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Cheng Y, Meng X, Gao H, Yang C, Li P, Li H, Chatterjee S, Rezende PC, Bonnet M, Li H, Zhang Z, Ji F, Zhang W. Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2024; 24:117. [PMID: 38373881 PMCID: PMC10877850 DOI: 10.1186/s12872-024-03758-6] [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: 11/02/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients. METHODS This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027). CONCLUSION The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.
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Affiliation(s)
- Yalin Cheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haiyang Gao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Peng Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hongfei Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Saurav Chatterjee
- Clinical Assistant Professor of Medicine, Northwell Health, Zucker School of Medicine, Hempstead, NY, USA
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marc Bonnet
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Huimin Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zunlei Zhang
- Department of Cardiology, People's Hospital of Weishan County, Jining, Shandong, 277600, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Manukyan M, Falkovskaya A, Mordovin V, Pekarskiy S, Zyubanova I, Solonskaya E, Ryabova T, Khunkhinova S, Vtorushina A, Popov S. Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus. Front Cardiovasc Med 2022; 9:1010546. [PMID: 36601066 PMCID: PMC9806766 DOI: 10.3389/fcvm.2022.1010546] [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: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the effect of renal denervation (RDN) on renal vascular resistance and renal function in patients with drug-resistant hypertension (HTN) and type 2 diabetes mellitus (T2DM). Materials and methods Fifty-nine patients (mean age 60.3 ± 7.9 years, 25 men) with resistant HTN [mean 24-h ambulatory blood pressure (BP) 158.0 ± 16.3/82.5 ± 12.7 mmHg, systolic/diastolic] and T2DM (mean HbA1c 7.5 ± 1.5%) were included in the single-arm prospective study and underwent RDN. Renal resistive index (RRI) derived from ultrasound Doppler; estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula), office and 24-h ambulatory BP were measured at baseline, 6, and 12 months after RDN to evaluate the respective changes in renal vascular resistance, renal function, and BP during treatment. Results Forty-three patients completed 12 months follow-up. The RRI changed depending on the baseline value. Specifically, the RRI decreased significantly in patients with elevated baseline RRI values ≥ 0.7 {n = 23; -0.024 [95% confidence interval (CI): -0.046, -0.002], p = 0.035} and did not change in those with baseline RRI < 0.7 [n = 36; 0.024 (95% CI: -0.002, 0.050), p = 0.069]. No significant change was observed in eGFR whereas BP was significantly reduced at 12 months after RDN by -10.9 (95% CI: -16.7, -5.0)/-5.5 (95% CI: -8.7, -2.4) mmHg, systolic/diastolic. No relationship was found between the changes in RRI and BP. Conclusion Our study shows that RDN can decrease elevated renal vascular resistance (RRI > 0.7) and stabilize kidney function in patients with RHTN and T2DM independently of its BP-lowering effect.
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Pyrros A, Flanders AE, Rodríguez-Fernández JM, Chen A, Cole P, Wenzke D, Hart E, Harford S, Horowitz J, Nikolaidis P, Muzaffar N, Boddipalli V, Nebhrajani J, Siddiqui N, Willis M, Darabi H, Koyejo O, Galanter W. Predicting Prolonged Hospitalization and Supplemental Oxygenation in Patients with COVID-19 Infection from Ambulatory Chest Radiographs using Deep Learning. Acad Radiol 2021; 28:1151-1158. [PMID: 34134940 PMCID: PMC8139280 DOI: 10.1016/j.acra.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/18/2022]
Abstract
Rationale and Objectives The clinical prognosis of outpatients with coronavirus disease 2019 (COVID-19) remains difficult to predict, with outcomes including asymptomatic, hospitalization, intubation, and death. Here we determined the prognostic value of an outpatient chest radiograph, together with an ensemble of deep learning algorithms predicting comorbidities and airspace disease to identify patients at a higher risk of hospitalization from COVID-19 infection. Materials and Methods This retrospective study included outpatients with COVID-19 confirmed by reverse transcription-polymerase chain reaction testing who received an ambulatory chest radiography between March 17, 2020 and October 24, 2020. In this study, full admission was defined as hospitalization within 14 days of the COVID-19 test for > 2 days with supplemental oxygen. Univariate analysis and machine learning algorithms were used to evaluate the relationship between the deep learning model predictions and hospitalization for > 2 days. Results The study included 413 patients, 222 men (54%), with a median age of 51 years (interquartile range, 39–62 years). Fifty-one patients (12.3%) required full admission. A boosted decision tree model produced the best prediction. Variables included patient age, frontal chest radiograph predictions of morbid obesity, congestive heart failure and cardiac arrhythmias, and radiographic opacity, with an internally validated area under the curve (AUC) of 0.837 (95% CI: 0.791–0.883) on a test cohort. Conclusion Deep learning analysis of single frontal chest radiographs was used to generate combined comorbidity and pneumonia scores that predict the need for supplemental oxygen and hospitalization for > 2 days in patients with COVID-19 infection with an AUC of 0.837 (95% confidence interval: 0.791–0.883). Comorbidity scoring may prove useful in other clinical scenarios.
