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Yao H, Feng G, Liu Y, Chen Y, Shao C, Wang Z. Coronary artery calcification burden, atherogenic index of plasma, and risk of adverse cardiovascular events in the general population: evidence from a mediation analysis. Lipids Health Dis 2024; 23:258. [PMID: 39164730 PMCID: PMC11334389 DOI: 10.1186/s12944-024-02255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Dyslipidemia and abnormal cholesterol metabolism are closely related to coronary artery calcification (CAC) and are also critical factors in cardiovascular disease death. In recent years, the atherogenic index of plasma (AIP) has been widely used to evaluate vascular sclerosis. This study aimed to investigate the potential association of AIP between CAC and major adverse cardiovascular events (MACEs). METHODS This study included 1,121 participants whose CACs were measured by multislice spiral CT. Participants' CAC Agatston score, CAC mass, CAC volume, and number of vessels with CACs were assessed. AIP is defined as the base 10 logarithm of the ratio of triglyceride (TG) concentration to high-density lipoprotein-cholesterol (HDL-C) concentration. We investigated the multivariate-adjusted associations between AIP, CAC, and MACEs. The mediating role of the AIP in CAC and MACEs was subsequently discussed. RESULTS During a median follow-up of 31 months, 74 MACEs were identified. For each additional unit of log-converted CAC, the MACE risk increased by 48% (HR 1.48 [95% CI 1.32-1.65]). For each additional unit of the AIP (multiplied by 10), the MACEs risk increased by 19%. Causal mediation analysis revealed that the AIP played a partial mediating role between CAC (CAC Agatston score, CAC mass) and MACEs, and the mediating proportions were 8.16% and 16.5%, respectively. However, the mediating effect of CAC volume tended to be nonsignificant (P = 0.137). CONCLUSIONS An increased AIP can be a risk factor for CAC and MACEs. Biomarkers based on lipid ratios are a readily available and low-cost strategy for identifying MACEs and mediating the association between CAC and MACEs. These findings provide a new perspective on CAC treatment, early diagnosis, and prevention of MACEs.
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Affiliation(s)
- Haipeng Yao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
- Institue of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Yi Liu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
- Institue of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, China
| | - Yiliu Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
- Institue of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
- Institue of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China.
- Institue of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, China.
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2
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Ouchi K, Sakuma T, Nojiri A, Kano R, Higuchi T, Hasumi J, Suzuki T, Ogihara A, Ojiri H, Kawai M. Accuracy of aortic valve calcification volume score for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography compared to the Agatston scoring system. J Cardiovasc Comput Tomogr 2024; 18:352-362. [PMID: 38556394 DOI: 10.1016/j.jcct.2024.03.014] [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: 12/13/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Considering the absence of reports validating the precision of the volume score and the relationship between the volume and Agatston scores, this study evaluated the accuracy of the volume score compared to the Agatston score for the quantitative measurement of aortic valve calcification (AVC) on non-electrocardiographic-gated computed tomography (CT). METHODS We retrospectively analysed the AVC scores of 5385 patients who underwent transthoracic echocardiography between March 1, 2013 and December 26, 2019 at our institution, using non-contrast non-electrocardiographic-gated CT. The thresholds for significant aortic stenosis (AS) were computed using receiver operating characteristic curves based on the AVC scores. The area under the curve (AUC) of the Agatston and volume scores for significant AS were compared to evaluate the accuracy of the scoring method. RESULTS All sex-specific AVC thresholds of the volume score for significant AS (moderate and high AS severity, moderate and high AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.978-0.996; sensitivity, 94.2-98.4%; specificity, 90.1-100%). No significant differences in the AUC were observed between the Agatston and volume scores for significant AS in male and female patients. CONCLUSION All volume score threshold values showed high sensitivity and specificity for identifying significant AS. The accuracy of the test for AVC thresholds of the volume score for significant AS was comparable to that of the Agatston score. Our findings raise questions about the significance of weighting calcium density in the Agatston score for assessing AS severity.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ayumi Nojiri
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Rui Kano
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takahiro Higuchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Akira Ogihara
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Makoto Kawai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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3
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Halfmann MC, Allmendinger T, Hagenauer J, Griffith JP, Vecsey-Nagy M, Pinos D, Ebersberger U, Ricke J, Varga-Szemes A, Emrich T. Impact of Cardiac Motion on coronary artery calcium scoring using a virtual non-iodine algorithm on photon-counting detector CT: a dynamic phantom study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2083-2092. [PMID: 37452987 DOI: 10.1007/s10554-023-02912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
This study assessed the impact of cardiac motion and in-vessel attenuation on coronary artery calcium (CAC) scoring using virtual non-iodine (VNI) against virtual non-contrast (VNC) reconstructions on photon-counting detector CT. Two artificial vessels containing calcifications and different in-vessel attenuations (500, 800HU) were scanned without (static) and with cardiac motion (60, 80, 100 beats per minute [bpm]). Images were post-processed using a VNC and VNI algorithm at 70 keV and quantum iterative reconstruction (QIR) strength 2. Calcium mass, Agatston scores, cardiac motion susceptibility (CMS)-indices were compared to physical mass, static scores as well as between reconstructions, heart rates and in-vessel attenuations. VNI scores decreased with rising heart rate (p < 0.01) and showed less underestimation than VNC scores (p < 0.001). Only VNI scores were similar to the physical mass at static measurements, and to static scores at 60 bpm. Agatston scores using VNI were similar to static scores at 60 and 80 bpm. Standard deviation of CMS-indices was lower for VNI-based than for VNC-based CAC scoring. VNI scores were higher at 500 than 800HU (p < 0.001) and higher than VNC scores (p < 0.001) with VNI scores at 500 HU showing the lowest deviation from the physical reference. VNI-based CAC quantification is influenced by cardiac motion and in-vessel attenuation, but least when measuring Agatston scores, where it outperforms VNC-based CAC scoring.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Siemens Medical Solutions, Malvern, PA, 19355, USA
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
| | | | - Junia Hagenauer
- Siemens Healthcare GmbH, Siemensstr. 1, Forchheim, 91301, Germany
- Faculty of Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstr. 12, Erlangen, 91054, Germany
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor utca 68, Budapest, 1122, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Ullrich Ebersberger
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, 80636, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
- German Centre for Cardiovascular Research, Mainz, 55131, Germany
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4
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Allaire BT, Mousavi SJ, James JN, Bouxsein ML, Anderson DE. Dependence of trunk muscle size and position on age, height, and weight in a multi-ethnic cohort of middle-aged and older men and women. J Biomech 2023; 157:111710. [PMID: 37437459 PMCID: PMC10470847 DOI: 10.1016/j.jbiomech.2023.111710] [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: 02/16/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
Trunk muscle size and location relative to the spine are key factors affecting their capacity to assist in trunk movement, strength, and function. There remains limited information on how age, weight and height affect these measurements across multiple spinal levels, and prior studies had limited samples in terms of size and ethnicity. In this study, we measured trunk muscles in coronal plane slices at T4 - L4 of CT scans acquired in 507 participants, aged 40-90 years, from the community-based Framingham Heart Study. Mixed-effects linear regressions, stratified by sex, determined the contributions of age, height and weight, to muscle cross-sectional area (CSA), the distance from the vertebral body centroid (CD), and the in-plane angle of the line between the vertebral body and the muscle centroids (CA). Muscle CSA decreased with higher age by an average of -0.8% per year, but weight (average 0.8% per kg) and height (average -0.05% per cm) had mixed results, with both positive and negative effects depending on muscle group and level. Muscle CD increased with weight by an average of 0.3% per kg, but had mixed effects for age (average 0.8% per year) and height (average 0.1% per cm). Muscle CA had mixed associations with age (average 0.05% per year), weight (average 0.01% per kg) and height (average -0.05% per cm). A prediction program created with these results provides a simple approach for estimating probable values for trunk muscle size and position in the absence of medical imaging.
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Affiliation(s)
- Brett T Allaire
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Seyed Javad Mousavi
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Joanna N James
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States.
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5
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Kumar P, Bhatia M. Coronary Artery Calcium Data and Reporting System (CAC-DRS): A Primer. J Cardiovasc Imaging 2023; 31:1-17. [PMID: 36693339 PMCID: PMC9880346 DOI: 10.4250/jcvi.2022.0029] [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: 03/05/2022] [Revised: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 01/26/2023] Open
Abstract
The Coronary Artery Calcium Data and Reporting System (CAC-DRS) is a standardized reporting method for calcium scoring on computed tomography. CAC-DRS is applied on a per-patient basis and represents the total calcium score with the number of vessels involved. There are 4 risk categories ranging from CAC-DRS 0 to CAC-DRS 3. CAC-DRS also provides risk prediction and treatment recommendations for each category. The main strengths of CAC-DRS include a detailed and meaningful representation of CAC, improved communication between physicians, risk stratification, appropriate treatment recommendations, and uniform data collection, which provides a framework for education and research. The major limitations of CAC-DRS include a few missing components, an overly simple visual approach without any standard reference, and treatment recommendations lacking a basis in clinical trials. This consistent yet straightforward method has the potential to systemize CAC scoring in both gated and non-gated scans.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
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6
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Assessing Agreement When Agreement Is Hard to Assess-The Agatston Score for Coronary Calcification. Diagnostics (Basel) 2022; 12:diagnostics12122993. [PMID: 36553000 PMCID: PMC9777110 DOI: 10.3390/diagnostics12122993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Method comparison studies comprised simple scatterplots of paired measurements, a 45-degree line as benchmark, and correlation coefficients up to the advent of Bland-Altman analysis in the 1980s. The Agatston score for coronary calcification is based on computed tomography of the heart, and it originated in 1990. A peculiarity of the Agatston score is the often-observed skewed distribution in screening populations. As the Agatston score has manifested itself in preventive cardiology, it is of interest to investigate how reproducibility of the Agatston score has been established. This review is based on literature findings indexed in MEDLINE/PubMed before 20 November 2021. Out of 503 identified articles, 49 papers were included in this review. Sample sizes were highly variable (10-9761), the main focus comprised intra- and interrater as well as intra- and interscanner variability assessments. Simple analysis tools such as scatterplots and correlation coefficients were successively supplemented by first difference, later Bland-Altman plots; however, only very few publications were capable of deriving Limits of Agreement that fit the observed data visually in a convincing way. Moreover, several attempts have been made in the recent past to improve the analysis and reporting of method comparison studies. These warrant increased attention in the future.
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7
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van Velzen SGM, de Vos BD, Noothout JMH, Verkooijen HM, Viergever MA, Išgum I. Generative models for reproducible coronary calcium scoring. J Med Imaging (Bellingham) 2022; 9:052406. [PMID: 35664539 DOI: 10.1117/1.jmi.9.5.052406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose: Coronary artery calcium (CAC) score, i.e., the amount of CAC quantified in CT, is a strong and independent predictor of coronary heart disease (CHD) events. However, CAC scoring suffers from limited interscan reproducibility, which is mainly due to the clinical definition requiring application of a fixed intensity level threshold for segmentation of calcifications. This limitation is especially pronounced in non-electrocardiogram-synchronized computed tomography (CT) where lesions are more impacted by cardiac motion and partial volume effects. Therefore, we propose a CAC quantification method that does not require a threshold for segmentation of CAC. Approach: Our method utilizes a generative adversarial network (GAN) where a CT with CAC is decomposed into an image without CAC and an image showing only CAC. The method, using a cycle-consistent GAN, was trained using 626 low-dose chest CTs and 514 radiotherapy treatment planning (RTP) CTs. Interscan reproducibility was compared to clinical calcium scoring in RTP CTs of 1662 patients, each having two scans. Results: A lower relative interscan difference in CAC mass was achieved by the proposed method: 47% compared to 89% manual clinical calcium scoring. The intraclass correlation coefficient of Agatston scores was 0.96 for the proposed method compared to 0.91 for automatic clinical calcium scoring. Conclusions: The increased interscan reproducibility achieved by our method may lead to increased reliability of CHD risk categorization and improved accuracy of CHD event prediction.
