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Halkoaho J, Niiranen O, Salli E, Kaseva T, Savolainen S, Kangasniemi M, Hakovirta H. Quantifying the calcification of abdominal aorta and major side branches with deep learning. Clin Radiol 2024; 79:e665-e674. [PMID: 38365540 DOI: 10.1016/j.crad.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
AIM To explore the possibility of a neural network-based method for quantifying calcifications of the abdominal aorta and its branches. MATERIALS AND METHODS In total, 58 computed tomography (CT) angiography volumes were selected from a dataset of 609 to represent different stages of sclerosis. The ground truth segmentations of the abdominal aorta, coeliac trunk, superior mesenteric artery, renal arteries, common iliac arteries, and their calcifications were delineated manually. Two V-Net ensemble models were trained, one for segmenting arteries of interest and another for calcifications. The branches of interest were shortened algorithmically. The volumes of calcification were then evaluated from the arteries of interest. RESULTS The results indicate that automatic detection is possible with a high correlation to the ground truth. The scores for the ensemble calcification model were dice score of 0.69 and volumetric similarity (VS) of 0.80 and for the arteries of interest segmentations: aorta: dice 0.96, VS 0.98; aortic branches: dice 0.74, VS 0.87; and common iliac arteries: dice 0.72, VS 0.91. CONCLUSIONS The presented neural network model is the first to be capable of automatically segmenting, in addition to calcification, both the aorta and its branches from contrast-enhanced CT angiography. This technology shows promise in addressing limitations inherent in earlier methods that relied solely on plain CT.
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Affiliation(s)
- J Halkoaho
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Physics, University of Helsinki, P.O. Box 64, FI-00014 Helsinki, Finland.
| | - O Niiranen
- Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - E Salli
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Kaseva
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - S Savolainen
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Physics, University of Helsinki, P.O. Box 64, FI-00014 Helsinki, Finland
| | - M Kangasniemi
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Hakovirta
- Department of Surgery, University of Turku, Turku, Finland; Division of Gastroenterology and Urology, Turku University Hospital, Turku, Finland; Department of Surgery, Satasairaala, Pori, Finland
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Cai Z, Liu Z, Zhang Y, Ma H, Li R, Guo S, Wu S, Guo X. Associations Between Life's Essential 8 and Abdominal Aortic Calcification Among Middle-Aged and Elderly Populations. J Am Heart Assoc 2023; 12:e031146. [PMID: 38063150 PMCID: PMC10863763 DOI: 10.1161/jaha.123.031146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Abdominal aortic calcification (AAC) is an independent risk factor for cardiovascular disease. We aim to examine the associations between Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health (CVH), and AAC among participants aged ≥40 years. METHODS AND RESULTS This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2013 to 2014. AAC (AAC score>0) and severe AAC (AAC score>6) were quantified by the Kauppila score system. Multiple linear, multivariable logistic, and restricted cubic spline models were used to assess the associations. A total of 2369 participants were included with a mean AAC score of 1.41 (0.13). Participants in the high-cardiovascular-health group had lower AAC scores, lower prevalence of AAC, and lower prevalence of severe AAC. After the adjustment of potential confounders (age, sex, race and ethnicity, education levels, marital status, poverty income ratio, estimated glomerular filtration rate, serum creatinine, serum uric acid, serum phosphorus, and serum total calcium), higher cardiovascular health was significantly associated with lower risk of AAC. Meanwhile, elevated nicotine exposure score, blood glucose score, and blood pressure score within the LE8 components were significantly associated with lower risk of AAC. Also, nonlinear dose-response relationships were observed. Subgroup analyses (age strata, sex, poverty income ratio, education levels, marital status) indicated the inverse associations of LE8 and AAC were generally similar in different populations. CONCLUSIONS LE8 was negatively and nonlinearly related to the risk of AAC among middle-aged and older populations. Meanwhile, LE8 components should prioritize higher scores for nicotine exposure, blood glucose, and blood pressure evaluations.
