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Ngamdu KS, Kalra DK. Risk of Stroke, Dementia, and Cognitive Decline with Coronary and Arterial Calcification. J Clin Med 2024; 13:4263. [PMID: 39064303 PMCID: PMC11277788 DOI: 10.3390/jcm13144263] [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: 06/05/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
Extant research shows that following a cerebrovascular insult to the brain, patients may develop a wide range of cognitive disorders, spanning from mild cognitive impairment (CI) to advanced dementia. Several studies have shown that atherosclerosis in the carotid, coronary, and breast arteries is associated with an increased risk of stroke, CI, and dementia. In this review, we examine the association of subclinical atherosclerotic calcification detected by computed tomography (CT) in these arterial beds and the risk of stroke, CI, and dementia. A major advantage of CT is that it can accurately quantify vascular calcification in different parts of the vasculature during a single examination. However, the strength of the association between CT findings and CI and stroke varies with the location and severity of the arteries involved. Data are still limited on this topic, highlighting the need for additional investigations to further our understanding of the risk of cognitive impairment in patients with subclinical atherosclerosis. It is equally important to test preventive strategies for managing patients in whom vascular calcifications are identified incidentally in randomized controlled trials to study the effects on outcomes, including incidents of stroke and CI.
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Affiliation(s)
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA
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2
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Wu T, Huang J, Wang X, Lian H, Guo R, Shi C. Association of Oral Anticoagulant Therapy with the Prevalence and Severity of Vascular Calcification among Patients with Atrial Fibrillation: A Cohort Study. ACS Pharmacol Transl Sci 2024; 7:1262-1269. [PMID: 38751625 PMCID: PMC11092121 DOI: 10.1021/acsptsci.3c00307] [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: 10/31/2023] [Revised: 02/09/2024] [Accepted: 03/22/2024] [Indexed: 05/18/2024]
Abstract
Many patients with atrial fibrillation (AF) requiring long-term use of oral anticoagulants (OACs) are at high risk for vascular calcification and anticoagulation therapy with warfarin exacerbate vascular calcification. However, the effect of nonvitamin K agonists on vascular calcification has not been clearly investigated. This study explored the effects of dabigatran etexilate, rivaroxaban, and warfarin on vascular calcification among 1527 patients with AF. Demographics, comorbidities, laboratory test data, medications, and the prevalence and severity of vascular calcification in different vascular beds were compared. After propensity score matching, the incidence of vascular calcification in the rivaroxaban and warfarin group was significantly higher than that in the nonanticoagulant group, while there was no difference between the dabigatran etexilate group and the nonanticoagulant group. Similarly, we found that the rivaroxaban group had more severe calcification in the overall vascular level (P < 0.001), thoracic aorta (P < 0.001), aortic arch (P = 0.001), and left common carotid artery (P = 0.005) than the nonanticoagulant group. In addition, in the left common carotid artery, there was more severe calcification in the rivaroxaban group than that in the dabigatran group (P = 0.005). Our results suggest that rivaroxaban can significantly increase both the incidence and severity of vascular calcification among patients with AF, while dabigatran etexilate has no such effect. Many patients with AF requiring long-term use of OACs are at high risk for vascular calcification. This is the first study to conduct a head-to-head comparison of the effects of dabigatran etexilate and rivaroxaban on vascular calcification. Rivaroxaban, rather than dabigatran etexilate, promotes vascular calcification in patients with AF, providing important implications to aid clinicians in their choice for OAC selection, especially those at high risk for vascular calcification.
