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Föllmer B, Tsogias S, Biavati F, Schulze K, Bosserdt M, Hövermann LG, Stober S, Samek W, Kofoed KF, Maurovich-Horvat P, Donnelly P, Benedek T, Williams MC, Dewey M. Automated segment-level coronary artery calcium scoring on non-contrast CT: a multi-task deep-learning approach. Insights Imaging 2024; 15:250. [PMID: 39412613 DOI: 10.1186/s13244-024-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVES To develop and evaluate a multi-task deep-learning (DL) model for automated segment-level coronary artery calcium (CAC) scoring on non-contrast computed tomography (CT) for precise localization and quantification of calcifications in the coronary artery tree. METHODS This study included 1514 patients (mean age, 60.0 ± 10.2 years; 56.0% female) with stable chest pain from 26 centers participating in the multicenter DISCHARGE trial (NCT02400229). The patients were randomly assigned to a training/validation set (1059) and a test set (455). We developed a multi-task neural network for performing the segmentation of calcifications on the segment level as the main task and the segmentation of coronary artery segment regions with weak annotations as an auxiliary task. Model performance was evaluated using (micro-average) sensitivity, specificity, F1-score, and weighted Cohen's κ for segment-level agreement based on the Agatston score and performing interobserver variability analysis. RESULTS In the test set of 455 patients with 1797 calcifications, the model assigned 73.2% (1316/1797) to the correct coronary artery segment. The model achieved a micro-average sensitivity of 0.732 (95% CI: 0.710-0.754), a micro-average specificity of 0.978 (95% CI: 0.976-0.980), and a micro-average F1-score of 0.717 (95% CI: 0.695-0.739). The segment-level agreement was good with a weighted Cohen's κ of 0.808 (95% CI: 0.790-0.824), which was only slightly lower than the agreement between the first and second observer (0.809 (95% CI: 0.798-0.845)). CONCLUSION Automated segment-level CAC scoring using a multi-task neural network approach showed good agreement on the segment level, indicating that DL has the potential for automated coronary artery calcification classification. CRITICAL RELEVANCE STATEMENT Multi-task deep learning can perform automated coronary calcium scoring on the segment level with good agreement and may contribute to the development of new and improved calcium scoring methods. KEY POINTS Segment-level coronary artery calcium scoring is a tedious and error-prone task. The proposed multi-task model achieved good agreement with a human observer on the segment level. Deep learning can contribute to the automation of segment-level coronary artery calcium scoring.
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Affiliation(s)
- Bernhard Föllmer
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Sotirios Tsogias
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Federico Biavati
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kenrick Schulze
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars Gerrit Hövermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Stober
- Artificial Intelligence Lab, Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Wojciech Samek
- Department of Artificial Intelligence, Fraunhofer Heinrich Hertz Institute, Berlin, Germany
- Department of Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany
- BIFOLD-Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
| | - Klaus F Kofoed
- Department of Cardiology and Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pál Maurovich-Horvat
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Patrick Donnelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK
| | - Theodora Benedek
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | | | - Marc Dewey
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- BIH (Berlin Institute of Health), DHZC (German Heart Center of the Charité) and DZHK (German Center for Cardiovascular Research), Berlin, Germany
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Koopman MY, van der Ende MY, Reijnders JJW, Willemsen RTA, van Bruggen R, Gratama JWC, Kietselaer BLJH, van der Harst P, Vliegenthart R. Exploration of the relationship between general health-related problems and subclinical coronary artery disease: a cross-sectional study in a general population. BMJ Open 2024; 14:e079835. [PMID: 39401960 PMCID: PMC11474743 DOI: 10.1136/bmjopen-2023-079835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/25/2024] [Indexed: 10/17/2024] Open
Abstract
OBJECTIVE To explore associations between general health-related problems and subclinical coronary artery disease (CAD), determined by CT coronary calcium score (CT-CCS), in a general population. DESIGN A cross-sectional design. SETTING This study was performed in a prospective population-based cohort, examining the health and health-related behaviour of individuals living in the Northern Netherlands. PARTICIPANTS The initial cohort comprised 6763 participants ≥45 years of age who underwent CT-scanning. Participants were included for the current analysis if they filled in three validated questionnaires (Symptomatic Checklist-90, Research and Development Survey-36 and Reviving the Early Diagnosis of CardioVascular Diseases questionnaire (RED-CVD)) and did not have a history of cardiovascular disease. The final analysis included 6530 participants. PRIMARY OUTCOME MEASURE Backward-stepwise and forward-stepwise logistic regression analyses were performed to determine associations between general health-related problems and subclinical CAD (CCS≥100 and ≥300). RESULTS The median age was 53 years (25th, 75th percentile: 48, 58); 57% were women. CRCS≥100 was found in 1236 (19%) participants, 437 (12%) in women and 799 (29%) men and CCS≥300 in 643 (9.9%) participants of which 180 (4.8%) were women and 463 (16.6%) men. In univariate analysis, in women the expectation of health to worsen (OR=1.13, 95% CI: 1.05 to 1.21), and in men reduced exercise intolerance (OR=1.14, 95% CI: 1.06 to 1.23) were associated with CCS≥100. The total RED-CVD score in women (OR=1.06, (95% CI: 1.05 to 1.08) and men (OR=1.07, 95% CI: 1.06 to 1.09), and in men also reduced exercise intolerance (OR=1.15, 95% CI: 1.06 to 1.25) and headache (OR=0.55, 95% CI: 0.38 to 0.79) were associated with CCS≥300. In multivariate analyses, only general health expectation in women was still significantly associated with subclinical CAD (CCS≥300) (OR=1.92, 95% CI: 1.56 to 2.37). CONCLUSION Only a few general health-related problems were associated with the presence of subclinical CAD in the general population, however, these problems showed no strong association. Therefore, using health-related symptoms does not seem useful to pre-select for CT-CCS. TRIAL REGISTRATION NUMBER CCMO Register, NL17981.042.07 and NL58592.042.16.
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Affiliation(s)
- Moniek Y Koopman
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Yldau van der Ende
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorn J W Reijnders
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert T A Willemsen
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rykel van Bruggen
- General Practitioners Organisation ‘HuisartsenOrganisatie Oost-Gelderland’, Apeldoorn, The Netherlands
| | | | | | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
- DataScience Center in Health (DASH), University Medical Center Groningen, Groningen, The Netherlands
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3
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Sharma SP, Lemmens MJDK, Smulders MW, Budde RPJ, Hirsch A, Mihl C. Photon-counting detector computed tomography in cardiac imaging. Neth Heart J 2024:10.1007/s12471-024-01904-5. [PMID: 39356451 DOI: 10.1007/s12471-024-01904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 10/03/2024] Open
Abstract
Photon-counting detector computed tomography (PCD-CT) has emerged as a revolutionary technology in CT imaging. PCD-CT offers significant advancements over conventional energy-integrating detector CT, including increased spatial resolution, artefact reduction and inherent spectral imaging capabilities. In cardiac imaging, PCD-CT can offer a more accurate assessment of coronary artery disease, plaque characterisation and the in-stent lumen. Additionally, it might improve the visualisation of myocardial fibrosis through qualitative late enhancement imaging and quantitative extracellular volume measurements. The use of PCD-CT in cardiac imaging holds significant potential, positioning itself as a valuable modality that could serve as a one-stop-shop by integrating both angiography and tissue characterisation into a single examination. Despite its potential, large-scale clinical trials, standardisation of protocols and cost-effectiveness considerations are required for its broader integration into clinical practice. This narrative review provides an overview of the current literature on PCD-CT regarding the possibilities and limitations of cardiac imaging.
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Affiliation(s)
- Simran P Sharma
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
- Department of Cardiology, Cardiovascular Institute, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Marie-Julie D K Lemmens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn W Smulders
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
- Department of Cardiology, Cardiovascular Institute, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
- Department of Cardiology, Cardiovascular Institute, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Ference BA, Braunwald E, Catapano AL. The LDL cumulative exposure hypothesis: evidence and practical applications. Nat Rev Cardiol 2024; 21:701-716. [PMID: 38969749 DOI: 10.1038/s41569-024-01039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 07/07/2024]
Abstract
The trapping of LDL and other apolipoprotein B-containing lipoproteins within the artery wall causes atherosclerosis. As more LDL becomes trapped within the artery wall over time, the atherosclerotic plaque burden gradually increases, raising the risk of an acute cardiovascular event. Therefore, the biological effect of LDL on the risk of atherosclerotic cardiovascular disease (ASCVD) depends on both the magnitude and duration of exposure. Maintaining low levels of LDL-cholesterol (LDL-C) over time decreases the number of LDL particles trapped within the artery wall, slows the progression of atherosclerosis and, by delaying the age at which mature atherosclerotic plaques develop, substantially reduces the lifetime risk of ASCVD events. Summing LDL-C measurements over time to calculate cumulative exposure to LDL generates a unique biomarker that captures both the magnitude and duration of exposure, which facilitates the estimation of the absolute risk of having an acute cardiovascular event at any point in time. Titrating LDL-C lowering to keep cumulative exposure to LDL below the threshold at which acute cardiovascular events occur can effectively prevent ASCVD. In this Review, we provide the first comprehensive overview of how the LDL cumulative exposure hypothesis can guide the prevention of ASCVD. We also discuss the benefits of maintaining lower LDL-C levels over time and how this knowledge can be used to inform clinical practice guidelines as well as to design novel primary prevention trials and ASCVD prevention programmes.
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Affiliation(s)
- Brian A Ference
- DeepCausalAI Institute for Clinical Translation, Cambridge, UK.
| | - Eugene Braunwald
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milano, Milan, Italy.
- Multimedica IRCCS, Milan, Italy.
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5
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Kampaktsis PN, Hennecken C, Shetty M, McLaughlin L, Rampidis G, Samaras A, Avgerinos D, Spilias N, Kuno T, Briasoulis A, Einstein AJ. Current and Emerging Approaches for Primary Prevention of Coronary Artery Disease Using Cardiac Computed Tomography. Curr Cardiol Rep 2024; 26:1047-1062. [PMID: 39066990 DOI: 10.1007/s11886-024-02104-8] [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] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE OF REVIEW To summarize the current use of cardiac computed tomography (CT) technologies as well as their pertinent evidence in regards to prevention of coronary artery disease (CAD). RECENT FINDINGS Cardiac CTA has now become a main non-invasive method for the evaluation of symptomatic CAD. In addition to coronary calcium score, other CT technologies such as atherosclerotic plaque analysis, fractional flow reserve estimation by CT, pericoronary fat attenuation, and endothelial wall shear stress have emerged. Whether the use of CT modalities can enhance risk prediction and prevention in CAD has not been fully answered. We discuss the evidence for coronary artery calcium scoring and coronary CT angiography in primary prevention and the current barriers to their use. We attempt to delineate what can be done to expand use and what studies are needed to broaden adoption in the future. We also examine the potential roles of emerging CT technologies. Finally, we describe potential clinical approaches to prevention that would incorporate cardiac CT technologies.
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Affiliation(s)
- Polydoros N Kampaktsis
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 177 Fort Washington Ave, MHB2, New York, NY, 10032, USA.
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA.
- Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
| | - Carolyn Hennecken
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 177 Fort Washington Ave, MHB2, New York, NY, 10032, USA
| | - Mrinali Shetty
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 177 Fort Washington Ave, MHB2, New York, NY, 10032, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Laura McLaughlin
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 177 Fort Washington Ave, MHB2, New York, NY, 10032, USA
| | - Georgios Rampidis
- Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Athanasios Samaras
- Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | | | - Nikolaos Spilias
- Cardiovascular Division, University of Miami Health System, Miami, FL, USA
| | | | | | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 177 Fort Washington Ave, MHB2, New York, NY, 10032, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
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6
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Schulz A, Otton J, Hussain T, Miah T, Schuster A. Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments. Curr Cardiol Rep 2024; 26:1063-1076. [PMID: 39162955 PMCID: PMC11461626 DOI: 10.1007/s11886-024-02110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to provide a profound overview on most recent studies on the clinical significance of Cardiovascular Computed Tomography (CCT) in diagnostic and therapeutic pathways. Herby, this review helps to pave the way for a more extended but yet purposefully use in modern day cardiovascular medicine. RECENT FINDINGS In recent years, new clinical applications of CCT have emerged. Major applications include the assessment of coronary artery disease and structural heart disease, with corresponding recommendations by major guidelines of international societies. While CCT already allows for a rapid and non-invasive diagnosis, technical improvements enable further in-depth assessments using novel imaging parameters with high temporal and spatial resolution. Those developments facilitate diagnostic and therapeutic decision-making as well as improved prognostication. This review determined that recent advancements in both hardware and software components of CCT allow for highly advanced examinations with little radiation exposure. This particularly strengthens its role in preventive care and coronary artery disease. The addition of functional analyses within and beyond coronary artery disease offers solutions in wide-ranging patient populations. Many techniques still require improvement and validation, however, CCT possesses potential to become a "one-stop-shop" examination.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - James Otton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Tayaba Miah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany.