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Affiliation(s)
- Sanne G M van Velzen
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.,University of Amsterdam, Informatics Institute, Faculty of Science, Amsterdam, The Netherlands.,Utrecht University, University Medical Center Utrecht, Image Sciences Institute, Utrecht, The Netherlands
| | - Bob D de Vos
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.,University of Amsterdam, Informatics Institute, Faculty of Science, Amsterdam, The Netherlands
| | - Julia M H Noothout
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.,University of Amsterdam, Informatics Institute, Faculty of Science, Amsterdam, The Netherlands
| | - Helena M Verkooijen
- University Medical Center Utrecht, Imaging Division, Utrecht, The Netherlands
| | - Max A Viergever
- Utrecht University, University Medical Center Utrecht, Image Sciences Institute, Utrecht, The Netherlands
| | - Ivana Išgum
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.,University of Amsterdam, Informatics Institute, Faculty of Science, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
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8
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Jubran A, Mastrodicasa D, van Praagh GD, Willemink MJ, Kino A, Wang J, Fleischmann D, Nieman K. Low-dose coronary calcium scoring CT using a dedicated reconstruction filter for kV-independent calcium measurements. Eur Radiol 2022; 32:4225-4233. [PMID: 34989838 PMCID: PMC10017097 DOI: 10.1007/s00330-021-08451-2] [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] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
In this prospective, pilot study, we tested a kV-independent coronary artery calcium scoring CT protocol, using a novel reconstruction kernel (Sa36f). From December 2018 to November 2019, we performed an additional research scan in 61 patients undergoing clinical calcium scanning. For the standard protocol (120 kVp), images were reconstructed with a standard, medium-sharp kernel (Qr36d). For the research protocol (automated kVp selection), images were reconstructed with a novel kernel (Sa36f). Research scans were sequentially performed using a higher (cohort A, n = 31) and a lower (cohort B, n = 30) dose optimizer setting within the automatic system with customizable kV selection. Agatston scores, coronary calcium volumes, and radiation exposure of the standard and research protocol were compared. A phantom study was conducted to determine inter-scan variability. There was excellent correlation for the Agatston score between the two protocols (r = 0.99); however, the standard protocol resulted in slightly higher Agatston scores (29.4 [0-139.0] vs 17.4 [0-158.2], p = 0.028). The median calcium volumes were similar (11.5 [0-109.2] vs 11.2 [0-118.0] mm3; p = 0.176), and the number of calcified lesions was not significantly different (p = 0.092). One patient was reclassified to another risk category. The research protocol could be performed at a lower kV and resulted in a substantially lower radiation exposure, with a median volumetric CT dose index of 4.1 vs 5.2 mGy, respectively (p < 0.001). Our results showed that a consistent coronary calcium scoring can be achieved using a kV-independent protocol that lowers radiation doses compared to the standard protocol. KEY POINTS: • The Sa36f kernel enables kV-independent Agatston scoring without changing the original Agatston weighting threshold. • Agatston scores and calcium volumes of the standard and research protocols showed an excellent correlation. • The research protocol resulted in a significant reduction in radiation exposure with a mean reduction of 22% in DLP and 25% in CTDIvol.
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Affiliation(s)
- Ayman Jubran
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Gijs D van Praagh
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jia Wang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Koen Nieman
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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9
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van der Werf NR, Rodesch PA, Si-Mohamed S, van Hamersvelt RW, Greuter MJW, Leiner T, Boussel L, Willemink MJ, Douek P. Improved coronary calcium detection and quantification with low-dose full field-of-view photon-counting CT: a phantom study. Eur Radiol 2022; 32:3447-3457. [PMID: 34997284 DOI: 10.1007/s00330-021-08421-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the current study was to systematically assess coronary artery calcium (CAC) detection and quantification for spectral photon-counting CT (SPCCT) in comparison to conventional CT and, in addition, to evaluate the possibility of radiation dose reduction. METHODS Routine clinical CAC CT protocols were used for data acquisition and reconstruction of two CAC containing cylindrical inserts which were positioned within an anthropomorphic thorax phantom. In addition, data was acquired at 50% lower radiation dose by reducing tube current, and slice thickness was decreased. Calcifications were considered detectable when three adjacent voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). Quantification of CAC (as volume and mass score) was assessed by comparison with known physical quantities. RESULTS In comparison with CT, SPCCT detected 33% and 7% more calcifications for the small and large phantoms, respectively. At reduced radiation dose and reduced slice thickness, small phantom CAC detection increased by 108% and 150% for CT and SPCCT, respectively. For the large phantom size, noise levels interfered with CAC detection. Although comparable between CT and SPCCT, routine protocols CAC quantification showed large deviations (up to 134%) from physical CAC volume. At reduced radiation dose and slice thickness, physical volume overestimations decreased to 96% and 72% for CT and SPCCT, respectively. In comparison with volume scores, mass score deviations from physical quantities were smaller. CONCLUSION CAC detection on SPCCT is superior to CT, and was even preserved at a reduced radiation dose. Furthermore, SPCCT allows for improved physical volume estimation. KEY POINTS • In comparison with conventional CT, increased coronary artery calcium detection (up to 156%) for spectral photon-counting CT was found, even at 50% radiation dose reduction. • Spectral photon-counting CT can more accurately measure physical volumes than conventional CT, especially at reduced slice thickness and for high-density coronary artery calcium. • For both conventional and spectral photon-counting CT, reduced slice thickness reconstructions result in more accurate physical mass approximation.
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Affiliation(s)
- N R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - P A Rodesch
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - S Si-Mohamed
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - R W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boussel
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - M J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - P Douek
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
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10
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Mergen V, Higashigaito K, Allmendinger T, Manka R, Euler A, Alkadhi H, Eberhard M. Tube voltage-independent coronary calcium scoring on a first-generation dual-source photon-counting CT-a proof-of-principle phantom study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:905-912. [PMID: 34780012 DOI: 10.1007/s10554-021-02466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
To evaluate the accuracy of coronary artery calcium (CAC) scoring at various tube voltages and different monoenergetic image reconstructions on a first-generation dual-source photon-counting detector CT (PCD-CT). A commercially available anthropomorphic chest phantom with calcium inserts was scanned at different tube voltages (90 kV, Sn100kV, 120 kV, and Sn140kV) on a first-generation dual-source PCD-CT system with quantum technology using automatic exposure control with an image quality (IQ) level of 20. The same phantom was also scanned on a conventional energy-integrating detector CT (120 kV; weighted filtered back projection) for reference. Extension rings were used to emulate different patient sizes. Virtual monoenergetic images at 65 keV and 70 keV applying different levels of quantum iterative reconstruction (QIR) were reconstructed from the PCD-CT data sets. CAC scores were determined and compared to the reference. Radiation doses were noted. At an IQ level of 20, radiation doses ranged between 1.18 mGy and 4.64 mGy, depending on the tube voltage and phantom size. Imaging at 90 kV or Sn100kV was associated with a size-dependent radiation dose reduction between 23% and 48% compared to 120 kV. Tube voltage adapted image reconstructions with 65 keV and QIR 3 at 90 kV and with 70 keV and QIR 1 at Sn100kV allowed to calculate CAC scores comparable to conventional EID-CT scans with a percentage deviation of ≤ 5% for all phantom sizes. Our phantom study indicates that CAC scoring with dual-source PCD-CT is accurate at various tube voltages, offering the possibility of substantial radiation dose reduction.
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Affiliation(s)
- V Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - K Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | | | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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11
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van der Star S, de Jong DJ, Bleys RLAW, Kuijf HJ, Schilham A, de Jong PA, Kok M. Quantification of Calcium in Peripheral Arteries of the Lower Extremities: Comparison of Different CT Scanners and Scoring Platforms. Invest Radiol 2022; 57:141-147. [PMID: 34411031 DOI: 10.1097/rli.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the interscanner and interscoring platform variability of calcium quantification in peripheral arteries of the lower extremities. MATERIALS AND METHODS Twenty human fresh-frozen legs were scanned using 3 different computed tomography (CT) scanners. The radiation dose (CTDIvol) was kept similar for all scanners. The calcium scores (Agatston and volume scores) were quantified using 4 semiautomatic scoring platforms. Comparative analysis of the calcium scores between scanners and scoring platforms was performed by using the Friedman test; post hoc analysis was performed by using the Wilcoxon signed rank test with Bonferroni correction. RESULTS Sixteen legs had calcifications and were used for data analysis. Agatston and volume scores ranged from 12.1 to 6580 Agatston units and 18.2 to 5579 mm3. Calcium scores differed significantly between Philips IQon and Philips Brilliance 64 (Agatston: 19.5% [P = 0.001]; volume: 14.5% [P = 0.001]) and Siemens Somatom Force (Agatston: 18.1% [P = 0.001]; volume: 17.5% [P = 0.001]). The difference between Brilliance 64 and Somatom Force was smaller (Agatston: 5.6% [P = 0.778]; volume: 7.7% [P = 0.003]). With respect to the interscoring platform variability, OsiriX produced significantly different Agatston scores compared with the other 3 scoring platforms (OsiriX vs IntelliSpace: 14.8% [P = 0.001] vs Syngo CaScore: 13.9% [P = 0.001] vs iX viewer: 13.2% [P < 0.001]). For the volume score, the differences between all scoring platforms were small ranging from 2.9% to 4.0%. Post hoc analysis showed a significant difference between OsiriX and IntelliSpace (3.8% [P = 0.001]). CONCLUSIONS The use of different CT scanners resulted in notably different Agatston and volume scores, whereas the use of different scoring platforms resulted in limited variability especially for the volume score. In conclusion, the variability in calcium quantification was most evident between different CT scanners and for the Agatston score.