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Affiliation(s)
- Tian Wu
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
- Department
of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, China
| | - Jun Huang
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xia Wang
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Huilin Lian
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ren Guo
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Can Shi
- The
Third Xiangya Hospital, Central South University, Changsha 410013, China
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3
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Heo J, Lee H, Lee IH, Lim IH, Hong SH, Shin J, Nam HS, Kim YD. Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis. Sci Rep 2024; 14:304. [PMID: 38172278 PMCID: PMC10764735 DOI: 10.1038/s41598-023-51013-3] [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: 04/04/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid atherosclerotic disease was present with non-valvular atrial fibrillation (NVAF). This was a retrospective study using a prospective cohort of consecutive patients with ischemic stroke. Patients with NVAF and comorbid atherosclerotic disease were assigned to the OAC + antiplatelet or OAC group based on discharge medication. All-cause mortality, recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and bleeding events within 1 year after the index stroke were compared. Of the 445 patients included in this study, 149 (33.5%) were treated with OAC + antiplatelet. There were no significant differences in all outcomes between groups. After inverse probability of treatment weighting, OAC + antiplatelet was associated with a lower risk of all-cause mortality (hazard ratio 0.48; 95% confidence interval 0.23-0.98; P = 0.045) and myocardial infarction (0% vs. 3.0%, P < 0.001). The risk of hemorrhagic stroke was not significantly different (P = 0.123). OAC + antiplatelet was associated with a decreased risk of all-cause mortality and myocardial infarction but an increased risk of ischemic stroke among patients with NVAF and systemic atherosclerotic diseases.
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Affiliation(s)
- JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - In Hwan Lim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Soon-Ho Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonggyeong Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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4
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Elsheikh S, Hill A, Irving G, Lip GYH, Abdul-Rahim AH. Atrial fibrillation and stroke: State-of-the-art and future directions. Curr Probl Cardiol 2024; 49:102181. [PMID: 37913929 DOI: 10.1016/j.cpcardiol.2023.102181] [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: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
Atrial fibrillation (AF) and stroke remain a major cause of morbidity and mortality. The two conditions shared common co-morbidities and risk factors. AF-related strokes are associated with worse clinical outcomes and higher mortality compared to non-AF-related. Early detection of AF is vital for prevention. While various scores have been developed to predict AF in such a high-risk group, they are yet to incorporated into clinical guidelines. Novel markers and predictors of AF including coronary and intracranial arterial calcification have also been studied. There are also ongoing debates on the management of acute stroke in patients with AF, and those who experienced breakthrough stroke while on oral anticoagulants. We provided an overview of the complex interplay between AF and stroke, as well as the treatment and secondary prevention of stroke in AF. We also comprehensively discussed the current evidence and the ongoing conundrums, and highlighted the future directions on the topic.
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Affiliation(s)
- Sandra Elsheikh
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK.
| | - Andrew Hill
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK
| | - Greg Irving
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Health Research Institute, Edge Hill University Faculty of Health and Social Care, Ormskirk, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK
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5
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Farooqi M, Papaioannou A, Bangdiwala S, Rangarajan S, Leong D. How regional versus global thresholds for physical activity and grip strength influence physical frailty prevalence and mortality estimates in PURE: a prospective multinational cohort study of community-dwelling adults. BMJ Open 2023; 13:e066848. [PMID: 37270191 DOI: 10.1136/bmjopen-2022-066848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES Handgrip strength and physical activity are commonly used to evaluate physical frailty; however, their distribution varies worldwide. The thresholds that identify frail individuals have been established in high-income countries but not in low-income and middle-income countries. We created two adaptations of physical frailty to study how global versus regional thresholds for handgrip strength and physical activity affect frailty prevalence and its association with mortality in a multinational population. DESIGN, SETTING AND PARTICIPANTS Our sample included 137 499 adults aged 35-70 years (median age: 61 years, 60% women) from Population Urban Rural Epidemiology Studies community-dwelling prospective cohort across 25 countries, covering the following geographical regions: China, South Asia, Southeast Asia, Africa, Russia and Central Asia, North America/Europe, Middle East and South America. PRIMARY AND SECONDARY OUTCOME MEASURES We measured and compared frailty prevalence and time to all-cause mortality for two adaptations of frailty. RESULTS Overall frailty prevalence was 5.6% using global frailty and 5.8% using regional frailty. Global frailty prevalence ranged from 2.4% (North America/Europe) to 20.1% (Africa), while regional frailty ranged from 4.1% (Russia/Central Asia) to 8.8% (Middle East). The HRs for all-cause mortality (median follow-up of 9 years) were 2.42 (95% CI: 2.25 to 2.60) and 1.91 (95% CI: 1.77 to 2.06) using global frailty and regional frailty, respectively, (adjusted for age, sex, education, smoking status, alcohol consumption and morbidity count). Receiver operating characteristic curves for all-cause mortality were generated for both frailty adaptations. Global frailty yielded an area under the curve of 0.600 (95% CI: 0.594 to 0.606), compared with 0.5933 (95% CI: 0.587 to 5.99) for regional frailty (p=0.0007). CONCLUSIONS Global frailty leads to higher regional variations in estimated frailty prevalence and stronger associations with mortality, as compared with regional frailty. However, both frailty adaptations in isolation are limited in their ability to discriminate between those who will die during 9 years' follow-up from those who do not.
