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Yang T, Qiu Y, Zhang Y, Hu W, Li M, Dai Y, Zhou Y, Yin Y. The association of cardiovascular disease risk with coronary artery calcification and thoracic aortic dilation: a study in idiopathic inflammatory myopathies and systemic lupus erythematosus. Clin Rheumatol 2024:10.1007/s10067-024-07115-y. [PMID: 39186172 DOI: 10.1007/s10067-024-07115-y] [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: 05/03/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES We aim to explore the prevalence of coronary artery calcification (CAC) and ascending/descending thoracic aorta (AA/DA) dilation in idiopathic inflammatory myopathies (IIM) and systemic lupus erythematosus (SLE) patients, and to assess associations between cardiovascular disease (CVD) risk factors and these imaging signatures. METHODS This study recruited 151 IIM patients, 140 SLE patients, and 195 controls. The CAC and AA/DA diameters were quantified using non-gated chest CT images. The independent samples t-test or Mann-Whitney test was chosen for comparisons of continuous variables between patients and healthy controls. For categorical data, comparisons were made using the chi-square test or Fisher's exact test. Multivariate regression or Spearman's correlation analysis was employed to probe the associations between CVD risk factors and Framingham risk score (FRS) with imaging signatures. RESULTS The IIM and SLE patients showed significantly higher prevalence of CAC and AA/DA dilatation (P < 0.01). Age was a risk factor for both CAC and AA/DA dilatation in all cohorts (P < 0.01). In IIM patients, the AA/DA dilatation was associated with BMI (P = 0.05). In SLE patients, CAC was associated with the elevated CRP level (P = 0.05). Without CAC, both IIM and SLE patients showed significant correlations between AA/DA diameters and FRS (P < 0.01, P < 0.01). Only in SLE patients, the interleukin-6 (IL-6) level correlated with AA/DA diameters. CONCLUSION The IIM and SLE patients more commonly exhibit CAC and AA/DA dilation. These subclinical atherosclerosis signs are associated with traditional CVD risk factors. For AID patients without CAC, AA/DA diameters could serve as a potential biomarker for early CVD risk. Key Points • The study characterized the manifestation of subclinical atherosclerosis imaging biomarkers (CAC, AA/DA dilation) in IIM and SLE patients. • AA/DA diameters could serve as an early imaging biomarker in clinical management for IIM and SLE patients with early-onset and no CAC present.
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Affiliation(s)
- Tianshu Yang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China
| | - Yiming Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China
| | - Wentao Hu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China
| | - Muzi Li
- School of Education, Education Studies & Data Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Yongming Dai
- School of Biomedical Engineering & State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China.
| | - Yan Yin
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160, Pujian Road, Shanghai, China.
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Mensel B, Mahnken AH, Kaiser E, Völzke H, Dörr M, Felix SB, Ittermann T, Lieb W, Lorbeer R. Association of aortic diameters and mortality in the general population-an MRI-based study. Eur Radiol 2024:10.1007/s00330-024-10965-4. [PMID: 39026062 DOI: 10.1007/s00330-024-10965-4] [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: 05/13/2024] [Revised: 06/03/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Increased diameters of the aorta are associated with increased mortality risk. In the present analyses, we assessed whether aortic diameters are associated with cardiovascular and all-cause mortality in community-dwelling individuals free of known cardiovascular disease (CVD). METHODS MRI-derived vascular parameters of the thoracic and abdominal aorta from 2668 participants (median age = 53 years; 51.1% women) of the population-based SHIP-START-2 and SHIP-TREND-0 cohorts without CVD were analyzed. Age- and sex-adjusted, as well as multivariable-adjusted Cox-proportional hazard models, were used to estimate associations of diameters of six different aortic segments to mortality. RESULTS Over a median follow-up time of 10.6 years (IQR: 8.7; 12.4), a total of 188 participants (126 men and 62 women) died, of which 38 deaths were due to CVD. In unadjusted models, mortality rates were higher in participants with aortic diameters above the median compared to below the median for all investigated aortic sections (all log-rank p < 0.001). In multivariable-adjusted models, the diameters of the ascending thoracic aorta (HR = 1.34 95% CI: 1.04; 1.72, p = 0.022) and of the infrarenal aorta (HR = 3.75 95% CI: 1.06; 13.3, p = 0.040), modeled continuously, were associated with greater cardiovascular mortality. The diameter of the subphrenic aorta was associated with higher cardiovascular mortality only in the age and sex-adjusted model (HR = 3.65 95% CI: 1.01; 13.3, p = 0.049). None of the investigated aortic segments were associated with all-cause mortality. CONCLUSION Non-indexed diameters of the ascending thoracic and infrarenal aorta were associated with higher cardiovascular mortality but not with all-cause mortality in a population sample free of clinically overt CVD at baseline. CLINICAL RELEVANCE STATEMENT Increased aortic diameter is associated with cardiovascular mortality and can help to identify high-risk patients. KEY POINTS Increased aortic diameter is associated with mortality. Non-indexed diameters of the ascending and infrarenal aorta are associated with cardiovascular mortality but not all-cause mortality. Aortic diameter measurements support the estimate of cardiovascular mortality.
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Affiliation(s)
- Birger Mensel
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany.
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Central Hospital Bad Berka, Bad Berka, Germany.