- FORUM Cardiology, Rosdorf, Germany.
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Rosen RC, Miner M, Burnett AL, Blaha MJ, Ganz P, Goldstein I, Kim N, Kohler T, Lue T, McVary K, Mulhall J, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip I, Kloner RA. Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium. Sex Med Rev 2024; 12:681-709. [PMID: 38936840 DOI: 10.1093/sxmrev/qeae043] [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: 12/29/2023] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023. OBJECTIVES Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area. METHODS An expert panel reviewed existing research and clinical practice guidelines. RESULTS Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications. CONCLUSION Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.
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Affiliation(s)
- Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, 180 Corliss St. 2nd Floor, Providence, RI 02904, United States
| | - Arthur L Burnett
- Department of Urology, Ciccarone Center for Clinical Research, Johns Hopkins University, 600 N Wolfe St # B110, Baltimore, MD 21287, United States
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins Health Care & Surgery Center, Green Spring Station, Lutherville, 10755 Falls Road, Lutherville, MD 21093, United States
| | - Peter Ganz
- Department of Cardiology and Vascular Research, University of California, San Francisco, 1001 Potrero Ave # 107, San Francisco, CA 94110, United States
| | - Irwin Goldstein
- Institute for Sexual Medicine, 5555 Reservoir Dr # 300, San Diego, CA 92120, United States
| | - Noel Kim
- Institute for Sexual Medicine, 5555 Reservoir Drive, Suite 300, San Diego, CA 92120, United States
| | - Tobias Kohler
- Dept of Urology, Mayo Clinic, 200 First St. S.W., Rochester, Minnesota 55905, US, United States
| | - Tom Lue
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Kevin McVary
- Center for Male Health, Stritch School of Medicine, Loyola University, 6800 N Frontage Rd, Burr Ridge, IL 60527, United States
| | - John Mulhall
- Memorial Sloan Kettering Cancer Center, Sloan Kettering Hospital, 205 E 64th St, New York, NY 10065, United States
| | - Sharon J Parish
- Weill Cornell Medical College, 21 Bloomingdale Rd, White Plains, NY 10605, United States
| | - Hossein Sadeghi-Nejad
- Professor of Urology and Ob-Gyn, Department of Urology, Langone Grossman School of Medicine, New York University, 222 East 41st Street, 12th Floor, New York, NY 10017, United States
| | - Richard Sadovsky
- Dept of Family Medicine, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States
| | - Ira Sharlip
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Robert A Kloner
- Chief Scientist and Director, Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Ave., Pasadena, CA. 91105, United States
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Ayoub C, Scalia IG, Anavekar NS, Arsanjani R, Jokerst CE, Chow BJW, Kritharides L. Computed Tomography Evaluation of Coronary Atherosclerosis: The Road Travelled, and What Lies Ahead. Diagnostics (Basel) 2024; 14:2096. [PMID: 39335775 PMCID: PMC11431535 DOI: 10.3390/diagnostics14182096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to support CCTA diagnostic and prognostic value both for stable and acute symptoms. It enables rapid and cost-effective rule-out of CAD, and permits quantification and characterization of coronary plaque and associated significance. In this comprehensive review, we detail the road traveled as CCTA evolved to include quantitative assessment of plaque stenosis and extent, characterization of plaque characteristics including high-risk features, functional assessment including fractional flow reserve-CT (FFR-CT), and CT perfusion techniques. The state of current guideline recommendations and clinical applications are reviewed, as well as future directions in the rapidly advancing field of CT technology, including photon counting and applications of artificial intelligence (AI).
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Affiliation(s)
- Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Isabel G Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Benjamin J W Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Department of Radiology, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney Local Health District, Concord, NSW 2137, Australia
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9
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Marchandot B, Faller E, Akladios C, Matsushita K, Bäck M, Jesel L, Schini-Kerth V, Morel O. Fostering cardio-endometriosis: a call to action for a comprehensive understanding of cardiovascular disease in endometriosis. Eur J Prev Cardiol 2024; 31:1574-1582. [PMID: 38421615 DOI: 10.1093/eurjpc/zwae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Recently, a growing body of evidence has highlighted a concerning link between endometriosis and cardiovascular disease. Endometriosis, a chronic, inflammatory, hormone-dependent condition affecting 5-10% of reproductive-aged women worldwide, has long been associated with reproductive and gynaecological consequences. However, emerging research has suggested that it may also contribute to adverse cardiovascular outcomes. This paper aims to shed light on the importance of recognizing cardio-endometriosis as a new and developing sphere of research in the field of cardiology, thereby urging the medical community to address this pressing issue.
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Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, 1 Place de l'Hopital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, CRBS, 1 Rue Eugène Boeckel, 67000 Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Hautepierre Hospital, University Hospital, 1 Avenue Molière, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, University Hospital, 1 Avenue Molière, 67000 Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology, Hautepierre Hospital, University Hospital, 1 Avenue Molière, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, University Hospital, 1 Avenue Molière, 67000 Strasbourg, France
| | - Kensuke Matsushita
- UR 3074 Médecine Cardiovasculaire Translationnelle, CRBS, 1 Rue Eugène Boeckel, 67000 Strasbourg, France
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Section of Translational Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Université de Lorraine, Institut National de la Sante et de la Recherche Medicale U1116, Nancy, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, 1 Place de l'Hopital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, CRBS, 1 Rue Eugène Boeckel, 67000 Strasbourg, France
| | - Valérie Schini-Kerth
- UR 3074 Médecine Cardiovasculaire Translationnelle, CRBS, 1 Rue Eugène Boeckel, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, 1 Place de l'Hopital, 67000 Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, CRBS, 1 Rue Eugène Boeckel, 67000 Strasbourg, France
- Hanoï Medical University, Vietnam
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10
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Geers J, Bing R, Pawade TA, Doris MK, Daghem M, Fletcher AJ, White AC, Forsyth L, Evans E, Kwieciński J, Williams MC, van Beek EJR, Kwak S, Peeters FECM, Tzolos E, Slomka PJ, Lucatelli C, Ralston SH, Prendergast B, Newby DE, Dweck MR. Effect of Denosumab or Alendronate on Vascular Calcification: Secondary Analysis of SALTIRE2 Randomized Controlled Trial. J Am Heart Assoc 2024; 13:e032571. [PMID: 39248270 DOI: 10.1161/jaha.123.032571] [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: 12/07/2023] [Accepted: 03/08/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Patients with osteoporosis demonstrate increased vascular calcification but the effect of osteoporosis treatments on vascular calcification remains unclear. The present study aimed to examine whether coronary or aortic calcification are influenced by denosumab and alendronic acid treatment. METHODS AND RESULTS In a double-blind randomized controlled SALTIRE2 (Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis) trial, patients with aortic stenosis were randomized 2:1:2:1 to denosumab, placebo injection, alendronic acid, or placebo capsule. Participants underwent serial imaging with computed tomography and 18F-sodium fluoride positron emission tomography for the assessment of vascular calcium burden and calcification activity, respectively. We report the prespecified secondary analyses of 24-month change in coronary calcium score, and 12-month changes in thoracic aorta calcium score, coronary and aortic 18F-sodium fluoride activity. One hundred fifty patients with aortic stenosis (72±8 years; 21% female) were randomized to denosumab (n=49), alendronic acid (n=51), and placebo (injection n=25, capsule n=25). There were no differences in change in coronary calcium scores between placebo (16 [-64 to 148] Agatston units) and either denosumab (94 [0-212] Agatston units, P=0.24) or alendronic acid (34 [-62 to 134], P=0.99). There were no differences in change in thoracic aorta calcium scores between placebo (132 [22-512] Agatston units) and either denosumab (118 [11-340], P=0.75) or alendronic acid (116 [26-498] Agatston units, P=0.62). There were no differences in changes in coronary or aortic 18F-sodium fluoride activity between treatment groups. CONCLUSIONS Neither alendronic acid nor denosumab are associated with changes in the activity or progression of coronary or aortic calcification. Osteoporosis treatments do not appear to have major impact on vascular calcification of atherosclerosis. REGISTRATION https://www.clinicaltrials.gov; Unique identifier: NCT02132026.
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Affiliation(s)
- Jolien Geers
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
- Department of Cardiology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Rong Bing
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Tania A Pawade
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Mhairi K Doris
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Marwa Daghem
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Alexander J Fletcher
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
- Department of Child Health University of Glasgow Glasgow UK
| | - Audrey C White
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit University of Edinburgh Edinburgh UK
| | - Emily Evans
- Edinburgh Clinical Research Facility University of Edinburgh Edinburgh UK
| | - Jacek Kwieciński
- Department of Interventional Cardiology and Angiology Institute of Cardiology Warsaw Poland
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
- Edinburgh Imaging University of Edinburgh Edinburgh UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
- Edinburgh Imaging University of Edinburgh Edinburgh UK
| | - Soongu Kwak
- Department of Internal Medicine Seoul National University Hospital Seoul South Korea
| | | | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Piotr J Slomka
- Departments of Biomedical Sciences and Medicine Cedars-Sinai Medical Center Biomedical Imaging Research Institute Los Angeles CA USA
| | | | - Stuart H Ralston
- Institute of Genetics and Molecular Medicine University of Edinburgh UK
| | | | - David E Newby
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh UK
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11
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Zhang L, Li D, Aierken Y, Zhang J, Liu Z, Lin Z, Jiang L, Li Q, Wu Y, Liu Y. KPV and RAPA Self-Assembled into Carrier-Free Nanodrugs for Vascular Calcification Therapy. Adv Healthc Mater 2024:e2402320. [PMID: 39252648 DOI: 10.1002/adhm.202402320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/14/2024] [Indexed: 09/11/2024]
Abstract
Cardiovascular disease (CVD) is a leading cause of death globally, and vascular calcification (VC) is an important independent risk factor for predicting CVD. Currently, there are no established therapeutic strategies for the treatment of VC. Although recognized combination therapies of nanomedicines can provide effective strategies for disease treatment, the clinical application of nanomedicines is limited because of their complex preparation processes, low drug loading rates, and unpredictable safety risks. Thus, developing a simple, efficient, and safe nanodrug to simultaneously regulate inflammation and autophagy may be a promising strategy for treating VC. Herein, an anti-inflammatory peptide (lysine-proline-valine peptides, KPV) and the autophagy activator rapamycin (RAPA) are self-assembled to form new carrier-free spherical nanoparticles (NPs), which shows good stability and biosafety. In vivo and in vitro, KPV-RAPA NPs significantly inhibit VC in mice compared to the other treatment groups. Mechanistically, KPV-RAPA NPs inhibit inflammatory responses and activated autophagy. Therefore, this study indicates that the new carrier-free KPV-RAPA NPs have great potential as therapeutic agents for VC combination therapy, which can promote the development of nanodrugs for VC.