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Affiliation(s)
- Maheen Farooqi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shrikant Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Darryl Leong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Zhao K, Zhang L, Wang L, Zeng J, Zhang Y, Xie X. Benign incidental cardiac findings in chest and cardiac CT imaging. Br J Radiol 2023; 96:20211302. [PMID: 35969186 PMCID: PMC9975525 DOI: 10.1259/bjr.20211302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 02/01/2023] Open
Abstract
With the continuous expansion of the disease scope of chest CT and cardiac CT, the number of these CT examinations has increased rapidly. In addition to their common indications, many incidental cardiac findings can be observed when carefully evaluating the coronary arteries, valves, pericardium, ventricles, and large vessels. These findings may have clinical significance or risk of complications, but they are sometimes overlooked or may not be described in the final reports. Although most of the incidental findings are benign, timely detection and treatment can improve the management of chronic diseases or reduce the possibility of severe complications. In this review, we summarized the imaging findings, incidence rate, and clinical relevance of some benign cardiac findings such as coronary artery calcification, aortic and mitral valve calcification, aortic calcification, cardiac thrombus, myocardial bridge, aortic dilation, cardiac myxoma, pericardial cyst, and coronary artery fistula. Reporting incidental cardiac findings will help reduce the risk of severe complications or disease deterioration and contribute to the recovery of patients.
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Affiliation(s)
- Keke Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lu Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lingyun Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Jinghui Zeng
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Yaping Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
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Machino R, Shimoyama K, Oku K, Yamasaki K, Tagawa T. Prevalence of coronary calcification on preoperative computed tomography and its management in thoracic surgery. Surg Today 2023; 53:62-72. [PMID: 35695922 PMCID: PMC9823058 DOI: 10.1007/s00595-022-02532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/24/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated the preoperative assessment of coronary artery calcification using computed tomography for appropriate intraoperative management to reduce the risk of perioperative cardiac complications during pulmonary resection. METHODS Patients (n = 665) who underwent anatomical lung resection were examined. The extent of preoperative asymptomatic coronary artery stenosis or cardiac complications in patients with coronary artery calcification was assessed. In addition, the risk factors for perioperative cardiac complications were determined. RESULTS Coronary artery calcification was detected in 233 (35.0%) asymptomatic patients. Nineteen (8.2%) patients with coronary artery calcification had coronary artery stenosis ≥ 75%. Percutaneous coronary intervention was performed preoperatively (n = 3) and postoperatively (n = 10), and preoperative drug intervention was performed in 10 cases. One case of severe postoperative cardiac complications and 20 cases of mild postoperative cardiac complications, including those without coronary artery calcification, occurred. Patients with calcified coronary arteries were at risk of cardiovascular complications in the perioperative period. However, patients with coronary artery calcification who underwent preoperative cardiology intervention had no significant perioperative cardiovascular complications. CONCLUSIONS Coronary artery calcification detected on preoperative computed tomography is a risk factor for perioperative cardiovascular complications. Early intervention may reduce the risk of such complications.
