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Demirel C, Halavina K, Hamzaraj K, Klement J, El-Shaer M, Hemetsberger R, Winter MP, Koschatko S, Jantsch C, Andreas M, Loewe C, Kammerlander A, Hengstenberg C, Bartko PE. Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement. J Clin Med 2024; 13:2698. [PMID: 38731227 PMCID: PMC11084390 DOI: 10.3390/jcm13092698] [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: 04/04/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95%CI: 1.01-1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068-1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.
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Affiliation(s)
- Caglayan Demirel
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Kseniya Halavina
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Kevin Hamzaraj
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Johanna Klement
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Manar El-Shaer
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Rayyan Hemetsberger
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Max Paul Winter
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Sophia Koschatko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Charlotte Jantsch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Martin Andreas
- Department of Internal Medicine II, Clinical Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christian Loewe
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Andreas Kammerlander
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Philipp E. Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
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Association between prior cancer diagnosis and osteoporosis: a matched case-control study. Arch Osteoporos 2022; 17:112. [PMID: 35960383 DOI: 10.1007/s11657-022-01152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
Epidemiological studies show an inconsistent association between cancer and osteoporosis. In this nationally representative population-based study, we found that a prior cancer diagnosis was not associated with osteoporosis. This finding may primarily apply to cancer survivors seen many years after their cancer diagnosis. BACKGROUND Epidemiological studies show an inconsistent association between cancer and osteoporosis. We examined the association between a prior cancer diagnosis and osteoporosis in population-based data. METHODS We performed an age- and sex-matched case-control study (1:2 matching ratio) using the National Health and Nutrition Examination Survey, 2011-2018. Cases were determined by self-reported prior diagnosis of cancer; all controls were free of cancer at the time of bone density measurement with dual-energy x-ray absorptiometry. We defined osteoporosis as a T-score ≤ - 2.5 at femoral neck, total hip, or lumbar spine. Unconditional multivariable logistic regression was used to test the association between a prior cancer diagnosis and osteoporosis. RESULTS We identified 246 prior cancer cases and 492 controls (mean age: 65.8 years) in females, and 243 prior cancer cases and 486 controls (mean age: 68.0 years) in males. The most common types of cancer in females and males were breast cancer and prostate cancer, respectively. Osteoporosis prevalences were comparable between cases and controls among females (19.1% in cases vs. 18.7% in controls; P = 0.894) and males (5.8% in cases vs. 6.8% in controls; P = 0.594). After adjusting for covariates, a prior cancer diagnosis was not associated with osteoporosis in females (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.54-1.29) or males (OR: 1.09; 95% CI: 0.51-2.30). Results were unaffected by cancer severity, cancer type, or time since cancer diagnosis. CONCLUSIONS A prior cancer diagnosis was not associated with osteoporosis in this nationally representative population.
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Zhao C, Wang Y, Cai X, Xu W, Wang D, Wang T, Jia Q, Gong H, Sun H, Wu Z, Xiao J. Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM). Cancer Manag Res 2020; 12:11501-11513. [PMID: 33204161 PMCID: PMC7667004 DOI: 10.2147/cmar.s273785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background Surgery remains the mainstay of treatment for breast cancer spinal metastasis (BCSM) to relieve symptoms and improve the quality of life of BCSM patients. Therefore, it is important to effectively predict the prognosis of patients to determine whether they can undergo surgical operation. However, the prevalent methods for prognosis evaluation lack specificity and sensitivity for indicated malignancies like breast cancer because they are built on a relatively small number of heterogeneous types of primary tumors. The aim of the present study was to explore a novel predictive model based on the clinical, pathological and blood parameters obtained from BCSM patients before they received surgical intervention. Methods Altogether, 144 patients were included in this study. Univariate and multivariate analyses were performed to investigate the significance of preoperative parameters and identify independent factors for prognostic prediction of BCSM. A nomogram for survival prediction was then established and validated. Time-dependent ROC (TDROC) curves were graphed to evaluate the accuracy of the novel model vs other scoring systems including Tomita Score, revised Tokuhashi Score, modified Bauer Score and New England Spinal Metastasis Score. P values <0.05 were considered statistically significant. Results Independent factors, including preoperative postmenopausal (P=0.034), visceral metastasIs (P=0.021), preoperative Frankel Score (P=0.001), estrogen receptor status (P=0.014), platelet-to-lymphocyte ratio (P=0.012), lymphocyte-monocyte ratio (P<0.001) and albumin-globulin ratio (P=0.017), were selected into the nomogram model with the C-index of 0.834 (95% CI, 0.789–0.890). TDROC curves showed that the Changzheng Hospital (CZ) Score system had the best performance and exhibited the largest IAUC value in comparison with the other scoring systems. Conclusion We constructed a nomogram model known as CZ Score based on the significant factors to predict the prognosis for BCSM patients. The result showed that CZ Score had a better value for prognostic evaluation and surgical decision-making as compared with the other scoring systems.
