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Klopf J, Fuchs L, Schernthaner R, Domenig CM, Gollackner B, Brostjan C, Neumayer C, Eilenberg W. The prognostic impact of vascular calcification on abdominal aortic aneurysm progression. J Vasc Surg 2021; 75:1926-1934. [PMID: 34921970 DOI: 10.1016/j.jvs.2021.11.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The maximal aortic diameter is currently the only clinically applied predictor of abdominal aortic aneurysm (AAA) progression. It is known that risk of rupture is associated with aneurysm size, hence accurate monitoring of AAA expansion is crucial. Aneurysmal vessel wall calcification and its implication on AAA expansion are insufficiently explored. We evaluated the vascular calcification using longitudinal computed tomography angiographies (CTA) of AAA patients and its association with AAA growth. METHODS We conducted a retrospective study of 102 AAA patients with a total number of 389 abdominal CTAs at six-month intervals, treated and followed-up at the Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna. Digitally stored CTAs were reviewed for vascular calcification (volume and score) of the infrarenal aorta and common iliac arteries as well as for morphometric AAA analysis. In the prognostic setting, slow versus fast AAA progression was defined as < 2 or ≥ 2 mm increase in AAA diameter over six months. In addition, to analyze the association of vascular calcification and AAA growth rate with longitudinal monitoring data, a specifically tailored log-linear mixed model was employed. RESULTS An inverse relation of increased abdominal vessel wall calcification and short-term AAA progression was detected. Compared to fast progressing AAA, the median calcification volume of the infrarenal aorta (1225.3 vs 519.8 mm³, P = 0.003), the median total calcification volume (2014.1 vs 1434.9 mm³, P = 0.008) and the median abdominal total customized Agatston calcium (cAC) score (1663.5 vs 718.4, P = 0.003) were significantly increased in slow progressing AAA. Importantly, a log-linear mixed model efficiently predicted AAA expansion based on current diameter and abdominal total cAC score (P = 0.042). CONCLUSION We assessed the prognostic value of CTA-measured vascular calcification for AAA progression. Increased vascular calcification stabilizes the aortic aneurysmal wall and likely protects against progressive AAA expansion, resulting in a significant decrease of aneurysm growth over time. As a consequence, this may have implications for rupture risk, mortality, morbidity, and cost.
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Affiliation(s)
- Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Lukas Fuchs
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Rüdiger Schernthaner
- Department of Biomedical Imaging and Image Guided Therapy: Division of Cardiovascular and Interventional Radiology, University Hospital Vienna, Medical University of Vienna, Vienna, Austria; Department of Radiology, Hospital Landstrasse, Vienna, Austria
| | - Christoph M Domenig
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Bernd Gollackner
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria.
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Kuiper LM, Ikram MK, Kavousi M, Vernooij MW, Ikram MA, Bos D. C-factor: a summary measure for systemic arterial calcifications. BMC Cardiovasc Disord 2021; 21:317. [PMID: 34187369 PMCID: PMC8243490 DOI: 10.1186/s12872-021-02126-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Arterial calcification, the hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites. Hitherto, a single measure capturing the systemic burden of arterial calcification was lacking. In this paper, we propose the C-factor as an overall measure of calcification burden. Methods To quantify calcification in the coronary arteries, aortic arch, extra- and intracranial carotid arteries, and vertebrobasilar arteries, 2384 Rotterdam Study participants underwent cardiac and extra-cardiac non-enhanced CT. We performed principal component analyses on the calcification volumes of all twenty-six possible combinations of these vessel beds. Each analysis’ first principal component represents the C-factor. Subsequently, we determined the correlation between the C-factor derived from all vessel beds and the other C-factors with intraclass correlation coefficient (ICC) analyses. Finally, we examined the association of the C-factor and calcification in the separate vessel beds with cardiovascular, non-cardiovascular, and overall mortality using Cox–regression analyses. Results The ICCs ranged from 0.80 to 0.99. Larger calcification volumes and a higher C-factor were all individually associated with higher risk of cardiovascular, non-cardiovascular, and overall mortality. When included simultaneously in a model, the C-factor was still associated with all three mortality types (adjusted hazard ratio per standard deviation increase (HR) > 1.52), whereas associations of the separate vessel beds with mortality attenuated substantially (HR < 1.26). Conclusions The C-factor summarizes the systemic component of arterial calcification on an individual level and appears robust among different combinations of vessel beds. Importantly, when mutually adjusted, the C-factor retains its strength of association with mortality while the site-specific associations attenuate. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02126-y.