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Affiliation(s)
- Ryusuke Machino
- grid.415640.2Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki 856-8562 Japan
| | - Koichiro Shimoyama
- grid.415640.2Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki 856-8562 Japan
| | - Koji Oku
- grid.415640.2Department of Cardiology, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | - Kazumi Yamasaki
- grid.415640.2Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | - Tsutomu Tagawa
- grid.415640.2Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki 856-8562 Japan
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Herczeg S, Simon J, Szegedi N, Karády J, Kolossváry M, Szilveszter B, Balogi B, Nagy VK, Merkely B, Széplaki G, Maurovich-Horvat P, Gellér L. High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation. Coron Artery Dis 2023; 34:18-23. [PMID: 36484216 PMCID: PMC9742003 DOI: 10.1097/mca.0000000000001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is often performed before catheter ablation of atrial fibrillation to map atrial and pulmonary anatomy. Incident coronary artery disease (CAD) may also be diagnosed during cardiac CT angiography (CTA). Our aim was to assess whether coronary CTA might be able to identify a significant proportion of patients with obstructive CAD prior to their catheter ablation procedure event, even in asymptomatic patients. METHODS Consecutive patients undergoing pre-ablation coronary CTA for atrial fibrillation between 2013 and 2020 were retrospectively selected. Patients with previously diagnosed CAD were excluded. Obstructive CAD was defined as ≥50% luminal stenosis. We analyzed the relationship between obstructive CAD, any chest pain, and traditional risk factors. RESULTS Overall, 2321 patients [median age 63.0 (54.4-69.2), 1052/2321 (45.3%) female] underwent coronary CTA and 488/2321 (21.0%) were diagnosed with obstructive CAD. There was no difference regarding the rate of obstructive CAD in patients with any chest pain compared to patients without any chest pain [91/404 (22.5%) vs. 397/1917 (20.7%), P = 0.416, respectively). The following parameters were associated with obstructive CAD: age > 65 years [odds ratio (OR) = 2.51; 95% confidence interval (CI), 2.02-3.13; P < 0.001), male sex (OR = 1.59; 95% CI, 1.28-1.98; P < 0.001), hypertension (OR = 1.40; 95% CI, 1.08-1.81; P = 0.012), diabetes (OR = 1.50; 95% CI, 1.13-1.99; P = 0.006), dyslipidaemia (OR = 1.33; 95% CI, 1.07-1.66; P = 0.011) and history of smoking (OR = 1.34; 95% CI, 1.07-1.68; P = 0.011). CONCLUSIONS The high prevalence of obstructive CAD even in patients without chest pain highlights the importance of additional coronary artery diagnostics in patients undergoing left atrial CTA awaiting catheter ablation for atrial fibrillation. These patients regardless of chest pain thus may require further risk modification to decrease their potential ischemic and thromboembolic risk.
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Affiliation(s)
- Szilvia Herczeg
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Bernadett Balogi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Vivien K Nagy
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
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Hou D, Yang X, Wang Y, Huang S, Tang Y, Wu D. Carotid Siphon Calcification Predicts the Symptomatic Progression in Branch Artery Disease With Intracranial Artery Stenosis. Arterioscler Thromb Vasc Biol 2022; 42:1094-1101. [PMID: 35652332 PMCID: PMC9311467 DOI: 10.1161/atvbaha.122.317670] [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] [Indexed: 12/02/2022]
Abstract
Arterial calcification in the aortic arch, carotid bifurcation, or siphon on computed tomography was associated with cardiovascular disease. The association between arterial calcification prevalence and progression of branch atheromatous disease (BAD) in intracranial artery atherosclerosis was little investigated.
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Affiliation(s)
- Duanlu Hou
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. (D.H., X.Y., Y.W., S.H., D.W.)
| | - Xiaoli Yang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. (D.H., X.Y., Y.W., S.H., D.W.)
| | - Yuanyuan Wang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. (D.H., X.Y., Y.W., S.H., D.W.)
| | - Shengwen Huang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. (D.H., X.Y., Y.W., S.H., D.W.)
| | - Yuping Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. (Y.T.)
