Budoff
- Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502.
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Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study. Atherosclerosis 2015; 243:631-7. [DOI: 10.1016/j.atherosclerosis.2015.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/20/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023]
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Yoon SH, Ohno Y, Araki M, Barbanti M, Lin MS, Ahn JM, Yang DH, Kim YH, Immé S, Gulino S, Tamburino CI, Sgroi C, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Muramatsu T, Kao HL, Tamburino C, Park SJ. Comparison of aortic root anatomy and calcification distribution between Asian and Caucasian patients who underwent transcatheter aortic valve implantation. Am J Cardiol 2015; 116:1566-73. [PMID: 26428022 DOI: 10.1016/j.amjcard.2015.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
The current transcatheter aortic valve implantation (TAVI) devices have been designed to fit Caucasian and Latin American aortic root anatomies. We evaluated the racial differences in aortic root anatomy and calcium distribution in patients with aortic stenosis who underwent TAVI. We conducted a multicenter study of 4 centers in Asia and Europe, which includes consecutive patients who underwent TAVI with preprocedural multidetector computed tomography. Quantitative assessment of aortic root dimensions, calcium volume for leaflet, and left ventricular outflow tract were retrospectively performed in a centralized core laboratory. A total of 308 patients (Asian group, n = 202; Caucasian group, n = 106) were analyzed. Compared to Caucasian group, Asian group had smaller annulus area (406.3 ± 69.8 vs 430.0 ± 76.8 mm(2); p = 0.007) and left coronary cusp diameter (30.2 ± 3.2 vs 31.1 ± 3.4 mm; p = 0.02) and lower height of left coronary artery ostia (12.0 ± 2.5 vs 13.4 ± 3.4 mm; p <0.001). Of baseline anatomic characteristics, body height showed the highest correlation with annulus area (Pearson correlation r = 0.64; p <0.001). Co-existence of lower height of left coronary artery ostia (<12 mm) and small diameter of left coronary cusp (<30 mm) were more frequent in Asian group compared with Caucasian group (35.6% vs 20.8%; p = 0.02). In contrast, there were no differences in calcium volumes of leaflet (367.2 ± 322.5 vs 359.1 ± 325.7 mm(3); p = 0.84) and left ventricular outflow tract (8.9 ± 23.4 vs 10.1 ± 23.8 mm(3); p = 0.66) between 2 groups. In conclusion, judicious consideration will be required to perform TAVI for short patients with lower height of left coronary artery ostia and small sinus of Valsalva.
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Kinugasa M, Mori S, Takaya T, Ito T, Tanaka H, Satomi-Kobayashi S, Fujiwara S, Nishii T, Kono AK, Okita Y, Hirata KI. Serum phosphate is an independent predictor of the total aortic calcification volume in non-hemodialysis patients undergoing cardiovascular surgery. J Cardiol 2015; 68:308-15. [PMID: 26572956 DOI: 10.1016/j.jjcc.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND A high serum phosphate level is a well-known risk factor for vascular calcification (VC) in patients on hemodialysis (HD). However, the association between the serum phosphate level and VC in non-HD patients is unclear. Our aim was to assess the impact of serum phosphate level on aortic calcification (AC) volume in non-HD patients undergoing cardiovascular surgery. METHODS A total of 117 patients who underwent thoracoabdominal computed tomography as a preoperative general evaluation before cardiovascular surgery were enrolled. The total AC volume was quantified using the volume-rendering method by extracting the area ≥130HU within the entire aorta. The total AC volume index (AC-VI) was estimated as the total AC volume divided by the body surface area. RESULTS In the 117 patients (64.7±13.1 years, 39% women), the median total AC-VI was 1.23mL/m(2). The mean estimated glomerular filtration rate (eGFR), adjusted serum calcium levels, and serum phosphate levels were 63.8±19.9mL/min/1.73m(2), 9.1±0.4mg/dL, and 3.6±0.6mg/dL, respectively. When the patients were classified into four quartiles based on their total AC-VI value, the serum phosphate level showed a positive correlation with a probability of being in the highest AC-VI quartile (R(2)=0.0146, p=0.0383) whereas the adjusted serum calcium level did not show a significant correlation (R(2)=0.0040, p=0.2615). A similar relationship between the serum phosphate level, adjusted serum calcium level, and AC-VI was confirmed when the total AC-VI was divided into the thoracic AC-VI and abdominal AC-VI. Multivariate analysis indicated that the serum phosphate level was an independent positive predictor of higher total AC-VI quartiles (β=0.8013, p=0.0160). CONCLUSIONS An increase in serum phosphate level was associated with an increased AC burden in non-HD patients undergoing cardiovascular surgery.