| | - Andreas H Mahnken
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Erhard Kaiser
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich, Germany
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Sanampudi S, Teixidó-Turà G, Fujii T, Noda C, Redhueil A, Wu CO, Hundley WG, Gomes AS, Bluemke DA, Lima JA, Ambale-Venkatesh B. Thoracic Aortic Volume as a Predictor of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. J Magn Reson Imaging 2024; 60:103-113. [PMID: 37916841 PMCID: PMC11063126 DOI: 10.1002/jmri.29110] [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: 08/11/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND It is unclear whether thoracic aortic volume (TAV) is useful for cardiovascular (CV) disease prognosis and risk assessment. PURPOSE This study evaluated cross-sectional associations of TAV with CV risk factors, and longitudinal association with incident CV events in the multiethnic study of atherosclerosis. STUDY TYPE Retrospective cohort analysis of prospective data. POPULATION 1182 participants (69 ± 9 years, 54% female, 37% Caucasian, 18% Chinese, 31% African American, 14% Hispanic, 60% hypertensive, and 20% diabetic) without prior CV disease. FIELD STRENGTH AND SEQUENCES Axial black-blood turbo spin echo or bright blood steady-state free precession images on 1.5T scanners. ASSESSMENT TAV was calculated using Simpson's method from axial images, and included the ascending arch and descending segments. Traditional CV risk factors were assessed at the time of MRI. CV outcomes over a 9-year follow-up period were recorded and represented a composite of stroke, stroke death, coronary heart disease (CHD), CHD death, atherosclerotic death, and CVD death. STATISTICAL TESTS Multivariable linear regression models adjusted for height and weight were used to determine the relationship (β coefficient) between TAV and CV risk factors. Cox regression models assessed the association of TAV and incident CV events. A P-value of <0.05 was deemed statistically significant. RESULTS Mean TAV was = 139 ± 41 mL. In multivariable regression, TAV was directly associated with age (β = 1.6), male gender (β = 23.9), systolic blood pressure (β = 0.1), and hypertension medication use (β = 7.9); and inversely associated with lipid medication use (β = -5.3) and treated diabetes (β = -8.9). Compared to Caucasians, Chinese Americans had higher TAV (β = 11.4), while African Americans had lower TAV (β = -7.0). Higher TAV was independently associated with incident CV events (HR: 1.057 per 10 mL). CONCLUSION Greater TAV is associated with incident CV events, increased age, and hypertension in a large multiethnic population while treated diabetes and lipid medication use were associated with lower TAV. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | - Gisela Teixidó-Turà
- Department of Cardiology, Hospital Universitari Vall d’Hebron, CIBER-CV, Barcelona, Spain
| | | | | | | | | | | | | | - David A. Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison WI
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Craiem D, Guilenea F, de Freminville JB, Azizi M, Casciaro ME, Gencer U, Jannot AS, Amar L, Soulat G, Mousseaux E. Abdominal aortic calcium and geometry in patients with essential hypertension. Diagn Interv Imaging 2024; 105:174-182. [PMID: 38148259 DOI: 10.1016/j.diii.2023.12.005] [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: 09/29/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Abdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. MATERIALS AND METHODS Patients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. RESULTS Among 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). CONCLUSION In patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.
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Affiliation(s)
- Damian Craiem
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Federico Guilenea
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Jean-Batiste de Freminville
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Michel Azizi
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Mariano E Casciaro
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Umit Gencer
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Anne-Sophie Jannot
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Laurence Amar
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Gilles Soulat
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Elie Mousseaux
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
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5
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Miyagawa M, Kojima K, Takahashi K, Nakajima Y, Migita S, Mizobuchi S, Tanaka Y, Fukumoto K, Arai R, Morikawa T, Mineki T, Murata N, Sudo M, Fukamachi D, Okumura Y. Association Between Aortic Wall Parameters on Multidetector Computed Tomography and Ruptured Plaques By Nonobstructive General Angioscopy. J Am Heart Assoc 2024; 13:e033233. [PMID: 38497463 PMCID: PMC11010013 DOI: 10.1161/jaha.123.033233] [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: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. METHODS AND RESULTS We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. CONCLUSIONS The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.
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Affiliation(s)
- Masatsugu Miyagawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Keisuke Kojima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Kurara Takahashi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuki Nakajima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shohei Migita
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Saki Mizobuchi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yudai Tanaka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Katsunori Fukumoto
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Riku Arai
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Tomoyuki Morikawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Takashi Mineki
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Nobuhiro Murata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Garg PK, Bhatia HS, Allen TS, Grainger T, Pouncey AL, Dichek D, Virmani R, Golledge J, Allison MA, Powell JT. Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies. Arterioscler Thromb Vasc Biol 2024; 44:24-47. [PMID: 38150519 PMCID: PMC10753091 DOI: 10.1161/atvbaha.123.320138] [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] [Indexed: 12/29/2023]
Abstract
BACKGROUND One strategy to reduce the burden of cardiovascular disease is the early detection and treatment of atherosclerosis. This has led to significant interest in studies of subclinical atherosclerosis, using different phenotypes, not all of which are accurate reflections of the presence of asymptomatic atherosclerotic plaques. The aim of part 2 of this series is to provide a review of the existing literature on purported measures of subclinical disease and recommendations concerning which tests may be appropriate in the prevention of incident cardiovascular disease. METHODS We conducted a critical review of measurements used to infer the presence of subclinical atherosclerosis in the major conduit arteries and focused on the predictive value of these tests for future cardiovascular events, independent of conventional cardiovascular risk factors, in asymptomatic people. The emphasis was on studies with >10 000 person-years of follow-up, with meta-analysis of results reporting adjusted hazard ratios (HRs) with 95% CIs. The arterial territories were limited to carotid, coronary, aorta, and lower limb arteries. RESULTS In the carotid arteries, the presence of plaque (8 studies) was independently associated with future stroke (pooled HR, 1.89 [1.04-3.44]) and cardiac events (7 studies), with a pooled HR, 1.77 (1.19-2.62). Increased coronary artery calcium (5 studies) was associated with the risk of coronary heart disease events, pooled HR, 1.54 (1.07-2.07) and increasing severity of calcification (by Agaston score) was associated with escalation of risk (13 studies). An ankle/brachial index (ABI) of <0.9, the pooled HR for cardiovascular death from 7 studies was 2.01 (1.43-2.81). There were insufficient studies of either, thoracic or aortic calcium, aortic diameter, or femoral plaque to synthesize the data based on consistent reporting of these measures. CONCLUSIONS The presence of carotid plaque, coronary artery calcium, or abnormal ankle pressures seems to be a valid indicator of the presence of subclinical atherosclerosis and may be considered for use in biomarker, Mendelian randomization and similar studies.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Keck School of Medicine, Los Angeles (G.P.)
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tara S Allen
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tabitha Grainger
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - Anna L Pouncey
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - David Dichek
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (D.D.)