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Affiliation(s)
| | | | | | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Saydam CD. Subclinical cardiovascular disease and utility of coronary artery calcium score. IJC HEART & VASCULATURE 2021; 37:100909. [PMID: 34825047 PMCID: PMC8604741 DOI: 10.1016/j.ijcha.2021.100909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
ASCVD are the leading causes of mortality and morbidity among Globe. Evaluation of patients' comprehensive and personalized risk provides risk management strategies and preventive interventions to achieve gain for patients. Framingham Risk Score (FRS) and Systemic Coronary Risk Evaluation Score (SCORE) are two well studied risk scoring models, however, can miss some (20-35%) of future cardiovascular events. To obtain more accurate risk assessment recalibrating risk models through utilizing novel risk markers have been studied in last 3 decades and both ESC and AHA recommends assessing Family History, hs-CRP, CACS, ABI, and CIMT. Subclinical Cardiovascular Disease (SCVD) has been conceptually developed for investigating gradually progressing asymptomatic development of atherosclerosis and among these novel risk markers it has been well established by literature that CACS having highest improvement in risk assessment. This review study mainly selectively discussing studies with CACS measurement. A CACS = 0 can down-stratify risk of patients otherwise treated or treatment eligible before test and can reduce unnecessary interventions and cost, whereas CACS ≥ 100 is equivalent to statin treatment threshold of ≥ 7.5% risk level otherwise statin ineligible before test. Since inflammation, insulin resistance, oxidative stress, dyslipidemia and ongoing endothelial damage due to hypertension could lead to CAC, ASCVD linked with comorbidities. Recent cohort studies have shown a CACS 100-300 as a sign of increased cancer risk. Physical activity, dietary factors, cigarette use, alcohol consumption, metabolic health, family history of CHD, aging, exposures of neighborhood environment and non-cardiovascular comorbidities can determine CACs changes.
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13
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Vasan RS, Pan S, Larson MG, Mitchell GF, Xanthakis V. Arteriosclerosis, Atherosclerosis, and Cardiovascular Health: Joint Relations to the Incidence of Cardiovascular Disease. Hypertension 2021; 78:1232-1240. [PMID: 34601961 PMCID: PMC8516717 DOI: 10.1161/hypertensionaha.121.18075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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14
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den Harder AM, Wolterink JM, Bartstra JW, Spiering W, Zwakenberg SR, Beulens JW, Slart RHJA, Luurtsema G, Mali WP, de Jong PA. Vascular uptake on 18F-sodium fluoride positron emission tomography: precursor of vascular calcification? J Nucl Cardiol 2021; 28:2244-2254. [PMID: 31975332 PMCID: PMC8648691 DOI: 10.1007/s12350-020-02031-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/14/2019] [Accepted: 12/31/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Microcalcifications cannot be identified with the present resolution of CT; however, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) imaging has been proposed for non-invasive identification of microcalcification. The primary objective of this study was to assess whether 18F-NaF activity can assess the presence and predict the progression of CT detectable vascular calcification. METHODS AND RESULTS The data of two longitudinal studies in which patients received a 18F-NaF PET-CT at baseline and after 6 months or 1-year follow-up were used. The target to background ratio (TBR) was measured on PET at baseline and CT calcification was quantified in the femoral arteries at baseline and follow-up. 128 patients were included. A higher TBR at baseline was associated with higher calcification mass at baseline and calcification progression (β = 1.006 [1.005-1.007] and β = 1.002 [1.002-1.003] in the studies with 6 months and 1-year follow-up, respectively). In areas without calcification at baseline and where calcification developed at follow-up, the TBR was .11-.13 (P < .001) higher compared to areas where no calcification developed. CONCLUSION The activity of 18F-NaF is related to the amount of calcification and calcification progression. In areas where calcification formation occurred, the TBR was slightly but significantly higher.
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Affiliation(s)
- Annemarie M den Harder
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands.
| | - Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas W Bartstra
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine R Zwakenberg
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joline W Beulens
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gert Luurtsema
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem P Mali
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
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15
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van der Werf NR, Booij R, Schmidt B, Flohr TG, Leiner T, de Groen JJ, Bos D, Budde RPJ, Willemink MJ, Greuter MJW. Evaluating a calcium-aware kernel for CT CAC scoring with varying surrounding materials and heart rates: a dynamic phantom study. Eur Radiol 2021; 31:9211-9220. [PMID: 34050386 PMCID: PMC8589753 DOI: 10.1007/s00330-021-08076-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/09/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was twofold. First, the influence of a novel calcium-aware (Ca-aware) computed tomography (CT) reconstruction technique on coronary artery calcium (CAC) scores surrounded by a variety of tissues was assessed. Second, the performance of the Ca-aware reconstruction technique on moving CAC was evaluated with a dynamic phantom. METHODS An artificial coronary artery, containing two CAC of equal size and different densities (196 ± 3, 380 ± 2 mg hydroxyapatite cm-3), was moved in the center compartment of an anthropomorphic thorax phantom at different heart rates. The center compartment was filled with mixtures, which resembled fat, water, and soft tissue equivalent CT numbers. Raw data was acquired with a routine clinical CAC protocol, at 120 peak kilovolt (kVp). Subsequently, reduced tube voltage (100 kVp) and tin-filtration (150Sn kVp) acquisitions were performed. Raw data was reconstructed with a standard and a novel Ca-aware reconstruction technique. Agatston scores of all reconstructions were compared with the reference (120 kVp) and standard reconstruction technique, with relevant deviations defined as > 10%. RESULTS For all heart rates, Agatston scores for CAC submerged in fat were comparable to the reference, for the reduced-kVp acquisition with Ca-aware reconstruction kernel. For water and soft tissue, medium-density Agatston scores were again comparable to the reference for all heart rates. Low-density Agatston scores showed relevant deviations, up to 15% and 23% for water and soft tissue, respectively. CONCLUSION CT CAC scoring with varying surrounding materials and heart rates is feasible at patient-specific tube voltages with the novel Ca-aware reconstruction technique. KEY POINTS • A dedicated calcium-aware reconstruction kernel results in similar Agatston scores for CAC surrounded by fatty materials regardless of CAC density and heart rate. • Application of a dedicated calcium-aware reconstruction kernel allows for radiation dose reduction. • Mass scores determined with CT underestimated physical mass.
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Affiliation(s)
- Niels R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Thomas G Flohr
- Computed Tomography, Siemens Healthineers, Forchheim, Germany
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joël J de Groen
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniël Bos
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
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16
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Castro-Diehl C, Ehrbar R, Obas V, Oh A, Vasan RS, Xanthakis V. Biomarkers representing key aging-related biological pathways are associated with subclinical atherosclerosis and all-cause mortality: The Framingham Study. PLoS One 2021; 16:e0251308. [PMID: 33989340 PMCID: PMC8121535 DOI: 10.1371/journal.pone.0251308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/24/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Increased oxidative stress, leukocyte telomere length (LTL) shortening, endothelial dysfunction, and lower insulin-like growth factor (IGF)-1 concentrations reflect key molecular mechanisms of aging. We hypothesized that biomarkers representing these pathways are associated with measures of subclinical atherosclerosis and all-cause mortality. METHODS AND RESULTS We evaluated up to 2,314 Framingham Offspring Study participants (mean age 61 years, 55% women) with available biomarkers of aging: LTL, circulating concentrations of IGF-1, asymmetrical dimethylarginine (ADMA), and urinary F2-Isoprostanes indexed to urinary creatinine. We evaluated the association of each biomarker with coronary artery calcium [ln (CAC+1)] and carotid intima-media thickness (IMT). In multivariable-adjusted linear regression models, higher ADMA levels were associated with higher CAC values (βADMA per 1-SD increase 0.25; 95% confidence interval [CI] [0.11, 0.39]). Additionally, shorter LTL and lower IGF-1 values were associated with higher IMT values (βLTL -0.08, 95%CI -0.14, -0.02, and βIGF-1 -0.04, 95%CI -0.08, -0.01, respectively). During a median follow-up of 15.5 years, 593 subjects died. In multivariable-adjusted Cox regression models, LTL and IGF-1 values were inversely associated with all-cause mortality (hazard ratios [HR] per SD increase in biomarker, 0.85, 95% CI 0.74-0.99, and 0.90, 95% CI 0.82-0.98 for LTL and IGF-1, respectively). F2-Isoprostanes and ADMA values were positively associated with all-cause mortality (HR per SD increase in biomarker, 1.15, 95% CI, 1.10-1.22, and 1.10, 95% CI, 1.02-1.20, respectively). CONCLUSION In our prospective community-based study, aging-related biomarkers were associated with measures of subclinical atherosclerosis cross-sectionally and with all-cause mortality prospectively, supporting the concept that these biomarkers may reflect the aging process in community-dwelling adults.
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Affiliation(s)
- Cecilia Castro-Diehl
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Rachel Ehrbar
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanesa Obas
- Department of Medicine, Internal Medicine Residency Program, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Albin Oh
- Department of Medicine, Internal Medicine Residency Program, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Lung, and Blood Institute’s Framingham Heart Study, Boston University’s and National Heart, Framingham, Massachusetts, United States of America
- Department of Medicine, Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Lung, and Blood Institute’s Framingham Heart Study, Boston University’s and National Heart, Framingham, Massachusetts, United States of America
- * E-mail:
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17
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Nenna A, Nappi F, Spadaccio C, Greco SM, Pilato M, Stilo F, Montelione N, Catanese V, Lusini M, Spinelli F, Chello M. Advanced measurements of coronary calcium scores: how does it affect current clinical practice? Future Cardiol 2021; 18:35-41. [PMID: 33885330 DOI: 10.2217/fca-2020-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Coronary artery calcium (CAC) scoring has emerged as a marker of the burden of atheromatous disease and has been included in scoring systems. The practice of myocardial revascularization, considering percutaneous procedures or surgical strategies, is dramatically changing over years and the prognostic significance of CAC scoring is gradually being conceived. In this interdisciplinary scenario, vessel specific calcium scoring, mapping of coronary calcification and its integration with functional assessment of coronary artery disease might change the future decisions in the catheterization lab and operative theaters. This article summarizes CAC evaluation techniques and its implications in clinical practice.
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Affiliation(s)
- Antonio Nenna
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord, Saint Denis, Paris, France
| | | | - Salvatore Matteo Greco
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.,Cardiac Surgery, ISMETT-IRCCS, Palermo, Italy
| | | | - Francesco Stilo
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Nunzio Montelione
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Catanese
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Spinelli
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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18
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Tao S, Sheedy E, Bruesewitz M, Weber N, Williams K, Halaweish A, Schmidt B, Williamson E, McCollough C, Leng S. Technical Note: kV-independent coronary calcium scoring: A phantom evaluation of score accuracy and potential radiation dose reduction. Med Phys 2021; 48:1307-1314. [PMID: 33332626 DOI: 10.1002/mp.14663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To determine the accuracy of CT number and calcium score of a kV-independent technique based on an artificial 120 kV reconstruction, and its potential to reduce radiation dose. METHODS Anthropomorphic chest phantoms were scanned on a third-generation dual-source CT system equipped with the artificial 120 kV reconstruction. First, a phantom module containing a 20-mm diameter hydroxyapatite (HA) insert was scanned inside the chest phantoms at different tube potentials (70-140 kV) to evaluate calcium CT number accuracy. Next, three small HA inserts (diameter/length = 5 mm) were inserted into a pork steak and scanned inside the phantoms to evaluate calcium score accuracy at different kVs. Finally, the same setup was scanned using automatic exposure control (AEC) at 120 kV, and then with automatic kV selection (auto-kV). Phantoms were also scanned at 120 kV using a size-dependent mA chart. CT numbers of soft tissue and calcium were measured from different kV images. Calcium score of each small HA insert was measured using commercial software. RESULTS The CT number difference from 120 kV was small with tube potentials from 90 to 140 kV for both soft tissue and calcium (maximal difference of 4/5 HU, respectively). Consistent calcium scores were obtained from images of different kVs compared to 120 kV, with a relative difference <8%. Auto-kV provided a 25-34% dose reduction compared to AEC alone. CONCLUSION A kV-independent calcium scoring technique can produce artificial 120 kV images with consistent soft tissue and calcium CT numbers compared to standard 120 kV examinations. When coupled with auto-kV, this technique can reduce radiation by 25-34% compared to that with AEC alone, while providing consistent calcium scores as that of standard 120 kV examinations.