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. (D.H., X.Y., Y.W., S.H., D.W.)
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10
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Kotalczyk A, Guo Y, Fawzy AM, Wang Y, Lip GYH. Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (
ChiOTEAF
) registry. J Arrhythm 2022; 38:580-588. [PMID: 35936042 PMCID: PMC9347193 DOI: 10.1002/joa3.12744] [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: 01/21/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Atrial fibrillation (AF) and coronary artery disease (CAD) are closely related; CAD may precede or complicate the clinical course of AF. Objective To evaluate the impact of CAD on clinical outcomes among elderly Chinese AF patients. Methods The ChiOTEAF registry is a prospective registry conducted in 44 sites from 20 provinces in China between October 2014 and December 2018. Primary outcome was the composite of all‐cause mortality/any thromboembolism (TE)/major bleeding/acute coronary syndrome (ACS). Results The eligible cohort for this analysis included 6403 individuals (mean age 74.8 ± 10.7; 39.2% female); of these, 3058 (47.8%) had a history of CAD. On multivariate analysis, CAD was independently associated with a higher odds ratio for ACS (OR: 1.98; 95% CI: 1.12–3.52) without a significant impact on other adverse outcomes. Independent variables associated with the composite outcome among CAD patients were: (i) the use of OAC (OR: 0.55; 95% CI: 0.42–0.72), age (OR: 1.09; 95% CI: 1.08–1.11), heart failure (OR: 1.95; 95% CI: 1.51–2.50), prior ischemic stroke (OR: 1.29; 95% CI: 1.02–1.64), chronic kidney disease (OR: 1.71; 95% CI: 1.32–2.22), and chronic obstructive pulmonary disease (OR: 1.42; 95% CI: 1.06–1.89). Conclusions AF patients with CAD were at an increased risk of developing ACS but there was no significant difference in the composite outcome, all cause death, cardiovascular death, thromboembolic events or major bleeding compared to the non‐CAD group. OAC use was inversely associated with adverse events, yet their uptake was poor in the AF‐CAD population.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy Medical University of Silesia, Silesian Centre for Heart Diseases Zabrze Poland
| | - Yutao Guo
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Centre Chinese PLA General Hospital Beijing China
| | - Ameenathul M. Fawzy
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
| | - Yutang Wang
- Department of Cardiology, Second Medical Centre Chinese PLA General Hospital Beijing China
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy Medical University of Silesia, Silesian Centre for Heart Diseases Zabrze Poland
- Department of Clinical Medicine Aalborg University Aalborg Denmark
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Wang X, Chen X, Chen Z, Zhang M. Arterial Calcification and Its Association With Stroke: Implication of Risk, Prognosis, Treatment Response, and Prevention. Front Cell Neurosci 2022; 16:845215. [PMID: 35634461 PMCID: PMC9130460 DOI: 10.3389/fncel.2022.845215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 01/07/2023] Open
Abstract
Stroke is a leading cause of death worldwide. Vascular calcification (VC), defined as deposition of calcium-phosphate complexes in the vessels, is considered as the characteristic of vascular aging. Calcifications at different vessel layers have different implications. Intimal calcification is closely related to atherosclerosis and affects plaque stability, while medial calcification can cause arterial stiffening and reduce compliance. Accumulating evidence suggested that arterial calcifications, including calcifications in the intracranial artery, coronary artery, and carotid artery, are associated with the risk, prognosis, and treatment response of stroke. VC can not only serve as a marker of atherosclerosis, but cause cerebral hemodynamic impairment. In addition, calcifications in large arteries are associated with cerebral small vessel disease. In this review, we summarize the findings of recently published studies focusing on the relationship between large artery calcification and the risk, prognosis, treatment response, and prevention of stroke and also discuss possible mechanisms behind those associations.