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Australia (G.J.)
| | - Matthew A Allison
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
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7
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Fujito H, Fukamachi D, Ohgaku A, Kojima K, Murata N, Yoda S, Saito Y, Yamada A, Koyama Y, Arai R, Ebuchi Y, Monden M, Tamaki T, Kitano D, Okumura Y. Hepatic steatosis evidenced by computed tomography in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. J Cardiol 2023; 82:414-422. [PMID: 37236437 DOI: 10.1016/j.jjcc.2023.05.008] [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: 01/09/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) and acute myocardial infarction (AMI) have common pathological links. This study investigates the prognostic impact of NAFLD assessed as hepatic steatosis (HS) by computed tomography (CT) in AMI patients and explores the mechanistic role of NAFLD in cardiovascular (CV) events using coronary angioscopy (CAS). METHODS We retrospectively examined 342 AMI patients who underwent CT followed by primary percutaneous coronary intervention (PCI) between January 2014 and December 2019. HS was defined as a hepatic to spleen attenuation ratio of <1.0 on CT scans. Major cardiac events (MCE) included cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and target-lesion revascularization. RESULTS HS was identified in 88 patients (26 %). Patients with HS were significantly younger, had a higher body mass index, and higher hemoglobin A1c, triglyceride, and malondialdehyde low-density lipoprotein levels (all p < 0.05). MCE occurred more frequently [27 (30.7 %) vs. 39 (15.4 %), p = 0.001] in the HS group than in the non-HS group. In the multivariate analysis, the presence of HS was an independent predictor of MCE after adjusting for metabolic risk factor and liver function markers. Among the 74 patients who underwent CAS for a median of 15 days after primary PCI, 51 (69 %) had intrastent thrombus, which was strongly associated with the presence of HS [18 (35 %) vs. 1 (4 %), p = 0.005]. CONCLUSIONS AMI patients with NAFLD detected by CT often had CAS-derived intrastent thrombi and were at a high risk for CV events. Therefore, these patients should be carefully monitored.
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Affiliation(s)
- Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Akihito Ohgaku
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Kojima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Akimasa Yamada
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Koyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasunari Ebuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masaki Monden
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takehiro Tamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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8
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Cuspidi C, Faggiano A, Tadic M. Aortic dilatation and cardiovascular events: a new piece of the puzzle? Hypertens Res 2023; 46:2436-2438. [PMID: 37587269 DOI: 10.1038/s41440-023-01403-x] [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: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Marijana Tadic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany
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9
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Airale L, Borrelli F, Arrivi A, Baracchi A, Bertacchini F, Cartella I, Curcio R, Izzo R, Lembo M, Mancusi C, Manzi MV, Milani M, Moreo A, Paini A, Pucci G, Ruscelli F, Salvetti M, Soldati M, Milan A. Ascending aorta dilatation is associated to hard cardiovascular events, follow-up from multicentric ARGO-Perspective project. Hypertens Res 2023; 46:2016-2023. [PMID: 37328694 DOI: 10.1038/s41440-023-01340-9] [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: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/18/2023]
Abstract
Aortic root dilatation has been proposed as hypertension-mediated organ damage (HMOD). Nevertheless, the role of the aortic root dilatation as a possible additional HMOD is still unclear since studies conducted so far are quite heterogeneous regarding the type of population analyzed, the aortic tract considered, and the type of outcomes accounted for. The aim of the present study is to assess whether the presence of aortic dilatation is associated with strong cardiovascular (CV) events (MACE: heart failure, CV death, stroke, acute coronary syndrome, myocardial revascularization) in a population of patients affected by essential hypertension. Four hundred forty-five hypertensive patients from six Italian hospitals were recruited as part of ARGO-SIIA study1. For all centers, follow-up was obtained by re-contacting all patients by telephone and through the hospital's computer system. Aortic dilatation (AAD) was defined through absolute sex-specific thresholds as in previous studies (41 mm for males, 36 mm for females). Median follow-up was 60 months. AAD was found to be associated with the occurrence of MACE (HR = 4.07 [1.81-9.17], p < 0.001). This result was confirmed after correction for main demographic characteristics such as age, sex and BSA (HR = 2.91 [1.18-7.17], p = 0.020). At penalized Cox regression, age, left atrial dilatation, left ventricular hypertrophy and AAD were identified as best predictor of MACEs and AAD resulted a significant predictor of MACEs even after correction for these confounders (HR = 2.43 [1.02-5.78], p = 0.045). The presence of AAD was found to be associated with an increased risk of MACE independently of for major confounders, including established HMODs. AAD ascending aorta dilatation, LAe left atrial enlargement, LVH left ventricular hypertrophy, MACEs major adverse cardiovascular events, SIIA Società Italiana dell'Ipertensione Arteriosa (Italian Society for Arterial Hypertension).
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Affiliation(s)
- Lorenzo Airale
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Borrelli
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessio Arrivi
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Alessandro Baracchi
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio Bertacchini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Iside Cartella
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Rosa Curcio
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Lembo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Virgina Manzi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Martina Milani
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Antonella Moreo
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Anna Paini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giacomo Pucci
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Federico Ruscelli
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Salvetti
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Soldati
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy.
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10
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Bianchini E, Lønnebakken MT, Wohlfahrt P, Piskin S, Terentes‐Printzios D, Alastruey J, Guala A. Magnetic Resonance Imaging and Computed Tomography for the Noninvasive Assessment of Arterial Aging: A Review by the VascAgeNet COST Action. J Am Heart Assoc 2023; 12:e027414. [PMID: 37183857 PMCID: PMC10227315 DOI: 10.1161/jaha.122.027414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Magnetic resonance imaging and computed tomography allow the characterization of arterial state and function with high confidence and thus play a key role in the understanding of arterial aging and its translation into the clinic. Decades of research into the development of innovative imaging sequences and image analysis techniques have led to the identification of a large number of potential biomarkers, some bringing improvement in basic science, others in clinical practice. Nonetheless, the complexity of some of these biomarkers and the image analysis techniques required for their computation hamper their widespread use. In this narrative review, current biomarkers related to aging of the aorta, their founding principles, the sequence, and postprocessing required, and their predictive values for cardiovascular events are summarized. For each biomarker a summary of reference values and reproducibility studies and limitations is provided. The present review, developed in the COST Action VascAgeNet, aims to guide clinicians and technical researchers in the critical understanding of the possibilities offered by these advanced imaging modalities for studying the state and function of the aorta, and their possible clinically relevant relationships with aging.
