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Li X, Du H, Cheng Y, Li X, Gao Q, Chen X. Serum phosphorus concentration and its association with the degree and pattern of intracranial arterial calcification. Nutr Metab Cardiovasc Dis 2024; 34:1696-1702. [PMID: 38664122 DOI: 10.1016/j.numecd.2024.03.013] [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: 07/26/2023] [Revised: 03/02/2024] [Accepted: 03/09/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND AIM The aim of this study was to determine whether the serum phosphorus concentrations (SPC) are associated with the degree and pattern of intracranial arterial calcification (IAC) in patients with normal renal function or mild-moderate renal impairment. METHODS AND RESULTS A total of 513 patients were enrolled in this study. The degree of IAC measured by IAC scores was evaluated on non-contrast head computed tomography (CT) images and IAC was classified as intimal or medial calcification. Study participants were classified according to IAC degrees (mild, moderate and severe) and patterns (intimal and medial calcification). A multivariate regression model was used to assess the independent relationship of SPC with IAC scores and patterns. Of 513 study participants (mean [SD] age, 68.3 [10.3] years; 246 females [48%]), the mean SPC was 1.07 ± 0.17 mmol/L and IAC scores was 4.0 (3.0-5.0). Multivariate analysis showed that higher serum phosphorus was a significant risk factor for moderate/severe IAC in both patients with eGFR ≥60 ml/min/1.73 m2 (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.01-1.59; P < 0.05) and eGFR <60 ml/min/1.73 m2 (OR, 1.92; 95% CI, 1.04-3.57; P < 0.05), when those with mild IAC were considered as the reference group. However, higher SPC was associated with an increased odds of medial calcification only in patients with eGFR <60 ml/min/1.73 m2 (OR, 1.67; 95% CI, 1.08 to 2.61). CONCLUSIONS High levels of serum phosphorus were positively correlated with the degree of IAC, and this significant effect on medial IAC was only present in patients with impaired renal function (eGFR <60 ml/min/1.73 m2).
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Affiliation(s)
- Xuelong Li
- Department of Neurology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China; Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
| | - Yangyang Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
| | - Xianliang Li
- Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Qingchun Gao
- Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
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Kamphuis MJ, van der Kamp LT, Lette E, Rinkel GJE, Vergouwen MDI, van der Schaaf IC, de Jong PA, Ruigrok YM. Intracranial arterial calcification in patients with unruptured and ruptured intracranial aneurysms. Eur Radiol 2024:10.1007/s00330-024-10789-2. [PMID: 38806803 DOI: 10.1007/s00330-024-10789-2] [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: 12/19/2023] [Revised: 02/13/2024] [Accepted: 03/09/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Arterial calcification is thought to protect against rupture of intracranial aneurysms, but studies in a representative population of intracranial aneurysm patients have not yet been performed. The aim was to compare the prevalence of aneurysm wall calcification and intracranial carotid artery calcification (ICAC) between patients with an unruptured intracranial aneurysm (UIA) and a ruptured intracranial aneurysm (RIA). MATERIALS AND METHODS We matched 150 consecutive UIA patients to 150 RIA patients on age and sex. Aneurysm wall calcification and ICAC were quantified on non-contrast enhanced computed tomography images with the modified Agatston score. We compared the prevalence of aneurysm wall calcification, ICAC, and severe ICAC (defined as a modified Agatston score in the fourth quartile) between UIA and RIA patients using univariate and multivariate conditional logistic regression models adjusted for aneurysm characteristics and cardiovascular risk factors. RESULTS Aneurysm wall calcification was more prevalent in UIA compared to RIA patients (OR 5.2, 95% CI: 2.0-13.8), which persisted after adjustment (OR 5.9, 95% CI: 1.7-20.2). ICAC prevalence did not differ between the two groups (crude OR 0.9, 95% CI: 0.5-1.8). Severe ICAC was more prevalent in UIA patients (OR 2.0, 95% CI: 1.1-3.6), but not after adjustment (OR 1.0, 95% CI: 0.5-2.3). CONCLUSIONS Aneurysm wall calcification but not ICAC was more prevalent in UIAs than in RIAs, which corresponds to the hypothesis that calcification may protect against aneurysmal rupture. Aneurysm wall calcification should be further assessed as a predictor of aneurysm stability in prospective cohort studies. CLINICAL RELEVANCE STATEMENT Calcification of the intracranial aneurysm wall was more prevalent in unruptured than ruptured intracranial aneurysms after adjustment for cardiovascular risk factors. Calcification may therefore protect the aneurysm against rupture, and aneurysm wall calcification is a candidate predictor of aneurysm stability. KEY POINTS Aneurysm wall calcification was more prevalent in patients with unruptured than ruptured aneurysms, while internal carotid artery calcification was similar. Aneurysm wall calcification but not internal carotid artery calcification is a candidate predictor of aneurysm stability. Cohort studies are needed to assess the predictive value of aneurysm wall calcification for aneurysm stability.
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Affiliation(s)
- Maarten J Kamphuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Laura T van der Kamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Lette
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Bartstra JW, van den Beukel T, Kranenburg G, Geurts LJ, den Harder AM, Witkamp T, Wolterink JM, Zwanenburg JJM, van Valen E, Koek HL, Mali WPTM, de Jong PA, Hendrikse J, Spiering W. Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum. AJNR Am J Neuroradiol 2024; 45:386-392. [PMID: 38548304 PMCID: PMC11288551 DOI: 10.3174/ajnr.a8212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 12/02/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum. MATERIALS AND METHODS Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models. RESULTS Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94-1.21 versus 0.94; range, 0.82-1.04; P = .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; P < .01), more white matter lesions (2.6; range, 0.5-7.5 versus 1.1; range, 0.5-2.4) mL; P = .05), and more lacunar infarctions (64 versus 8, P = .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01-0.18). CONCLUSIONS Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.
