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Xie Y, Shen H, Xu Q, Tu C, Yang R, Liu T, Tang H, Miao Z, Zhang J. Evaluating coronary arteries and predicting MACEs using CCTA in lung cancer patients receiving chemotherapy or chemoradiotherapy. Radiother Oncol 2024; 200:110498. [PMID: 39182582 DOI: 10.1016/j.radonc.2024.110498] [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: 02/25/2024] [Revised: 08/17/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Whether coronary computed-tomography angiography (CCTA) can detect cancer treatment-related impairments of coronary artery and predict major adverse cardiovascular events (MACEs) in lung cancer patients receiving chemotherapy (CHT) or chemoradiotherapy (CRT) is unclear. OBJECTIVES This study aimed to evaluate coronary arteries using CCTA parameters and explore the association of these parameters with MACEs in patients with lung cancer receiving CHT or CRT. MATERIALS AND METHODS This study retrospectively collected data from 697 lung cancer patients who received CHT or CRT and underwent CCTA examination within 2 weeks before or after treatment from June 2013 to May 2019. The patients were divided into CHT and CRT group, and for the control group, the propensity score matching (PSM) was used and 125 participants without carcinoma with a single CCTA examination were included. CCTA parameters, assessed using artificial intelligence software, were compared across different groups (control vs. CHT & CRT; CHT vs. CRT). We analyzed associations between CCTA parameters and MACEs using a Cox-regression model and Kaplan-Meier curves to compare MACE-free survival rates. RESULTS Before CHT or CRT, compared with the control group, in CHT&CRT group we observed higher fat attenuation index (FAI), coronary-artery calcium (CAC) score, CAD-RADS classification, stenosis severity and lower computed-tomography fractional flow reserve (CT-FFR; all P<0.05). After treatment, the CT-FFR decreased and the FAI increased; simultaneously, we observed a lower CT-FFR and higher FAI (all P<0.05) in the CRT than in the CHT group. Among the 146 cases developed MACEs, lower CT-FFR and higher FAI values were found compared with the non-MACE group (all P<0.05), and CT-FFR and FAI before treatment were associated with MACEs. CONCLUSION Cancer treatment-related impairments of coronary arteries could be identified using CT-FFR and FAI. Before treatment, these parameters were associated with MACEs in lung cancer patients receiving CHT or CRT.
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Affiliation(s)
- Yuhang Xie
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Hesong Shen
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Qian Xu
- School of Medicine, Chongqing University, Chongqing, China.
| | - Chunrong Tu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Rui Yang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Tao Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Hao Tang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Zhiming Miao
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing, Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
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Rao S, Weng M, Lian R, Zhuo Y, Lin J, You D, Cui J, Chen Y, Wan J. Correlation between coronary calcification and cardiac structure in non-dialysis patients with chronic kidney disease. ESC Heart Fail 2024. [PMID: 39239806 DOI: 10.1002/ehf2.15057] [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: 06/20/2024] [Revised: 08/04/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024] Open
Abstract
AIMS We aim to explore the correlation between coronary artery calcification (CAC) score (CACS) and cardiac structure and function in chronic kidney disease (CKD) patients, create a clinical prediction model for severe CAC associated with cardiac ultrasound indexes. METHODS AND RESULTS The study included 178 non-dialysis CKD patients who underwent CACS testing and collected general information, serological indices, cardiac ultrasound findings and follow-up on renal function, heart failure (HF) manifestations and re-hospitalization. The mean age of participants in the study cohort was 67.4 years; 59% were male, and 66.9% of patients had varying degrees of comorbid CAC. CKD patients with CACS > 100 were older, predominantly male and had a higher proportion of smoking, diabetes and hypertension (P < 0.05) compared with those with CACS = 0 and 0 < CACS ≤ 100, and had higher brain natriuretic peptide, serum magnesium and fibrinogen levels were also higher (P < 0.05). CACS was positively correlated with left atrial inner diameter (LAD), left ventricular end-diastolic inner diameter (LVDd), left ventricular volume at diastole (LVVd), output per beat (SV) and mitral orifice early diastolic blood flow velocity/early mitral annular diastolic myocardial motion velocity (E/e) (P < 0.05). We tested the associations between varying degrees of CAC and HF and heart valve calcification using multivariable-adjusted regression models. The risk of HF in patients with severe CAC was about 1.95 times higher than that in patients without coronary calcification, and the risk of heart valve calcification was 2.46 times higher than that in patients without coronary calcification. Heart valve calcification and HF diagnosis, LAD and LVDd are essential in predicting severe CAC. During a mean follow-up time of 18.26 ± 10.17 months, 65 (36.52%) patients had a composite renal endpoint event, of which 36 (20.22%) were admitted to renal replacement therapy. Patients with severe CAC had a higher risk of progression of renal function, re-admission due to cardiovascular and renal events and more pronounced symptoms of HF (P < 0.05). CONCLUSIONS There is a correlation between CACS and cardiac structure and function in non-dialysis CKD patients, which may mainly involve abnormalities in left ventricular structure and cardiac diastolic function. CAC may affect renal prognosis and quality of survival in CKD patients. Based on clinical information, HF, valvular calcification status and indicators related to left ventricular hypertrophy can identify people at risk for severe CAC.