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Affiliation(s)
| | - Mai Tone Lønnebakken
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Peter Wohlfahrt
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
- Centre for Cardiovascular PreventionCharles University Medical School I and Thomayer HospitalPragueCzech Republic
- Department of Medicine IICharles University in Prague, First Faculty of MedicinePragueCzech Republic
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Engineering and Natural SciencesIstinye UniversityIstanbulTurkey
- Modeling, Simulation and Extended Reality LaboratoryIstinye UniversityIstanbulTurkey
| | - Dimitrios Terentes‐Printzios
- First Department of Cardiology, Hippokration Hospital, Athens Medical SchoolNational and Kapodistrian University of AthensGreece
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR)BarcelonaSpain
- CIBER‐CV, Instituto de Salud Carlos IIIMadridSpain
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11
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Qazi S, Gona PN, Musgrave RM, Fox CS, Massaro JM, Hoffmann U, Chuang ML, O’Donnell CJ. Distribution, Determinants and Normal Reference Values of Aortic Arch Width: Thoracic Aortic Geometry in the Framingham Heart Study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100247. [PMID: 36742989 PMCID: PMC9894311 DOI: 10.1016/j.ahjo.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Study Objective Aortic arch geometry changes with age, including an increase in aortic arch width (AAW). High AAW is a predictor of incident adverse cardiovascular disease (CVD) events, but its distribution and determinants are unknown. We hypothesized that traditional CVD risk factors, in addition to age, are associated with increased AAW in community-dwelling adults. Study Design Framingham Offspring and Third Generation cohort participants (N=3026, 52% Men) underwent thoracic multidetector computed tomography (MDCT). A referent group (733M, 738W) free of clinical CVD, hypertension, dyslipidemia, smoking, and diabetes was used to generate sex and 10-year age-group specific upper 90th percentile (P90) cut-points for AAW. AAW was measured as the distance between the cross-sectional centroids of the ascending and descending thoracic aorta. Multivariable logistic regression models were used to identify clinical correlates of high AAW (≥referent P90) in the overall study group. Results Among referent participants, AAW increased with greater age-group, p for trend <0.0001 in each sex. Overall and within each age group, AAW was greater in men than women, p<0.0001 all comparisons. Across all participants, high AAW was associated with greater age (odds ratio, OR=1.34/10y; 95% confidence interval 1.20 - 1.50), body surface area (OR=1.97/SD; 1.62 - 2.40), diastolic blood pressure (OR=1.59/10mmHg; 1.40 - 1.81), pack-years smoked (OR=1.07; 1.02 - 1.13), and prevalent CVD (OR=1.64; 1.08 - 2.49). Conclusion AAW increases with greater age, body size, diastolic blood pressure and burden of smoking. High AAW (≥referent P90) is also associated with prevalent (clinically apparent) CVD. AAW is often seen on and easily measured from tomographic thoracic images and has prognostic value.
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Affiliation(s)
- Saadia Qazi
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Division of Cardiology, Brigham and Women’s Hospital, Boston, MA
- Division of Non-Invasive Cardiovascular Imaging, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Philimon N. Gona
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA
| | - Rebecca M. Musgrave
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
| | - Caroline S. Fox
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
| | - Joseph M. Massaro
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Udo Hoffmann
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Massachusetts General Hospital, Boston, MA
| | - Michael L. Chuang
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center
| | - Christopher J. O’Donnell
- The National Heart, Lung and Blood Institute’s (NHLBI) Framingham Heart Study, Framingham, MA
- Novartis Institutes for Biomedical Research, Brigham and Women’s Hospital, Boston, MA
- Division of Cardiology, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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12
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Stoll S, Sowah SA, Fink MA, Nonnenmacher T, Graf ME, Johnson T, Schlett CL, von Stackelberg O, Kirsten R, Bamberg F, Keller J, Ulrich CM, Kaaks R, Kauczor HU, Rengier F, Kühn T, Nattenmüller J. Changes in aortic diameter induced by weight loss: The HELENA trial- whole-body MR imaging in a dietary intervention trial. Front Physiol 2022; 13:976949. [PMID: 36203934 PMCID: PMC9531129 DOI: 10.3389/fphys.2022.976949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity-related metabolic disorders such as hypertension, hyperlipidemia and chronic inflammation have been associated with aortic dilatation and resulting in aortic aneurysms in many cases. Whether weight loss may reduce the risk of aortic dilatation is not clear. In this study, the diameter of the descending thoracic aorta, infrarenal abdominal aorta and aortic bifurcation of 144 overweight or obese non-smoking adults were measured by MR-imaging, at baseline, and 12 and 50 weeks after weight loss by calorie restriction. Changes in aortic diameter, anthropometric measures and body composition and metabolic markers were evaluated using linear mixed models. The association of the aortic diameters with the aforementioned clinical parameters was analyzed using Spearman`s correlation. Weight loss was associated with a reduction in the thoracic and abdominal aortic diameters 12 weeks after weight loss (predicted relative differences for Quartile 4: 2.5% ± 0.5 and -2.2% ± 0.8, p < 0.031; respectively). Furthermore, there was a nominal reduction in aortic diameters during the 50-weeks follow-up period. Aortic diameters were positively associated with weight, visceral adipose tissue, glucose, HbA1c and with both systolic and diastolic blood pressure. Weight loss induced by calorie restriction may reduce aortic diameters. Future studies are needed to investigate, whether the reduction of aortic diameters via calorie restriction may help to prevent aortic aneurysms.
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Affiliation(s)
- Sibylle Stoll
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Solomon A. Sowah
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Matthias A. Fink
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Tobias Nonnenmacher
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Mirja E. Graf
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Theron Johnson
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Romy Kirsten
- National Center for Tumor Diseases (NCT), Liquid Biobank, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Cornelia M. Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Fabian Rengier
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Johanna Nattenmüller
- Heidelberg University Hospital, Diagnostic and Interventional Radiology, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Johanna Nattenmüller,
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13
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Neisius U, Gona PN, Oyama-Manabe N, Chuang ML, O’Donnell CJ, Manning WJ, Tsao CW. Relation of MRI Aortic Wall Area and Plaque to Incident Cardiovascular Events: The Framingham Heart Study. Radiology 2022; 304:542-550. [PMID: 35638924 PMCID: PMC9434818 DOI: 10.1148/radiol.210830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 01/21/2023]
Abstract
Background Arterial arteriosclerosis and atherosclerosis reflect vascular disease, the subclinical detection of which allows opportunity for cardiovascular disease (CVD) prevention. Larger cohort studies simultaneously quantifying anatomic thoracic and abdominal aortic pathologic abnormalities are lacking in the literature. Purpose To investigate the association of aortic wall area (AWA) and atherosclerotic plaque presence and burden as measured on MRI scans with incident CVD in a community sample. Materials and Methods In this prospective cohort study, participants in the Framingham Heart Study Offspring Cohort without prevalent CVD underwent 1.5-T MRI (between 2002-2005) of the descending thoracic and abdominal aorta with electrocardiogram-gated axial T2-weighted black-blood acquisitions. The wall thickness of the thoracic aorta was measured at the pulmonary bifurcation level and used to calculate the AWA as the difference between cross-sectional vessel area and lumen area. For primary or secondary analyses, multivariable Cox proportional hazards regression models were used to examine the association of aortic MRI measures with risk of first-incident CVD events or stroke and coronary heart disease, respectively. Results In 1513 study participants (mean age, 64 years ± 9 [SD]; 842 women [56%]), 223 CVD events occurred during follow-up (median, 13.1 years), of which 97 were major events (myocardial infarction, ischemic stroke, or CVD death). In multivariable analysis, thoracic AWA and prevalent thoracic plaque were associated with incident CVD (hazard ratio [HR], 1.20 per SD unit [95% CI: 1.05, 1.37] [P = .006] and HR, 1.63 [95% CI: 1.12, 2.35] [P = .01], respectively). AWA and prevalent thoracic plaque were associated with increased hazards: 1.32 (95% CI: 1.07, 1.62; P = .01) and 2.20 (95% CI: 1.28, 3.79; P = .005), for stroke and coronary heart disease, respectively. Conclusion In middle-aged community-dwelling adults, thoracic aortic wall area (AWA), plaque prevalence, and plaque volumes measured with MRI were independently associated with incident cardiovascular disease, with AWA associated in particular with stroke, and plaque associated with coronary heart disease. Clinical trial registration no. NCT00041418 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Peshock in this issue.