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Affiliation(s)
- Mitsuo Kinugasa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Tatsuro Ito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seimi Satomi-Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Liyanage L, Lee NJ, Cook T, Herrmann HC, Jagasia D, Litt H, Han Y. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis. Int J Cardiovasc Imaging 2015; 32:173-9. [DOI: 10.1007/s10554-015-0752-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
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Mantovani A, Pernigo M, Bergamini C, Bonapace S, Lipari P, Valbusa F, Bertolini L, Zenari L, Pichiri I, Dauriz M, Zoppini G, Barbieri E, Byrne CD, Bonora E, Targher G. Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease. Metabolism 2015; 64:879-87. [PMID: 25957758 DOI: 10.1016/j.metabol.2015.04.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/03/2015] [Accepted: 04/20/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the etiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown. METHODS We undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography. RESULTS Overall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p < 0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95% CI 1.89-6.51, p < 0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95% CI 1.23-7.38, p < 0.01). CONCLUSIONS Our results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Matteo Pernigo
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Paola Lipari
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Filippo Valbusa
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Barbieri
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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Guerraty MA, Chai B, Hsu JY, Ojo AO, Gao Y, Yang W, Keane MG, Budoff MJ, Mohler ER. Relation of aortic valve calcium to chronic kidney disease (from the Chronic Renal Insufficiency Cohort Study). Am J Cardiol 2015; 115:1281-6. [PMID: 25791240 DOI: 10.1016/j.amjcard.2015.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
Although subjects with chronic kidney disease (CKD) are at markedly increased risk for cardiovascular mortality, the relation between CKD and aortic valve calcification has not been fully elucidated. Also, few data are available on the relation of aortic valve calcification and earlier stages of CKD. We sought to assess the relation of aortic valve calcium (AVC) with estimated glomerular filtration rate (eGFR), traditional and novel cardiovascular risk factors, and markers of bone metabolism in the Chronic Renal Insufficiency Cohort (CRIC) Study. All patients who underwent aortic valve scanning in the CRIC study were included. The relation between AVC and eGFR, traditional and novel cardiovascular risk factors, and markers of calcium metabolism were analyzed using both unadjusted and adjusted regression models. A total of 1,964 CRIC participants underwent computed tomography for AVC quantification. Decreased renal function was independently associated with increased levels of AVC (eGFR 47.11, 44.17, and 39 ml/min/1.73 m2, respectively, p<0.001). This association persisted after adjusting for traditional, but not novel, AVC risk factors. Adjusted regression models identified several traditional and novel risk factors for AVC in patients with CKD. There was a difference in AVC risk factors between black and nonblack patients. In conclusion, our study shows that eGFR is associated in a dose-dependent manner with AVC in patients with CKD, and this association is independent of traditional cardiovascular risk factors.