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Affiliation(s)
- Li Zhang
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Dongze Li
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Yierpani Aierken
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Jie Zhang
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Zhenyu Liu
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Zipeng Lin
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Longqi Jiang
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Qingzhu Li
- Department of General Surgery, Gulin People's Hospital, Luzhou, 646000, China
| | - Ya Wu
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Yong Liu
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, 646000, China
- Department of General Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
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12
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Jakubiak GK, Pawlas N, Morawiecka-Pietrzak M, Zalejska-Fiolka J, Stanek A, Cieślar G. Relationship of Thyroid Volume and Function with Ankle-Brachial Index, Toe-Brachial Index, and Toe Pressure in Euthyroid People Aged 18-65. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1445. [PMID: 39336486 PMCID: PMC11434524 DOI: 10.3390/medicina60091445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/14/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The interrelationship between thyroid function and the state of the cardiovascular system has been investigated both in preclinical and human studies. However, it remains unclear whether there is any association between thyroid hormones and features of subclinical cardiovascular dysfunction in euthyroid patients. Material and Methods: This study involved 45 people (females: 57.8%) with no thyroid disease who, during planned hospitalization, underwent thyroid ultrasound, determination of biochemical parameters of thyroid function, and measurement of ankle-brachial index (ABI) and toe-brachial index (TBI). People with signs of acute illness or a deterioration of their health were excluded. Results: Significant correlations were found between free triiodothyronine (FT3) and several parameters of both ABI (R = 0.347; p = 0.019 for the mean ABI taken from right side and left side values) and TBI (R = 0.396; p = 0.007 for the mean TBI taken from right side and left side values), as well as the maximal toe pressure (TP) taken from right side and left side values (R = 0.304; p = 0.045). Thyrotropin (TSH) was shown to be significantly correlated only with the maximal TBI value (taken from right side and left side values) (R = 0.318; p = 0.033), whereas free thyroxin (FT4) was shown to be significantly correlated only with the minimal TBI value (taken from right side and left side values) (R = 0.381; p = 0.01). Thyroid volume (TV) was shown to be correlated with TP (R = 0.4; p = 0.008 for the mean TP taken from right side and left side values) and some parameters of TBI value (R = 0.332; p = 0.028 for the mean TBI taken from right side and left side values), but no significant correlations were found between TVand ABI parameters. Patients with a mean ABI value ≤ 1.0 or a mean TBI value ≤ 0.75 have lower TSH, FT3, FT4, and TV than the rest of the study population, but the difference was statistically significant only for FT3. Conclusions: Even in a population of euthyroid patients with no diagnosed thyroid disease, there are some significant correlations between the volume and function of the thyroid gland and the selected features of subclinical cardiovascular dysfunction such as ABI and TBI.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| | | | - Jolanta Zalejska-Fiolka
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland; (A.S.); (G.C.)
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland; (A.S.); (G.C.)
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13
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Savo MT, De Amicis M, Cozac DA, Cordoni G, Corradin S, Cozza E, Amato F, Lassandro E, Da Pozzo S, Tansella D, Di Paolantonio D, Baroni MM, Di Stefano A, De Conti G, Motta R, Pergola V. Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease. J Clin Med 2024; 13:5205. [PMID: 39274418 PMCID: PMC11395785 DOI: 10.3390/jcm13175205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/24/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024] Open
Abstract
Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.
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Affiliation(s)
- Maria Teresa Savo
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Morena De Amicis
- Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Dan Alexandru Cozac
- Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania
| | - Gabriele Cordoni
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Simone Corradin
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Elena Cozza
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Filippo Amato
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Eleonora Lassandro
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Stefano Da Pozzo
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Donatella Tansella
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Diana Di Paolantonio
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Maria Maddalena Baroni
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Antonio Di Stefano
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Giorgio De Conti
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Raffaella Motta
- Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Valeria Pergola
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
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14
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Nayfeh M, Sayed A, Alwan M, Alfawara M, Al Rifai M, Al-Mallah MH. Hybrid Imaging: Calcium Score and Myocardial Perfusion Imaging. Semin Nucl Med 2024; 54:638-647. [PMID: 39034159 DOI: 10.1053/j.semnuclmed.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 07/23/2024]
Abstract
Coronary heart disease (CHD) remains the top cause of death due to cardiovascular conditions worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out atherosclerosis, leading to the adoption of hybrid imaging techniques. Hybrid imaging combines computed tomography (CT) with MPI techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of radiotracer uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.
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Affiliation(s)
- Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | | | - Maria Alwan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Moath Alfawara
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
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15
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Gui Z, Shao C, Zhan Y, Wang Z, Li L. Vascular calcification: High incidence sites, distribution, and detection. Cardiovasc Pathol 2024; 72:107667. [PMID: 38866090 DOI: 10.1016/j.carpath.2024.107667] [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: 03/15/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
Vascular calcification is an important pathological change in a variety of disease states such as atherosclerosis (AS), diabetes, chronic kidney disease (CKD), hypertension, and is a strong predictor of cardiovascular events. The distribution and location of calcification in different vessels may have different clinical effects and prognosis. Therefore, the study of high-risk sites of vascular calcification will help us to better understand the prevention, diagnosis, and treatment of related diseases, as well as to evaluate the efficacy and prognosis. So far, although there are some studies on the sites with high incidence of vascular calcification, there is a lack of systematic sorting out the distribution and location of vascular calcification in humans. Based on this, relevant databases were searched, literatures were retrieved, analyzed, and summarized, and the locations of high incidence of vascular calcification and their distribution characteristics, the relationship between high incidence of vascular calcification and hemodynamics, and the common detection methods of high incidence of vascular calcification were systematically described, hoping to provide help for clinical and research.
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Affiliation(s)
- Zebin Gui
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuanzi Zhan
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
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16
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Ballester-Servera C, Alonso J, Taurón M, Rotllán N, Rodríguez C, Martínez-González J. Lysyl oxidase expression in smooth muscle cells determines the level of intima calcification in hypercholesterolemia-induced atherosclerosis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:286-298. [PMID: 38402026 DOI: 10.1016/j.arteri.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Cardiovascular calcification is an important public health issue with an unmeet therapeutic need. We had previously shown that lysyl oxidase (LOX) activity critically influences vascular wall smooth muscle cells (VSMCs) and valvular interstitial cells (VICs) calcification by affecting extracellular matrix remodeling. We have delved into the participation of LOX in atherosclerosis and vascular calcification, as well as in the mineralization of the aortic valve. METHODS Immunohistochemical and expression studies were carried out in human atherosclerotic lesions and experimental models, valves from patients with aortic stenosis, VICs, and in a genetically modified mouse model that overexpresses LOX in CMLV (TgLOXCMLV). Hyperlipemia and atherosclerosis was induced in mice through the administration of adeno-associated viruses encoding a PCSK9 mutated form (AAV-PCSK9D374Y) combined with an atherogenic diet. RESULTS LOX expression is increased in the neointimal layer of atherosclerotic lesions from human coronary arteries and in VSMC-rich regions of atheromas developed both in the brachiocephalic artery of control (C57BL/6J) animals transduced with PCSK9D374Y and in the aortic root of ApoE-/- mice. In TgLOXCMLV mice, PCSK9D374Y transduction did not significantly alter the enhanced aortic expression of genes involved in matrix remodeling, inflammation, oxidative stress and osteoblastic differentiation. Likewise, LOX transgenesis did not alter the size or lipid content of atherosclerotic lesions in the aortic arch, brachiocephalic artery and aortic root, but exacerbated calcification. Among lysyl oxidase isoenzymes, LOX is the most expressed member of this family in highly calcified human valves, colocalizing with RUNX2 in VICs. The lower calcium deposition and decreased RUNX2 levels triggered by the overexpression of the nuclear receptor NOR-1 in VICs was associated with a reduction in LOX. CONCLUSIONS Our results show that LOX expression is increased in atherosclerotic lesions, and that overexpression of this enzyme in VSMC does not affect the size of the atheroma or its lipid content, but it does affect its degree of calcification. Further, these data suggest that the decrease in calcification driven by NOR-1 in VICs would involve a reduction in LOX. These evidences support the interest of LOX as a therapeutic target in cardiovascular calcification.
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MESH Headings
- Animals
- Humans
- Atherosclerosis/pathology
- Atherosclerosis/genetics
- Protein-Lysine 6-Oxidase/metabolism
- Protein-Lysine 6-Oxidase/genetics
- Mice
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Vascular Calcification/pathology
- Vascular Calcification/genetics
- Vascular Calcification/etiology
- Vascular Calcification/metabolism
- Disease Models, Animal
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Hypercholesterolemia/complications
- Mice, Inbred C57BL
- Aortic Valve Stenosis/pathology
- Aortic Valve Stenosis/metabolism
- Aortic Valve Stenosis/genetics
- Aortic Valve/pathology
- Aortic Valve/metabolism
- Male
- Proprotein Convertase 9/genetics
- Proprotein Convertase 9/metabolism
- Mice, Transgenic
- Tunica Intima/pathology
- Tunica Intima/metabolism
- Diet, Atherogenic/adverse effects
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Affiliation(s)
- Carme Ballester-Servera
- Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud CarlosIII, Madrid, España; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España
| | - Judith Alonso
- Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud CarlosIII, Madrid, España; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España
| | - Manel Taurón
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud CarlosIII, Madrid, España; Departamento de Cirugía Cardíaca, Hospital de la Santa Creu i Sant Pau-Universitat Autònoma de Barcelona (HSCSP-UAB), Barcelona, España
| | - Noemí Rotllán
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud CarlosIII, Madrid, España
| | - Cristina Rodríguez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud CarlosIII, Madrid, España; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España
| | - José Martínez-González
- Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud CarlosIII, Madrid, España; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España.
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17
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Mendonça RM, Queiroz INA, Gonçalves AK. Letter to the editor regarding assessing breast arterial calcification in mammograms and its implications for atherosclerotic cardiovascular disease risk. Clin Imaging 2024; 113:110243. [PMID: 39106654 DOI: 10.1016/j.clinimag.2024.110243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Roberto M Mendonça
- Department of Radiology and Diagnostic Imaging, University Hospital Onofre Lopes, Natal, RN, Brazil.
| | - Ingrid N A Queiroz
- Department of Radiology and Diagnostic Imaging, University Hospital Onofre Lopes, Natal, RN, Brazil
| | - Ana Katherine Gonçalves
- Department of Obstetric and Gynecology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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18
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Yanagawa M, Hata A. Transforming Lung Cancer Screening with AI: Comprehensive Evaluation and Personalized Medicine Prospects. Radiology 2024; 312:e242118. [PMID: 39287526 DOI: 10.1148/radiol.242118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Affiliation(s)
- Masahiro Yanagawa
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Akinori Hata
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
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19
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Boersma HE, Xia C, van der Klauw MM, Vonder M, Oudkerk M, van der Harst P, Jan Pelgrim G, Wolffenbuttel BHR, Smit AJ, Vliegenthart R. Association between skin autofluorescence and coronary calcification in the general population. PLoS One 2024; 19:e0309059. [PMID: 39186712 PMCID: PMC11346912 DOI: 10.1371/journal.pone.0309059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE To address the relationship between tissue accumulation of advanced glycation end-products, assessed by skin autofluorescence (SAF), and subclinical atherosclerosis quantified with coronary artery calcium score (CACS) in the general Dutch population. METHODS A total of 3,839 participants of the LifeLines Cohort Study without diabetes or cardiovascular disease were included in this cross-sectional evaluation. They underwent SAF measurement and cardiac computed tomography to measure CACS. Associations between SAF and CACS was assessed using regression models. Participants at elevated risk for cardiovascular disease were selected by either CACS≥100, or SAF value in the top 15%; overlap and cardiovascular risk profile of these participants were compared. RESULTS In univariate analysis, every 1 arbitrary unit (AU) increase in SAF resulted in an odds ratio of 2.91 (95% confidence interval 2.44-3.48, p<0.001) for coronary calcification. After adjustment for cardiovascular risk factors, there was still 20% higher odds of coronary calcification with 1 AU increase in SAF, but significance was lost. In total, 1025 (27%) participants either had high SAF and/or high CACS, of these 441 (12%) had only high SAF, 450 (12%) had only high CACS and 134 (3%) participants had high SAF and high CACS. CONCLUSION In a population-based Dutch cohort, SAF was associated with the degree of coronary calcification. This association was largely explained by classical cardiovascular risk factors. Limited overlap was found in subgroups with high SAF or high CACS, indicating that SAF and CACS may have complementary role in identifying individuals at elevated cardiovascular risk.