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Affiliation(s)
- Zongao Cai
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Zaoqu Liu
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
- Interventional Institute of Zhengzhou UniversityZhengzhouHenanChina
- Interventional Treatment and Clinical Research Center of Henan ProvinceZhengzhouHenanChina
| | - Yuyuan Zhang
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
- Interventional Institute of Zhengzhou UniversityZhengzhouHenanChina
- Interventional Treatment and Clinical Research Center of Henan ProvinceZhengzhouHenanChina
| | - Hongxuan Ma
- Department of Kidney TransportationThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Ruihui Li
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Shuang Guo
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Shiyong Wu
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Xueli Guo
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
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Liang D, Liu C, Yang M. Blood Cadmium and Abdominal Aortic Calcification in Population with Different Weight Statuses: a Population-Based Study. J Cardiovasc Transl Res 2023; 16:1425-1438. [PMID: 37468727 DOI: 10.1007/s12265-023-10414-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
The aim of our study was to assess the effect of blood cadmium levels (B-Cd) on abdominal aortic calcification (AAC). We used the data from the 2013-2014 NHANES database. A total of 1530 participants were included in our study, with a mean AAC score of 1.40 ± 0.10, and a prevalence of severe AAC of 7.98%. Participants with higher B-Cd quartiles showed a higher prevalence of severe AAC. B-Cd was positively associated with higher AAC scores and increased risk of severe AAC. In the obese population, blood cadmium levels showed a positive association with the risk of severe AAC. There may be a positive correlation between B-Cd levels and AAC scores and risk of severe AAC, and this correlation is more pronounced in the obese population. Therefore, the cadmium load in AAC patients in the obese population should be considered in clinical work.
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Affiliation(s)
- Dan Liang
- Department of Endocrine, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Chang Liu
- School of Medicine, Nankai University, Tianjin, China
| | - Mei Yang
- Department of Endocrine, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China.
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Qin Z, Liu Q, Jiao P, Geng J, Liao R, Su B. Higher Blood Cadmium Concentration Is Associated With Increased Likelihood of Abdominal Aortic Calcification. Front Cardiovasc Med 2022; 9:870169. [PMID: 35557529 PMCID: PMC9086707 DOI: 10.3389/fcvm.2022.870169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThis study aimed to evaluate the association between blood cadmium concentration (BCC) and abdominal aortic calcification (AAC) in adults aged ≥40 years in the United States.MethodsData were obtained from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Participants without data about BCC and AAC scores were excluded. BCC was directly measured using inductively coupled plasma mass spectrometry (ICP–MS). AAC scores were quantified by the Kauppila scoring system, and severe AAC was defined as an AAC score >6. Weighted multivariable regression analysis and subgroup analysis were conducted to explore the independent relationship between cadmium exposure with AAC scores and severe AAC.ResultsA total of 1,530 participants were included with an average BCC of 0.47 ± 0.02 μg/L and AAC score of 1.40 ± 0.10 [mean ± standard error (SE)]. The prevalence of severe AAC was 7.96% in the whole subjects and increased with the higher BCC tertiles (Tertile 1: 4.74%, Tertile 2: 9.83%, and Tertile 3: 10.17%; p = 0.0395). We observed a significant positive association between BCC and the AAC score (β = 0.16, 95% CI: 0.01~0.30) and an increased risk of severe AAC [odds ratio (OR) = 1.45; 95% CI: 1.03~2.04]. Subgroup analysis and interaction tests revealed that there was no dependence for the association between BCC and AAC.ConclusionBlood cadmium concentration was associated with a higher AAC score and an increased likelihood of severe AAC in adults in the United States. Cadmium exposure is a risk factor for AAC, and attention should be given to the management of blood cadmium.