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Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Choo SJ, Chung CH, Lee JW, Cohen DJ, Yeung AC, Hur SH, Seung KB, Ahn TH, Kwon HM, Lim DS, Rha SW, Jeong MH, Lee BK, Tresukosol D, Fu GS, Ong TK. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015; 372:1204-12. [PMID: 25774645 DOI: 10.1056/nejmoa1415447] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most trials comparing percutaneous coronary intervention (PCI) with coronary-artery bypass grafting (CABG) have not made use of second-generation drug-eluting stents. METHODS We conducted a randomized noninferiority trial at 27 centers in East Asia. We planned to randomly assign 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary end point was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years after randomization. Event rates during longer-term follow-up were also compared between groups. RESULTS After the enrollment of 880 patients (438 patients randomly assigned to the PCI group and 442 randomly assigned to the CABG group), the study was terminated early owing to slow enrollment. At 2 years, the primary end point had occurred in 11.0% of the patients in the PCI group and in 7.9% of those in the CABG group (absolute risk difference, 3.1 percentage points; 95% confidence interval [CI], -0.8 to 6.9; P=0.32 for noninferiority). At longer-term follow-up (median, 4.6 years), the primary end point had occurred in 15.3% of the patients in the PCI group and in 10.6% of those in the CABG group (hazard ratio, 1.47; 95% CI, 1.01 to 2.13; P=0.04). No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke. However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG. CONCLUSIONS Among patients with multivessel coronary artery disease, the rate of major adverse cardiovascular events was higher among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. (Funded by CardioVascular Research Foundation and others; BEST ClinicalTrials.gov number, NCT00997828.).
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Affiliation(s)
- Seung-Jung Park
- From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.J.C., C.H.C., J.W.L.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Catholic University of Korea, St. Mary's Hospital (K.B.S.), Gangnam Severance Hospital (H.M.K.), Korea University Anam (D.-S.L.), and Guro Hospital (S.-W.R.), Seoul, Keimyung University Dongsan Medical Center, Daegu (S.H.H.), Gachon University Gil Hospital, Incheon (T.H.A.), Chonnam National University Hospital, Gwangju (M.-H.J.), and Kangwon National University Hospital, Chuncheon (B.-K.L.) - all in South Korea; Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C.); Stanford University School of Medicine, Palo Alto, CA (A.C.Y.); Siriraj Hospital, Bangkok, Thailand (D.T.); Sir Run Run Shaw Hospital, Hangzhou, China (G.S.F.); and Sarawak General Hospital, Kuching, Malaysia (T.K.O.)
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Jairam PM, de Jong PA, Mali WPTM, Isgum I, van der Graaf Y. Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value? Eur Radiol 2015; 25:1646-54. [PMID: 25773934 PMCID: PMC4419189 DOI: 10.1007/s00330-014-3495-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/16/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Objective Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings. Methods A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification. Results During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71–0.74) to 0.74 (95 % CI 0.72–0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)). Conclusion Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans. Key Points • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features Electronic supplementary material The online version of this article (doi:10.1007/s00330-014-3495-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pushpa M Jairam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands,
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Jilaihawi H, Wu Y, Yang Y, Xu L, Chen M, Wang J, Kong X, Zhang R, Wang M, Lv B, Wang W, Xu B, Makkar RR, Sievert H, Gao R. Morphological characteristics of severe aortic stenosis in China: Imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv 2015; 85 Suppl 1:752-61. [PMID: 25630494 DOI: 10.1002/ccd.25863] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hasan Jilaihawi
- Division of Cardiology; Cedars-Sinai Heart Institute; Los Angeles California
| | - Yongjian Wu
- Department of Cardiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Yuejin Yang
- Department of Cardiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Liang Xu
- Cardiac Catheterization Laboratory; Fuwai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Mao Chen
- Department of Cardiology; West China Hospital, Sichuan University; Chengdu China
| | - Jianan Wang
- Department of Cardiology; The Second Affiliated Hospital of Zhejiang University School of Medicine; Hangzhou China
| | - Xiangqing Kong
- Department of Cardiology; The Jiangsu Provincial People's Hospital, Nanjing Medical University; Nanjing China
| | - Ruiyan Zhang
- Department of Cardiology; Rui Jin Hospital, Jiao Tong University School of Medicine; Shanghai China
| | - Moyang Wang
- Department of Cardiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Bin Lv
- Department of Radiology; Fuwai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Wei Wang
- Department of Cardiovascular Surgery; Fuwai Hospital, National Center for Cardiovascular Disease; Beijing China
| | - Bo Xu
- Department of Cardiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Raj R. Makkar