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Affiliation(s)
- Henderikus E. Boersma
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Congying Xia
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen Vonder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy B.V, Groningen, The Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andries J. Smit
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Gerber Y, Gabriel KP, Jacobs DR, Liu JY, Rana JS, Sternfeld B, Carr JJ, Thompson PD, Sidney S. The Relationship of Cardiorespiratory Fitness, Physical Activity, and Coronary Artery Calcification to Cardiovascular Disease Events in CARDIA Participants. Eur J Prev Cardiol 2024:zwae272. [PMID: 39158112 DOI: 10.1093/eurjpc/zwae272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/30/2024] [Accepted: 08/16/2024] [Indexed: 08/20/2024]
Abstract
AIMS Moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF), and coronary artery calcification (CAC) are associated with cardiovascular disease (CVD) risk. While a U-shaped relationship between CRF or MVPA and CAC has been reported, the presence of CAC among highly fit individuals might be benign. We examined interactive associations of CRF or MVPA and CAC with outcomes and evaluated the relationship of CRF and MVPA to CAC incidence. METHODS CARDIA participants with CAC assessed in 2005-06 were included (n=3,141, mean age 45). MVPA was assessed by self-report and accelerometer. CRF was estimated with a maximal graded exercise test. Adjudicated CVD events and mortality data were obtained through 2019. CAC was reassessed in 2010-11. Cox models were constructed to assess hazard ratios (HRs) for CVD, coronary heart disease (CHD), and mortality in groups defined by CAC presence/absence and lower/higher CRF or MVPA levels. Logistic models were constructed to assess associations with CAC incidence. Adjustment was made for sociodemographic and CVD risk factors. RESULTS Relative to participants with no CAC and higher CRF, the adjusted HRs for CVD were 4.68 for CAC and higher CRF, 2.22 for no CAC and lower CRF, and 3.72 for CAC and lower CRF. For CHD, the respective HRs were 9.98, 2.28, and 5.52. For mortality, the HRs were 1.15, 1.58, and 3.14, respectively. Similar findings were observed when MVPA, measured either by self-report or accelerometer, was substituted for CRF. A robust inverse association of CRF and accelerometer-derived MVPA with CAC incidence was partly accounted for by adjusting for CVD risk factors. CONCLUSIONS In middle-aged adults, CRF and MVPA demonstrated an inverse association with CAC incidence but did not mitigate the increased cardiovascular risk associated with CAC, indicating that CAC is not benign in individuals with higher CRF or MVPA levels.
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Affiliation(s)
- Yariv Gerber
- School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Jamal S Rana
- Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - J Jeffrey Carr
- Vanderbilt University Medical Center, Nashville, TN, USA
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21
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Yoo TK, Lee MY, Sung KC. The Risk of Coronary Artery Calcification according to Different Lipid Parameters and Average Lipid Parameters. J Atheroscler Thromb 2024; 31:1194-1214. [PMID: 38417908 PMCID: PMC11300743 DOI: 10.5551/jat.64600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024] Open
Abstract
AIM We compared the association between the baseline and average lipid parameters over time and the coronary artery calcification (CAC) risk. METHODS Participants who underwent annual (biannual) health examinations and coronary artery computed tomography to measure CAC at least twice between March 2010 and December 2019, with a baseline CAC of 0, were included. The levels of apolipoprotein B (ApoB), Apolipoprotein A-I (ApoA1), ApoB/ApoA1, non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), TG/HDL-C, and TC/HDL-C were measured or calculated. The remnant cholesterol (RC) levels were calculated. The average lipid parameters before study entry were calculated using data from 2002 to 2010. The participants were divided into quartiles (Q) according to the parameter values. Cox proportional hazard modeling, adjusted for confounding factors, compared the CAC risk of the highest quartile to the lowest quartile. RESULTS Among 29,278 participants (mean age, 39.19±5.21; men, 88.27%), 2,779 developed CAC >0. The highest quartile of ApoB showed a numerically strong association with CAC risk, compared with the lowest quartile of ApoB (Q1: reference; Q2: HR,1.41, 95% CI,1.25-1.59; Q3: HR,1.97, 95% CI,1.75-2.21; Q4: HR,2.72, 95% CI,2.41-3.07). RC showed a modest association with CAC risk (Q1: reference; Q2: HR,1.13, 95% CI,0.99-1.28; Q3: HR,1.3, 95% CI,1.15-1.47; Q4: HR,1.7, 95% CI,1.51-1.91). The strength of the association was comparable between the parameters at baseline and the average lipid parameters over time. CONCLUSIONS A high ApoB level showed a strong association with CAC risk compared with the lowest ApoB quartile. The baseline lipid parameters can predict CAC development as effectively as the average of multiple measurements can.
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Affiliation(s)
- Tae Kyung Yoo
- Department of Medicine, MetroWest Medical Center, Framingham, MA, USA
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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22
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Rodrigues FG, Bruins MSM, Vliegenthart R, Kremer D, Sotomayor CG, Nolte IM, Douwe J Mulder U, Navis GJ, Heilberg IP, Pol RA, Bakker SJL, de Borst MH, Te Velde-Keyzer CA. Phase angle and donor type are determinants of coronary artery calcification in stable kidney transplant recipients at twelve months after transplantation. Nutr Metab Cardiovasc Dis 2024; 34:1912-1921. [PMID: 38740537 DOI: 10.1016/j.numecd.2024.04.008] [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: 10/31/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Coronary artery calcification (CAC) partially explains the excess cardiovascular morbidity and mortality after kidney transplantation. This study aimed to investigate determinants of CAC in stable kidney transplant recipients at 12 months post-transplantation. METHODS AND RESULTS CAC-score was quantified by the Agatston method using non-contrast enhanced computed tomography, and age- and sex-standardized CAC-percentiles were calculated. Univariable and multivariable multinomial logistic regression was performed to study potential determinants of CAC. The independent determinants were included in multivariable multinomial logistic regression adjusting for potential confounders. 203 KTRs (age 54.0 ± 14.7 years, 61.1% male) were included. Participants were categorized into four groups according to CAC percentiles (p = 0 [CAC-score = 0], n = 68; p ≥ 1%-p ≤ 50% [CAC score = 29.0 (4.0-166.0)], n = 31; p > 50 ≤ 75% [CAC score = 101.0 (23.8-348.3)], n = 26; and p>75% [CAC score = 581.0 (148.0-1652)], n = 83). Upon multivariable multinomial logistic regression, patients with a narrower phase angle and patients who had received a graft from a deceased donor had a higher risk of being in the >75th CAC-percentile. CONCLUSIONS This study identifies not only metabolic and transplant-related factors, but also phase angle, a composite marker of cell integrity, as an independent determinant of CAC at 12 months after kidney transplantation. This study offers new perspectives for future research into the value of bioelectrical impedance analysis in relation to vascular calcification in kidney transplant recipients.
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Affiliation(s)
- Fernanda G Rodrigues
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Nutrition Post Graduation Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Megan S M Bruins
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Daan Kremer
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Camilo G Sotomayor
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Udo Douwe J Mulder
- Department of Internal Medicine, Division Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan J Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ita Pfeferman Heilberg
- Nutrition Post Graduation Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Robert A Pol
- Department of Vascular and Transplant Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotte A Te Velde-Keyzer
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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23
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Meyer HJ, Dermendzhiev T, Hetz M, Osterhoff G, Kleber C, Denecke T, Henkelmann J, Metze M, Werdehausen R, Hempel G, Struck MF. Coronary artery calcification detected by initial polytrauma CT in severely injured patients: retrospective single-center cohort study. Eur J Trauma Emerg Surg 2024; 50:1527-1536. [PMID: 38441580 PMCID: PMC11458666 DOI: 10.1007/s00068-024-02487-x] [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: 12/30/2023] [Accepted: 02/24/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVES Coronary artery calcifications detected by computed tomography (CT) provide prognostic relevance for vascular disorders and coronary heart disease, whereas their prognostic relevance in severely injured trauma patients remains unclear. MATERIAL AND METHODS All consecutive trauma patients requiring emergency tracheal intubation before initial CT at a level-1 trauma center and admission to the intensive care unit (ICU) over a 12-year period (2008-2019) were reanalyzed. The Weston score, a semiquantitative method to quantify coronary calcifications, was evaluated as a prognostic variable based upon whole-body trauma CT analysis. RESULTS Four hundred fifty-eight patients (74.6% male) with a median age of 49 years, median injury severity score of 26 points, 24-h mortality rate of 7.6%, and 30-day mortality rate of 22.1% met the inclusion criteria and were analyzed. Coronary artery calcification was present in 214 patients (46.7%). After adjustment for confounding factors, the Weston score was an independent predictor for 24-h mortality (hazard ratio, HR 1.19, 95% confidence interval, CI 1.06-1.32, p = .002) and 30-day mortality (HR 1.09, 95% CI 1.01-1.17, p = .027). In a subanalysis of 357 survivors, the Weston score was significantly associated with ICU length of stay (LOS) (beta weight 0.89, 95% CI 0.3-1.47, p = .003) but not with mechanical ventilation duration (beta weight 0.05, 95% CI -0.2-0.63, p = .304). CONCLUSION CT-detected coronary calcification was a significant prognostic factor for 24-h- and 30-day-mortality in severely injured trauma patients requiring tracheal intubation, and influenced ICU LOS in survivors.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Tihomir Dermendzhiev
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Michael Hetz
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christian Kleber
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Michael Metze
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Gunther Hempel
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany.
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24
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Barkas F, Sener YZ, Golforoush PA, Kheirkhah A, Rodriguez-Sanchez E, Novak J, Apellaniz-Ruiz M, Akyea RK, Bianconi V, Ceasovschih A, Chee YJ, Cherska M, Chora JR, D'Oria M, Demikhova N, Kocyigit Burunkaya D, Rimbert A, Macchi C, Rathod K, Roth L, Sukhorukov V, Stoica S, Scicali R, Storozhenko T, Uzokov J, Lupo MG, van der Vorst EPC, Porsch F. Advancements in risk stratification and management strategies in primary cardiovascular prevention. Atherosclerosis 2024; 395:117579. [PMID: 38824844 DOI: 10.1016/j.atherosclerosis.2024.117579] [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: 03/20/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for advancements in risk assessment and management strategies. Although significant progress has been made recently, identifying and managing apparently healthy individuals at a higher risk of developing atherosclerosis and those with subclinical atherosclerosis still poses significant challenges. Traditional risk assessment tools have limitations in accurately predicting future events and fail to encompass the complexity of the atherosclerosis trajectory. In this review, we describe novel approaches in biomarkers, genetics, advanced imaging techniques, and artificial intelligence that have emerged to address this gap. Moreover, polygenic risk scores and imaging modalities such as coronary artery calcium scoring, and coronary computed tomography angiography offer promising avenues for enhancing primary cardiovascular risk stratification and personalised intervention strategies. On the other hand, interventions aiming against atherosclerosis development or promoting plaque regression have gained attention in primary ASCVD prevention. Therefore, the potential role of drugs like statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, omega-3 fatty acids, antihypertensive agents, as well as glucose-lowering and anti-inflammatory drugs are also discussed. Since findings regarding the efficacy of these interventions vary, further research is still required to elucidate their mechanisms of action, optimize treatment regimens, and determine their long-term effects on ASCVD outcomes. In conclusion, advancements in strategies addressing atherosclerosis prevention and plaque regression present promising avenues for enhancing primary ASCVD prevention through personalised approaches tailored to individual risk profiles. Nevertheless, ongoing research efforts are imperative to refine these strategies further and maximise their effectiveness in safeguarding cardiovascular health.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Yusuf Ziya Sener
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Azin Kheirkhah
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Rodriguez-Sanchez
- Division of Cardiology, Department of Medicine, Department of Physiology, and Molecular Biology Institute, UCLA, Los Angeles, CA, USA
| | - Jan Novak
- 2(nd) Department of Internal Medicine, St. Anne's University Hospital in Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic; Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Maria Apellaniz-Ruiz
- Genomics Medicine Unit, Navarra Institute for Health Research - IdiSNA, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Ralph Kwame Akyea
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, United Kingdom
| | - Vanessa Bianconi
- Department of Medicine and Surgery, University of Perugia, Italy
| | - Alexandr Ceasovschih
- Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Ying Jie Chee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Mariia Cherska
- Cardiology Department, Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | - Joana Rita Chora
- Unidade I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Universidade de Lisboa, Faculdade de Ciências, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nadiia Demikhova
- Sumy State University, Sumy, Ukraine; Tallinn University of Technology, Tallinn, Estonia
| | | | - Antoine Rimbert
- Nantes Université, CNRS, INSERM, l'institut du Thorax, Nantes, France
| | - Chiara Macchi
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università Degli Studi di Milano, Milan, Italy
| | - Krishnaraj Rathod
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Lynn Roth
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Vasily Sukhorukov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Svetlana Stoica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Institute of Cardiovascular Diseases Timisoara, Timisoara, Romania
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Jamol Uzokov
- Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | | | - Emiel P C van der Vorst
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, 52074, Aachen, Germany; Aachen-Maastricht Institute for CardioRenal Disease (AMICARE), RWTH Aachen University, 52074, Aachen, Germany; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich, 80336, Munich, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, 52074, Aachen, Germany
| | - Florentina Porsch
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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25
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Wen H, Huang R, Xu X, Xiong Z, Liu M, Guo Y, Zhuang X, Liao X. Prognostic significance of aortic valve calcification in relation to coronary artery calcification for cardiovascular diseases. Eur J Prev Cardiol 2024; 31:1173-1182. [PMID: 38394450 DOI: 10.1093/eurjpc/zwae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
AIMS Both coronary artery calcification (CAC) and aortic valve calcification (AVC) are strongly associated with cardiovascular diseases (CVDs), but data about the prognostic significance of multiple cardiovascular calcifications are limited. We aim to investigate the interaction relationship between AVC and CAC for major events. METHODS AND RESULTS We included 6695 participants from the Multi-Ethnic Study of Atherosclerosis at baseline and divided them into four groups: (i) no AVC or CAC; (ii) only AVC; (iii) only CAC; and (iv) with CAC and CAC. The Cox regression model and the Kaplan-Meier method were used to analyse CVD outcomes. We evaluated the interaction between AVC and CAC and their added predictive value based on the pooled cohort equations (PCEs). Subgroup analyses were also explored. Among 6695 participants (mean age 62.2 ± 10.2 years, 47.2% male), after follow-up, 943 cases (14.1%) of CVD and 1274 cases (19.0%) of all-cause death occurred. For participants with both AVC and CAC, the risk of CVD significantly increased [hazard ratio = 3.43 (2.69-4.37), P < 0.001], even higher than the sum of the ones with only AVC and only CAC. This trend remained the same for all-cause death and among subgroup analyses. The addictive interaction was statistically significant (P < 0.001). When AVC and CAC were added, the predictive value of PCEs increased. CONCLUSION Our results indicated a synergistic interaction between valve calcification and coronary calcification in CVDs. Management for both AVC and CAC may bring health co-benefits in preventing poor outcomes.