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Affiliation(s)
- Ulf Neisius
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Philimon N. Gona
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | | | - Michael L. Chuang
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Christopher J. O’Donnell
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Warren J. Manning
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Connie W. Tsao
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
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14
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Pirruccello JP, Di Achille P, Nauffal V, Nekoui M, Friedman SF, Klarqvist MDR, Chaffin MD, Weng LC, Cunningham JW, Khurshid S, Roselli C, Lin H, Koyama S, Ito K, Kamatani Y, Komuro I, Jurgens SJ, Benjamin EJ, Batra P, Natarajan P, Ng K, Hoffmann U, Lubitz SA, Ho JE, Lindsay ME, Philippakis AA, Ellinor PT. Genetic analysis of right heart structure and function in 40,000 people. Nat Genet 2022; 54:792-803. [PMID: 35697867 PMCID: PMC10313645 DOI: 10.1038/s41588-022-01090-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/26/2022] [Indexed: 01/29/2023]
Abstract
Congenital heart diseases often involve maldevelopment of the evolutionarily recent right heart chamber. To gain insight into right heart structure and function, we fine-tuned deep learning models to recognize the right atrium, right ventricle and pulmonary artery, measuring right heart structures in 40,000 individuals from the UK Biobank with magnetic resonance imaging. Genome-wide association studies identified 130 distinct loci associated with at least one right heart measurement, of which 72 were not associated with left heart structures. Loci were found near genes previously linked with congenital heart disease, including NKX2-5, TBX5/TBX3, WNT9B and GATA4. A genome-wide polygenic predictor of right ventricular ejection fraction was associated with incident dilated cardiomyopathy (hazard ratio, 1.33 per standard deviation; P = 7.1 × 10-13) and remained significant after accounting for a left ventricular polygenic score. Harnessing deep learning to perform large-scale cardiac phenotyping, our results yield insights into the genetic determinants of right heart structure and function.
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Affiliation(s)
- James P Pirruccello
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paolo Di Achille
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Victor Nauffal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel F Friedman
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marcus D R Klarqvist
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonathan W Cunningham
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shaan Khurshid
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Honghuang Lin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Satoshi Koyama
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Kaoru Ito
- Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Yoichiro Kamatani
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emelia J Benjamin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Udo Hoffmann
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- Harvard Medical School, Boston, MA, USA
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mark E Lindsay
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Patrick T Ellinor
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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15
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Tadic M, Gherbesi E, Sala C, Carugo S, Cuspidi C. Is Thoracic Aortic Diameter an Independent Predictor of Cardiovascular Disease and Mortality? A Narrative Review. Front Cardiovasc Med 2022; 9:867026. [PMID: 35571154 PMCID: PMC9098814 DOI: 10.3389/fcvm.2022.867026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of recognized adverse prognostic values, such as left ventricular hypertrophy (LVH), concentric remodeling, systolic/diastolic dysfunction, left atrial dilatation, and alterations of LV geometry. The excess cardiovascular risk associated with these markers has been documented in multiple clinical settings, such as the general population, hypertensive cohorts, patients with coronary heart disease, diabetes mellitus, chronic heart failure, and chronic kidney disease. On the contrary, the value of aortic root (AR) and ascending aortic diameter in predicting cardiovascular outcomes and all-cause mortality in populations free from overt aortic pathology is still debated. The present review, aimed at pointing out the prognostic implications of thoracic aortic dimensions in populations free from known connective and aortic diseases, suggests that available evidence supporting an association between aortic diameter and cardiovascular events, and all-cause mortality is based on the limited number of studies, conducted with different imaging techniques and definition of the aortic phenotype.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital “Dr. Dragisa Misovic-Dedinje”, Belgrade, Serbia
- *Correspondence: Marijana Tadic, ;
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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16
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Rueda-Ochoa OL, Bons LR, Zhu F, Rohde S, El Ghoul K, Budde RPJ, Ikram MK, Deckers JW, Vernooij MW, Franco OH, van der Lugt A, Bos D, Roos-Hesselink JW, Kavousi M. Thoracic Aortic Diameter and Cardiovascular Events and Mortality among Women and Men. Radiology 2022; 304:208-215. [PMID: 35412363 DOI: 10.1148/radiol.210861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Thoracic aortic diameter may have a role as a biomarker for major adverse cardiovascular events. Purpose To evaluate the sex-specific association of the diameters of the ascending (AA) and descending (DA) thoracic aorta with risk of stroke, coronary heart disease, heart failure, cardiovascular mortality, and all-cause mortality. Materials and Methods Study participants from the population-based Rotterdam Study who underwent multidetector-row CT between 2003 and 2006 were evaluated. Cox proportional hazard models were conducted to evaluate the associations of AA and DA diameters indexed and not indexed for body mass index (BMI) with cardiovascular events and mortality for men and women. Hazard ratios (HRs) were calculated per 1-unit greater SD of aortic diameters. Results A total of 2178 participants (mean age, 69 years; 55% women) were included. Mean follow-up was 9 years. Each 0.23-mm/(kg/m2) larger BMI-indexed AA diameter was associated with a 33% higher cardiovascular mortality risk in women (HR, 1.33; 95% CI: 1.03, 1.73). Each 0.16-mm/(kg/m2) larger BMI-indexed DA diameter was associated with a 38% higher risk of stroke (HR, 1.38; 95% CI: 1.07, 1.78) and with a 46% greater risk of cardiovascular mortality (HR, 1.46; 95% CI: 1.10, 1.94) in women. Larger BMI-indexed AA and DA diameters were associated with greater risk of all-cause mortality in both sexes. Conclusion Larger ascending and descending thoracic aortic diameters indexed by body mass index were associated with greater risk of adverse cardiovascular outcomes and mortality in women and men. Clinical trial registration no. NTR6831 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Williams in this issue.