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Affiliation(s)
- Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Emily Sheedy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nikkole Weber
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kyle Williams
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Bernhard Schmidt
- Siemens Healthineers, Siemensstraße 1, Forchheim, 91301, Germany
| | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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19
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Coronary artery calcium: A technical argument for a new scoring method. J Cardiovasc Comput Tomogr 2019; 13:347-352. [DOI: 10.1016/j.jcct.2018.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/24/2023]
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20
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Šprem J, de Vos BD, Lessmann N, van Hamersvelt RW, Greuter MJW, de Jong PA, Leiner T, Viergever MA, Išgum I. Coronary calcium scoring with partial volume correction in anthropomorphic thorax phantom and screening chest CT images. PLoS One 2018; 13:e0209318. [PMID: 30571729 PMCID: PMC6301689 DOI: 10.1371/journal.pone.0209318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The amount of coronary artery calcium determined in CT scans is a well established predictor of cardiovascular events. However, high interscan variability of coronary calcium quantification may lead to incorrect cardiovascular risk assignment. Partial volume effect contributes to high interscan variability. Hence, we propose a method for coronary calcium quantification employing partial volume correction. METHODS Two phantoms containing artificial coronary artery calcifications and 293 subject chest CT scans were used. The first and second phantom contained nine calcifications and the second phantom contained three artificial arteries with three calcifications of different volumes, shapes and densities. The first phantom was scanned five times with and without extension rings. The second phantom was scanned three times without and with simulated cardiac motion (10 and 30 mm/s). Chest CT scans were acquired without ECG-synchronization and reconstructed using sharp and soft kernels. Coronary calcifications were annotated employing the clinically used intensity value thresholding (130 HU). Thereafter, a threshold separating each calcification from its background was determined using an Expectation-Maximization algorithm. Finally, for each lesion the partial content of calcification in each voxel was determined depending on its intensity and the determined threshold. RESULTS Clinical calcium scoring resulted in overestimation of calcium volume for medium and high density calcifications in the first phantom, and overestimation of calcium volume for high density and underestimation for low density calcifications in the second phantom. With induced motion these effects were further emphasized. The proposed quantification resulted in better accuracy and substantially lower over- and underestimation of calcium volume even in presence of motion. In chest CT, the agreement between calcium scores from the two reconstructions improved when proposed method was used. CONCLUSION Compared with clinical calcium scoring, proposed quantification provides a better estimate of the true calcium volume in phantoms and better agreement in calcium scores between different subject scan reconstructions.
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Affiliation(s)
- Jurica Šprem
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Bob D de Vos
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Nikolas Lessmann
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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Chuang ML, Gona PN, Qazi S, Musgrave RM, Fox CS, Massaro JM, Hoffmann U, O'Donnell CJ. Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community. J Am Heart Assoc 2018; 7:e008057. [PMID: 29909404 PMCID: PMC6220524 DOI: 10.1161/jaha.117.008057] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/20/2017] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to determine whether increased aortic arch width (AAW) adds to standard Framingham risk factors and coronary artery calcium (CAC) for prediction of incident adverse cardiovascular disease (CVD) events in community-dwelling adults. METHODS AND RESULTS A total of 3026 Framingham Heart Study Offspring and Third Generation cohort participants underwent noncontrast multidetector computed tomography from 2002 to 2005 to quantify CAC. We measured AAW as the distance between the centroids of the ascending and descending thoracic aorta, at the level of main pulmonary artery bifurcation or the right pulmonary artery. We determined sex, age group, and body size specific cut points for high (≥90th percentile) AAW from a healthy referent group (N=1471) and dichotomized AAW as high or not high across all study participants. Clinical covariates were obtained at Offspring cycle 7 (1998-2001) or Third Generation cycle 1 (2002-2005) examinations. The primary CVD outcome was a composite of myocardial infarction, coronary insufficiency, cerebrovascular accident, first hospitalization for heart failure, or CVD death. Cox proportional hazards models were used to estimate hazard ratio of high AAW on time-to-incident CVD after adjustment for Framingham risk factors and CAC. Net reclassification improvement was used to assess the effect of adding AAW to the baseline Framingham risk factor+CAC model. A total of 2826 participants (aged 51±11 years, 48% women) had complete covariates and were free of CVD at multidetector computed tomography. Over a median 8.9 years of follow-up, there were 135 incident CVD events. High AAW was independently predictive of CVD events (hazard ratio, 1.55; P=0.032) and appropriately reclassified participants at risk: net reclassification improvement, 0.31 (95% confidence interval, 0.15-0.48). CONCLUSION AAW augments traditional CVD risk factors and CAC for prediction of incident adverse CVD events among community-dwelling adults.
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Affiliation(s)
- Michael L Chuang
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Philimon N Gona
- College of Nursing and Health Sciences, University of Massachusetts, Boston, MA
| | - Saadia Qazi
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
- Cardiology Section, Boston Veteran's Affairs Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rebecca M Musgrave
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
| | - Caroline S Fox
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
| | - Joseph M Massaro
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Udo Hoffmann
- Harvard Medical School, Boston, MA
- Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Christopher J O'Donnell
- The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA
- Cardiology Section, Boston Veteran's Affairs Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
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Coronary artery calcium assessed with calibrated mass scoring in asymptomatic individuals: results from the Copenhagen General Population Study. Eur Radiol 2018; 28:4607-4614. [DOI: 10.1007/s00330-018-5446-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 01/07/2023]
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van der Werf NR, Willemink MJ, Willems TP, Greuter MJW, Leiner T. Influence of iterative reconstruction on coronary calcium scores at multiple heart rates: a multivendor phantom study on state-of-the-art CT systems. Int J Cardiovasc Imaging 2017; 34:947-957. [DOI: 10.1007/s10554-017-1292-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
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Noguchi T, Nakao K, Asaumi Y, Morita Y, Otsuka F, Kataoka Y, Hosoda H, Miura H, Fukuda T, Yasuda S. Noninvasive Coronary Plaque Imaging. J Atheroscler Thromb 2017; 25:281-293. [PMID: 29225326 PMCID: PMC5906180 DOI: 10.5551/jat.rv17019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Early identification of high-risk or vulnerable atherosclerotic plaques prone to rupture and performing preemptive therapy prior to catastrophic cardiovascular events are optimal goals of plaque imaging. Despite the advances in imaging modalities to identify vulnerable characteristics, the predictive value of the imaging techniques in the clinical setting is still developing. In this regard, reliable and high-sensitive imaging modalities identifying vulnerable plaque characters that may lead to future cardiovascular events will be useful. In this review article, we describe a current non-invasive plaque imaging technique to identify high-risk coronary plaque features.
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Affiliation(s)
- Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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25
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Landreth SP, Spearman JV. Machine Learning in Cardiac CT. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Pursnani A, Massaro JM, D'Agostino RB, O'Donnell CJ, Hoffmann U. Guideline-Based Statin Eligibility, Cancer Events, and Noncardiovascular Mortality in the Framingham Heart Study. J Clin Oncol 2017; 35:2927-2933. [PMID: 28700275 DOI: 10.1200/jco.2016.71.3594] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Cancer and cardiovascular disease share risk factors, and there is some evidence that statins reduce cancer mortality. We sought to determine the accuracy of the 2013 American College of Cardiology/American Heart Association statin eligibility criteria to identify individuals at a higher risk of developing cancer or of dying as a result of cancer or other noncardiovascular causes. Methods We included 2,196 participants (50.5 ± 8.1 years of age; 55% female) who were statin naïve and free of cancer at baseline from the offspring and third-generation cohorts of the community-based longitudinal Framingham Heart Study. Statin eligibility was determined per American College of Cardiology/American Heart Association guidelines, and subclinical coronary atherosclerosis was assessed by computed tomography. The primary outcome was incident cancer at a median of 10.0 years (interquartile range, 9.1-10.6 years) of follow-up, and secondary outcomes were cancer mortality and noncardiovascular mortality. Results The incident cancer rate was 11.2% (247 of 2,196), with 58 noncardiovascular deaths, including 39 cancer deaths (1.8%). Overall, 37% (812 of 2,196) were statin eligible. Incident cancer occurred in 125 (15%) of the 812 statin-eligible participants versus 122 (8.8%) of the 1,384 of noneligible participants (subdistribution hazard ratio [SDHR], 1.8 [1.4 to 2.3]; P < .001). Cancer mortality occurred in 34 (4.2%) of the 812 statin-eligible participants versus five (0.4%) of the 1,384 noneligible participants (SDHR, 12.1 [4.7 to 31]; P < .001). Noncardiovascular mortality occurred in 49 (6.0%) of the 812 statin-eligible participants versus nine (0.7%) of the 1,384 noneligible participants (SDHR, 10.1 [5.0 to 21]; P < .001). In stratified analyses, these findings were independent of any individual causative risk factor such as body mass index, age, or smoking status. Conclusion In this community-based primary prevention cohort, guideline-based statin eligibility accurately identified patients at a higher risk of developing cancer and cancer-related mortality. Shared risk profiles and potential benefits of statins between cancer and cardiovascular outcomes may provide a unique opportunity to improve population health.