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Affiliation(s)
- Siyi Rao
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Mengjie Weng
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ruoshan Lian
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yongjie Zhuo
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jiaqun Lin
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Danyu You
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jiong Cui
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi Chen
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianxin Wan
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Li XX, Chen ZD, Sun XJ, Yang YQ, Jin H, Liu NF. Empagliflozin ameliorates vascular calcification in diabetic mice through inhibiting Bhlhe40-dependent NLRP3 inflammasome activation. Acta Pharmacol Sin 2024; 45:751-764. [PMID: 38172306 PMCID: PMC10943241 DOI: 10.1038/s41401-023-01217-0] [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: 09/20/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) patients exhibit greater susceptibility to vascular calcification (VC), which has a higher risk of death and disability. However, there is no specific drug for VC therapy. NLRP3 inflammasome activation as a hallmark event of medial calcification leads to arterial stiffness, causing vasoconstrictive dysfunction in T2DM. Empagliflozin (EMPA), a sodium-glucose co-transporter 2 inhibitor (SGLT2i), restrains hyperglycemia with definite cardiovascular benefits. Given the anti-inflammatory activity of EMPA, herein we investigated whether EMPA protected against VC in the aorta of T2DM mice by inhibiting NLRP3 inflammasome activation. Since db/db mice receiving a normal diet developed VC at the age of about 20 weeks, we administered EMPA (5, 10, 20 mg·kg-1·d-1, i.g) to 8 week-old db/db mice for 12 weeks. We showed that EMPA intervention dose-dependently ameliorated the calcium deposition, accompanied by reduced expression of RUNX2 and BMP2 proteins in the aortas. We found that EMPA (10 mg·kg-1·d-1 for 6 weeks) also protected against VC in vitamin D3-overloaded mice, suggesting the protective effects independent of metabolism. We showed that EMPA (10 mg·kg-1·d-1) inhibited the abnormal activation of NLRP3 inflammasome in aortic smooth muscle layer of db/db mice. Knockout (KO) of NLRP3 significantly alleviated VC in STZ-induced diabetic mice. The protective effects of EMPA were verified in high glucose (HG)-treated mouse aortic smooth muscle cells (MOVASs). In HG-treated NLRP3 KO MOVASs, EMPA (1 μM) did not cause further improvement. Bioinformatics and Western blot analysis revealed that EMPA significantly increased the expression levels of basic helix-loop-helix family transcription factor e40 (Bhlhe40) in HG-treated MOVASs, which served as a negative transcription factor directly binding to the promotor of Nlrp3. We conclude that EMPA ameliorates VC by inhibiting Bhlhe40-dpendent NLRP3 inflammasome activation. These results might provide potential significance for EMPA in VC therapy of T2DM patients.
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Affiliation(s)
- Xiao-Xue Li
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China
| | - Zheng-Dong Chen
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China
| | - Xue-Jiao Sun
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China
| | - Yi-Qing Yang
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China
| | - Hong Jin
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China
| | - Nai-Feng Liu
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China.