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Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, West China School of Medicine of Sichuan University, Chengdu, China
- Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Qiang Liu
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, West China School of Medicine of Sichuan University, Chengdu, China
- Chengdu First People's Hospital, Chengdu, China
| | - Pengcheng Jiao
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiwen Geng
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, West China School of Medicine of Sichuan University, Chengdu, China
- Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, West China School of Medicine of Sichuan University, Chengdu, China
- Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, West China School of Medicine of Sichuan University, Chengdu, China
- Med-X Center for Materials, Sichuan University, Chengdu, China
- *Correspondence: Baihai Su
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Qin Z, Jiang L, Sun J, Geng J, Chen S, Yang Q, Su B, Liao R. Higher visceral adiposity index is associated with increased likelihood of abdominal aortic calcification. Clinics (Sao Paulo) 2022; 77:100114. [PMID: 36166992 PMCID: PMC9513216 DOI: 10.1016/j.clinsp.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The negative effects of visceral adiposity accumulation on cardiovascular health have drawn much attention. However, the association between the Visceral Adiposity Index (VAI) and Abdominal Aortic Calcification (AAC) has never been reported before. The authors aimed to investigate the association between the VAI and AAC in US adults. METHODS Cross-sectional data were derived from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) of participants with complete data of VAI and AAC scores. Weighted multivariable regression and logistic regression analysis were conducted to explore the independent relationship between VAI and AAC. Subgroup analysis and interaction tests were also performed. RESULTS A total of 2958 participants were enrolled and participants in the higher VAI tertile tended to have a higher mean AAC score and prevalence of severe AAC. In the fully adjusted model, a positive association between VAI and AAC score and severe AAC was observed (β = 0.04, 95% CI 0.01‒0.08; OR = 1.04, 95% CI 1.01‒1.07). Participants in the highest VAI tertile had a 0.41-unit higher AAC score (β = 0.41, 95% CI 0.08‒0.73) and a significantly 68% higher risk of severe AAC than those in the lowest VAI tertile (OR = 1.68, 95% CI 1.04‒2.71). Subgroup analysis and interaction tests indicated that there was no dependence for the association of VAI and AAC. CONCLUSION Visceral adiposity accumulation evaluated by the VAI was associated with a higher AAC score and an increased likelihood of severe AAC.
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Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China
| | - Luojia Jiang
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Jiantong Sun
- West China School of Medicine, West China Hospital, Sichuan University, China
| | - Jiwen Geng
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China
| | - Shanshan Chen
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med+ Biomaterial Institute of West China School of Medicine, West China Hospital of Sichuan University, China.
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Qin Z, Chang K, Liao R, Jiang L, Yang Q, Su B. Greater Dietary Inflammatory Potential Is Associated With Higher Likelihood of Abdominal Aortic Calcification. Front Cardiovasc Med 2021; 8:720834. [PMID: 34485417 PMCID: PMC8414543 DOI: 10.3389/fcvm.2021.720834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 02/05/2023] Open
Abstract
Aims: We aimed to assess the association between dietary inflammation index (DII) and abdominal aortic calcification (AAC) in US adults aged ≥40 years. Methods: Data were obtained from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Participants who were <40 years old and missing the data of DII and AAC were excluded. DII was calculated based on a 24-h dietary recall interview for each participant. AAC score was quantified by assessing lateral spine images and severe AAC was defined as AAC score >6. Weighted multivariable regression analysis and subgroup analysis were preformed to estimate the independent relationship between DII with AAC score and severe AAC. Results: A total of 2,897 participants were included with the mean DII of -0.17 ± 2.80 and the mean AAC score of 1.462 ± 3.290. The prevalence of severe AAC was 7.68% overall, and participants in higher DII quartile tended to have higher rates of severe AAC (Quartile 1: 5.03%, Quartile 2: 7.44%, Quartile 3: 8.38%, Quartile 4: 10.46%, p = 0.0016). A positive association between DII and AAC score was observed (β = 0.055, 95% CI: 0.010, 0.101, p = 0.01649), and higher DII was associated with an increased risk of severe AAC (OR = 1.067, 95% CI: 1.004, 1.134, p = 0.03746). Subgroup analysis indicated that this positive association between DII and AAC was similar in population with differences in gender, age, BMI, hypertension status, and diabetes status and could be appropriate for different population settings. Conclusion: Higher pro-inflammatory diet was associated with higher AAC score and increased risk of severe AAC. Anti-inflammatory dietary management maybe beneficial to reduce the risk of AAC.