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Affiliation(s)
- Oscar L Rueda-Ochoa
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Lidia R Bons
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Fang Zhu
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Sofie Rohde
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Khalid El Ghoul
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ricardo P J Budde
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - M Kamran Ikram
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jaap W Deckers
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Meike W Vernooij
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Oscar H Franco
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Aad van der Lugt
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Daniel Bos
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Maryam Kavousi
- From the Departments of Epidemiology (O.L.R.O., F.Z., M.K.I., M.W.V., O.H.F., D.B., M.K.), Cardiology (L.R.B., S.R., K.E.G., J.W.D., J.W.R.H.), Radiology and Nuclear Medicine (R.P.J.B., M.W.V., A.v.d.L., D.B.), and Neurology (M.K.I.), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
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17
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Williams MC. Sex-based Differences in Outcomes Related to Thoracic Aorta Dimensions. Radiology 2022; 304:216-217. [PMID: 35412369 DOI: 10.1148/radiol.220402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michelle C Williams
- From the British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 SUF, UK
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18
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Wang Y, Yang J, Lu Y, Fan W, Bai L, Nie Z, Wang R, Yu J, Liu L, Liu Y, He L, Wen K, Chen L, Yang F, Qi B. Thoracic Aorta Diameter Calculation by Artificial Intelligence Can Predict the Degree of Arterial Stiffness. Front Cardiovasc Med 2022; 8:737161. [PMID: 34977168 PMCID: PMC8714774 DOI: 10.3389/fcvm.2021.737161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Arterial aging is characterized by decreased vascular function, caused by arterial stiffness (AS), and vascular morphological changes, caused by arterial dilatation. We analyzed the relationship of pre-AS and AS, as assessed by cardio ankle vascular index (CAVI), with arterial diameters (AD) at nine levels, from the aortic sinus to the abdominal aorta, as measured by artificial intelligence (AI) on non-enhanced chest computed tomography (CT) images. Methods: Overall, 801 patients who underwent both chest CT scan and arterial elasticity test were enrolled. Nine horizontal diameters of the thoracic aorta (from the aortic sinuses of Valsalva to the abdominal aorta at the celiac axis origin) were measured by AI using CT. Patients were divided into non-AS (mean value of the left and right CAVIs [M.CAVI] < 8), pre-AS (8 ≤ M.CAVI < 9), and AS (M.CAVI ≥ 9) groups. We compared AD differences among groups, analyzed the correlation of age, ADs, and M.CAVI or the mean pressure-independent CAVI (M.CAVI0), Furthermore, we evaluated the risk predictors and the diagnostic value of the nine ADs for pre-AS and AS. Results: The AD at mid descending aorta (MD) correlated strongest with CAVI (r = 0.46, p < 0.001) or M.CAVI0 (r = 0.42, p < 0.001). M.CAVI was most affected by the MD AD and by age. An increase in the MD AD independently predicted the occurrence of pre-AS or AS. For MD AD, every 4.37 mm increase caused a 14% increase in the pre-AS and AS risk and a 13% increase in the AS risk. With a cut-off value of 26.95 mm for the MD AD, the area under the curve (AUC) for identifying the risk of AS was 0.743. With a cut-off value of 25.15 mm, the AUC for identifying the risk of the stage after the prophase of AS is 0.739. Conclusions: Aging is associated with an increase in AD and a decrease in arterial elasticity. An increase in AD, particularly at the MD level is an independent predictor of AS development.
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Affiliation(s)
- Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yichen Lu
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijuan Bai
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuang Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiyun Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lihua Liu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Liu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linfeng He
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Wen
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Li Chen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Benling Qi
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Pirruccello JP, Chaffin MD, Chou EL, Fleming SJ, Lin H, Nekoui M, Khurshid S, Friedman SF, Bick AG, Arduini A, Weng LC, Choi SH, Akkad AD, Batra P, Tucker NR, Hall AW, Roselli C, Benjamin EJ, Vellarikkal SK, Gupta RM, Stegmann CM, Juric D, Stone JR, Vasan RS, Ho JE, Hoffmann U, Lubitz SA, Philippakis AA, Lindsay ME, Ellinor PT. Deep learning enables genetic analysis of the human thoracic aorta. Nat Genet 2022; 54:40-51. [PMID: 34837083 PMCID: PMC8758523 DOI: 10.1038/s41588-021-00962-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
Enlargement or aneurysm of the aorta predisposes to dissection, an important cause of sudden death. We trained a deep learning model to evaluate the dimensions of the ascending and descending thoracic aorta in 4.6 million cardiac magnetic resonance images from the UK Biobank. We then conducted genome-wide association studies in 39,688 individuals, identifying 82 loci associated with ascending and 47 with descending thoracic aortic diameter, of which 14 loci overlapped. Transcriptome-wide analyses, rare-variant burden tests and human aortic single nucleus RNA sequencing prioritized genes including SVIL, which was strongly associated with descending aortic diameter. A polygenic score for ascending aortic diameter was associated with thoracic aortic aneurysm in 385,621 UK Biobank participants (hazard ratio = 1.43 per s.d., confidence interval 1.32-1.54, P = 3.3 × 10-20). Our results illustrate the potential for rapidly defining quantitative traits with deep learning, an approach that can be broadly applied to biomedical images.
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Affiliation(s)
- James P Pirruccello
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Elizabeth L Chou
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen J Fleming
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
| | - Honghuang Lin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | | | - Alexander G Bick
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Arduini
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Amer-Denis Akkad
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
| | | | - Amelia W Hall
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Emelia J Benjamin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | | | - Rajat M Gupta
- Department of Medicine, Divisions of Cardiovascular Medicine and Genetics, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian M Stegmann
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Dejan Juric
- Harvard Medical School, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - James R Stone
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramachandran S Vasan
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Jennifer E Ho
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony A Philippakis
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
- GV, Mountain View, CA, USA
| | - Mark E Lindsay
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA.