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Affiliation(s)
- Amit Pursnani
- Amit Pursnani, NorthShore University Health System, Evanston, IL; Amit Pursnani and Udo Hoffmann, Massachusetts General Hospital, Harvard Medical School; Joseph M. Massaro and Ralph B. D'Agostino Sr, Boston University; Christopher J. O'Donnell, Boston Veterans Administration Healthcare, Boston; Joseph M. Massaro, Ralph B. D'Agostino Sr, and Christopher J. O'Donnell, The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, MA; and Christopher J. O'Donnell, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Joseph M Massaro
- Amit Pursnani, NorthShore University Health System, Evanston, IL; Amit Pursnani and Udo Hoffmann, Massachusetts General Hospital, Harvard Medical School; Joseph M. Massaro and Ralph B. D'Agostino Sr, Boston University; Christopher J. O'Donnell, Boston Veterans Administration Healthcare, Boston; Joseph M. Massaro, Ralph B. D'Agostino Sr, and Christopher J. O'Donnell, The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, MA; and Christopher J. O'Donnell, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Ralph B D'Agostino
- Amit Pursnani, NorthShore University Health System, Evanston, IL; Amit Pursnani and Udo Hoffmann, Massachusetts General Hospital, Harvard Medical School; Joseph M. Massaro and Ralph B. D'Agostino Sr, Boston University; Christopher J. O'Donnell, Boston Veterans Administration Healthcare, Boston; Joseph M. Massaro, Ralph B. D'Agostino Sr, and Christopher J. O'Donnell, The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, MA; and Christopher J. O'Donnell, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Christopher J O'Donnell
- Amit Pursnani, NorthShore University Health System, Evanston, IL; Amit Pursnani and Udo Hoffmann, Massachusetts General Hospital, Harvard Medical School; Joseph M. Massaro and Ralph B. D'Agostino Sr, Boston University; Christopher J. O'Donnell, Boston Veterans Administration Healthcare, Boston; Joseph M. Massaro, Ralph B. D'Agostino Sr, and Christopher J. O'Donnell, The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, MA; and Christopher J. O'Donnell, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Udo Hoffmann
- Amit Pursnani, NorthShore University Health System, Evanston, IL; Amit Pursnani and Udo Hoffmann, Massachusetts General Hospital, Harvard Medical School; Joseph M. Massaro and Ralph B. D'Agostino Sr, Boston University; Christopher J. O'Donnell, Boston Veterans Administration Healthcare, Boston; Joseph M. Massaro, Ralph B. D'Agostino Sr, and Christopher J. O'Donnell, The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, MA; and Christopher J. O'Donnell, National Heart, Lung and Blood Institute, Bethesda, MD
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Paixao ARM, Neeland IJ, Ayers CR, Xing F, Berry JD, de Lemos JA, Abbara S, Peshock RM, Khera A. Defining coronary artery calcium concordance and repeatability - Implications for development and change: The Dallas Heart Study. J Cardiovasc Comput Tomogr 2017; 11:347-353. [PMID: 28732689 DOI: 10.1016/j.jcct.2017.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/14/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Development and change of coronary artery calcium (CAC) are associated with coronary heart disease. Interpretation of serial CAC measurements will require better understanding of changes in CAC beyond the variability in the test itself. METHODS Dallas Heart Study participants (2888) with duplicate CAC scans obtained minutes apart were analyzed to determine interscan concordance and 95% confidence bounds (ie: repeatability limits) for each discrete CAC value. These data derived cutoffs were then used to define change above measurement variation and determine the frequency of CAC development and change among 1779 subjects with follow up CAC scans performed 6.9 years later. RESULTS Binary concordance (0 vs. >0) was 91%. The value of CAC denoting true development of CAC by exceeding the 95% confidence bounds for a single score of 0 was 2.7 Agatston units (AU). Among those with scores >0, the 95% confidence bounds for CAC change were determined by the following formulas: for CAC≤100AU: 5.6√CAC + 0.3*CAC - 3.1; for CAC>100AU: 12.4√CAC - 67.7. Using these parameters, CAC development occurred in 15.0% and CAC change occurred in 48.9%. Although 225 individuals (24.9%) had a decrease in CAC over follow up, only 1 (0.1%) crossed the lower confidence bound. Compared with prior reported definition of CAC development (ie: >0), the novel threshold of 2.7AU resulted in better measures of model performance. In contrast, for CAC change, no consistent differences in performance metrics were observed compared with previously reported definitions. CONCLUSION There is significant interscan variability in CAC measurement, including around scores of 0. Incorporating repeatability estimates may help discern true differences from those due to measurement variability, an approach that may enhance determination of CAC development and change.
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Affiliation(s)
- Andre R M Paixao
- Arkansas Heart Hospital, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ian J Neeland
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Frank Xing
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jarett D Berry
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ronald M Peshock
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Niiranen TJ, Lyass A, Larson MG, Hamburg NM, Benjamin EJ, Mitchell GF, Vasan RS. Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort: The Framingham Heart Study. Hypertension 2017; 70:267-274. [PMID: 28559398 DOI: 10.1161/hypertensionaha.117.09026] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/17/2017] [Accepted: 04/02/2017] [Indexed: 12/24/2022]
Abstract
Hypertension and increased vascular stiffness are viewed as inevitable parts of aging. To elucidate whether the age-related decrease in vascular function is avoidable, we assessed the prevalence, correlates, and prognosis of healthy vascular aging (HVA) in 3196 Framingham Study participants aged ≥50 years. We defined HVA as absence of hypertension and pulse wave velocity <7.6 m/s (mean+2 SD of a reference sample aged <30 years). Overall, 566 (17.7%) individuals had HVA, with prevalence decreasing from 30.3% in people aged 50 to 59 to 1% in those aged ≥70 years. In regression models adjusted for physical activity, caloric intake, and traditional cardiovascular disease (CVD) risk factors, we observed that lower age, female sex, lower body mass index, use of lipid-lowering drugs, and absence of diabetes mellitus were cross-sectionally associated with HVA (P<0.001 for all). A unit increase in a cardiovascular health score (Life's Simple 7) was associated with 1.55-fold (95% confidence interval, 1.38-1.74) age- and sex-adjusted odds of HVA. During a follow-up of 9.6 years, 391 CVD events occurred. In Cox regression models adjusted for traditional CVD risk factors, including blood pressure, HVA was associated with a hazard ratio of 0.45 (95% confidence interval, 0.26-0.77) for CVD relative to absence of HVA. Although HVA is achievable in individuals acculturated to a Western lifestyle, maintaining normal vascular function beyond 70 years of age is challenging. Although our data are observational, our findings support prevention strategies targeting modifiable factors and behaviors and obesity, in particular, to prevent or delay vascular aging and the associated risk of CVD.
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Affiliation(s)
- Teemu J Niiranen
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.).
| | - Asya Lyass
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Martin G Larson
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Naomi M Hamburg
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Gary F Mitchell
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Ramachandran S Vasan
- From the National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N., A.L., M.G.L., E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, MA (A.L., M.G.L.); Department of Biostatistics (M.G.L.), Evans Department of Medicine, Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), Section of Preventive Medicine, Department of Medicine (E.J.B., R.S.V.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
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Lee JJ, Pedley A, Weinberg I, Britton KA, Massaro JM, Hoffmann U, Manders E, Fox CS, Murabito JM. Relation of Iliac Artery Calcium With Adiposity Measures and Peripheral Artery Disease. Am J Cardiol 2017; 119:1217-1223. [PMID: 28219666 DOI: 10.1016/j.amjcard.2016.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022]
Abstract
Arterial calcification is associated with cardiovascular morbidity and mortality. To improve the understanding of the pathogenesis involved with iliac artery calcium (IAC), we sought to examine the associations between the burden of IAC with adiposity measures and peripheral artery disease (PAD). Participants (n = 1,236, 52% women, mean age 60 years) were drawn from the Framingham Heart Study Offspring cohort who underwent multidetector computed tomography. The extent of IAC was quantified based on calcified atherosclerotic plaques detected in the iliac arteries. High IAC was defined based on gender-specific 90th percentile cut-off points from a healthy referent subsample. PAD is defined as an ankle-brachial index < 0.9, intermittent claudication, and/or history of lower extremity revascularization. The association between PAD and IAC was assessed using multivariable-adjusted logistic regression models. The burden of high IAC was 20.5% in women and 25.5% in men. High IAC was not associated with generalized (body mass index) or area-specific (waist circumference, and volumes of thoracic periaortic, abdominal subcutaneous, and visceral adipose tissue) adiposity measures (all p ≥0.22). High IAC was associated with increased odds of PAD (odds ratio 10.36, 95% confidence interval 4.28 to 25.09). This association persisted even after additionally adjusting for coronary artery calcium (odds ratio 11.25, 95% confidence interval 4.29 to 29.53). Burden of IAC was associated with an increased risk of PAD.
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Nezarat N, Kim M, Budoff M. Role of Coronary Calcium for Risk Stratification and Prognostication. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:8. [DOI: 10.1007/s11936-017-0509-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fuchs A, Groen JM, Arnold BA, Nikolovski S, Knudsen AD, Kühl JT, Nordestgaard BG, Greuter MJ, Kofoed KF. Assessment of coronary calcification using calibrated mass score with two different multidetector computed tomography scanners in the Copenhagen General Population Study. Eur J Radiol 2017; 88:21-25. [DOI: 10.1016/j.ejrad.2016.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/16/2016] [Accepted: 12/28/2016] [Indexed: 01/07/2023]
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Yau MS, Demissie S, Zhou Y, Anderson DE, Lorbergs AL, Kiel DP, Allaire BT, Yang L, Cupples LA, Travison TG, Bouxsein ML, Karasik D, Samelson EJ. Heritability of Thoracic Spine Curvature and Genetic Correlations With Other Spine Traits: The Framingham Study. J Bone Miner Res 2016; 31:2077-2084. [PMID: 27455046 PMCID: PMC5282513 DOI: 10.1002/jbmr.2925] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
Abstract
Hyperkyphosis is a common spinal disorder in older adults, characterized by excessive forward curvature of the thoracic spine and adverse health outcomes. The etiology of hyperkyphosis has not been firmly established, but may be related to changes that occur with aging in the vertebrae, discs, joints, and muscles, which function as a unit to support the spine. Determining the contribution of genetics to thoracic spine curvature and the degree of genetic sharing among co-occurring measures of spine health may provide insight into the etiology of hyperkyphosis. The purpose of our study was to estimate heritability of thoracic spine curvature using T4 -T12 kyphosis (Cobb) angle and genetic correlations between thoracic spine curvature and vertebral fracture, intervertebral disc height narrowing, facet joint osteoarthritis (OA), lumbar spine volumetric bone mineral density (vBMD), and paraspinal muscle area and density, which were all assessed from computed tomography (CT) images. Participants included 2063 women and men in the second and third generation offspring of the original cohort of the Framingham Study. Heritability of kyphosis angle, adjusted for age, sex, and weight, was 54% (95% confidence interval [CI], 43% to 64%). We found moderate genetic correlations between kyphosis angle and paraspinal muscle area (ρˆG , -0.46; 95% CI, -0.67 to -0.26), vertebral fracture (ρˆG , 0.39; 95% CI, 0.18 to 0.61), vBMD (ρˆG , -0.23; 95% CI, -0.41 to -0.04), and paraspinal muscle density (ρˆG , -0.22; 95% CI, -0.48 to 0.03). Genetic correlations between kyphosis angle and disc height narrowing (ρˆG , 0.17; 95% CI, -0.05 to 0.38) and facet joint OA (ρˆG , 0.05; 95% CI, -0.15 to 0.24) were low. Thoracic spine curvature may be heritable and share genetic factors with other age-related spine traits including trunk muscle size, vertebral fracture, and bone mineral density. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Michelle S Yau
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Amanda L Lorbergs
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Brett T Allaire
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Laiji Yang
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- National Heart Lung and Blood Institute Framingham Heart Study, Framingham, MA, USA
| | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David Karasik
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Elizabeth J Samelson
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Aortic Valve and Thoracic Aortic Calcification Measurements: How Low Can We Go in Radiation Dose? J Comput Assist Tomogr 2016; 41:148-155. [PMID: 27560017 DOI: 10.1097/rct.0000000000000477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to determine the lowest radiation dose and iterative reconstruction level(s) at which computed tomography (CT)-based quantification of aortic valve calcification (AVC) and thoracic aortic calcification (TAC) is still feasible. METHODS Twenty-eight patients underwent a cardiac CT and 20 patients a chest CT at 4 different dose levels (routine dose and approximately 40%, 60%, and 80% reduced dose). Data were reconstructed with filtered back projection, 3 iDose levels, and 3 iterative model-based reconstruction levels. Two observers scored subjective image quality. The AVC and TAC were quantified using mass and compared to the reference scan (routine dose reconstructed with filtered back projection). RESULTS In cardiac CT at 0.35 mSv (60% reduced), all scans reconstructed with iDose (all levels) were diagnostic, calcification detection errors occurred in only 1 patient, and there were no significant differences in mass scores compared to the reference scan. Similar results were found for chest CT at 0.48 mSv (75% reduced) with iDose levels 4 and 6 and iterative model reconstruction levels 1 and 2. CONCLUSIONS Iterative reconstruction enables AVC and TAC quantification on CT at submillisievert dose.