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Affiliation(s)
- Han Wen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Rihua Huang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xinghao Xu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Zhenyu Xiong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Yue Guo
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
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Napoli G, Mushtaq S, Basile P, Carella MC, De Feo D, Latorre MD, Baggiano A, Ciccone MM, Pontone G, Guaricci AI. Beyond Stress Ischemia: Unveiling the Multifaceted Nature of Coronary Vulnerable Plaques Using Cardiac Computed Tomography. J Clin Med 2024; 13:4277. [PMID: 39064316 PMCID: PMC11278082 DOI: 10.3390/jcm13144277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/04/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Historically, cardiovascular prevention has been predominantly focused on stress-induced ischemia, but recent trials have challenged this paradigm, highlighting the emerging role of vulnerable, non-flow-limiting coronary plaques, leading to a shift towards integrating plaque morphology with functional data into risk prediction models. Coronary computed tomography angiography (CCTA) represents a high-resolution, low-risk, and largely available non-invasive modality for the precise delineation of plaque composition, morphology, and inflammatory activity, further enhancing our ability to stratify high-risk plaque and predict adverse cardiovascular outcomes. Coronary artery calcium (CAC) scoring, derived from CCTA, has emerged as a promising tool for predicting future cardiovascular events in asymptomatic individuals, demonstrating incremental prognostic value beyond traditional cardiovascular risk factors in terms of myocardial infarction, stroke, and all-cause mortality. Additionally, CCTA-derived information on adverse plaque characteristics, geometric characteristics, and hemodynamic forces provides valuable insights into plaque vulnerability and seems promising in guiding revascularization strategies. Additionally, non-invasive assessments of epicardial and pericoronary adipose tissue (PCAT) further refine risk stratification, adding prognostic significance to coronary artery disease (CAD), correlating with plaque development, vulnerability, and rupture. Moreover, CT imaging not only aids in risk stratification but is now emerging as a screening tool able to monitor CAD progression and treatment efficacy over time. Thus, the integration of CAC scoring and PCAT evaluation into risk stratification algorithms, as well as the identification of high-risk plaque morphology and adverse geometric and hemodynamic characteristics, holds promising results for guiding personalized preventive interventions, helping physicians in identifying high-risk individuals earlier, tailoring lifestyle and pharmacological interventions, and improving clinical outcomes in their patients.
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Affiliation(s)
- Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Daniele De Feo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
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Yu F, Zong B, Ji L, Sun P, Jia D, Wang R. Free Fatty Acids and Free Fatty Acid Receptors: Role in Regulating Arterial Function. Int J Mol Sci 2024; 25:7853. [PMID: 39063095 PMCID: PMC11277118 DOI: 10.3390/ijms25147853] [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: 06/16/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
The metabolic network's primary sources of free fatty acids (FFAs) are long- and medium-chain fatty acids of triglyceride origin and short-chain fatty acids produced by intestinal microorganisms through dietary fibre fermentation. Recent studies have demonstrated that FFAs not only serve as an energy source for the body's metabolism but also participate in regulating arterial function. Excess FFAs have been shown to lead to endothelial dysfunction, vascular hypertrophy, and vessel wall stiffness, which are important triggers of arterial hypertension and atherosclerosis. Nevertheless, free fatty acid receptors (FFARs) are involved in the regulation of arterial functions, including the proliferation, differentiation, migration, apoptosis, inflammation, and angiogenesis of vascular endothelial cells (VECs) and vascular smooth muscle cells (VSMCs). They actively regulate hypertension, endothelial dysfunction, and atherosclerosis. The objective of this review is to examine the roles and heterogeneity of FFAs and FFARs in the regulation of arterial function, with a view to identifying the points of intersection between their actions and providing new insights into the prevention and treatment of diseases associated with arterial dysfunction, as well as the development of targeted drugs.
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Affiliation(s)
- Fengzhi Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; (F.Y.); (L.J.)
| | - Boyi Zong
- College of Physical Education and Health, East China Normal University, Shanghai 200241, China; (B.Z.); (P.S.)
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai 200241, China
| | - Lili Ji
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; (F.Y.); (L.J.)
| | - Peng Sun
- College of Physical Education and Health, East China Normal University, Shanghai 200241, China; (B.Z.); (P.S.)
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai 200241, China
| | - Dandan Jia
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; (F.Y.); (L.J.)
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; (F.Y.); (L.J.)
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Yoo JY, Kang SR, Chun EJ. Progression of Coronary Artery Calcification According to Changes in Risk Factors in Asymptomatic Individuals. J Pers Med 2024; 14:757. [PMID: 39064011 PMCID: PMC11278493 DOI: 10.3390/jpm14070757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
This retrospective study aimed to assess coronary artery calcium (CAC) progression in serial computed tomography measurements according to risk factor changes. In 448 asymptomatic adults who underwent CAC measurements with more than one-year intervals, CAC progression was assessed according to age, sex, variable traditional risk factors (diabetes mellitus, hypertension, hyperlipidemia, and smoking), and initial CAC score (0, 0.1-100, and >100). Univariate and multivariate logistic regression analyses were assessed for independent predictors of rapid CAC progression (ΔCAC/year > 20). During the 3.5-year follow-up, coronary artery calcifications occurred in 43 (12.8%) of 336 individuals with an initial CAC score of zero. Of 112 individuals with initial CAC presence, 60 (53.6%) had ΔCAC/year > 20. Age, male sex, body mass index, and all risk factors were significantly associated with ΔCAC/year > 20, but recently diagnosed hypertension (odds ratio [OR], 11.3) and initial CAC score (OR, 1.05) were significant independent predictors in multivariate regression analyses. CAC progression was affected by demographic and traditional risk factors; but, adjusting for these factors, recently diagnosed hypertension and initial CAC score were the most influential factors for rapid CAC progression. These findings suggest that individuals with higher initial CAC scores may benefit from more frequent follow-up scans and checks regarding risk factor changes.
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Affiliation(s)
- Jin-Young Yoo
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Se-Ri Kang
- Department of Radiology, Wonkwang University College of Medicine and Hospital, Iksan 54538, Republic of Korea
| | - Eun-Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
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29
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Sentagne JP, Ohana M, Severac F, Le Borgne P, Sauleau EA, Bilbault P, Kepka S. Diagnostic performance of coronary calcifications on CT to rule out acute coronary syndrome in the emergency department. BMC Emerg Med 2024; 24:116. [PMID: 38997628 PMCID: PMC11242020 DOI: 10.1186/s12873-024-01038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED. METHODS This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED. RESULTS Of the 280 patients included, 141 didn't have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group. CONCLUSIONS A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone.
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Affiliation(s)
- Julie Paget Sentagne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
| | - Mickaël Ohana
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - François Severac
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
- UMR 1260, INSERM / Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Erik-André Sauleau
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
- UMR 1260, INSERM / Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France.
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400, Strasbourg, Illkirch-Graffenstaden, France.
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de L'hôpital, 67091, Strasbourg, France.
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Parsa S, Somani S, Dudum R, Jain SS, Rodriguez F. Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time? Curr Atheroscler Rep 2024; 26:263-272. [PMID: 38780665 PMCID: PMC11457745 DOI: 10.1007/s11883-024-01210-w] [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] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology. RECENT FINDINGS AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.
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Affiliation(s)
- Shyon Parsa
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Sulaiman Somani
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Sneha S Jain
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Center for Digital Health, Stanford University, Stanford, California, USA.
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Faridi KF, Lahan S, Budoff MJ, Cury RC, Feldman T, Pan AP, Fialkow J, Nasir K. Serum Lipoproteins Are Associated With Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. JACC. ADVANCES 2024; 3:101049. [PMID: 39129991 PMCID: PMC11312344 DOI: 10.1016/j.jacadv.2024.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 08/13/2024]
Abstract
Background The relationship between atherogenic lipoproteins and subclinical coronary atherosclerosis has not been thoroughly evaluated in low-risk adults. Objectives The purpose of this study was to assess the association of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (apoB) with coronary atherosclerosis in adults without traditional risk factors. Methods We assessed atherosclerosis on coronary computed tomography angiography among asymptomatic adults in the Miami Heart Study not taking lipid-lowering therapy and without hypertension, diabetes, or active tobacco use. Prevalence of atherosclerosis was evaluated based on serum LDL-C, non-HDL-C, and apoB, and multivariable logistic regression with forward selection was used to assess variables associated with coronary plaque. Results Among 1,033 adults 40 to 65 years of age, 55.0% were women and 86.3% had estimated 10-year atherosclerotic cardiovascular disease risk <5%. Coronary atherosclerosis prevalence was 35.9% (50.6% in men; 23.8% in women) and 3.4% had ≥1 high-risk plaque feature. Atherosclerosis prevalence increased with LDL-C, ranging from 13.2% in adults with LDL-C <70 mg/dL up to 48.2% with ≥160 mg/dL. Higher LDL-C (adjusted OR [aOR]: 1.13 [95% CI: 1.08-1.18] per 10 mg/dL), age (aOR: 1.43 [95% CI: 1.28-1.60] per 5 years), male sex (aOR: 3.81 [95% CI: 2.86-5.10]), and elevated lipoprotein(a) (aOR: 1.46 [95% CI: 1.01-2.09]) were associated with atherosclerosis. Higher serum non-HDL-C and apoB were similarly associated with atherosclerosis. In adults with optimal risk factors, 21.2% had atherosclerosis with greater prevalence at higher lipoprotein levels. Conclusions Among asymptomatic middle-aged adults without traditional risk factors, coronary atherosclerosis is common and increasingly prevalent at higher levels of atherogenic lipoproteins. These findings emphasize the importance of lipid-lowering strategies to prevent development and progression of atherosclerosis regardless of risk factors.
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Affiliation(s)
- Kamil F. Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shubham Lahan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Alan P. Pan
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Peng J, Zhou B, Xu T, Hu X, Zhu Y, Wang Y, Pan S, Li W, Qian W, Zong J, Li F. The Serum NLRP1 Level and Coronary Artery Calcification: From Association to Development of a Risk-Prediction Nomogram. Rev Cardiovasc Med 2024; 25:265. [PMID: 39139411 PMCID: PMC11317339 DOI: 10.31083/j.rcm2507265] [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: 10/11/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 08/15/2024] Open
Abstract
Background To investigate the correlation between inflammasomes and coronary artery calcification (CAC), and develop and validating a nomogram for predicting the risk of CAC in patients with coronary artery disease (CAD). Methods A total of 626 patients with CAD at the Affiliated Hospital of Xuzhou Medical University were enrolled in this study. The patients were divided into the calcification group and the non-calcification group based on the assessment of coronary calcification. We constructed a training set and a validation set through random assignment. The least absolute shrinkage and selection operator (LASSO) regression and multivariate analysis were performed to identify independent risk factors of CAC in patients with CAD. Based on these independent predictors, we developed a web-based dynamic nomogram prediction model. The area under the receiver operating characteristic curve (AUC-ROC), calibration curves, and decision curve analysis (DCA) were used to evaluate this nomogram. Results Age, smoking, diabetes mellitus (DM), hyperlipidemia, the serum level of nucleotide-binding oligomerization domain (NOD)-like receptor protein 1 (NLRP1), alkaline phosphatase (ALP) and triglycerides (TG) were identified as independent risk factors of CAC. The AUC-ROC of the nomogram is 0.881 (95% confidence interval (CI): 0.850-0.912) in the training set and 0.825 (95% CI: 0.760-0.876) in the validation set, implying high discriminative ability. Satisfactory performance of this model was confirmed using calibration curves and DCA. Conclusions The serum NLRP1 level is an independent predictor of CAC. We established a web-based dynamic nomogram, providing a more accurate estimation and comprehensive perspective for predicting the risk of CAC in patients with CAD.