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Affiliation(s)
- Lieke M Kuiper
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daniel Bos
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Cahalane RM, Barrett HE, Ross AM, Mulvihill JJE, Purtill H, Selvarajah L, O'Brien J, Kavanagh EG, Moloneye MA, Egan SM, Leahy FC, Griffin TP, Islam MN, O'Shea PM, Walsh MT, O'Connor EM. On the association between circulating biomarkers and atherosclerotic calcification in a cohort of arterial disease participants. Nutr Metab Cardiovasc Dis 2021; 31:1533-1541. [PMID: 33810961 DOI: 10.1016/j.numecd.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Atherosclerotic calcification is a powerful predictor of cardiovascular disease. This study aims to determine whether circulating levels of a local/systemic calcification inhibitor or a marker of bone formation correlate with measures of coronary or extracoronary calcification. METHODS AND RESULTS Clinical computed tomography (CT) was performed on 64 arterial disease participants undergoing carotid and lower extremity endarterectomy. Coronary artery calcium (CAC) scores and volumes were acquired from the CT scans (n = 42). CAC scores and volumes were used to derive CAC density scores. Micro-CT was performed on excised carotid (n = 36) and lower extremity (n = 31) plaques to quantify the volume and volume fraction of extracoronary calcification. Circulating levels of dephospho-uncarboxylated Matrix Gla Protein (dp-ucMGP), fetuin-A, carboxylated and uncarboxylated osteocalcin (ucOC) were quantified using commercial immunoassays. Carotid participant CAC density scores were moderately negatively correlated with plasma dp-ucMGP (rs = -0.592, P = 0.008). A weak negative association was found between CAC scores and %ucOC for all participants (rs = -0.335, P = 0.040). Another weak negative correlation was observed between fetuin-A and the volume of calcification within excised carotid specimens (rs = -0.366, P = 0.031). Despite substantial differences in coronary and extracoronary calcium measurements, the levels of circulating biomarkers did not vary significantly between carotid and lower extremity subgroups. CONCLUSION Correlations identified between circulating biomarkers and measures of coronary and extracoronary calcium were not consistent among participant subgroups. Further research is required to determine the association between circulating biomarkers, coronary and extracoronary calcium.
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Affiliation(s)
- Rachel M Cahalane
- BioScience and BioEngineering Research, Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland.
| | - Hilary E Barrett
- BioScience and BioEngineering Research, Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland.
| | - Aisling M Ross
- BioScience and BioEngineering Research, Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland.
| | - John J E Mulvihill
- BioScience and BioEngineering Research, Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
| | - Helen Purtill
- Health Research Institute, University of Limerick, Ireland; Department of Mathematics and Statistics, Aging Research Centre, University of Limerick, Ireland.
| | | | - Julie O'Brien
- Department of Radiology, University Hospital Limerick, Ireland.
| | - Eamon G Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Ireland.
| | | | - Siobhan M Egan
- Clinical Research Support Unit, University Hospital Limerick, Ireland.
| | - Fiona C Leahy
- Clinical Research Support Unit, University Hospital Limerick, Ireland.
| | - Tomás P Griffin
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland; Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - M N Islam
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Clinical Biochemistry, University Hospital Galway, Ireland.
| | - Paul M O'Shea
- Department of Clinical Biochemistry, University Hospital Galway, Ireland.
| | - Michael T Walsh
- BioScience and BioEngineering Research, Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
| | - Eibhlís M O'Connor
- Health Research Institute, University of Limerick, Ireland; Department of Biological Sciences, School of Natural Sciences, University of Limerick, Ireland; Alimentary Pharmabiotic Centre, Microbiome Institute, University College Cork, Ireland.
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