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Wolterink JM, Leiner T, de Vos BD, van Hamersvelt RW, Viergever MA, Išgum I. Automatic coronary artery calcium scoring in cardiac CT angiography using paired convolutional neural networks. Med Image Anal 2016; 34:123-136. [PMID: 27138584 DOI: 10.1016/j.media.2016.04.004] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/07/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023]
Abstract
The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. CAC is clinically quantified in cardiac calcium scoring CT (CSCT), but it has been shown that cardiac CT angiography (CCTA) may also be used for this purpose. We present a method for automatic CAC quantification in CCTA. This method uses supervised learning to directly identify and quantify CAC without a need for coronary artery extraction commonly used in existing methods. The study included cardiac CT exams of 250 patients for whom both a CCTA and a CSCT scan were available. To restrict the volume-of-interest for analysis, a bounding box around the heart is automatically determined. The bounding box detection algorithm employs a combination of three ConvNets, where each detects the heart in a different orthogonal plane (axial, sagittal, coronal). These ConvNets were trained using 50 cardiac CT exams. In the remaining 200 exams, a reference standard for CAC was defined in CSCT and CCTA. Out of these, 100 CCTA scans were used for training, and the remaining 100 for evaluation of a voxel classification method for CAC identification. The method uses ConvPairs, pairs of convolutional neural networks (ConvNets). The first ConvNet in a pair identifies voxels likely to be CAC, thereby discarding the majority of non-CAC-like voxels such as lung and fatty tissue. The identified CAC-like voxels are further classified by the second ConvNet in the pair, which distinguishes between CAC and CAC-like negatives. Given the different task of each ConvNet, they share their architecture, but not their weights. Input patches are either 2.5D or 3D. The ConvNets are purely convolutional, i.e. no pooling layers are present and fully connected layers are implemented as convolutions, thereby allowing efficient voxel classification. The performance of individual 2.5D and 3D ConvPairs with input sizes of 15 and 25 voxels, as well as the performance of ensembles of these ConvPairs, were evaluated by a comparison with reference annotations in CCTA and CSCT. In all cases, ensembles of ConvPairs outperformed their individual members. The best performing individual ConvPair detected 72% of lesions in the test set, with on average 0.85 false positive (FP) errors per scan. The best performing ensemble combined all ConvPairs and obtained a sensitivity of 71% at 0.48 FP errors per scan. For this ensemble, agreement with the reference mass score in CSCT was excellent (ICC 0.944 [0.918-0.962]). Aditionally, based on the Agatston score in CCTA, this ensemble assigned 83% of patients to the same cardiovascular risk category as reference CSCT. In conclusion, CAC can be accurately automatically identified and quantified in CCTA using the proposed pattern recognition method. This might obviate the need to acquire a dedicated CSCT scan for CAC scoring, which is regularly acquired prior to a CCTA, and thus reduce the CT radiation dose received by patients.
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Affiliation(s)
- Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht, Q.02.4.45, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, E.01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Bob D de Vos
- Image Sciences Institute, University Medical Center Utrecht, Q.02.4.45, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, E.01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Q.02.4.45, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Q.02.4.45, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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Hoffmann U, Massaro JM, D'Agostino RB, Kathiresan S, Fox CS, O'Donnell CJ. Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study. J Am Heart Assoc 2016; 5:e003144. [PMID: 26903006 PMCID: PMC4802453 DOI: 10.1161/jaha.115.003144] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality independent of Framingham risk factors in the community-based Framingham Heart Study. METHODS AND RESULTS Coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C-statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all-cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all-cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78-0.82; net reclassification index 32%, 95% CI 11-53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5-10%) 10-year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%). CONCLUSIONS CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community-dwelling persons and accurately reclassifies two-thirds of the intermediate-risk population.
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Affiliation(s)
- Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joseph M Massaro
- Department of Mathematics, Boston University, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA
| | - Ralph B D'Agostino
- Department of Mathematics, Boston University, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA
| | - Sekar Kathiresan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Caroline S Fox
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA Division of Intramural Research, NHLBI, Bethesda, MD
| | - Christopher J O'Donnell
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA Division of Intramural Research, NHLBI, Bethesda, MD
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Chan JJ, Cupples LA, Kiel DP, O'Donnell CJ, Hoffmann U, Samelson EJ. QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study. J Bone Miner Res 2015; 30:1767-74. [PMID: 25871790 PMCID: PMC4809363 DOI: 10.1002/jbmr.2530] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/24/2015] [Accepted: 04/09/2015] [Indexed: 11/06/2022]
Abstract
There is increasing evidence that bone and vascular calcification share common pathogenesis. Little is known about potential links between bone and valvular calcification. The purpose of this study was to determine the association between spine bone mineral density (BMD) and vascular and valvular calcification. Participants included 1317 participants (689 women, 628 men) in the Framingham Offspring Study (mean age 60 years). Integral, trabecular, and cortical volumetric bone density (vBMD) and arterial and valvular calcification were measured from computed tomography (CT) scans and categorized by sex-specific quartiles (Q4 = high vBMD). Calcification of the coronary arteries (CAC), abdominal aorta (AAC), aortic valve (AVC), and mitral valve (MVC) were quantified using the Agatston Score (AS). Prevalence of any calcium (AS >0) was 69% for CAC, 81% for AAC, 39% for AVC, and 20% for MVC. In women, CAC increased with decreasing quartile of trabecular vBMD: adjusted mean CAC = 2.1 (Q4), 2.2 (Q3), 2.5 (Q2), 2.6 (Q1); trend p = 0.04. However, there was no inverse trend between CAC and trabecular vBMD in men: CAC = 4.3 (Q4), 4.3 (Q3), 4.2 (Q2), 4.3 (Q1); trend p = 0.92. AAC increased with decreasing quartile of trabecular vBMD in both women (AAC = 4.5 [Q4], 4.8 [Q3], 5.4 [Q2], 5.1 [Q1]; trend p = 0.01) and men (AAC = 5.5 [Q4], 5.8 [Q3], 5.9 [Q2], 6.2 [Q1]; trend p = 0.01). We observed no association between trabecular vBMD and AVC or MVC in women or men. Finally, cortical vBMD was unrelated to vascular calcification and valvular calcification in women and men. Women and men with low spine vBMD have greater severity of vascular calcification, particularly at the abdominal aorta. The inverse relation between AAC and spine vBMD in women and men may be attributable to shared etiology and may be an important link on which to focus treatment efforts that can target individuals at high risk of both fracture and cardiovascular events.
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Affiliation(s)
- Jimmy J Chan
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - L Adrienne Cupples
- Boston University School of Public Health, Boston, MA, USA
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Douglas P Kiel
- Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Udo Hoffmann
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth J Samelson
- Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ohmoto-Sekine Y, Yanagibori R, Amakawa K, Ishihara M, Tsuji H, Ogawa K, Ishimura R, Ishiwata S, Ohno M, Yamaguchi T, Arase Y. Prevalence and distribution of coronary calcium in asymptomatic Japanese subjects in lung cancer screening computed tomography. J Cardiol 2015. [PMID: 26213250 DOI: 10.1016/j.jjcc.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) is associated with a risk of coronary heart disease. The prevalence and distribution of the CAC score have been examined in Western countries, but few studies have been performed in Asia, and especially in Japan. The goal of this study was to investigate CAC scores in an asymptomatic Japanese population. METHODS CAC score and risk factors were analyzed in 1834 asymptomatic subjects who underwent lung cancer screening computed tomography. RESULTS CAC was present in 26.9% of all the subjects, 29.8% of the males, and 17.1% of the females. In all age groups, the CAC score was higher in males. In multivariate analysis, male gender [odds ratio (OR) 2.461, 95% confidence interval (CI) 1.361-4.452, p=0.002], aging (OR 1.102, 95% CI 1.081-1.123, p<0.001), dyslipidemia (OR 1.740, 95% CI 1.216-2.490, p=0.002), and fasting glucose (OR 1.008, 95% CI 1.002-1.015, p=0.012) were significantly associated with a CAC score >100. CONCLUSION The results of this study provide a pattern of CAC distribution based on age and gender in asymptomatic Japanese subjects. This pattern was similar to that in Western countries, although the absolute CAC scores were lower. High CAC scores were associated with male gender, aging, dyslipidemia, and fasting glucose.
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Affiliation(s)
| | - Ryoko Yanagibori
- Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | | | | | - Hiroshi Tsuji
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Kyoko Ogawa
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | | | | | - Minoru Ohno
- Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | | | - Yasuji Arase
- Health Management Center, Toranomon Hospital, Tokyo, Japan
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Pursnani A, Massaro JM, D'Agostino RB, O'Donnell CJ, Hoffmann U. Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA 2015; 314:134-41. [PMID: 26172893 PMCID: PMC4754085 DOI: 10.1001/jama.2015.7515] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for cholesterol management defined new eligibility criteria for statin therapy. However, it is unclear whether this approach improves identification of adults at higher risk of cardiovascular events. OBJECTIVE To determine whether the ACC/AHA guidelines improve identification of individuals who develop incident cardiovascular disease (CVD) and/or have coronary artery calcification (CAC) compared with the National Cholesterol Education Program's 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines. DESIGN, SETTING, AND PARTICIPANTS Longitudinal community-based cohort study, with participants for this investigation drawn from the offspring and third-generation cohorts of the Framingham Heart Study. Participants underwent multidetector computed tomography for CAC between 2002 and 2005 and were followed up for a median of 9.4 years for incident CVD. EXPOSURES Statin eligibility was determined based on Framingham risk factors and low-density lipoprotein thresholds for ATP III, whereas the pooled cohort calculator was used for ACC/AHA. MAIN OUTCOMES AND MEASURES The primary outcome was incident CVD (myocardial infarction, death due to coronary heart disease [CHD], or ischemic stroke). Secondary outcomes were CHD and CAC (as measured by the Agatston score). RESULTS Among 2435 statin-naive participants (mean age, 51.3 [SD, 8.6] years; 56% female), 39% (941/2435) were statin eligible by ACC/AHA compared with 14% (348/2435) by ATP III (P < .001). There were 74 incident CVD events (40 nonfatal myocardial infarctions, 31 nonfatal ischemic strokes, and 3 fatal CHD events). Participants who were statin eligible by ACC/AHA had increased hazard ratios for incident CVD compared with those eligible by ATP III: 6.8 (95% CI, 3.8-11.9) vs 3.1 (95% CI, 1.9-5.0), respectively (P<.001). Similar results were seen for CVD in participants with intermediate Framingham Risk Scores and for CHD. Participants who were newly statin eligible (n = 593 [24%]) had an incident CVD rate of 5.7%, yielding a number needed to treat of 39 to 58. Participants with CAC were more likely to be statin eligible by ACC/AHA than by ATP III: CAC score >0 (n = 1015): 63% vs 23%; CAC score >100 (n = 376): 80% vs 32%; and CAC score >300 (n = 186): 85% vs 34% (all P < .001). A CAC score of 0 identified a low-risk group among ACC/AHA statin-eligible participants (306/941 [33%]) with a CVD rate of 1.6%. CONCLUSIONS AND RELEVANCE In this community-based primary prevention cohort, the ACC/AHA guidelines for determining statin eligibility, compared with the ATP III, were associated with greater accuracy and efficiency in identifying increased risk of incident CVD and subclinical coronary artery disease, particularly in intermediate-risk participants.