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Affiliation(s)
- Jingfeng Peng
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Bihan Zhou
- Department of Electrocardiography, The Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, 226000 Nantong, Jiangsu, China
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Xiabing Hu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Yinghua Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Yixiao Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Siyu Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Wenhua Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Wenhao Qian
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Jing Zong
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
| | - Fangfang Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, 221000 Xuzhou, Jiangsu, China
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Ichikawa K, Wang R, McClelland RL, Manubolu VS, Susarla S, Lee D, Pourafkari L, Fazlalizadeh H, Bitar JA, Robin R, Kinninger A, Roy S, Post WS, Budoff M. Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction. Heart 2024; 110:947-953. [PMID: 38627022 PMCID: PMC11199114 DOI: 10.1136/heartjnl-2023-323838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT. METHODS A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores. RESULTS Participants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores. CONCLUSION Our study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.
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Affiliation(s)
| | - Rui Wang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | | | | | - Duo Lee
- The Lundquist Institute, Torrance, California, USA
| | | | | | | | - Rick Robin
- The Lundquist Institute, Torrance, California, USA
| | | | - Sion Roy
- The Lundquist Institute, Torrance, California, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Filho RCF, Generoso G, Cardoso R, Jones SR, Santos RD, Toth PP, Bensenor IM, Lotufo PA, Bittencourt MS. GlycA Levels Independently Predict Coronary Artery Calcium Incidence and Progression in the ELSA-Brasil Cohort (Brazilian Longitudinal Study of Adult Health). Am J Cardiol 2024; 221:29-36. [PMID: 38636622 DOI: 10.1016/j.amjcard.2024.03.041] [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: 12/09/2023] [Revised: 02/28/2024] [Accepted: 03/30/2024] [Indexed: 04/20/2024]
Abstract
Atherosclerosis is an inflammatory disease. Coronary artery calcium (CAC) is a marker of atherosclerotic disease events and mortality risk. Increased GlycA, an emerging marker of inflammation, is associated with a higher risk for coronary artery disease (CAD). However, there is conflicting evidence on whether GlycA predicts subclinical CAD progression. We hypothesized that GlycA can predict subclinical CAC incidence/progression in healthy participants. We included 2,690 ELSA-Brasil cohort participants without cardiovascular/chronic inflammatory disease not receiving statin therapy who had GlycA levels measured and 2 interval CAC assessments between 2010 and 2018. Multivariable logistic and linear regression models were computed to evaluate GlycA as a predictor of CAC incidence and progression. CAC incidence required a baseline CAC of 0. CAC progression required a baseline CAC >0. The mean age of participants was 48.6 ± 7.7 years, 56.7% were women, and 54.6% and 16.1% (429 of 2,690) were White and Black, respectively. The mean CAC interscan period was 5.1 ± 0.9 years, the mean GlycA level was 414.7 ± 65 μmol/L, and the incidence of CAC was 13.1% (280 of 2,129). The GlycA level odds ratio for CAC incidence was 1.002 (95% confidence interval 1.0005 to 1.005, p = 0.016), adjusted for demographics, lifestyle, a family history of early CAD (≤60 years), lipids, and co-morbidities. The GlycA (≤p25 vs ≥p75) odds ratio for CAC progression (Berry definition) was 1.77 (95% confidence interval 1.07 to 2.96, p = 0.03) in a similar multivariable-adjusted model. Higher GlycA levels were associated with CAC incidence and progression in a healthy Brazilian cohort.
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Affiliation(s)
- Ronaldo C Fabiano Filho
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Giuliano Generoso
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins, University School of Medicine, Baltimore, Maryland
| | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | | | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Tassetti L, Sfriso E, Torlone F, Baggiano A, Mushtaq S, Cannata F, Del Torto A, Fazzari F, Fusini L, Junod D, Maragna R, Volpe A, Carrabba N, Conte E, Guglielmo M, La Mura L, Pergola V, Pedrinelli R, Indolfi C, Sinagra G, Perrone Filardi P, Guaricci AI, Pontone G. The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes. J Clin Med 2024; 13:3450. [PMID: 38929984 PMCID: PMC11205051 DOI: 10.3390/jcm13123450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.
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Affiliation(s)
- Luigi Tassetti
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Enrico Sfriso
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | | | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Francesco Cannata
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alberico Del Torto
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Fabio Fazzari
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Laura Fusini
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Daniele Junod
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Riccardo Maragna
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alessandra Volpe
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Edoardo Conte
- Department of Clinical Cardiology and Cardiovascular Imaging, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20157 Milan, Italy;
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy;
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Gianfranco Sinagra
- Cardiology Specialty School, University of Trieste, 34127 Trieste, Italy;
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34149 Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Andrea Igoren Guaricci
- Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Liu M, Zhen Y, Shang J, Dang Y, Zhang Q, Ni W, Qiao Y, Hou Y. The predictive value of lesion-specific pericoronary fat attenuation index for major adverse cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 2024; 23:191. [PMID: 38835028 PMCID: PMC11149297 DOI: 10.1186/s12933-024-02272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the prognostic significance of the lesion-specific pericoronary fat attenuation index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). METHODS This study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific pericoronary FAI, FAI of the three prime coronary arteries, features of high-risk plaques, and the coronary artery calcium score (CACS). The MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure. RESULTS Within the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific pericoronary FAI in patients who experienced MACE was notably higher compared to those without MACE (-84.87 ± 11.36 Hounsfield Units (HU) vs. -88.65 ± 11.89 HU, p = 0.016). Multivariate Cox regression analysis revealed that CACS ≥ 100 (hazard ratio [HR] = 4.071, 95% confidence interval [CI] 2.157-7.683, p < 0.001) and lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.400, 95% CI 1.399-4.120, p = 0.001) were independently associated with heightened risk of MACE in patients with T2DM over a three-year period. Kaplan-Meier analysis showed that patients with higher lesion-specific pericoronary FAI were more likely to develop MACE (p = 0.0023). Additionally, lesions characterized by higher lesion-specific pericoronary FAI values were found to have a greater proportion of high-risk plaques (p = 0.015). Subgroup analysis indicated that lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.017, 95% CI 1.143-3.559, p = 0.015) was independently correlated with MACE in patients with T2DM who have moderate to severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific pericoronary FAI>-83.5 HU significantly enhanced the predictive value of MACE in patients with T2DM within 3 years. CONCLUSIONS The elevated lesion-specific pericoronary FAI emerged as an independent prognostic factor for MACE in patients with T2DM, inclusive of those with moderate to severe coronary artery calcification. Incorporating lesion-specific pericoronary FAI with the CACS provided incremental predictive power for MACE in patients with T2DM.
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Affiliation(s)
- Meiju Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yanhua Zhen
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Qian Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Weishi Ni
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yujuan Qiao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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Liang J, Zhou K, Chu MP, Wang Y, Yang G, Li H, Chen W, Yin K, Xue Q, Zheng C, Gu R, Li Q, Chen X, Sheng Z, Chu B, Mu D, Yu H, Zhang B. Automated detection and classification of coronary atherosclerotic plaques on coronary CT angiography using deep learning algorithm. Quant Imaging Med Surg 2024; 14:3837-3850. [PMID: 38846308 PMCID: PMC11151262 DOI: 10.21037/qims-23-1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/05/2024] [Indexed: 06/09/2024]
Abstract
Background Coronary artery disease (CAD) is the leading cause of mortality worldwide. Recent advances in deep learning technology promise better diagnosis of CAD and improve assessment of CAD plaque buildup. The purpose of this study is to assess the performance of a deep learning algorithm in detecting and classifying coronary atherosclerotic plaques in coronary computed tomographic angiography (CCTA) images. Methods Between January 2019 and September 2020, CCTA images of 669 consecutive patients with suspected CAD from Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine were included in this study. There were 106 patients included in the retrospective plaque detection analysis, which was evaluated by a deep learning algorithm and four independent physicians with varying clinical experience. Additionally, 563 patients were included in the analysis for plaque classification using the deep learning algorithm, and their results were compared with those of expert radiologists. Plaques were categorized as absent, calcified, non-calcified, or mixed. Results The deep learning algorithm exhibited higher sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy {92% [95% confidence interval (CI): 89.5-94.1%], 87% (95% CI: 84.2-88.5%), 79% (95% CI: 76.1-82.4%), 95% (95% CI: 93.4-96.3%), and 89% (95% CI: 86.9-90.0%)} compared to physicians with ≤5 years of clinical experience in CAD diagnosis for the detection of coronary plaques. The algorithm's overall sensitivity, specificity, PPV, NPV, accuracy, and Cohen's kappa for plaque classification were 94% (95% CI: 92.3-94.7%), 90% (95% CI: 88.8-90.3%), 70% (95% CI: 68.3-72.1%), 98% (95% CI: 97.8-98.5%), 90% (95% CI: 89.8-91.1%) and 0.74 (95% CI: 0.70-0.78), indicating strong performance. Conclusions The deep learning algorithm has demonstrated reliable and accurate detection and classification of coronary atherosclerotic plaques in CCTA images. It holds the potential to enhance the diagnostic capabilities of junior radiologists and junior intervention cardiologists in the CAD diagnosis, as well as to streamline the triage of patients with acute coronary symptoms.
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Affiliation(s)
- Jing Liang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Kefeng Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Michael P. Chu
- Clinical Atherosclerosis Research Laboratory, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Yujie Wang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Gang Yang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Hui Li
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenping Chen
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Kejie Yin
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiucang Xue
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Zheng
- Shukun (Beijing) Network Technology Co., Ltd., Beijing, China
| | - Rong Gu
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiaoling Li
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, Shanghai, China
| | - Zhihong Sheng
- Clinical Science, Philips Healthcare, Shanghai, China
| | - Baocheng Chu
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dan Mu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongming Yu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Institute of Brain Science, Nanjing University, Nanjing, China
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Sharma SP, van der Bie J, van Straten M, Hirsch A, Bos D, Dijkshoorn ML, Booij R, Budde RPJ. Coronary calcium scoring on virtual non-contrast and virtual non-iodine reconstructions compared to true non-contrast images using photon-counting computed tomography. Eur Radiol 2024; 34:3699-3707. [PMID: 37940711 PMCID: PMC11166815 DOI: 10.1007/s00330-023-10402-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/17/2023] [Accepted: 09/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To compare coronary artery calcification (CAC) scores measured on virtual non-contrast (VNC) and virtual non-iodine (VNI) reconstructions computed from coronary computed tomography angiography (CCTA) using photon-counting computed tomography (PCCT) to true non-contrast (TNC) images. METHODS We included 88 patients (mean age = 59 years ± 13.5, 69% male) who underwent a TNC coronary calcium scan followed by CCTA on PCCT. VNC images were reconstructed in 87 patients and VNI in 88 patients by virtually removing iodine from the CCTA images. For all reconstructions, CAC scores were determined, and patients were classified into risk categories. The overall agreement of the reconstructions was analyzed by Bland-Altman plots and the level of matching classifications. RESULTS The median CAC score on TNC was 27.8 [0-360.4] compared to 8.5 [0.2-101.6] (p < 0.001) on VNC and 72.2 [1.3-398.8] (p < 0.001) on VNI. Bland-Altman plots depicted a bias of 148.8 (ICC = 0.82, p < 0.001) and - 57.7 (ICC = 0.95, p < 0.001) for VNC and VNI, respectively. Of all patients with CACTNC = 0, VNC reconstructions scored 63% of the patients correctly, while VNI scored 54% correctly. Of the patients with CACTNC > 0, VNC and VNI reconstructions detected the presence of coronary calcium in 90% and 92% of the patients. CACVNC tended to underestimate CAC score, whereas CACVNI overestimated, especially in the lower risk categories. According to the risk categories, VNC misclassified 55% of the patients, while VNI misclassified only 32%. CONCLUSION Compared to TNC images, VNC underestimated and VNI overestimated the actual CAC scores. VNI reconstructions quantify and classify coronary calcification scores more accurately than VNC reconstructions. CLINICAL RELEVANCE STATEMENT Photon-counting CT enables spectral imaging, which might obviate the need for non-contrast enhanced coronary calcium scoring, but optimization is necessary for the clinical implementation of the algorithms. KEY POINTS • Photon-counting computed tomography uses spectral information to virtually remove the signal of contrast agents from contrast-enhanced scans. • Virtual non-contrast reconstructions tend to underestimate coronary artery calcium scores compared to true non-contrast images, while virtual non-iodine reconstructions tend to overestimate the calcium scores. • Virtual non-iodine reconstructions might obviate the need for non-contrast enhanced calcium scoring, but optimization is necessary for the clinical implementation of the algorithms.