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Affiliation(s)
- J W Bartstra
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - T van den Beukel
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - G Kranenburg
- Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L J Geurts
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - A M den Harder
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - T Witkamp
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - J M Wolterink
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - J J M Zwanenburg
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - E van Valen
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - H L Koek
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - W P T M Mali
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - P A de Jong
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - J Hendrikse
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - W Spiering
- Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Feng L, Liu Y, Li P, Wan H, Deng X, Wang T, Fu H, Duan X. Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study. Int J Surg 2024; 110:353-360. [PMID: 37916928 PMCID: PMC10793752 DOI: 10.1097/js9.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Previous studies have shown that patients with cerebrovascular disease (CVD) have a significantly increased risk of cognitive decline or dementia; however, the association between preoperative CVD and perioperative neurocognitive disorders (PNDs) remains unclear. This study aimed to explore the correlation between preoperative CVD and PNDs, as well as combine logistic regression and receiver operating characteristic (ROC) curves to construct a clinical prediction PND model. MATERIALS AND METHODS This retrospective cohort study evaluated 13 899 surgical patients of a large-scale comprehensive hospital between January 2021 and January 2022 to explore the association between preoperative CVD and PNDs, with follow-up to monitor postoperative survival until 28 February 2023, unless the patient died. The study participants comprised all inpatients from the Bone and Joint Surgery, Spine Surgery, Urology, Hepatobiliary Surgery, Gastrointestinal Surgery, and Thoracic Surgery departments. Patients were classified into two groups: the CVD group with a confirmed diagnosis and the noncerebrovascular disease group. The incidence of PNDs was measured, and potential associations between patient demographic information, preoperative comorbidities, and CVD, as well as the correlation between preoperative CVD and PNDs, were investigated by multivariate logistic regression analysis. Next, the authors constructed a clinical prediction PND model by drawing the ROC curve. The postoperative survival of all patients was tracked, and a survival curve was constructed and incorporated into the Cox proportional hazard regression model to analyze the relationship between preoperative CVD and the overall postoperative survival rate. RESULTS Of the included 13 899 patients, propensity score matching yielded 1006 patient pairs. Multivariate logistic regression analysis revealed that CVD was an independent risk factor for PNDs [odds ratio: 10.193; 95% CI: 7.454-13.938; P <0.001]. Subsequently, the authors developed a clinical prediction model for PNDs by multivariate logistic regression analysis. The area under the ROC curve was 0.798 (95% CI: 0.765-0.830). The survival of 11 702 patients was followed up. Multivariate Cox hazard ratio regression analysis revealed that CVD affected the overall postoperative survival rate (hazard ratio, 1.398; 95% CI: 1.112-1.758; P <0.001). CONCLUSION CVD was an independent risk factor for PNDs and affected the overall postoperative survival rate of surgical patients with preoperative CVD.
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Affiliation(s)
- Lan Feng
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, People’s Republic of China
| | - Yuanhui Liu
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - PengFei Li
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Hengjun Wan
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Xiren Deng
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Tingting Wang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University
| | - Hong Fu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, People’s Republic of China
| | - Xiaoxia Duan
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
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Du H, Zheng J, Li X, Dong Y, Cheng Y, Liu C, Hu J, Chen X. The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities. Atherosclerosis 2023; 381:117247. [PMID: 37634296 DOI: 10.1016/j.atherosclerosis.2023.117247] [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: 04/11/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND AIMS Despite reported correlations between intracranial arterial calcification (IAC) and white matter hyperintensities (WMH), little is known about the relationship between IAC pattern and WMH. By differentiating intimal and medial IAC, we aimed to investigate the relationship between IAC pattern and WMH. METHODS Consecutive acute stroke patients were included. IAC pattern was categorized as intimal or medial on plain brain CT. The number of cerebral arteries involved by IAC for each patient was recorded. IAC severity was defined as focal or diffuse. On brain MRI, the burden of WMH was visually graded and classified as absent mild, moderate and severe. Multiple logistic regression was performed to examine the relationship between IAC and WMH. RESULTS Among 265 patients, intimal IAC was detected in 54.7% patients and medial IAC in 48.5% patients. Diffuse IAC was present in 27.9% patients, all of which were medial. WMH was found in 75.5% patients, including 39.6% patients with mild WMH, 26.0% with moderate WMH, and 9.8% with severe WMH. The severity of medial IAC was correlated with WMH occurrence (p < 0.001). Chi-square linear trend suggested the number of arteries involved by medial IAC (p < 0.001) and the severity of medial IAC (p < 0.001) were correlated with WMH burden. Multiple ordinal logistic regression demonstrated a positive correlation of WMH burden with the number of arteries involved by medial IAC (p < 0.001) and the severity of medial IAC (p < 0.001). CONCLUSIONS Medial IAC was correlated with WMH. The dose-effect relationship between medial IAC and WMH suggests underlying shared mechanisms of intracranial large artery disease and small vessel disease.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region of China
| | - Jianrong Zheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xuelong Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region of China
| | - Yanjing Dong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region of China
| | - Yajing Cheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Cong Liu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region of China.
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