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Shen M, Li Z, Li H, Yan X, Feng B, Xu L. Association of periodontitis and tooth loss with extent of coronary atherosclerosis in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1243992. [PMID: 38075042 PMCID: PMC10702216 DOI: 10.3389/fendo.2023.1243992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Aim The objective was to investigate the association of periodontitis and tooth loss with extent of diabetic coronary atherosclerosis. Materials and methods 272 patients who were hospitalized at Shanghai East hospital and underwent a coronary artery calcium (CAC) CT scan were enrolled in this study. Individuals were grouped based on their CAC scores into a normal-to-mild coronary atherosclerosis (AS) group (0 ≤ score ≤ 100, n=184) and a moderate-to-severe group (score≥101, n=88). Periodontitis parameters and number of missing teeth were evaluated for every patient. The severity of periodontitis was categorized as mild, moderate, or severe. The taxonomic composition of the microbiota was determined using full-length 16S ribosomal RNA gene sequencing. Salivary inflammatory factors were tested by ELISA. Results Clinical attachment loss (CAL) (P =0.05) and the number of teeth lost (P = 0.016) were significantly higher in the moderate-to-severe coronary AS group, with these differences being more obvious in younger patients and patients with short-duration diabetes. Multivariate logistic regression analysis revealed that CAL (OR = 1.231, 95% CI = 1.066-1.214, P = 0.047) and having 10-19 missing teeth (OR = 1.604, 95% CI = 1.393-6.555, P = 0.05) were strongly associated with the presence of moderate-to-severe coronary AS. Salivary IL-6 and TNF-α levels, as well as levels of Porphyromonas gingivalis and Neisseria mucosa, were significantly elevated in the moderate-to-severe coronary AS group. Conclusion It was found that both tooth loss and CAL were related to the extent of diabetic coronary AS. Saliva inflammatory factors and oral bacteremia may be new biomarkers for moderate-to-severe coronary AS.
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Affiliation(s)
- Minhua Shen
- Department of Stomatology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Li
- Department of Stomatology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huizhi Li
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinfeng Yan
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Feng
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
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Zhang Y, Liu P, Tang LJ, Lin PM, Li R, Luo HR, Luo P. Basing on the machine learning model to analyse the coronary calcification score and the coronary flow reserve score to evaluate the degree of coronary artery stenosis. Comput Biol Med 2023; 163:107130. [PMID: 37329614 DOI: 10.1016/j.compbiomed.2023.107130] [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: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
AIM To obtain the coronary artery calcium score (CACS) for each branch in coronary artery computed tomography angiography (CCTA) examination combined with the flow fraction reserve (FFR) of each branch in the coronary artery detected by CT and apply a machine learning model (ML) to analyse and predict the severity of coronary artery stenosis. METHODS All patients who underwent coronary computed tomography angiography (CCTA) from January 2019 to April 2022 in the HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY) were retrospectively screened, and their sex, age, characteristics of lipid-containing lesions, coronary calcium score (CACS) and CT-FFR values were collected. Five machine learning models, random forest (RF), k-nearest neighbour algorithm (KNN), kernel logistic regression, support vector machine (SVM) and radial basis function neural network (RBFNN), were used as predictive models to evaluate the severity of coronary stenosis. RESULTS Among the five machine learning models, the SVM model achieved the best prediction performance, and the prediction accuracy of mild stenosis was up to 90%. Second, age and male sex were important influencing factors of increasing CACS and decreasing CT-FFR. Moreover, the critical CACS value of myocardial ischemia >200.70 was calculated. CONCLUSION Through computer machine learning model analysis, we prove the importance of CACS and FFR in predicting coronary stenosis, especially the prominent vector machine model, which promotes the application of artificial intelligence computer learning methods in the field of medical analysis.