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Affiliation(s)
- Xiang Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinghang Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuohui Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Mengqi Zhang,
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Elsadek Seaoud EAM, Amin MI, Abdelbasit MS. Total cholesterol/high-density lipoprotein cholesterol and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol as predictors of coronary artery calcification assessed by multidetector computed tomography coronary angiography. ARYA ATHEROSCLEROSIS 2022; 18:1-7. [PMID: 36819834 PMCID: PMC9931617 DOI: 10.48305/arya.v18i0.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/01/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronary artery calcification (CAC) is an important marker of total burden of coronary atherosclerosis. Furthermore, it is a measure of subclinical atherosclerotic disease that correlates well with the cardiovascular risk. The aim of our study was to determine the role of the different lipid parameters in prediction of calcification in coronary arteries using multidetector computed tomography (MDCT). METHODS This study was conducted on 120 patients presenting to the clinic with typical or atypical chest pain or dyspnea on exertion, or equivocal stress test results along with standard cardiac risk factors; they all underwent computed tomography (CT) coronary angiography. A total calcium score was determined by summing individual lesion scores from each of our anatomic sites: left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). The amount of calcium present in the coronary arteries was scored according to Agatston score, and patients were divided into 2 groups based on absence (group I) and presence (group II) of CAC. Clinical characteristics, lipid ratios, and a full blood count were calculated and compared between both groups. RESULTS Mean and standard deviation (SD) for age of group I was 52.4 ± 8.4 years, while that of group II was 53.7 ± 7.9 (P > 0.005). Patients in group II had a higher total cholesterol (TC), low-density lipoprotein (LDL), TC/high-density lipoprotein cholesterol (HDL-C) and LDL/HDL-C ratio, and lower HDL levels. TC/HDL ratio and LDL/HDL ratio were found to be good predictors of calcium using a regression analysis model. Finally, at a cut-off value of ≥ 3.108, LDL/HDL ratio showed a sensitivity of 58.8% and specificity of 84.6% in prediction of coronary calcium, while TC/HDL ratio ≥ 4.742 showed a sensitivity of 60.3% and specificity of 88.5%. CONCLUSION Amongst the different lipid parameters, TC/HDL-C and LDL/HDL ratio were found to be good predictors of presence of CAC in coronary arteries.
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Affiliation(s)
- Elshaimaa Aly M. Elsadek Seaoud
- Department of Cardiology, School of Medicine, Zagazig University, Zagazig, Egypt,Address for correspondence: Elshaimaa Aly M.Elsadek Seaoud; Department of Cardiology, School of Medicine, Zagazig University,
Zagazig, Egypt;
| | - Mohamed Ibrahim Amin
- Department of Cardiology, School of Medicine, Zagazig University, Zagazig, Egypt
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Abolbashari M. Atherosclerosis and Atrial Fibrillation: Double Trouble. Curr Cardiol Rep 2022; 24:67-73. [PMID: 34993746 DOI: 10.1007/s11886-021-01625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This review aims to evaluate the major cardiovascular adverse events (MACE) and antithrombotic approaches in concomitant atrial fibrillation (AF) and atherosclerosis. RECENT FINDINGS MACE in concomitant AF and atherosclerosis has been evaluated in recent studies. A recent retrospective study of 2670 patients with AF revealed that atherosclerosis burden with AF can be a marker of adverse vascular outcomes with extracranial atherosclerosis as a potent predictor of MACE. Trials to evaluate the antithrombotic approaches in concomitant atherosclerotic disease and AF has been mainly in patients with coronary artery disease (CAD). AFIRE trial demonstrated that in patients with AF and stable CAD rivaroxaban alone is not inferior to rivaroxaban plus aspirin with better safety profile. Atherosclerosis is common in AF and poses additional risk to patients. Antithrombotic management of atherosclerosis in AF is not well investigated and needs further trial to identify the subgroups that benefit from more intensive antithrombotic measures.