- Division of Cardiology; Cedars-Sinai Heart Institute; Los Angeles California
| | - Horst Sievert
- Department of Cardiology; CardioVascular Center; Frankfurt Germany
| | - Runlin Gao
- Department of Cardiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
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Arasaratnam P, Ayoub C, Ruddy TD. Canadian Multiethnicity—Differences in Coronary Artery Disease Prevalence and Progression and Relevance to Cardiac Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yutzey KE, Demer LL, Body SC, Huggins GS, Towler DA, Giachelli CM, Hofmann-Bowman MA, Mortlock DP, Rogers MB, Sadeghi MM, Aikawa E. Calcific aortic valve disease: a consensus summary from the Alliance of Investigators on Calcific Aortic Valve Disease. Arterioscler Thromb Vasc Biol 2014; 34:2387-93. [PMID: 25189570 DOI: 10.1161/atvbaha.114.302523] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Calcific aortic valve disease (CAVD) is increasingly prevalent worldwide with significant morbidity and mortality. Therapeutic options beyond surgical valve replacement are currently limited. In 2011, the National Heart Lung and Blood Institute assembled a working group on aortic stenosis. This group identified CAVD as an actively regulated disease process in need of further study. As a result, the Alliance of Investigators on CAVD was formed to coordinate and promote CAVD research, with the goals of identifying individuals at risk, developing new therapeutic approaches, and improving diagnostic methods. The group is composed of cardiologists, geneticists, imaging specialists, and basic science researchers. This report reviews the current status of CAVD research and treatment strategies with identification of areas in need of additional investigation for optimal management of this patient population.
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Affiliation(s)
- Katherine E Yutzey
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Linda L Demer
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Simon C Body
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Gordon S Huggins
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Dwight A Towler
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Cecilia M Giachelli
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Marion A Hofmann-Bowman
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Douglas P Mortlock
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Melissa B Rogers
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Mehran M Sadeghi
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.)
| | - Elena Aikawa
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (K.E.Y.); Departments of Medicine, Physiology and Bioengineering, University of California, Los Angeles (L.L.D.); Center for Perioperative Genomics, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA (S.C.B.); MCRI Center for Translational Genomics, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (G.S.H.); Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Center, Orlando, FL (D.A.T.); Bioengineering Department, University of Washington, Seattle (C.M.G.); Department of Medicine, Section of Cardiology, University of Chicago, IL (M.A.H.-B.); Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN (D.P.M.); Biochemistry and Molecular Biology, Rutgers-NJ Medical School, Newark (M.B.R.); Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (M.M.S.); VA Connecticut Healthcare System, West Haven (M.M.S.); and Center of Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.).
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Jairam PM, de Jong PA, Mali WPTM, Gondrie MJA, Jacobs PCA, van der Graaf Y. Age and sex based reference values for incidental coronary artery and thoracic aorta calcifications on routine clinical chest CT: a powerful tool to appreciate available imaging findings. Atherosclerosis 2014; 235:546-53. [PMID: 24956527 DOI: 10.1016/j.atherosclerosis.2014.05.949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/25/2014] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish age and gender specific reference values for incidental coronary artery and thoracic aorta calcification scores on routine diagnostic CT scans. These reference values can aid in structured reporting and interpretation of readily available imaging data by chest CT readers in routine practice. METHODS A random sample of 1572 (57% male, median age 61 years) was taken from a study population of 12,063 subjects who underwent diagnostic chest CT for non-cardiovascular indications between January 2002 and December 2005. Coronary artery and thoracic aorta calcifications were graded using a validated ordinal score. The 25th, 50th and 75th percentile cut points were calculated for the coronary artery and thoracic aorta calcification scores within each age/gender stratum. RESULTS The 75th percentile cut points for coronary artery calcification scores were higher for men than for women across all age groups, with the exception of the lowest age group. The 75th percentile cut points for thoracic aorta calcifications scores were comparable for both genders across all age groups. Based on the obtained age and gender reference values a calculation tool is provided, that allows one to enter an individual's age, gender and calcification scores to obtain the corresponding estimated percentiles. CONCLUSIONS The calculation tool as provided in this study can be used in daily practice by CT readers to examine whether a subject has high calcifications scores relative to others with the same age and gender.