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Affiliation(s)
- Ying Zhang
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau; Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Ping Liu
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Li-Jia Tang
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Pei-Min Lin
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Run Li
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Huai-Rong Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
| | - Pei Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
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Hou KY, Yang CC. Investigating the Feasibility of Using DenseNet to Improve Coronary Calcification Detection in CT. Acad Radiol 2023; 30:1600-1613. [PMID: 36396585 DOI: 10.1016/j.acra.2022.10.018] [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: 09/15/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Interscan reproducibility of coronary artery calcium (CAC) scoring can be improved by using a smaller slice thickness but at the cost of higher image noise. This study aimed to investigate the feasibility of using densely connected convolutional network (DenseNet) to reduce the image noise in CAC scans reconstructed with slice thickness < 3 mm for improving coronary calcification detection in CT. METHODS Phantom data acquired with QRM and CIRS phantoms were used for model training and testing, where the DenseNet model adopted in this work was a convolutional neural network (CNN) designed for super resolution recovery. After phantom study, the proposed method was evaluated in terms of its ability to improve calcification detection using patient data. The CNN input images (IMGinput) were CAC scans reconstructed with 0.5-, 1.0- and 1.5-mm slice thickness, while CNN label images were CAC scans reconstructed with 3-mm slice thickness (IMG3mm). Region of interest (ROI) analysis was carried out on IMG3mm, IMGinput and CNN output images (IMGoutput). Two-sample t test was used to compare the difference in Hounsfield Unit (HU) values within ROI between IMG3mm and IMGoutput. RESULTS For the calcifications in QRM phantoms, no statistically significant difference was found when comparing the HU values of 400- and 800-HA calcifications identified on IMG3mm to those on IMGoutput with slice thickness of 0.5, 1.0 or 1.5 mm. On the other hand, statistically significant difference was found when comparing the HU values of 200-HA calcifications identified on IMG3mm to those on IMGoutput with a slice thickness of 0.5 and 1.0 mm. Meanwhile, no statistically significant difference was found when comparing the HU values of 200-HA calcifications identified on IMG3mm to those on IMGoutput with a slice thickness of 1.5 mm. As for the rod inserts in CIRS phantoms simulating 9 different tissue types in human body, there was no statistically significant difference between IMG3mm and IMGoutput with slice thickness of 1.5 mm, and all the p values were larger than 0.10. With regards to patient study, more calcification pixels were detected on IMGoutput with a slice thickness of 1.5 mm than on IMG3mm, so calcifications were more clear on the denoised images. CONCLUSION According to our results, the CNN-based denoising method could reduce statistical noise in IMGinput with a slice thickness of 1.5 mm without causing significant texture change or variation in HU values. The proposed method could improve cardiovascular risk prediction by detecting small and soft calcifications that are barely identified on 3-mm slice images used in conventional CAC scans.
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Affiliation(s)
- Kuei-Yuan Hou
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan, ROC (K.Y.H); Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung, Taiwan, 80708, ROC (C.C.Y.); Department of Medical Research, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, ROC (C.C.Y.); Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC (K.Y.H)
| | - Ching-Ching Yang
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan, ROC (K.Y.H); Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung, Taiwan, 80708, ROC (C.C.Y.); Department of Medical Research, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, ROC (C.C.Y.); Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC (K.Y.H).
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Marsh JF, VanMeter PD, Rajendran K, Leng S, McCollough CH. Ex vivo coronary calcium volume quantification using a high-spatial-resolution clinical photon-counting-detector computed tomography. J Med Imaging (Bellingham) 2023; 10:043501. [PMID: 37408984 PMCID: PMC10319293 DOI: 10.1117/1.jmi.10.4.043501] [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: 09/21/2022] [Revised: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Coronary artery calcification (CAC) is an important indicator of coronary disease. Accurate volume quantification of CAC is challenging using computed tomography (CT) due to calcium blooming, which is a consequence of limited spatial resolution. Ex vivo coronary specimens were scanned on an ultra-high-resolution (UHR) clinical photon-counting detector (PCD) CT scanner, and the accuracy of CAC volume estimation was compared with a state-of-the-art conventional energy-integrating detector (EID) CT, a previous-generation investigational PCD-CT, and micro-CT. Approach CAC specimens (n = 13 ) were scanned on EID-CT and PCD-CT using matched parameters (120 kV, 9.3 mGy CTDI vol ). EID-CT images were reconstructed using our institutional routine clinical protocol for CAC quantification. UHR PCD-CT data were reconstructed using a sharper kernel. An image-based denoising algorithm was applied to the PCD-CT images to achieve similar noise levels as EID-CT. Micro-CT images served as the volume reference standard. Calcification images were segmented, and their volume estimates were compared. The CT data were further compared with previous work using an investigational PCD-CT. Results Compared with micro-CT, CT volume estimates had a mean absolute percent error of 24.1 % ± 25.6 % for clinical PCD-CT, 60.1 % ± 48.2 % for EID-CT, and 51.1 % ± 41.7 % for previous-generation PCD-CT. Clinical PCD-CT absolute percent error was significantly (p < 0.01 ) lower than both EID-CT and previous generation PCD-CT. The mean calcification CT number and contrast-to-noise ratio were both significantly (p < 0.01 ) higher in clinical PCD-CT relative to EID-CT. Conclusions UHR clinical PCD-CT showed reduced calcium blooming artifacts and further enabled improved accuracy of CAC quantification beyond that of conventional EID-CT and previous generation PCD-CT systems.