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Affiliation(s)
- Amit Pursnani
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston2Cardiology Division, NorthShore University Health System, Evanston, Illinois
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts4The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts
| | - Ralph B D'Agostino
- The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts5Department of Mathematics, Boston University, Boston, Massachusetts
| | - Christopher J O'Donnell
- The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts6Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland7Cardiology Division, Department of Me
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston7Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Dauriz M, Porneala BC, Guo X, Bielak LF, Peyser PA, Durant NH, Carnethon MR, Bonadonna RC, Bonora E, Bowden DW, Florez JC, Fornage M, Hivert MF, Jacobs DR, Kabagambe EK, Lewis CE, Murabito JM, Rasmussen-Torvik LJ, Rich SS, Vassy JL, Yao J, Carr JJ, Kardia SL, Siscovick D, O'Donnell CJ, Rotter JI, Dupuis J, Meigs JB. Association of a 62 Variants Type 2 Diabetes Genetic Risk Score With Markers of Subclinical Atherosclerosis: A Transethnic, Multicenter Study. CIRCULATION. CARDIOVASCULAR GENETICS 2015; 8:507-15. [PMID: 25805414 PMCID: PMC4472563 DOI: 10.1161/circgenetics.114.000740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 03/09/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) and cardiovascular disease share risk factors and subclinical atherosclerosis (SCA) predicts events in those with and without diabetes mellitus. T2D genetic risk may predict both T2D and SCA. We hypothesized that greater T2D genetic risk is associated with higher extent of SCA. METHODS AND RESULTS In a cross-sectional analysis, including ≤9210 European Americans, 3773 African Americans, 1446 Hispanic Americans, and 773 Chinese Americans without known cardiovascular disease and enrolled in the Framingham Heart Study, Coronary Artery Risk Development in Young Adults, Multi-Ethnic Study of Atherosclerosis, and Genetic Epidemiology Network of Arteriopathy studies, we tested a 62 T2D-loci genetic risk score for association with measures of SCA, including coronary artery or abdominal aortic calcium score, common and internal carotid artery intima-media thickness, and ankle-brachial index. We used ancestry-stratified linear regression models, with random effects accounting for family relatedness when appropriate, applying a genetic-only (adjusted for sex) and a full SCA risk factors-adjusted model (significance, P<0.01=0.05/5, number of traits analyzed). An inverse association with coronary artery calcium score in Multi-Ethnic Study of Atherosclerosis Europeans (fully-adjusted P=0.004) and with common carotid artery intima-media thickness in the Framingham Heart Study (P=0.009) was not confirmed in other study cohorts, either separately or in meta-analysis. Secondary analyses showed no consistent associations with β-cell and insulin resistance genetic risk sub-scores in the Framingham Heart Study and in the Coronary Artery Risk Development in Young Adults. CONCLUSIONS SCA does not have a major genetic component linked to a burden of 62 T2D loci identified by large genome-wide association studies. A shared T2D-SCA genetic basis, if any, might become apparent from better functional information about both T2D and cardiovascular disease risk loci.
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Affiliation(s)
- Marco Dauriz
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Verona Medical School & Hospital Trust of Verona, Verona, Italy
| | - Bianca C. Porneala
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Xiuqing Guo
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Lawrence F. Bielak
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Patricia A. Peyser
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Nefertiti H. Durant
- Division of Pediatrics & Adolescent Medicine, Department of Pediatrics, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Riccardo C. Bonadonna
- Division of Endocrinology, Department of Clinical & Experimental Medicine, University of Parma School of Medicine & AOI of Parma, Parma, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Verona Medical School & Hospital Trust of Verona, Verona, Italy
| | - Donald W. Bowden
- Centers for Diabetes Research & Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biochemistry & Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jose C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA
| | - Myriam Fornage
- Institute of Molecular Medicine & Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX
| | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Division of Endocrinology & Metabolism, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Edmond K. Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama Birmingham School of Public Health, Birmingham, AL
| | - Joanne M. Murabito
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
| | | | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Jason L. Vassy
- Department of Medicine, Harvard Medical School, Boston, MA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Jie Yao
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Sharon L.R. Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Christopher J. O'Donnell
- Department of Medicine, Harvard Medical School, Boston, MA
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | - Jerome I. Rotter
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Josée Dupuis
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - James B. Meigs
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Radiation dose reduction for coronary artery calcium scoring at 320-detector CT with adaptive iterative dose reduction 3D. Int J Cardiovasc Imaging 2015; 31:1045-52. [DOI: 10.1007/s10554-015-0637-7] [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: 01/08/2015] [Accepted: 03/05/2015] [Indexed: 12/20/2022]
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Alluri K, Joshi PH, Henry TS, Blumenthal RS, Nasir K, Blaha MJ. Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 2015; 239:109-17. [PMID: 25585030 DOI: 10.1016/j.atherosclerosis.2014.12.040] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/07/2023]
Abstract
Coronary artery calcium (CAC) scanning is a reliable, noninvasive technique for estimating overall coronary plaque burden and for identifying risk for future cardiac events. Arthur Agatston and Warren Janowitz published the first technique for scoring CAC scans in 1990. Given the lack of available data correlating CAC with burden of coronary atherosclerosis at that time, their scoring algorithm was remarkable, but somewhat arbitrary. Since then, a few other scoring techniques have been proposed for the measurement of CAC including the Volume score and Mass score. Yet despite new data, little in this field has changed in the last 15 years. The main focus of our paper is to review the implications of the current approach to scoring CAC scans in terms of correlation with the central disease - coronary atherosclerosis. We first discuss the methodology of each available scoring system, describing how each of these scores make important indirect assumptions in the way they account (or do not account) for calcium density, location of calcium, spatial distribution of calcium, and microcalcification/emerging calcium that might limit their predictive power. These assumptions require further study in well-designed, large event-driven studies. In general, all of these scores are adequate and are highly correlated with each other. Despite its age, the Agatston score remains the most extensively studied and widely accepted technique in both the clinical and research settings. After discussing CAC scoring in the era of contrast enhanced coronary CT angiography, we discuss suggested potential modifications to current CAC scanning protocols with respect to tube voltage, tube current, and slice thickness which may further improve the value of CAC scoring. We close with a focused discussion of the most important future directions in the field of CAC scoring.
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Affiliation(s)
- Krishna Alluri
- Department of Internal Medicine, UPMC Mckeesport Hospital, Mckeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Travis S Henry
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
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Suri P, Hunter DJ, Boyko EJ, Rainville J, Guermazi A, Katz JN. Physical activity and associations with computed tomography-detected lumbar zygapophyseal joint osteoarthritis. Spine J 2015; 15:42-9. [PMID: 25011094 PMCID: PMC4268336 DOI: 10.1016/j.spinee.2014.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/25/2014] [Accepted: 06/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are no previous epidemiologic studies examining associations between physical activity and imaging-detected lumbar zygapophyseal joint osteoarthritis (ZJO) in a community-based sample. PURPOSE To determine whether physical activity is associated with prevalent lumbar ZJO on computed tomography (CT). STUDY DESIGN/SETTING A community-based cross-sectional study. PATIENT SAMPLE Four hundred twenty-four older adults from the Framingham Heart Study. OUTCOME MEASURES Participants received standardized CT assessments of lumbar ZJO at the L2-S1 levels. Severe lumbar ZJO was defined according to the presence and/or degree of joint space narrowing, osteophytosis, articular process hypertrophy, articular erosions, subchondral cysts, and intra-articular vacuum phenomenon. This definition of lumbar ZJO was based entirely on CT imaging findings and did not include any clinical criteria such as low back pain. METHODS Physical activity was measured using the Physical Activity Index, which estimate hours per day typically spent in these activity categories: sleeping, sitting, slight activity, moderate activity, and heavy activity. Participants reported on usual frequency of walking, running, swimming, and weightlifting. We used multivariable logistic regression to examine associations between self-reported activity and severe lumbar ZJO, while adjusting for key covariates including age, sex, height, and weight. RESULTS In multivariable analyses, ordinal categories of heavy physical activity duration per day were significantly associated with severe lumbar ZJO (p for trend=.04), with the greatest risk observed for the category 3 or more hours per day, odds ratio 2.13 (95% confidence interval [CI] 0.97-4.67). When heavy activity was modeled as a continuous independent variable, each hour was independently associated with 1.19 times the odds of severe lumbar ZJO (95% CI 1.03-1.38, p=.02). Less vigorous types of physical activity and the type of exercise were not associated with severe lumbar ZJO. Older age, lesser height, and greater weight were independently and significantly associated with severe lumbar ZJO. In multivariable models predicting lumbar ZJO, neither model discrimination nor reclassification improved with the addition of physical activity variables, compared with a multivariable model including age, sex, height, and weight. CONCLUSIONS Our findings demonstrate a statistically significant cross-sectional association between heavy physical activity and CT-detected severe lumbar ZJO. However, the additional discriminatory capability of heavy physical activity above and beyond that contributed by other factors was negligible.
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Affiliation(s)
- Pradeep Suri
- VA Puget Sound Healthcare System, 1660 S. Columbian Way, RCS-117, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98103, USA.
| | - David J Hunter
- Department of Rheumatology, Kolling Institute, University of Sydney, Royal North Shore Hospital, Sydney, Clinical Administration 7C, Pacific Highway, St. Leonards, New South Wales, Australia
| | - Edward J Boyko
- VA Puget Sound Healthcare System, 1660 S. Columbian Way, RCS-117, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, RR-512 Health Sciences Building, Box 356420, Seattle, WA 98103, USA
| | - James Rainville
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02215, USA
| | - Jeffrey N Katz
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, BC-4-4016, Boston, MA 02446, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, BC-4-4016, Boston, MA 02446, USA
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Kim DS, Smith JA, Bielak LF, Wu CY, Sun YV, Sheedy PF, Turner ST, Peyser PA, Kardia SLR. The relationship between diastolic blood pressure and coronary artery calcification is dependent on single nucleotide polymorphisms on chromosome 9p21.3. BMC MEDICAL GENETICS 2014; 15:89. [PMID: 25185447 PMCID: PMC4168694 DOI: 10.1186/s12881-014-0089-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/18/2014] [Indexed: 12/20/2022]
Abstract
Background Single nucleotide polymorphisms (SNPs) within the 9p21.3 genomic region have been consistently associated with coronary heart disease (CHD), myocardial infarction, and quantity of coronary artery calcification (CAC), a marker of subclinical atherosclerosis. Prior studies have established an association between blood pressure measures and CAC. To examine mechanisms by which the 9p21.3 genomic region may influence CHD risk, we investigated whether SNPs in 9p21.3 modified associations between blood pressure and CAC quantity. Methods As part of the Genetic Epidemiology Network of Arteriopathy (GENOA) Study, 974 participants underwent non-invasive computed tomography (CT) to measure CAC quantity. Linear mixed effects models were used to investigate whether seven SNPs in the 9p21.3 region modified the association between blood pressure levels and CAC quantity. Four SNPs of at least marginal significance in GENOA for a SNP-by-diastolic blood pressure (DBP) interaction were then tested for replication in the Framingham Heart Study’s Offspring Cohort (N = 1,140). Results We found replicated evidence that one SNP, rs2069416, in CDKN2B-AS1, significantly modified the association between DBP and CAC quantity (combined P = 0.0065; Bonferroni-corrected combined P = 0.0455). Conclusions Our results represent a novel finding that the relationship between DBP and CAC is dependent on genetic variation in the 9p21.3 region. Thus, variation in 9p21.3 may not only be an independent genetic risk factor for CHD, but also may modify the association between DBP levels and the extent of subclinical coronary atherosclerosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sharon L R Kardia
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor 48109, MI, USA.