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Affiliation(s)
- Simran P Sharma
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith van der Bie
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel L Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Hedayati Goudarzi MT, Abrotan S, Ziaie N, Amin K, Saravi M, Jalali SF, Pourkia R, Jafaripour I, Moradi A, kargar-soleimanabad S, Saffar H. Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran. Ann Med Surg (Lond) 2024; 86:3227-3232. [PMID: 38846865 PMCID: PMC11152861 DOI: 10.1097/ms9.0000000000001661] [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: 09/14/2023] [Accepted: 12/17/2023] [Indexed: 06/09/2024] Open
Abstract
Background Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined. Objective To investigate the association between CAC score and in-hospital mortality of COVID-19 patients. Method This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes. Results The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70-10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13-1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47-2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79-18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18-40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001). Conclusion Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.
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Affiliation(s)
| | - Saeed Abrotan
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Naghmeh Ziaie
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Kamyar Amin
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Mehrdad Saravi
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Seyed farzad Jalali
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Roghayeh Pourkia
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Iraj Jafaripour
- Department of Cardiology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol
| | - Amir Moradi
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Saeed kargar-soleimanabad
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homina Saffar
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Raitakari OT, Magnussen CG, Juonala M, Kartiosuo N, Pahkala K, Rovio S, Koskinen JS, Mykkänen J, Laitinen TP, Kähönen M, Nuotio J, Viikari JSA. Subclinical atherosclerosis in young adults predicting cardiovascular disease: The Cardiovascular Risk in Young Finns Study. Atherosclerosis 2024; 393:117515. [PMID: 38582639 DOI: 10.1016/j.atherosclerosis.2024.117515] [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: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND AIMS Atherosclerosis is accompanied by pre-clinical vascular changes that can be detected using ultrasound imaging. We examined the value of such pre-clinical features in identifying young adults who are at risk of developing atherosclerotic cardiovascular disease (ASCVD). METHODS A total of 2641 individuals free of ASCVD were examined at the mean age of 32 years (range 24-45 years) for carotid artery intima-media thickness (IMT) and carotid plaques, carotid artery elasticity, and brachial artery flow-mediated endothelium-dependent vasodilation (FMD). The average follow-up time to event/censoring was 16 years (range 1-17 years). RESULTS Sixty-seven individuals developed ASCVD (incidence 2.5%). The lowest incidence (1.1%) was observed among those who were estimated of having low risk according to the SCORE2 risk algorithm (<2.5% 10-year risk) and who did not have plaque or high IMT (upper decile). The highest incidence (11.0%) was among those who were estimated of having a high risk (≥2.5% 10-year risk) and had positive ultrasound scan for carotid plaque and/or high IMT (upper decile). Carotid plaque and high IMT remained independently associated with higher risk in multivariate models. The distributions of carotid elasticity indices and brachial FMD did not differ between cases and non-cases. CONCLUSIONS Screening for carotid plaque and high IMT in young adults may help identify individuals at high risk for future ASCVD.
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Affiliation(s)
- Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20520, Turku, Finland.
| | - Costan G Magnussen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Noora Kartiosuo
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Katja Pahkala
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, 20520, Turku, Finland
| | - Suvi Rovio
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Public Health, University of Turku and Turku University Hospital, 20520, Turku, Finland
| | - Juhani S Koskinen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Juha Mykkänen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine University of Eastern Finland, Kuopio, Finland
| | - Mika Kähönen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Joel Nuotio
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
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Solanki AJ, Kamrava M, Posadas EM, Freedland SJ, Ballas L, Sandler HM, Bairey Merz CN, Atkins KM, Nikolova AP. A practical guide for assessing and managing cardiovascular risk during androgen-deprivation therapy in patients with prostate cancer. Cancer 2024; 130:1916-1929. [PMID: 38529566 DOI: 10.1002/cncr.35285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk. Because, for most patients with prostate cancer, death is predominantly from noncancer-related causes, cardiovascular disease and its risk factors should be optimized during cancer treatment. This review provides an overview of the landscape of ADT treatment and serves as a guide for appropriate cardiovascular screening and risk-mitigation strategies. The authors emphasize the importance of shared communication between the multidisciplinary cancer team and primary care to improve baseline cardiovascular screening and treatment of modifiable risk factors within this higher risk population.
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Affiliation(s)
- Aum J Solanki
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Edwin M Posadas
- Department of Medicine, Division of Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andriana P Nikolova
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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42
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Zook S, Tayal B, Kragholm K, Abdelkarim O, Tran D, Cocker M, Ramirez-Giraldo JC, Hallam K, Sexton C, Johnson S, Chang SM. Intraindividual Comparison of Dose Reduction and Coronary Calcium Scoring Accuracy Using Kilovolt-independent and Tin Filtration CT Protocols. Radiol Cardiothorac Imaging 2024; 6:e230246. [PMID: 38934769 PMCID: PMC11211948 DOI: 10.1148/ryct.230246] [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: 08/14/2023] [Revised: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Purpose To investigate the ability of kilovolt-independent (hereafter, kV-independent) and tin filter spectral shaping to accurately quantify the coronary artery calcium score (CACS) and radiation dose reductions compared with the standard 120-kV CT protocol. Materials and Methods This prospective, blinded reader study included 201 participants (mean age, 60 years ± 9.8 [SD]; 119 female, 82 male) who underwent standard 120-kV CT and additional kV-independent and tin filter research CT scans from October 2020 to July 2021. Scans were reconstructed using a Qr36f kernel for standard scans and an Sa36f kernel for research scans simulating artificial 120-kV images. CACS, risk categorization, and radiation doses were compared by analyzing data with analysis of variance, Kruskal-Wallis test, Mann-Whitney test, Bland-Altman analysis, Pearson correlations, and κ analysis for agreement. Results There was no evidence of differences in CACS across standard 120-kV, kV-independent, and tin filter scans, with median CACS values of 1 (IQR, 0-48), 0.6 (IQR, 0-58), and 0 (IQR, 0-51), respectively (P = .85). Compared with standard 120-kV scans, kV-independent and tin filter scans showed excellent correlation in CACS values (r = 0.993 and r = 0.999, respectively), with high agreement in CACS risk categorization (κ = 0.95 and κ = 0.93, respectively). Standard 120-kV scans had a mean radiation dose of 2.09 mSv ± 0.84, while kV-independent and tin filter scans reduced it to 1.21 mSv ± 0.85 and 0.26 mSv ± 0.11, cutting doses by 42% and 87%, respectively (P < .001). Conclusion The kV-independent and tin filter research CT acquisition techniques showed excellent agreement and high accuracy in CACS estimation compared with standard 120-kV scans, with large reductions in radiation dose. Keywords: CT, Cardiac, Coronary Arteries, Radiation Safety, Coronary Artery Calcium Score, Radiation Dose Reduction, Low-Dose CT Scan, Tin Filter, kV-Independent Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Salma Zook
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Bhupendar Tayal
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Kristian Kragholm
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Ola Abdelkarim
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Diana Tran
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Myra Cocker
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Juan Carlos Ramirez-Giraldo
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Kristina Hallam
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Colleen Sexton
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Stephanie Johnson
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Su Min Chang
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
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Yoshida K, Tanabe Y, Hosokawa T, Morikawa T, Fukuyama N, Kobayashi Y, Kouchi T, Kawaguchi N, Matsuda M, Kido T, Kido T. Coronary computed tomography angiography for clinical practice. Jpn J Radiol 2024; 42:555-580. [PMID: 38453814 PMCID: PMC11139719 DOI: 10.1007/s11604-024-01543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
Abstract
Coronary artery disease (CAD) is a common condition caused by the accumulation of atherosclerotic plaques. It can be classified into stable CAD or acute coronary syndrome. Coronary computed tomography angiography (CCTA) has a high negative predictive value and is used as the first examination for diagnosing stable CAD, particularly in patients at intermediate-to-high risk. CCTA is also adopted for diagnosing acute coronary syndrome, particularly in patients at low-to-intermediate risk. Myocardial ischemia does not always co-exist with coronary artery stenosis, and the positive predictive value of CCTA for myocardial ischemia is limited. However, CCTA has overcome this limitation with recent technological advancements such as CT perfusion and CT-fractional flow reserve. In addition, CCTA can be used to assess coronary artery plaques. Thus, the indications for CCTA have expanded, leading to an increased demand for radiologists. The CAD reporting and data system (CAD-RADS) 2.0 was recently proposed for standardizing CCTA reporting. This RADS evaluates and categorizes patients based on coronary artery stenosis and the overall amount of coronary artery plaque and links this to patient management. In this review, we aimed to review the major trials and guidelines for CCTA to understand its clinical role. Furthermore, we aimed to introduce the CAD-RADS 2.0 including the assessment of coronary artery stenosis, plaque, and other key findings, and highlight the steps for CCTA reporting. Finally, we aimed to present recent research trends including the perivascular fat attenuation index, artificial intelligence, and the advancements in CT technology.
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Affiliation(s)
- Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Takaaki Hosokawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoro Morikawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Kobayashi
- Department of Radiology, Matsuyama Red Cross Hospital, Bunkyocho, Matsuyama, Ehime, Japan
| | - Takanori Kouchi
- Department of Radiology, Juzen General Hospital, Kitashinmachi, Niihama, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Megumi Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Santilli F, Albrecht G, Blaha M, Lanas A, Li L, Sibbing D. Needs-based considerations for the role of low-dose aspirin along the CV risk continuum. Am J Prev Cardiol 2024; 18:100675. [PMID: 38694728 PMCID: PMC11061695 DOI: 10.1016/j.ajpc.2024.100675] [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: 12/06/2023] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/04/2024] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death worldwide. The risk of a cardiovascular (CV) event is not static and increases along a continuum, making identification and management complex. Aspirin has been the cornerstone of antiplatelet therapy in CV risk reduction and remains the only antiplatelet agent with current guideline recommendations throughout the CV risk continuum. In light of recent trials, the role of aspirin in CVD prevention in asymptomatic patients has been downgraded in clinical guidelines. However, a substantial proportion of asymptomatic patients have underlying conditions, such as advanced subclinical atherosclerosis that are associated with high CV risk. Advanced subclinical atherosclerosis has not been extensively investigated in patients in clinical trials but in the absence of significant bleeding risks, patients with subclinical atherosclerosis may particularly benefit from preventive aspirin therapy. Recent studies and clinical guidelines support the need for a personalized treatment approach for these patients, balancing their risk of future CV events against their relative bleeding risk. In this commentary, we first discussed various tools and strategies currently available for assessing CV and bleeding risks; we then provided two hypothetical cases to outline how these tools can be implemented for optimal management of patients with no prior CV events who, nonetheless, are susceptible to CVD. The first case details a young and apparently healthy patient with underlying advanced subclinical atherosclerosis; whereas the second case describes a patient with recently diagnosed type 2 diabetes mellitus who is at higher risk of CVD than their non-diabetic counterparts. For both cases, we considered patient clinical characteristics, CV and bleeding risks, as well as other risk factors to evaluate the appropriate treatment strategy and determine whether patients would obtain a net clinical benefit from low-dose aspirin therapy. These cases can serve as examples to guide clinical decision-making on the use of low-dose aspirin for primary CVD prevention and improve CVD management via a personalized approach.