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Affiliation(s)
- Jeffrey F. Marsh
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | | - Kishore Rajendran
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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Yang P, Zhao R, Deng W, An S, Li Y, Sheng M, Chen X, Qian Y, Yu Y, Mu D, Wang Y, Li X. Feasibility and accuracy of coronary artery calcium score on virtual non-contrast images derived from a dual-layer spectral detector CT: A retrospective multicenter study. Front Cardiovasc Med 2023; 10:1114058. [PMID: 36937907 PMCID: PMC10018184 DOI: 10.3389/fcvm.2023.1114058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Rationale and objective This retrospective study was to evaluate the feasibility and accuracy of coronary artery calcium score (CACS) from virtual non-contrast (VNC) images in comparison with that from true non-contrast (TNC) images. Materials and methods A total of 540 patients with suspected of coronary artery disease (CAD) who underwent a dual-layer spectral detector CT (SDCT) in three hospitals were eligible for this study and 233 patients were retrospectively enrolled for further analysis. The CACS was calculated from both TNC and VNC images and compared. Linear regression analysis of the CACS was performed between TNC and VNC images. Results The correlation of overall CACS from VNC and TNC images was very strong (r = 0.923, p < 0.001). The CACS from VNC images were lower than that from TNC images (221 versus. 69, p < 0.001). When the regression equation of the overall coronary artery was applied, the mean calibrated CACS-VNC was 221 which had a significant difference from the CACS-TNC (p = 0.017). When the regression equation of each coronary branch artery was applied, the mean calibrated CACS-VNC was 221, which had a significant difference from the CACS-TNC (p = 0.003). But the mean difference between the CACS-TNC and the calibrated CACS-VNC in either way was less than 1. The agreement on risk stratification with CACS-TNC and CCACS-VNC was almost perfect. Conclusion This multicenter study with dual-layer spectral detector CT showed that it was feasible to calculate CACS from the VNC images derived from the spectral coronary artery CT angiography scan, and the results were in good accordance with the TNC images after correction. Therefore, the TNC scan could be omitted, reducing the radiation dose to patients and saving examination time while using dual-layer spectral detector CT.
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Affiliation(s)
- Panpan Yang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Deng
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Shutian An
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Yuguo Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Mao Sheng
- Department of Radiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, Shanghai, China
| | - Yingfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Dan Mu
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
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9
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Wu H, Luo Z, Liu J, Luo D, Song L, Zhao Y. Association between psoriasis and coronary artery calcification: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1044117. [PMID: 36505373 PMCID: PMC9732247 DOI: 10.3389/fcvm.2022.1044117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a hallmark of atherosclerosis and a predictor of poor cardiovascular prognosis, remains to be determined. We performed a systematic review and meta-analysis to comprehensively evaluate the association between these related inflammatory conditions. Methods Observational studies evaluating the relationship between psoriasis and CAC were retrieved by searching PubMed, Cochrane's Library, and Embase databases. Presence of CAC was confirmed according to an Agatston's Score >0 upon computed tomography examination. A random-effect model incorporating between-study heterogeneity was used to pool the results. Results Sixteen studies involving 3,039 patients with psoriasis and 46,191 controls without psoriasis were included in the meta-analysis. All participants were without previously known cardiovascular diseases. Pooled results showed that psoriasis was associated with overall CAC [odds ratio (OR): 1.54, 95% confidence interval: 1.23-1.91, p < 0.001; I 2 = 57%], after matching or adjusting the conventional cardiovascular risk factors. Subgroup analyses showed that study country, comorbidity of psoriatic arthritis, baseline Psoriasis Area and Severity Index, and duration of psoriasis (p for subgroup difference all >0.05) did not significantly affect the association of psoriasis and CAC. However, a stronger association was observed in younger patients (mean age <50 years, OR: 2.63, p < 0.001) compared to older patients (≥50 years, OR: 1.24, p = 0.02; p for subgroup difference <0.001). Conclusion Psoriasis is associated with CAC, and the association may be stronger in younger patients.