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Could aortic arch calcification help in detection of hypertensive retinopathy? Blood Press Monit 2021; 26:118-123. [PMID: 33234808 DOI: 10.1097/mbp.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hypertension-induced end-organ damage is one of the important determinants of morbidity and mortality in patients with hypertension. All types of hypertension-induced end-organ damages start with vascular damage. Vascular calcification is a marker of vascular damage and aortic arch calcification (AAC) is one of the easily identifiable types of vascular calcification. We hypothesized that AAC predicts retinopathy in hypertensive patients. METHODS Consecutive hypertensive patients without diabetes mellitus were included. Chest radiography in the posterior-anterior was used to assess the presence of AAC. All patients underwent ophthalmologic examination for retinopathy. RESULTS We included 495 hypertensive patients in this study. Of these, 306 (62%) had hypertensive retinopathy. Patients with hypertensive retinopathy had significantly higher prevalence of AAC as compared to the patients without hypertensive retinopathy (88% vs. 22%, P < 0.001). We found a strong and positive correlation between hypertensive retinopathy and AAC grades (r = 639, P < 0.001). Receiver operator characteristics curve analysis yielded a strong predictive ability of AAC for the presence of hypertensive retinopathy [area under curve = 0.814, 95% confidence interval (CI): 0.775-0.853, P < 0.0001]. In multivariate logistic regression analysis, presence of AAC [odds ratio (OR) 13.128; CI: 7.894-21.832] and serum glucose levels (OR 1.020; CI: 1.003-1.037) were strongly and independently associated with hypertensive retinopathy. CONCLUSION Presence of AAC on chest radiograph is strongly and independently associated with retinopathy in nondiabetic hypertensive patients. This simple, inexpensive and widely available tool may help in early detection of retinopathy in patients with hypertension.
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Adar A, Onalan O, Cakan F, Akbay E, Karakaya E. Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern. Arq Bras Cardiol 2020; 114:109-117. [PMID: 31664318 PMCID: PMC7025298 DOI: 10.5935/abc.20190229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 03/20/2019] [Indexed: 01/20/2023] Open
Abstract
Background Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. Objectives The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. Methods All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of ≤10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. Results A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. Conclusions Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern.
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Affiliation(s)
- Adem Adar
- Karabuk University Faculty of Medicine - Cardiology, Karabuk - Turkey
| | - Orhan Onalan
- Karabuk University Faculty of Medicine - Cardiology, Karabuk - Turkey
| | - Fahri Cakan
- Karabuk University Faculty of Medicine - Cardiology, Karabuk - Turkey
| | - Ertan Akbay
- Karabuk University Faculty of Medicine - Cardiology, Karabuk - Turkey
| | - Ekrem Karakaya
- Karabuk University Faculty of Medicine - Cardiology, Karabuk - Turkey
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Sistani SS, Alidadi A, Moghadam AA, Mohamadnezhad F, Ghahderijani BH. Comparison of renal arterial resistive index in type 2 diabetic nephropathy stage 0-4. Eur J Transl Myol 2019; 29:8364. [PMID: 31908744 PMCID: PMC6926434 DOI: 10.4081/or.2019.8364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) is one of world health problems and its prevalence and incidence is increasing. Chronic Kidney Failure involves a range of pathophysiologic processes that are associated with impaired renal function, leading to cardiovascular morbidity and mortality. Renal artery resistive index (RI) is indicator of atherosclerotic change in small vessels. The current study was aimed to assess RI in diabetic nephropathy patients at stage 0-4 and to compare RRI with HbA1c, systolic blood pressure, diastolic blood pressure, albuminuria and glomerular filtration rate (GFR). In this cross sectional study,100 diabetic nephropathy patients who attend to nephrology clinic of Ali-ibn Abi Talib Hospital were entered to the study. Ultrasound Doppler renal resistive index was measured and other information was recorded from their last lab data that was recorded in their medical records. Variable included: systolic blood pressure, diastolic blood pressure, albuminuria, GFR, HbA1c. All data was analyzed by Pearson's Correlation Coefficient. The findings indicated a significant correlation of RI with systolic BP (p=0.04 R=0.75), microalbuminuria (P=0.001 R=0.67), and GFR (P=0.001 R=0.76), while diastolic BP (P=0/45 R=0/32), HbA1c (P=0/56 R=0/43) were not found to be associated with RI. The findings indicated that increased systolic blood pressure, albumin excretion (microalbuminuria) and severity of disease were capable of increasing RI values in diabetic nephropathy patients. In addition, decreased GFR.
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Affiliation(s)
- Sharareh Sanei Sistani
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Alidadi
- Department of Nephrology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Fatemeh Mohamadnezhad
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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