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Affiliation(s)
- Chenglong Zhao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yao Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Xiaopan Cai
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Wei Xu
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Dongsheng Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Ting Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Qi Jia
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Haiyi Gong
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Haitao Sun
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Zhipeng Wu
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Jianru Xiao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
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Buttros DDAB, Branco MT, Orsatti CL, Almeida-Filho BDS, Nahas-Neto J, Nahas EAP. High risk for cardiovascular disease in postmenopausal breast cancer survivors. Menopause 2019; 26:1024-1030. [PMID: 31453965 DOI: 10.1097/gme.0000000000001348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Breast cancer patients have a higher mortality risk of cardiovascular disease (CVD) than women from the general population. CVD risk may increase significantly in postmenopausal women with early-stage breast cancer. The aim of this study was to evaluate risk factors for CVD in postmenopausal breast cancer survivors. METHODS In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared with 192 postmenopausal women. The main group included women with amenorrhea >12 months, aged ≥45 years, with breast cancer, and without established CVD. The control group fulfilled the same criteria, but did not have breast cancer. Groups were matched by age, time since menopause, and body mass index, in a ratio of 1 case to 2 controls (1:2). Women with three or more of the following criteria were diagnosed with metabolic syndrome: waist circumference >88 cm; triglycerides ≥150 mg/dL; high-density lipoprotein cholesterol <50 mg/dL; blood pressure ≥130/85 mm Hg; and glucose ≥100 mg/dL. Immunoassays were used (enzyme-linked immunosorbent assay test) for measurement of plasma heat shock proteins (HSP) 60 and 70 concentrations. Atherosclerotic disease was determined by intima-media thickness (>1 mm) of the carotid arteries and/or the presence of atheromatous plaque assessed by carotid artery ultrasound (scanner duplex). RESULTS Breast cancer patients had higher HSP60 levels and lower HSP70 levels than controls (P < 0.05). Analysis showed that the odds of developing metabolic syndrome (odds ratio [OR] = 4.21, 95% CI, 2.28-7.76), atheromatous plaque (OR = 2.61, 95% CI, 1.19-5.72), diabetes (OR = 4.42; 95% CI, 1.86-10.49), hypertriglyceridemia (OR = 2.32, 95% CI, 1.33-4.0), and increased waist circumference (OR = 11.22, 95% CI, 4.0-31.65) was significantly higher in women treated for cancer than in women without breast cancer. CONCLUSIONS Postmenopausal breast cancer survivors had a stronger association with risk factors for cardiovascular disease than postmenopausal women without breast cancer.
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Terra Branco M, de Araujo Brito Buttros D, Carvalho-Pessoa E, Lima Sobreira M, Yukie Nakano Schincariol C, Nahas-Neto J, Nahas EAP. Atherosclerotic disease and cardiovascular risk factors in postmenopausal breast cancer survivors: a case-control study. Climacteric 2019; 22:202-207. [PMID: 30624095 DOI: 10.1080/13697137.2018.1551345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Breast cancer (BC) therapies and the longevity that the women achieve imply a higher cardiovascular risk. The aim of the study was to evaluate the frequency of atherosclerotic disease and its association with cardiovascular risk factors in postmenopausal breast cancer survivors (BCS) compared to postmenopausal women without BC. METHODS In this study, 96 women with BC (case group) were compared to 192 women without BC (control group), age range 45-75 years. The case group included women with a histological diagnosis of BC, amenorrhea ≥ 12 months, and age ≥ 45 years, without metastatic disease or cardiovascular disease (CVD). The control group consisted of women with amenorrhea ≥ 12 months and age ≥ 45 years, without BC or CVD. Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, and insulin were measured. Atherosclerotic disease was determined by increased intima-media thickness (thickness > 1.0 mm) of the carotid arteries and/or presence of atheromatous plaques evaluated by carotid duplex ultrasound. RESULTS The frequency of diabetes and metabolic syndrome were higher in BCS compared to controls (19.8% vs. 6.8% and 54.2% vs. 37.0%, respectively, p < 0.05). There was no difference in subclinical atherosclerosis between groups (BCS 26% vs. controls 18.7%, p = 0.062). However, atheromatous plaques were more frequent in BCS compared to controls (19.8% vs. 9.4%, p = 0.013). In the risk analysis, adjusted for age, time since menopause, and body mass index, BCS had a 2.4-fold higher risk of atheromatous plaques (odds ratio = 2.42; 95% confidence interval 1.18-4.93, p = 0.033) than women without BC. CONCLUSION Postmenopausal BCS had a higher risk of developing atherosclerotic disease, associated with a higher frequency of cardiovascular risk factors such as metabolic syndrome and diabetes, when compared to women of the same age group without BC.
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Affiliation(s)
- M Terra Branco
- a Department of Gynecology and Obstetrics , Sao Paulo State University - UNESP , Sao Paulo , Brazil
| | | | - E Carvalho-Pessoa
- a Department of Gynecology and Obstetrics , Sao Paulo State University - UNESP , Sao Paulo , Brazil
| | - M Lima Sobreira
- b Department of Surgery, Botucatu Medical School , Sao Paulo State University - UNESP , Sao Paulo , Brazil
| | | | - J Nahas-Neto
- a Department of Gynecology and Obstetrics , Sao Paulo State University - UNESP , Sao Paulo , Brazil
| | - E Aguiar Petri Nahas
- a Department of Gynecology and Obstetrics , Sao Paulo State University - UNESP , Sao Paulo , Brazil
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