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Affiliation(s)
- Huihui Wu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zeyu Luo
- Department of Dermatology, Guangzhou Development District Hospital, Guangzhou, China
| | - Juanhua Liu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Diqing Luo
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Luli Song
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yukun Zhao
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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10
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Wei Y, Wang Z, He Q, Siddiqi SM, Zhou Z, Liu L, Song Y, Chen P, Li J, Zhang Y, Mao G, Wang B, Tang G, Qin X, Xu X, Huo Y, Guo H, Zhang H. Inverse Association between Plasma Phylloquinone and Risk of Ischemic Stroke in Chinese Adults with Hypertension and High BMI: A Nested Case-Control Study. J Nutr 2022; 152:1927-1935. [PMID: 35660920 DOI: 10.1093/jn/nxac131] [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: 02/24/2022] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence on the association between phylloquinone status and cardiovascular diseases is scarce and conflicting. These inconsistencies may be due to differences in individual characteristics of the study populations, which may modify the association. OBJECTIVE This study aimed to evaluate the association between plasma phylloquinone and the risk of first total stroke and its subtypes, and to examine potential effect modifications by BMI in patients with hypertension. METHODS We performed a nested case-control study including 604 first stroke cases and 604 matched controls. The mean age was 62.2 y (range, 45 to 75). Lower BMI was defined as <25 kg/m2 and higher BMI was defined as ≥25 kg/m2. The risks of the first stroke were estimated by ORs and 95% CIs using conditional logistic regression. The primary outcome was total stroke or ischemic stroke. RESULTS The relation between log-transformed phylloquinone concentration and stroke or ischemic stroke was modified by BMI. Higher phylloquinone concentrations were associated with lower stroke risk in those with a higher BMI. When plasma phylloquinone was assessed as tertiles, the adjusted ORs of first stroke and ischemic stroke for participants with a high BMI in tertile 2-3 were 0.70 (95% CI: 0.46, 1.08) and 0.57 (95% CI: 0.35, 0.92) compared with those in tertile 1, respectively. However, there was no significant association between plasma phylloquinone and risk of first total stroke or ischemic stroke for those with a lower BMI. Patients with a higher BMI and lower phylloquinone concentrations had the highest risk of ischemic stroke and showed a statistically significant difference compared with the reference group with a lower BMI and higher phylloquinone (OR = 1.80, 95% CI: 1.06, 3.10; P-interaction: 0.017). CONCLUSIONS In Chinese patients with hypertension, there was an inverse association between baseline plasma phylloquinone and risk of first ischemic stroke among those with a higher BMI. This trial was registered at clinicaltrials.gov as NCT00794885.
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Affiliation(s)
- Yaping Wei
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Zhuo Wang
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Qiangqiang He
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Sultan Mehmood Siddiqi
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Ziyi Zhou
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Lishun Liu
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Yun Song
- Shenzhen Evergreen Medical Institute, Shenzhen, China.,Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Ping Chen
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Guangyun Mao
- Department of Preventive Medicine, School of Public Health & Management, Wenzhou Medical University, Wenzhou, China
| | - Binyan Wang
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Genfu Tang
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiping Xu
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Huiyuan Guo
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Hao Zhang
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
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11
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Makhija R, Mukherjee D. Chest Pain: Who Needs Additional Testing Beyond ECG and Troponin? JACC Case Rep 2021; 3:1643-1648. [PMID: 34766010 PMCID: PMC8571782 DOI: 10.1016/j.jaccas.2021.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022]
Abstract
In the first case, we describe a 45-year-old man who presented to the emergency department for evaluation of chest pain. He reported having chest discomfort 5 days prior that lasted a few minutes after an altercation with his coworker. In the second case, we describe a 54-year-old woman with history of well-controlled diabetes mellitus, hypertension, and dyslipidemia who presented to the ED with a 10-day history of intermittent sharp and burning chest pain in the substernal region, 5/10 intensity, lasting 15-20 minutes, associated with exertion. (Level of Difficulty: Intermediate.).