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Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Kaixi Chang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Luojia Jiang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China
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Sawicki P, Tałałaj M, Życińska K, Zgliczyński WS, Wierzba W. Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry. Med Sci Monit 2021; 27:e930839. [PMID: 34131097 PMCID: PMC8216008 DOI: 10.12659/msm.930839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.
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Affiliation(s)
- Piotr Sawicki
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland
| | - Marek Tałałaj
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Waldemar Wierzba
- Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Warsaw, Poland
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Zhao S, Cao J, Li J, Yang X, Cao P, Lan J, Lu G. Association between serum elastin-derived peptides and abdominal aortic calcification in peritoneal dialysis patients: a cross-sectional study. Ren Fail 2021; 43:860-868. [PMID: 33993833 PMCID: PMC8143601 DOI: 10.1080/0886022x.2021.1918163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Peritoneal dialysis (PD) patients experience accelerated arterial aging, which is characterized by elastin degradation. Elastin-derived peptides (EDPs) are direct products of elastin fragmentation. This study tried to explore the association between serum EDPs and abdominal aortic calcification (AAC) in PD patients. Methods Serum levels of EDPs were analyzed in 126 eligible PD patients and 30 controls. PD patients were grouped according to the annularity of AAC evaluated by an abdominal computed tomography (CT) scan. Serum EDPs were analyzed in relation to the presence of AAC or severe AAC in PD patients by logistic regression analysis. Results Serum EDPs in PD patients were significantly higher than age-matched controls. In 126 PD patients, higher EDPs was associated with greater risk of present AAC (OR = 1.056, 95%CI 1.010–1.103) and severe AAC (OR = 1.062, 95%CI 1.004–1.123). A combination of EDPs substantially improved the accuracy of diagnostic performance for AAC and severe AAC. Conclusions EDPs can predict the presence and extent of AAC in PD patients, indicating its possible role to recognize PD patients at risk for AAC and severe AAC.
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Affiliation(s)
- Shizhu Zhao
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingyuan Cao
- Department of Nephrology, Taizhou People's hospital, The Fifth Affiliated Hospital of Nantong University, Taizhou, China
| | - Jianzhong Li
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaochun Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Peiyang Cao
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingjing Lan
- Department of Nephology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Guoyuan Lu
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Tsai CH, Lin LY, Lin YH, Tsai IJ, Huang JW. Abdominal aorta calcification predicts cardiovascular but not non-cardiovascular outcome in patients receiving peritoneal dialysis: A prospective cohort study. Medicine (Baltimore) 2020; 99:e21730. [PMID: 32925715 PMCID: PMC7489593 DOI: 10.1097/md.0000000000021730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6-9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.
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Affiliation(s)
- Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital, JinShan Branch, New Taipei
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - I-Jung Tsai
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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10
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Ma D, Yan H, Yang X, Yu Z, Ni Z, Fang W. Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study. BMC Nephrol 2020; 21:151. [PMID: 32349690 PMCID: PMC7191690 DOI: 10.1186/s12882-020-01822-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background Abdominal aortic calcification assessed by X-ray is recommended to evaluate vascular calcification in dialysis patients. It has been shown that abdominal aortic calcification score (AACS) is a predictor of adverse outcomes in hemodialysis patients, but evidence regarding its prognostic value in peritoneal dialysis (PD) patients is still insufficient. We aimed to examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE) and mortality in PD patients. Methods Eligible patients undergoing PD between July 2011 and July 2014 were recruited. AACS was quantified using lateral lumbar radiography at recruitment. Patients were prospectively followed up until death, PD cessation, or to the end of the study (August 31, 2018). Both subdistribution hazards and cause-specific hazards models were used to evaluate the association between AACS and MACCE as well as mortality. Results 292 patients were enrolled, including 160 males (54.8%) with mean age 57.1 ± 15.2 