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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20
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Golledge J, Velu R, Quigley F, Jenkins J, Singh TP. Editor's Choice - Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease. Eur J Vasc Endovasc Surg 2021; 62:960-968. [PMID: 34740532 DOI: 10.1016/j.ejvs.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 09/12/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD). METHODS In total, 1 752 participants with a variety of APOADs were prospectively recruited between 2002 and 2020 and had a maximum abdominal aortic diameter, aortic size index (aortic diameter relative to body surface area), and aortic height index (aortic diameter relative to height) measured by ultrasound at recruitment. Participants were followed for a median of 4.6 years (interquartile range 2.0 - 8.0 years) to record outcome events, including major adverse cardiovascular events (MACE), peripheral artery surgery, abdominal aortic aneurysm (AAA) events (rupture or repair), and all cause mortality. The association between aortic size and events was assessed using Cox proportional hazard analysis. The ability of aortic size to improve risk of events classification was assessed using the net reclassification index (NRI). RESULTS After adjusting for other risk factors, larger aortic diameter was associated with an increased risk of MACE (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 - 1.31), requirement for peripheral artery surgery (HR 2.05, 95% CI 1.90 - 2.22), AAA events (HR 3.01, 95% CI 2.77 - 3.26), and all cause mortality (HR 1.20, 95% CI 1.08 - 1.32). Findings were similar for aortic size and aortic height indices. According to the NRI, all three aortic size measures significantly improved classification of risk of peripheral artery surgery and AAA events but not MACE. Aortic size index, but not aortic diameter or aortic height index, significantly improved the classification of all cause mortality risk. CONCLUSION Larger abdominal aortic diameter, size index, and height index are all independently associated with an increased risk of major adverse events in patients with established vascular disease.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
| | - Ramesh Velu
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Frank Quigley
- The Mater Hospital, Townsville, Queensland, Australia
| | - Jason Jenkins
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
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21
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Ballegaard CR, Pham MHC, Sigvardsen PE, Kühl JT, Sørgaard M, Taudorf M, Fuchs A, Nordestgaard BG, Køber LV, Kofoed KF. Aortic enlargement and coronary artery calcification in a general population cohort. Eur Heart J Cardiovasc Imaging 2021; 23:855-862. [PMID: 34166489 DOI: 10.1093/ehjci/jeab122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/03/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS The role of atherosclerosis in the pathogenesis of aortic enlargement is uncertain. We aimed to evaluate the relationship between the diameters of the ascending, descending and abdominal aorta, and coronary artery calcification. METHODS AND RESULTS Individuals in the Copenhagen General Population Study underwent thoracic and abdominal computed tomography. Maximal aortic diameters were measured in each aortic segment and coronary artery calcium scores (CACS) were calculated. Participants were stratified into five predefined groups according to CACSs and compared to aortic dimensions. The relation between aortic diameter and CACS was adjusted for risk factors for aortic dilatation in a multivariable model. A total of 2678 eligible individuals were included. In all segments of the aorta, aortic diameter was associated to CACSs, with mean increases in aortic diameters ranging from 0.7 to 3.5 mm in individuals with calcified coronary arteries compared to non-calcified subjects (P-value < 0.001). After correction for risk factors, individuals with CACS above 400 had larger ascending, descending and abdominal aortic diameter than the non-calcified reference group (P-value < 0.01). CONCLUSION Enlarged thoracic and abdominal aortic vascular segments are associated with co-existing coronary artery calcification in the general population.
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Affiliation(s)
- Christian R Ballegaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark
| | - Michael H C Pham
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - J Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark
| | - Mathias Sørgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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22
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Zeleznik R, Foldyna B, Eslami P, Weiss J, Alexander I, Taron J, Parmar C, Alvi RM, Banerji D, Uno M, Kikuchi Y, Karady J, Zhang L, Scholtz JE, Mayrhofer T, Lyass A, Mahoney TF, Massaro JM, Vasan RS, Douglas PS, Hoffmann U, Lu MT, Aerts HJWL. Deep convolutional neural networks to predict cardiovascular risk from computed tomography. Nat Commun 2021; 12:715. [PMID: 33514711 PMCID: PMC7846726 DOI: 10.1038/s41467-021-20966-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Coronary artery calcium is an accurate predictor of cardiovascular events. While it is visible on all computed tomography (CT) scans of the chest, this information is not routinely quantified as it requires expertise, time, and specialized equipment. Here, we show a robust and time-efficient deep learning system to automatically quantify coronary calcium on routine cardiac-gated and non-gated CT. As we evaluate in 20,084 individuals from distinct asymptomatic (Framingham Heart Study, NLST) and stable and acute chest pain (PROMISE, ROMICAT-II) cohorts, the automated score is a strong predictor of cardiovascular events, independent of risk factors (multivariable-adjusted hazard ratios up to 4.3), shows high correlation with manual quantification, and robust test-retest reliability. Our results demonstrate the clinical value of a deep learning system for the automated prediction of cardiovascular events. Implementation into clinical practice would address the unmet need of automating proven imaging biomarkers to guide management and improve population health.
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Affiliation(s)
- Roman Zeleznik
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Borek Foldyna
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob Weiss
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ivanov Alexander
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Chintan Parmar
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raza M Alvi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dahlia Banerji
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mio Uno
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasuka Kikuchi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Julia Karady
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lili Zhang
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan-Erik Scholtz
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Asya Lyass
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute and Boston University, Framingham Heart Study, Framingham, MA, USA
- Departments of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pamela S Douglas
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Udo Hoffmann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo J W L Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, The Netherlands.
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23
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Raunsø J, Song RJ, Vasan RS, Bourdillon MT, Nørager B, Torp-Pedersen C, Gislason GH, Xanthakis V, Andersson C. Familial Clustering of Aortic Size, Aneurysms, and Dissections in the Community. Circulation 2020; 142:920-928. [DOI: 10.1161/circulationaha.120.045990] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
Ruptured aortic aneurysm and aortic dissections are potentially preventable disorders associated with high mortality. Screening of individuals at risk may translate into elective surgical interventions and lowered mortality. It is uncertain if the risk of aortic dilation of varying degrees aggregates within families.