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Affiliation(s)
- Mehran Abolbashari
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
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Association of Matrix Metalloproteinase-2 (MMP-2) and MMP-9 Promoter Polymorphisms, Their Serum Levels, and Activities with Coronary Artery Calcification (CAC) in an Iranian Population. Cardiovasc Toxicol 2021; 22:118-129. [PMID: 34731407 DOI: 10.1007/s12012-021-09707-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
The serum levels and activity of matrix metalloproteinases (MMPs) are associated with the risk of coronary artery calcification (CAC). We sought to investigate the association between MMP-2 -1575G>A (rs243866) and MMP-9 -1562 C>T (rs3918242) SNPs with MMP-2 and MMP-9 serum levels and activity in individuals with CAC. One hundred and fifty-five cases with CAC and 155 healthy individuals as control group from West of Iran were included and frequency of genotypes and alleles of rs243866 and rs3918242 in MMP-2 and MMP-9 genes were determined using PCR-RFLP. We also investigated the serum levels of MMP-2 and MMP-9 and their activity using ELISA and gelatin zymography, respectively. Additionally, serum biochemical parameters including FBS (fasting blood sugar), urea, creatinine, cholesterol, triglyceride, HDL (high-density lipoprotein), LDL (low-density lipoprotein), calcium, and phosphorus as well as blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were measured. Our results showed that both serum levels of MMP-2 and MMP-9 (P < 0.001) and their activity (P < 0.001) were higher in individuals with CAC when compared to the control group. Carrying A and T alleles in MMP-2 -1575G>A (rs243866) and MMP-9 -1562 C>T (rs3918242) SNPs, respectively, may predispose the individuals to CAC by acting as the risk factors. Serum levels and activity of MMP-2 and MMP-9 were found to be higher in CAC cases when compared to the healthy controls. Carriers of A allele in rs243866 SNP and T allele in rs3918242 SNP were shown to have higher MMP-2 and MMP-9 serum levels and activity that may result in increased ECM degradation and support the initiation and development of calcification.
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Wang TKM, Chan N, Cremer PC, Kanj M, Baranowski B, Saliba W, Wazni OM, Jaber WA. Incorporating coronary calcification by computed tomography into CHA2DS2-VASc score: impact on cardiovascular outcomes in patients with atrial fibrillation. Europace 2021; 23:1211-1218. [PMID: 33585883 DOI: 10.1093/europace/euab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS CHA2DS2-VASc score is widely utilized for risk stratification and guiding anticoagulation in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed for pulmonary vein isolation (PVI) can also identify coronary artery calcifications (CAC). We evaluated the frequency and outcomes of incorporating CAC into the CHA2DS2-VASc score in AF patients undergoing PVI. METHODS AND RESULTS Consecutive patients in a prospective PVI registry during 2014-18 having CCT within 1 year of PVI were studied. Reclassification of CHA2DS2-VASc score and associations between CAC as a binary variable detected on CCT with clinical characteristics, stroke as primary endpoint, death, myocardial infarction, and major adverse cardiovascular events (MACE) were analysed. Amongst 3604 AF patients, 2238 (62.1%) had CAC detected on CCT and was associated with most traditional cardiovascular risk factors. Coronary artery calcification was independently associated with all pre-specified endpoints adjusting for clinical parameters in multivariable analysis. Adjusting for CHA2DS2-VASc score, CAC was associated with stroke (hazards ratio 3.64, 95% confidence interval 1.25-10.6, P = 0.018), death (2.26, 1.29-3.98, P = 0.006), and MACE (2.08, 1.36-3.16, P = 0.001) during 2.8 ± 1.6-year follow-up. Incorporating CAC as a vascular disease parameter of CHA2DS2-VASc score, anticoagulation decision-making would be revised in 723 (20.1%) patients, including an additional 488 (13.5%) patients where anticoagulation would be now indicated. CONCLUSION Coronary artery calcification is prevalent in AF patients undergoing PVI and independently associated stroke, death and MACE even when adjusted for traditional CHA2DS2-VASc score. Adding CAC as vascular component to the CHA2DS2-VASc score requires further research as it potentially modified the anticoagulation management in 20% of our AF cohort.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Walid Saliba
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
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Editor's Notebook: August 2020. AJR Am J Roentgenol 2020; 215:265-266. [DOI: 10.2214/ajr.20.23632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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