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Prospective analysis of coronary calcium in patients on dialysis undergoing a near-total parathyroidectomy. Surgery 2013; 154:1315-21; discussion 1321-2. [DOI: 10.1016/j.surg.2013.06.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
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Suri P, Hunter DJ, Rainville J, Guermazi A, Katz JN. Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage 2013; 21:1199-206. [PMID: 23973131 PMCID: PMC4018241 DOI: 10.1016/j.joca.2013.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the presence and extent of severe lumbar facet joint osteoarthritis (OA) are associated with back pain in older adults, accounting for disc height narrowing and other covariates. DESIGN Two hundred and fifty-two older adults from the Framingham Offspring Cohort (mean age 67 years) were studied. Participants received standardized computed tomography (CT) assessments of lumbar facet joint OA and disc height narrowing at the L2-S1 interspaces using four-grade semi-quantitative scales. Severe facet joint OA was defined according to the presence and/or degree of joint space narrowing, osteophytosis, articular process hypertrophy, articular erosions, subchondral cysts, and intraarticular vacuum phenomenon. Severe disc height narrowing was defined as marked narrowing with endplates almost in contact. Back pain was defined as participant report of pain on most days or all days in the past 12 months. We used multivariable logistic regression to examine associations between severe facet joint OA and back pain, adjusting for key covariates including disc height narrowing, sociodemographics, anthropometrics, and health factors. RESULTS Severe facet joint OA was more common in participants with back pain than those without (63.2% vs 46.7%; P = 0.03). In multivariable analyses, presence of any severe facet joint OA remained significantly associated with back pain (odds ratio (OR) 2.15 [95% confidence interval (CI) 1.13-4.08]). Each additional joint with severe OA conferred greater odds of back pain [OR per joint 1.20 (95% CI 1.02-1.41)]. CONCLUSIONS The presence and extent of severe facet joint OA on CT imaging are associated with back pain in community-based older adults, independent of sociodemographics, health factors, and disc height narrowing.
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Affiliation(s)
- P Suri
- VA Puget Sound Healthcare System, Seattle, WA 98108, USA.
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A head-to-head comparison of the coronary calcium score by computed tomography with myocardial perfusion imaging in predicting coronary artery disease. J Geriatr Cardiol 2013; 9:349-54. [PMID: 23341839 PMCID: PMC3545251 DOI: 10.3724/sp.j.1263.2012.06291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/24/2012] [Accepted: 11/02/2012] [Indexed: 12/16/2022] Open
Abstract
Objectives The coronary artery calcium (CAC) score has been shown to predict future cardiac events. However the extent to which the added value of a CAC score to the diagnostic performance of myocardial perfusion imaging (MPI) by single photon emission computed tomography (SPECT) is unclear. The purpose of this study is to investigate the correlation between CAC score and SPECT in patients with suspected coronary artery disease. Methods A retrospective review of the CAC scores by use of the Agatston calcium scoring method and cardiac SPECT diagnostic reports was conducted in 48 patients, who underwent both coronary computed tomography (CT) and SPECT examinations due to suspected coronary artery disease. A Pearson correlation test was used to determine the relation between CAC scores and MPI-SPECT assessments with regard to the evaluation of the extent of disease. Results Forty-seven percent of the patients had CAC scores more than 100, while 42% of these patients demonstrated abnormal, or probably abnormal, MPI-SPECT. Of the 23% of patients with a zero CAC score, only 7% had normal MPI-SPECT findings. No significant correlation was found between the CAC scores and MPI-SPECT assessments (r value ranged from 0.012 to 0.080), regardless of the degree of coronary calcification. Conclusions There is a lack of correlation between the CAC scores and the MPI-SPECT findings in the assessment of the extent of coronary artery disease. CAC scores and MPI-SPECT should be considered complementary approaches in the evaluation of patients with suspected coronary artery disease.
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Samelson EJ, Booth SL, Fox CS, Tucker KL, Wang TJ, Hoffmann U, Cupples LA, O'Donnell CJ, Kiel DP. Calcium intake is not associated with increased coronary artery calcification: the Framingham Study. Am J Clin Nutr 2012; 96:1274-80. [PMID: 23134889 PMCID: PMC3497924 DOI: 10.3945/ajcn.112.044230] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Adequate calcium intake is known to protect the skeleton. However, studies that have reported adverse effects of calcium supplementation on vascular events have raised widespread concern. OBJECTIVE We assessed the association between calcium intake (from diet and supplements) and coronary artery calcification, which is a measure of atherosclerosis that predicts risk of ischemic heart disease independent of other risk factors. DESIGN This was an observational, prospective cohort study. Participants included 690 women and 588 men in the Framingham Offspring Study (mean age: 60 y; range: 36-83 y) who attended clinic visits and completed food-frequency questionnaires in 1998-2001 and underwent computed tomography scans 4 y later in 2002-2005. RESULTS The mean age-adjusted coronary artery-calcification Agatston score decreased with increasing total calcium intake, and the trend was not significant after adjustment for age, BMI, smoking, alcohol consumption, vitamin D-supplement use, energy intake, and, for women, menopause status and estrogen use. Multivariable-adjusted mean Agatston scores were 2.36, 2.52, 2.16, and 2.39 (P-trend = 0.74) with an increasing quartile of total calcium intake in women and 4.32, 4.39, 4.19, and 4.37 (P-trend = 0.94) in men, respectively. Results were similar for dietary calcium and calcium supplement use. CONCLUSIONS Our study does not support the hypothesis that high calcium intake increases coronary artery calcification, which is an important measure of atherosclerosis burden. The evidence is not sufficient to modify current recommendations for calcium intake to protect skeletal health with respect to vascular calcification risk.
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Affiliation(s)
- Elizabeth J Samelson
- Department of Medicine, Harvard Medical School and Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
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Weininger M, Ritz KS, Schoepf UJ, Flohr TG, Vliegenthart R, Costello P, Hahn D, Beissert M. Interplatform Reproducibility of CT Coronary Calcium Scoring Software. Radiology 2012; 265:70-7. [DOI: 10.1148/radiol.12112532] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Williams FMK, Bansal AT, van Meurs JB, Bell JT, Meulenbelt I, Suri P, Rivadeneira F, Sambrook PN, Hofman A, Bierma-Zeinstra S, Menni C, Kloppenburg M, Slagboom PE, Hunter DJ, MacGregor AJ, Uitterlinden AG, Spector TD. Novel genetic variants associated with lumbar disc degeneration in northern Europeans: a meta-analysis of 4600 subjects. Ann Rheum Dis 2012; 72:1141-8. [PMID: 22993228 PMCID: PMC3686263 DOI: 10.1136/annrheumdis-2012-201551] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Lumbar disc degeneration (LDD) is an important cause of low back pain, which is a common and costly problem. LDD is characterised by disc space narrowing and osteophyte growth at the circumference of the disc. To date, the agnostic search of the genome by genome-wide association (GWA) to identify common variants associated with LDD has not been fruitful. This study is the first GWA meta-analysis of LDD. METHODS We have developed a continuous trait based on disc space narrowing and osteophytes growth which is measurable on all forms of imaging (plain radiograph, CT scan and MRI) and performed a meta-analysis of five cohorts of Northern European extraction each having GWA data imputed to HapMap V.2. RESULTS This study of 4600 individuals identified four single nucleotide polymorphisms with p<5×10(-8), the threshold set for genome-wide significance. We identified a variant in the PARK2 gene (p=2.8×10(-8)) associated with LDD. Differential methylation at one CpG island of the PARK2 promoter was observed in a small subset of subjects (β=8.74×10(-4), p=0.006). CONCLUSIONS LDD accounts for a considerable proportion of low back pain and the pathogenesis of LDD is poorly understood. This work provides evidence of association of the PARK2 gene and suggests that methylation of the PARK2 promoter may influence degeneration of the intervertebral disc. This gene has not previously been considered a candidate in LDD and further functional work is needed on this hitherto unsuspected pathway.
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Affiliation(s)
- Frances M K Williams
- Department Twin Research and Genetic Epidemiology, King's College London, London, UK.
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Chuang ML, Massaro JM, Levitzky YS, Fox CS, Manders ES, Hoffmann U, O'Donnell CJ. Prevalence and distribution of abdominal aortic calcium by gender and age group in a community-based cohort (from the Framingham Heart Study). Am J Cardiol 2012; 110:891-6. [PMID: 22727181 PMCID: PMC3432173 DOI: 10.1016/j.amjcard.2012.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/04/2012] [Accepted: 05/04/2012] [Indexed: 11/22/2022]
Abstract
Abdominal aortic calcium (AAC) is associated with incident cardiovascular disease. However, the age- and gender-related distribution of AAC in a community-dwelling population free of standard cardiovascular disease risk factors has not been described. A total of 3,285 participants (aged 50.2 ± 9.9 years) in the Framingham Heart Study Offspring and Third Generation cohorts underwent abdominal multidetector computed tomography from 1998 to 2005. The presence and amount of AAC was quantified (Agatston score) by an experienced reader using standardized criteria. A healthy referent subsample (n = 1,656, 803 men) free of hypertension, hyperlipidemia, diabetes, obesity, and smoking was identified, and participants were stratified by gender and age (<45, 45 to 54, 55 to 64, 65 to 74, and ≥75 years). The prevalence and burden of AAC increased monotonically and supra-linearly with age in both genders but was greater in men than in women in each age group. For those <45 years old, <16% of the referent subsample participants had any quantifiable AAC. However, for those >65 years old, nearly 90% of the referent participants had >0 AAC. Across the entire study sample, AAC prevalence and burden similarly increased with greater age. Defining the 90th percentile of the referent group AAC as "high," the prevalence of high AAC was 19% for each gender in the overall study sample. The AAC also increased across categories of 10-year coronary heart disease risk, as calculated using the Framingham Risk Score, in the entire study sample. We found AAC to be widely prevalent, with the burden of AAC associated with 10-year coronary risk, in a white, free-living adult cohort.
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Affiliation(s)
- Michael L. Chuang
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Joseph M. Massaro
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- Boston University School of Public Health Department of Biostatistics, Boston MA
| | - Yamini S. Levitzky
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Caroline S. Fox
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- Division of Endocrinology, Metabolism, and Diabetes, Brigham and Women's Hospital, Boston MA
- Harvard Medical School, Boston, MA, USA
| | - Emily S. Manders
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Udo Hoffmann
- The Cardiac MR PET CT Program and Department of Radiology, Boston, MA
- Harvard Medical School, Boston, MA, USA
| | - Christopher J. O'Donnell
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- the Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, USA
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