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Chronic inflammatory diseases and coronary heart disease: Insights from cardiovascular CT. J Cardiovasc Comput Tomogr 2021; 16:7-18. [PMID: 34226164 DOI: 10.1016/j.jcct.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
Epidemiological and clinical studies have demonstrated a consistent relationship between increased systemic inflammation and increased risk of cardiovascular events. In chronic inflammatory states, traditional risk factors only partially account for the development of coronary artery disease (CAD) but underestimate total cardiovascular risk likely due to the residual risk of inflammation. Computed coronary tomography angiography (CCTA) may aid in risk stratification by noninvasively capturing early CAD, identifying high risk plaque morphology and quantifying plaque at baseline and in response to treatment. In this review, we focus on reviewing studies on subclinical atherosclerosis by CCTA in individuals with chronic inflammatory conditions including rheumatoid arthritis (RA), systemic lupus erythematous (SLE), human immunodeficiency virus (HIV) infection and psoriasis. We start with a brief review on the role of inflammation in atherosclerosis, highlight the utility of using CCTA to delineate vessel wall and plaque characteristics and discuss combining CCTA with laboratory studies and emerging technologies to complement traditional risk stratification in chronic inflammatory states.
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Zhou W, Abdelrahman KM, Dey AK, Reddy A, Uceda DE, Lateef SS, Elnabawi YA, Anzenberg P, Al Najafi M, Rodante JA, Keel A, Ortiz J, Teague HL, Erb-Alvarez J, Singh D, Joshi AA, Playford MP, Chen MY, Gelfand JM, Remaley AT, Bluemke DA, Mehta NN. Association Among Noncalcified Coronary Burden, Fractional Flow Reserve, and Myocardial Injury in Psoriasis. J Am Heart Assoc 2020; 9:e017417. [PMID: 33170072 PMCID: PMC7763703 DOI: 10.1161/jaha.119.017417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Myocardial infarction and premature death have been observed in patients with psoriasis. Although inflammation‐driven accelerated atherosclerosis has been proposed as a mechanism, the relationship between subclinical noncalcified coronary burden (NCB), functional coronary flow impairment, and myocardial injury is unclear. Methods and Results In an ongoing longitudinal cohort study, 202 consecutive patients with psoriasis (168 at 1 year) underwent coronary computed tomography angiography to identify coronary plaque, quantify NCB, and calculate coronary fractional flow reserve by computed tomography. Serum high‐sensitivity troponin‐T (hs‐cTn‐T) was measured using a fifth‐generation assay. Overall, patients were middle‐aged, predominantly male, and low cardiovascular risk. A higher than median NCB associated with a positive hs‐cTn‐T (fully adjusted model [odds ratio (OR), 1.72; 95% CI, 1.10–2.69, P=0.018]) at baseline. Additionally, patients with a higher than median baseline NCB had higher odds of positive hs‐cTn‐T at 1 year in fully adjusted analyses (adjusted OR, 2.36; 95% CI, 1.47–3.79, P<0.001). Higher NCB was associated with a higher frequency of fractional flow reserve by computed tomography ≤0.80 (36.11% versus 25.11%, Pearson χ2=6.84, P=0.009, unadjusted OR, 2.09; 95% CI, 1.36–3.22, P<0.001) and higher frequency of a positive hs‐cTn‐T (54.36% versus 27.54%, Pearson χ2=32.23, P<0.001) in adjusted models (OR, 2.63; 95% CI, 1.56–4.42, P<0.001). Conclusions NCB was associated with hs‐cTn‐T at baseline as well as at 1 year. Furthermore, patients with high NCB had higher prevalence of fractional flow reserve by computed tomography ≤0.80 and a >2‐ fold higher odds of positive hs‐cTn‐T. These findings underscore the importance of early vascular disease in driving myocardial injury, and support conduct of myocardial perfusion studies to better understand these findings.
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Affiliation(s)
- Wunan Zhou
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Amit K Dey
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Aarthi Reddy
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Sundus S Lateef
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Paula Anzenberg
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Mina Al Najafi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Andrew Keel
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Jenis Ortiz
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Heather L Teague
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Julie Erb-Alvarez
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Dolly Singh
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Martin P Playford
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | | | - Alan T Remaley
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health Madison WI
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
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