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Key Words
- ACS, acute coronary syndrome(s)
- CAD, coronary artery disease
- CCTA, coronary computed tomography angiography
- CDP, clinical decision pathway
- ECG, electrocardiogram
- ED, emergency department
- EDACS, Emergency Department Assessment of Chest Pain Score
- FFR-CT, fractional flow reserve–computed tomography
- HEART, History, ECG, Age, Risk factors and Troponin
- MACE, major adverse cardiac events
- acute coronary syndrome
- chest pain
- computed tomography
- hs-cTn, high sensitivity-troponin
- mADAPT, Modified Accelerated Diagnostic protocol to Assess chest Pain using Troponins
- nuclear medicine
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Affiliation(s)
- Rakhee Makhija
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
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12
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Katsiki N, Doumas M. Emerging Cardiovascular Risk Factors and Specific Patient Populations at Increased Cardiovascular Risk. Curr Vasc Pharmacol 2021; 19:241-242. [PMID: 33413053 DOI: 10.2174/157016111903201231115755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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13
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Nenna A, Nappi F, Spadaccio C, Greco SM, Pilato M, Stilo F, Montelione N, Catanese V, Lusini M, Spinelli F, Chello M. Advanced measurements of coronary calcium scores: how does it affect current clinical practice? Future Cardiol 2021; 18:35-41. [PMID: 33885330 DOI: 10.2217/fca-2020-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Coronary artery calcium (CAC) scoring has emerged as a marker of the burden of atheromatous disease and has been included in scoring systems. The practice of myocardial revascularization, considering percutaneous procedures or surgical strategies, is dramatically changing over years and the prognostic significance of CAC scoring is gradually being conceived. In this interdisciplinary scenario, vessel specific calcium scoring, mapping of coronary calcification and its integration with functional assessment of coronary artery disease might change the future decisions in the catheterization lab and operative theaters. This article summarizes CAC evaluation techniques and its implications in clinical practice.
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Affiliation(s)
- Antonio Nenna
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord, Saint Denis, Paris, France
| | | | - Salvatore Matteo Greco
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.,Cardiac Surgery, ISMETT-IRCCS, Palermo, Italy
| | | | - Francesco Stilo
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Nunzio Montelione
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Catanese
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Spinelli
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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14
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Mong N, Tarjanyi Z, Tothfalusi L, Bartykowszki A, Nagy AI, Szekely A, Becker D, Maurovich-Horvat P, Merkely B, Nagy G. Largely Accelerated Arterial Aging in Rheumatoid Arthritis Is Associated With Inflammatory Activity and Smoking in the Early Stage of the Disease. Front Pharmacol 2020; 11:523962. [PMID: 33390933 PMCID: PMC7774279 DOI: 10.3389/fphar.2020.601344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) patients have a shorter life expectancy than the general population primarily due to cardiovascular comorbidities. Objectives: To characterize arterial aging in RA. Patients and Methods: Coronary calcium score (CCS) were available from 112 RA patients; out of these patients, follow-up CCS were measured for 54 randomly selected individuals. Control CCS were obtained from the MESA database (includes 6,000 < participants); arterial age was calculated from CCS. Results: RA patients were significantly older (10.45 ± 18.45 years, p < 0.001) in terms of the arterial age than the age-, gender-, and race-matched controls. The proportion of RA patients who had zero CCS was significantly less (p < 0.01) than that of those in the MESA reference group. Each disease year contributed an extra 0.395 years (p < 0.01) on the top of the normal aging process. However, the rate of the accelerated aging is not uniform, in the first years of the disease it is apparently faster. Smoking (p < 0.05), previous cardiovascular events (p < 0.05), and high blood pressure (p < 0.05) had additional significant effect on the aging process. In the follow-up study, inflammatory disease activity (CRP > 5 mg/L, p < 0.05) especially in smokers and shorter than 10 years of disease duration (p = 0.05) had the largest impact. Conclusion: Arterial aging is faster in RA patients than in control subjects, particularly in the first 10 years of the disease. Inflammation, previous cardiovascular events, and smoking are additional contributing factors to the intensified coronary atherosclerosis progression. These data support that optimal control of inflammation is essential to attenuate the cardiovascular risk in RA.
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Affiliation(s)
- Nikolett Mong
- Polyclinic of Hospitaller Brothers of St. John of God, Budapest, Hungary
| | - Zoltan Tarjanyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Laszlo Tothfalusi
- Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | | | - Aniko Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anett Szekely
- Polyclinic of Hospitaller Brothers of St. John of God, Budapest, Hungary
| | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gyorgy Nagy
- Polyclinic of Hospitaller Brothers of St. John of God, Budapest, Hungary.,Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary.,Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
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