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Affiliation(s)
- Pushpa M Jairam
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem P Th M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn J A Gondrie
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter C A Jacobs
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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47
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Chuang ML, Gona P, Oyama-Manabe N, Manders ES, Salton CJ, Hoffmann U, Manning WJ, O'Donnell CJ. Risk factor differences in calcified and noncalcified aortic plaque: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2014; 34:1580-6. [PMID: 24833796 DOI: 10.1161/atvbaha.114.303600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and risk factor (RF) correlates of aortic plaque (AP) detected by cardiovascular magnetic resonance (CMR), which mainly shows noncalcified plaques, and by noncontrast computed tomography (CT), which best depicts calcified plaques, in community-dwelling adults. APPROACH AND RESULTS A total of 1016 Framingham Heart Study Offspring cohort members (64 ± 9 years; 474 men) underwent CMR and CT of the aorta. Potential RFs for AP (age; sex; body mass index; blood pressure; low-density lipoprotein and high-density lipoprotein cholesterol; fasting glucose; C-reactive protein; prevalent hypertension, diabetes mellitus, smoking; use of antihypertensive, diabetes mellitus, or lipid-lowering drugs) were compared between participants, with zero versus nonzero AP by CMR and by CT. Candidate RFs attaining P<0.05 for difference with either imaging modality were entered into multivariable logistic regression models adjusting for age, sex, and other RFs. Odds ratios were calculated for modality-specific prevalence of AP. Associations between RFs and continuous measures of AP were assessed using Tobit regression. Prevalence of CMR and CT AP was 49% and 82%, respectively. AP burdens by CMR and CT were correlated, r=0.28, P<0.0001. Increasing age and smoking were associated with prevalent AP by both CMR and CT. Additionally, prevalent AP by CMR was associated with female sex and fasting glucose and prevalent AP by CT with hypertension treatment and adverse lipid profile. CONCLUSIONS AP by CMR and CT are both associated with smoking and increasing age, but other RFs differ between calcified and noncalcified AP. The relative predictive value of AP detected by CMR versus by CT for incident cardiovascular events remains to be determined.
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Affiliation(s)
- Michael L Chuang
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Philimon Gona
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Noriko Oyama-Manabe
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Emily S Manders
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Carol J Salton
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Udo Hoffmann
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Warren J Manning
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Christopher J O'Donnell
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.).
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48
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Prognostic value of aortic and mitral valve calcium detected by contrast cardiac computed tomography angiography in patients with suspicion of coronary artery disease. Am J Cardiol 2014; 113:772-8. [PMID: 24423898 DOI: 10.1016/j.amjcard.2013.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/09/2013] [Accepted: 11/09/2013] [Indexed: 11/20/2022]
Abstract
Aortic valve calcium (VC) detected on noncontrast cardiac computed tomography angiography (CCTA) is known to be associated with all-cause mortality in asymptomatic and primary prevention population. However, the clinical significance of aortic and mitral VC remains unknown in symptomatic patients with suspected coronary artery disease (CAD). The aim of the present study was to assess whether aortic and mitral VC is independently associated with cardiac events and all-cause mortality in symptomatic patients with suspected CAD. A total of 369 symptomatic patients (mean age 55 ± 11 years, 60% men) who were referred for CCTA because of suspected CAD were included in the study. Aortic and mitral VC was detected and quantified by volume on contrast CCTA. Median follow-up for events (coronary events and all-cause mortality) was 2.8 (interquartile range 1.6 to 4.0) with a maximum of 5.5 years. A total of 39 patients (11%) had VC. Increased age, hypertension, and increased Agatston coronary artery calcium score were associated with VC. During the follow-up, patients with VC had higher risk for a coronary event (38.8% vs 11%, log-rank p <0.001) and worse survival rate (92.3% vs 99.1%, log-rank p = 0.002) compared with those without VC. Volume of VC was independently associated with outcome after adjusting for clinical variables (hazard ratio 1.88, p <0.001), Agatston coronary artery calcium score (hazard ratio 1.47, p = 0.03), and significant CAD (hazard ratio 1.81, p = 0.001). In conclusion, aortic and mitral VC volume quantified on contrast CCTA was independently associated with coronary events and all-cause mortality in patients with suspected CAD.