Methods:
We investigated the risk of having thoracic and abdominal aortic sizes in the highest quartile (measured by computed tomography scans and indexed for body size) if at least 1 parent did so in the Framingham Heart Study cohorts, and estimated the incidence rates and hazard ratios of developing aortic aneurysm or dissection among first-degree relatives of those with aortic aneurysm or dissection, in comparison with age- and sex-matched controls (1:10 for aortic aneurysm and 1:100 for aortic dissection) using the Danish nationwide administrative registries.
Results:
In the Framingham Heart Study, offspring (n=235) whose parent(s) had a sex- and age-standardized aortic size in the upper quartile had a multivariable-adjusted ≈3-fold increased odds ratio of belonging to the upper quartile themselves. In Denmark, a total of 68 939 individuals (mean age, 42 years) had a first-degree relative with aortic aneurysm and 7209 persons (mean age, 39 years) had a first-degree relative with aortic dissection. During an average follow-up of 7 years, first-degree relatives of patients with aortic aneurysm and dissection had a hazard ratio of 6.70 (95% CI, 5.96–7.52) for developing aortic aneurysm and a hazard ratio of 9.24 (95% CI, 5.53–15.44) for dissection in comparison with matched controls. These estimates remained unchanged on adjusting for several comorbidities, including prevalent hypertension, bicuspid aortic valve, and the Marfan syndrome. For both aortic aneurysm and dissections, the absolute event rates approached 1 per 1000 person-years for first-degree relatives versus 11 to 13 (aortic aneurysm) and 2 to 3 (aortic dissections) per 100 000 person-years among controls.
Conclusions:
Increased aortic size, a precursor of aortic aneurysm and a risk factor for dissection, clusters in families. The incidence rates of aortic aneurysm and dissections approach the incidence rates of other common cardiovascular conditions in first-degree relatives, supporting the use of systematic screening for these conditions.
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Affiliation(s)
- Jakob Raunsø
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Rebecca J. Song
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
| | - Ramachandran S. Vasan
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | | | - Betina Nørager
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark (C.T.-P.)
- Department of Cardiology, Aalborg University Hospital, Denmark (C.T.-P.)
| | - Gunnar H. Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
- The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.)
| | - Vanessa Xanthakis
- Department of Biostatistics (V.X.), Boston University School of Public Health, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
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24
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Mozzini C, Soresi M, Pesce G, Girelli D. A Five-Step Vascular Ultrasound Examination in Heart Failure: The First Two Years of the "ABCDE" G-SIUMB Multicenter Study 2018-2022. Curr Probl Cardiol 2020; 46:100578. [PMID: 32276739 DOI: 10.1016/j.cpcardiol.2020.100578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 01/07/2023]
Abstract
The aim of this study is the creation of a 5-step ultrasound examination to evaluate and monitor Heart Failure (HF) patients during hospitalization and follow-up. "ABCDE" is the acronym of an Italian multicentre study composed of a consecutive sample of HF patients admitted from the Emergency to the Internal Medicine/Geriatric Departments of several Italian hospitals. The "ABCDE" score includes the evaluations of A, the Ankle-brachial index (ABI), B, the B-lines, C, the Carotid intima media thickness (CIMT), D, the Diameter of the abdominal aorta and of the inferior cave vein and E, the echocardiographic assessment of the ejection fraction. This paper reports the preliminary results. Up to now, the "ABCDE" multicenter study seems an exciting opportunity to create an integrative ultrasound approach in HF. The definitive confirmation of these preliminary results and the effective usefulness of the "ABCDE" will be available in 2022, at the end of the study.
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25
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Góes Junior AMDO, Albuquerque FBAD, Beckmann FA, Centeno FV, Andrade MCD, Vieira WDB. Sexo e idade e sua influência sobre a anatomia da aorta abdominal e seus ramos. J Vasc Bras 2020; 19:e20200073. [PMID: 34211522 PMCID: PMC8218012 DOI: 10.1590/1677-5449.200073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Não se sabe ao certo como a idade e o sexo do paciente influenciam na anatomia da aorta abdominal e de seus ramos. Objetivos Determinar os padrões anatômicos (diâmetro e angulações) mais frequentes da aorta abdominal e de seus ramos e a influência do sexo e da idade dos pacientes sobre esses padrões. Métodos Foram avaliadas tomografias computadorizadas de abdome com contraste endovenoso de 157 pacientes. Foram aferidos calibre e angulação de artérias abdominais em indivíduos de ambos os sexos, agrupados em cinco faixas etárias: 20 a 30 anos, 31 a 40 anos, 41 a 50 anos, 51 a 60 anos e 61 a 70 anos. Foram analisadas 18 variáveis: seis ângulos de emergências arteriais, nove diâmetros arteriais, taxas de dilatação, sexo e faixa etária. Para a obtenção das medidas, utilizou-se o programa de computador RadiAnt 4.2.1 DICOM viewer (Medixant, Poznan, Polônia). Resultados Entre as 157 tomografias, 69 eram de homens e 88, de mulheres. Apresentaram diferença estatística (p < 0,05): ângulo de origem e diâmetro da artéria mesentérica superior; ângulo e diâmetro das artérias renais; diâmetro das artérias ilíacas comuns; diâmetro e taxa de dilatação em diversos segmentos da aorta, exceto na porção proximal ao tronco celíaco. Conclusões Os diâmetros da aorta (em diversos segmentos) e de seus ramos (exceto da artéria renal esquerda) aumentam progressivamente com o passar da idade em ambos os sexos e são maiores e possuem taxa de dilatação mais elevada em homens do que em mulheres da mesma faixa etária. Entre os sexos, o ângulo de emergência da artéria mesentérica superior foi maior em homens, exceto entre 20 e 30 anos; o ângulo de origem da artéria renal esquerda foi maior em mulheres entre 51 e 60 anos.
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26
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Mozzini C, Cominacini L, Casadei A, Schiavone C, Soresi M. Ultrasonography in Heart Failure: A Story that Matters. Curr Probl Cardiol 2019; 44:116-136. [PMID: 30172551 DOI: 10.1016/j.cpcardiol.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
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27
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Masri A, Cavalcante JL. Abdominal Aorta Dilatation and Cardiovascular Outcomes: Another Dimension of Arterial Age? Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.007289. [PMID: 29222123 DOI: 10.1161/circimaging.117.007289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmad Masri
- From the Department of Medicine, Division of Cardiology, University of Pittsburgh/UPMC, Pittsburgh, PA (A.M., J.L.C.)
| | - João L Cavalcante
- From the Department of Medicine, Division of Cardiology, University of Pittsburgh/UPMC, Pittsburgh, PA (A.M., J.L.C.).
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