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Affiliation(s)
- Francesca Santilli
- Department of Medicine and Aging and Center for Advanced Studies and Technology, University of Chieti, Chieti, Italy
| | - Gerhard Albrecht
- Medical & Clinical Affairs Consumer Health, Bayer U.S. L.L.C., Whippany, NJ, United States
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Angel Lanas
- University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain
| | - Li Li
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - Dirk Sibbing
- Ludwig-Maximilians University (LMU), Munich, Germany
- and Privatklinik Lauterbacher Mühle am Ostersee, Seeshaupt, Germany
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Natale F, Franzese R, Marotta L, Mollo N, Solimene A, Luisi E, Gentile C, Loffredo FS, Golino P, Cimmino G. Evolving Concepts of the SCORE System: Subtracting Cholesterol from Risk Estimation: A Way for a Healthy Longevity? Life (Basel) 2024; 14:679. [PMID: 38929662 PMCID: PMC11204887 DOI: 10.3390/life14060679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
The role of cholesterol, mainly low-density lipoproteins (LDL-C), as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) is now established and accepted by the international scientific community. Based on this evidence, the European and American guidelines recommend early risk stratification and "rapid" achievement of the suggested target according to the risk estimation to reduce the number of major cardiovascular events. Prolonged exposure over the years to high levels of LDL-C is one of the determining factors in the development and progression of atherosclerotic plaque, on which the action of conventional risk factors (cigarette smoking, excess weight, sedentary lifestyle, arterial hypertension, diabetes mellitus) as well as non-conventional risk factors (gut microbiota, hyperuricemia, inflammation), alone or in combination, favors the destabilization of the atherosclerotic lesion with rupture/fissuration/ulceration and consequent formation of intravascular thrombosis, which leads to the acute clinical manifestations of acute coronary syndromes. In the current clinical practice, there is a growing number of cases that, although extremely common, are emblematic of the concept of long-term exposure to the risk factor (LDL hypercholesterolemia), which, not adequately controlled and in combination with other risk factors, has favored the onset of major cardiovascular events. The triple concept of "go lower, start earlier and keep longer!" should be applied in current clinical practice at any level of prevention. In the present manuscript, we will review the current evidence and documents supporting the causal role of LDL-C in determining ASCVD and whether it is time to remove it from any score.
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Affiliation(s)
- Francesco Natale
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
| | - Rosa Franzese
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigi Marotta
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Noemi Mollo
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Achille Solimene
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Ettore Luisi
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Carmine Gentile
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco S. Loffredo
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Paolo Golino
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (F.N.); (R.F.); (L.M.); (N.M.); (A.S.); (E.L.); (C.G.); (F.S.L.); (P.G.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Cardiology Unit, AOU Luigi Vanvitelli, 80138 Naples, Italy
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Lin AE, Scimone ER, Thom RP, Balaguru D, Kinane TB, Moschovis PP, Cohen MS, Tan W, Hague CD, Dannheim K, Levitsky LL, Lilly E, DiGiacomo DV, Masse KM, Kadzielski SM, Zar-Kessler CA, Ginns LC, Neumeyer AM, Colvin MK, Elder JS, Learn CP, Mou H, Weagle KM, Buch KA, Butler WE, Alhadid K, Musolino PL, Sultana S, Bandyopadhyay D, Rapalino O, Peacock ZS, Chou EL, Heidary G, Dorfman AT, Morris SA, Bergin JD, Rayment JH, Schimmenti LA, Lindsay ME. Emergence of the natural history of Myhre syndrome: 47 patients evaluated in the Massachusetts General Hospital Myhre Syndrome Clinic (2016-2023). Am J Med Genet A 2024:e63638. [PMID: 38779990 DOI: 10.1002/ajmg.a.63638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
Myhre syndrome is an increasingly diagnosed ultrarare condition caused by recurrent germline autosomal dominant de novo variants in SMAD4. Detailed multispecialty evaluations performed at the Massachusetts General Hospital (MGH) Myhre Syndrome Clinic (2016-2023) and by collaborating specialists have facilitated deep phenotyping, genotyping and natural history analysis. Of 47 patients (four previously reported), most (81%) patients returned to MGH at least once. For patients followed for at least 5 years, symptom progression was observed in all. 55% were female and 9% were older than 18 years at diagnosis. Pathogenic variants in SMAD4 involved protein residues p.Ile500Val (49%), p.Ile500Thr (11%), p.Ile500Leu (2%), and p.Arg496Cys (38%). Individuals with the SMAD4 variant p.Arg496Cys were less likely to have hearing loss, growth restriction, and aortic hypoplasia than the other variant groups. Those with the p.Ile500Thr variant had moderate/severe aortic hypoplasia in three patients (60%), however, the small number (n = 5) prevented statistical comparison with the other variants. Two deaths reported in this cohort involved complex cardiovascular disease and airway stenosis, respectively. We provide a foundation for ongoing natural history studies and emphasize the need for evidence-based guidelines in anticipation of disease-specific therapies.
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Affiliation(s)
- Angela E Lin
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor R Scimone
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robyn P Thom
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Duraisamy Balaguru
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - T Bernard Kinane
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter P Moschovis
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Cohen
- Pediatric Otorhinolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Weizhen Tan
- Pediatric Nephrology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cole D Hague
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katelyn Dannheim
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lynne L Levitsky
- Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel V DiGiacomo
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara M Masse
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M Kadzielski
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire A Zar-Kessler
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leo C Ginns
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann M Neumeyer
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jack S Elder
- Division of Pediatric Urology, Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher P Learn
- Division of Cardiology, Department of Medicine, Corrigan Minehan Heart Center, Adult Congenital Heart Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hongmei Mou
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn M Weagle
- Department of Child Life, Pediatric Imaging Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen A Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenda Alhadid
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sadia Sultana
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary S Peacock
- Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Aaron T Dorfman
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James D Bergin
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan H Rayment
- Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Schimmenti
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Lindsay
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Cardiology, Department of Pediatrics, Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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47
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Fornasari A, Kuntz S, Martini C, Perini P, Cabrini E, Freyrie A, Lejay A, Chakfé N. Objective Methods to Assess Aorto-Iliac Calcifications: A Systematic Review. Diagnostics (Basel) 2024; 14:1053. [PMID: 38786352 PMCID: PMC11119820 DOI: 10.3390/diagnostics14101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 publications, 11 studies met the inclusion criteria. In total, 7 studies utilized manual methods, while 4 studies utilized automated technologies, including artificial intelligence and deep learning for image analyses. Age, systolic blood pressure, serum calcium, and lipoprotein(a) levels were found to be independent risk factors for aortic calcification. Mortality from CVDs was correlated with abdominal aorta calcification. Patients requiring reintervention after endovascular recanalization exhibited a significantly higher volume of calcification in their iliac arteries. Conclusions: This review reveals a diverse landscape of measurement methods for aorto-iliac calcifications; however, they lack a standardized reproducibility assessment. Automatic methods employing artificial intelligence appear to offer broader applicability and are less time-consuming. Assessment of calcium scoring could be routinely employed during preoperative workups for risk stratification and detailed surgical planning. Additionally, its correlation with clinical outcomes could be useful in predicting the risk of reinterventions and amputations.
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Affiliation(s)
- Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
| | - Salomé Kuntz
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
| | - Antonio Freyrie
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Anne Lejay
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
| | - Nabil Chakfé
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
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Cronin M, Lowery A, Kerin M, Wijns W, Soliman O. Risk Prediction, Diagnosis and Management of a Breast Cancer Patient with Treatment-Related Cardiovascular Toxicity: An Essential Overview. Cancers (Basel) 2024; 16:1845. [PMID: 38791923 PMCID: PMC11120055 DOI: 10.3390/cancers16101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Breast cancer is amongst the most common invasive cancers in adults. There are established relationships between anti-cancer treatments for breast cancer and cardiovascular side effects. In recent years, novel anti-cancer treatments have been established, as well as the availability of multi-modal cardiac imaging and the sophistication of treatment for cardiac disease. This review provides an in-depth overview regarding the interface of breast cancer and cancer therapy-related cardiovascular toxicity. Specifically, it reviews the pathophysiology of breast cancer, the method of action in therapy-related cardiovascular toxicity from anti-cancer treatment, the use of echocardiography, cardiac CT, MRI, or nuclear medicine as diagnostics, and the current evidence-based treatments available. It is intended to be an all-encompassing review for clinicians caring for patients in this situation.
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Affiliation(s)
- Michael Cronin
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
| | - Aoife Lowery
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Michael Kerin
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
| | - William Wijns
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Osama Soliman
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
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49
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Gami A, Bisht S, Satish P, Blaha MJ, Patel J. The utility of coronary artery calcium scoring to enhance cardiovascular risk assessment for South Asian adults. Prog Cardiovasc Dis 2024; 84:7-13. [PMID: 38723928 DOI: 10.1016/j.pcad.2024.05.001] [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: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
South Asian individuals represent a highly diverse population and are one of the fastest growing ethnic groups in the United States. This population has a high prevalence of traditional and non-traditional cardiovascular disease (CVD) risk factors and a disproportionately high prevalence of coronary heart disease. To reflect this, current national society guidelines have designated South Asian ancestry as a "risk enhancing factor" which may be used to guide initiation or intensification of statin therapy. However, current methods of assessing cardiovascular risk in South Asian adults may not adequately capture the true risk in this diverse population. Coronary artery calcium (CAC) scoring provides a reliable, reproducible, and highly personalized method to provide CVD risk assessment and inform subsequent pharmacotherapy recommendations, if indicated. This review describes the utility of CAC scoring for South Asian individuals.
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Affiliation(s)
- Abhishek Gami
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Baltimore, MD, USA
| | - Sushrit Bisht
- Anne Arundel Medical Center, Department of Internal Medicine, Annapolis, MD, USA
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, TX, USA
| | - Michael J Blaha
- South Asian Cardiovascular Health Initiative (SACHI), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Jaideep Patel
- South Asian Cardiovascular Health Initiative (SACHI), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
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50
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Hulot JS, Janiak P, Boutinaud P, Boutouyrie P, Chézalviel-Guilbert F, Christophe JJ, Cohen A, Damy T, Djadi-Prat J, Firat H, Hervé PY, Isnard R, Jondeau G, Mousseaux E, Pernot M, Prot P, Tyl B, Soulat G, Logeart D. Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study. Arch Cardiovasc Dis 2024; 117:332-342. [PMID: 38644067 DOI: 10.1016/j.acvd.2024.02.011] [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: 12/26/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that is poorly defined, reflecting an incomplete understanding of its pathophysiology. AIM To redefine the phenotypic spectrum of HFpEF. METHODS The PACIFIC-PRESERVED study is a prospective multicentre cohort study designed to perform multidimensional deep phenotyping of patients diagnosed with HFpEF (left ventricular ejection fraction≥50%), patients with heart failure with reduced ejection fraction (left ventricular ejection fraction≤40%) and subjects without overt heart failure (3:2:1 ratio). The study proposes prospective investigations in patients during a 1-day hospital stay: physical examination; electrocardiogram; performance-based tests; blood samples; cardiac magnetic resonance imaging; transthoracic echocardiography (rest and low-level exercise); myocardial shear wave elastography; chest computed tomography; and non-invasive measurement of arterial stiffness. Dyspnoea, depression, general health and quality of life will be assessed by dedicated questionnaires. A biobank will be established. After the hospital stay, patients are asked to wear a connected garment (with digital sensors) to collect electrocardiography, pulmonary and activity variables in real-life conditions (for up to 14 days). Data will be centralized for machine-learning-based analyses, with the aim of reclassifying HFpEF into more distinct subgroups, improving understanding of the disease mechanisms and identifying new biological pathways and molecular targets. The study will also serve as a platform to enable the development of innovative technologies and strategies for the diagnosis and stratification of patients with HFpEF. CONCLUSIONS PACIFIC-PRESERVED is a prospective multicentre phenomapping study, using novel analytical techniques, which will provide a unique data resource to better define HFpEF and identify new clinically meaningful subgroups of patients.
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Affiliation(s)
- Jean-Sébastien Hulot
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; CIC1418 and DMU CARTE, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France.
| | | | | | - Pierre Boutouyrie
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Pharmacology and DMU CARTE, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | | | | | - Ariel Cohen
- Cardiology, Hôpital Saint-Antoine, AP-HP, ICAN 1166, Sorbonne Université, 75012 Paris, France
| | - Thibaud Damy
- Cardiology, Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Juliette Djadi-Prat
- Clinical Research Unit, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | | | | | - Richard Isnard
- Cardiology, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | - Elie Mousseaux
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Cardiac Imaging Radiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, PSL University, CNRS FRE 2031, 75015 Paris, France
| | | | | | - Gilles Soulat
- Université Paris Cité, INSERM, PARCC, 75015 Paris, France; Cardiac Imaging Radiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Damien Logeart
- Cardiology, Hôpital Lariboisière, AP-HP, 75018 Paris, France
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