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Elmariah S, Budoff MJ, Delaney JA, Hamirani Y, Eng J, Fuster V, Kronmal RA, Halperin JL, O'Brien KD. Risk factors associated with the incidence and progression of mitral annulus calcification: the multi-ethnic study of atherosclerosis. Am Heart J 2013; 166:904-12. [PMID: 24176447 DOI: 10.1016/j.ahj.2013.08.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Significant cardiovascular morbidity has been associated with mitral annulus calcification (MAC), but limited data exist regarding its progression. The purpose of this study was to examine the natural history of and risk factors for MAC progression. METHODS The MESA is a longitudinal cohort study of participants aged 45 to 84 years without clinical cardiovascular disease who underwent serial cardiac computed tomography studies with quantification of MAC. Regression models were used to identify risk factors associated with MAC incidence and progression. RESULTS Prevalent MAC was observed in 534 (9%) of 5,895 participants. Over a median 2.3 years, 280 (5%) developed incident MAC. After adjustment, age was the strongest predictor of incident MAC (adjusted OR, 2.25 per 10 years; 95% CI, 1.97-2.58; P < .0001). Female gender, white ethnicity, body mass index, diabetes, hypertension, hyperlipidemia, serum cholesterol, smoking, and interleukin-6 were also significant predictors of incident MAC. In participants with prevalent MAC, the median rate of change was 10.1 [IQR, -6.7 to 60.7] Agatston units (AU)/year. Baseline MAC severity was the predominant predictor of rate of MAC progression (β-coefficient per 10 AU, 0.88; 95% CI, 0.85-0.91; P < .0001), although ethnicity and smoking status possessed modest influence. CONCLUSIONS Several cardiovascular risk factors predicted incident MAC, as did female gender. Severity of baseline MAC was the primary predictor of MAC progression, suggesting that, while atherosclerotic processes may initiate MAC, they are only modestly associated with its progression over these time frames.
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50
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Novaro GM, Houghtaling PL, Gillinov AM, Blackstone EH, Asher CR. Prevalence of mitral valve prolapse and congenital bicuspid aortic valves in black and white patients undergoing cardiac valve operations. Am J Cardiol 2013; 111:898-901. [PMID: 23276473 DOI: 10.1016/j.amjcard.2012.11.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/19/2012] [Accepted: 11/19/2012] [Indexed: 11/15/2022]
Abstract
The risk factors for aortic and mitral valve diseases that require surgical repair such as congenital bicuspid aortic valve (BAV) and mitral valve prolapse include acquired clinical factors and genetic influences. Whether race affects the prevalence of certain valvular diseases has not been sufficiently investigated. Through the Cleveland Clinic's Cardiovascular Information Registry, we evaluated the data from 40,419 patients who had undergone aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting from 1993 to 2007. Of these patients, 38,366 were white and 2,053 were black. The prospective evaluation of valvular disease was coded, identifying the etiology and morphology by echocardiographic, surgical, and pathologic inspection. At baseline, compared to white patients, the black patients were younger, more often women, had a greater body mass index, and a greater prevalence of hypertension, diabetes, tobacco use, and renal disease. The prevalence of congenital BAV and mitral valve prolapse was considerably lower in blacks than in whites (9% vs 25%, p <0.001, and 27% vs 52%, p <0.001, respectively), as was the presence of calcific aortic stenosis (14% vs 28%; p <0.001), pathologically determined aortic valve calcium (50% vs 67%; p <0.001), and mitral valve chordal rupture (13% vs 31%; p <0.001). In conclusion, in the present large surgical series, the valve etiologies and morphology differed among blacks and whites. Despite an adverse cardiovascular risk profile, blacks had a significantly lower prevalence of valvular calcium and degeneration than did the whites and a lower prevalence of congenital BAV and mitral valve prolapse. Our findings offer insight into the influence of race on the development of mitral valve disease and congenital BAV.
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Affiliation(s)
- Gian M Novaro
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, FL, USA.
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