years and median PD duration 28.4 (IQR 12.0, 57.8) months. Among them, 75 (25.7%) patients were comorbid with diabetes, and 94 (32.2%) patients had cardiovascular disease (CVD). The average AACS was 2.0 (0.0, 6.0). Patients were categorized on the tertiles of AACS (Low AACS group, AACS = 0, n = 125; Medium AACS group, AACS 1–4, n = 72; and High AACS group, AACS> 4, n = 95). AACS was associated with age (OR = 1.081, P < 0.001), PD duration (OR = 1.012, P = 0.003), CVD (OR = 1.919, P = 0.020) and diabetes (OR = 2.554, P = 0.002). During the follow-up period of 43.6 (24.6, 50.7) months, there were 65 MACCEs and 84 deaths. Significantly higher cumulative incidences of all-cause mortality (Log-rank = 35.992, P<0.001; Gray = 38.662, P < 0.001) and MACCE (Log-rank = 26.146, P<0.001; Gray = 27.810, P < 0.001) were observed in the upper AACS tertile. AACS was an independent predictor of all-cause mortality (HR = 2.438, 95% CI 1.246–4.772, P = 0.009; SHR = 2.323, 95%CI 1.229–4.389, P = 0.009) and MACCE (HR = 3.455, 95% CI 1.734–6.884, P < 0.001; SHR = 3.063, 95%CI 1.460–6.430, P = 0.003) in this study. Conclusions AACS was associated with age, PD duration, CVD and diabetes in PD patients. AACS could predict MACCE and all-cause mortality in this population. It thus might be a safe and feasible method to identify PD patients with adverse outcomes.
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Affiliation(s)
- Dahua Ma
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Xiaoxiao Yang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China. .,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
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Niu Q, Zhao H, Wu B, Tsai S, Wu J, Zhang M, Lu L, Qiao J, Men C, Zuo L, Wang M. Abdominal aortic calcification is superior to other arteries calcification in predicting the mortality in peritoneal dialysis patients - a 8 years cohort study. BMC Nephrol 2019; 20:439. [PMID: 31791277 PMCID: PMC6888938 DOI: 10.1186/s12882-019-1593-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In recent years, there has been a growing concern that abdominal aortic calcification (AAC) has a predictive effect on the prognosis of patients with end-stage renal disease (ESRD). However, whether other vascular calcification (VC) can predict the occurrence of adverse events in patients, and whether it is necessary to assess the calcification of other blood vessels remains controversial. This study aimed to assess VC in different sites using X-ray films, and to investigate the predictive effects of VC at different sites on all-cause mortality and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients. METHODS The data of Radiographs (lateral abdominal plain film, frontal pelvic radiograph and both hands radiograph) were collected to evaluate the calcification of abdominal aorta, iliac artery, femoral artery, radial artery, and finger arteries. Patients' demographic data, clinical characteristics, laboratory data were recorded. The total follow-up period was 8 years, and the time and cause of death were recorded. Survival curves were estimated using Kaplan-Meier analysis. COX regression analysis was used to examine independent predictors of all-cause mortality and CV mortality. RESULTS One hundred fifty PD patients were included, a total of 79 patients (52.7%) died at the end of follow-up. After adjusting variables in the multivariate COX regression analysis, AAC was an independent predictor of all-cause mortality in PD patients (HR = 2.089, 95% CI: 1.089-4.042, P = 0.029), and was also an independent predictor of CV mortality (HR = 4.660, 95% CI: 1.852-11.725, P = 0.001). We also found that femoral artery calcification had a predictive effect on all-cause and CV mortality. But the calcification in iliac artery, radial artery, and finger arteries were not independent predictors of patients' all-cause and CV mortality in PD patients. CONCLUSION AAC was more common in PD patients and was an independent predictor of all-cause mortality and CV mortality. The femoral artery calcification also can predict the mortality, but the calcification of iliac artery, radial artery, and finger arteries cannot predict the mortality of PD patients.
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Affiliation(s)
- Qingyu Niu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China.
| | - Bei Wu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shihming Tsai
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Meng Zhang
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Lixia Lu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Jie Qiao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Chuncui Men
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Nitta K, Hanafusa N, Tsuchiya K. Mineral bone disorders (MBD) in patients on peritoneal dialysis. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Niu Q, Hong Y, Lee CH, Men C, Zhao H, Zuo L. Abdominal aortic calcification can predict all-cause mortality and CV events in dialysis patients: A systematic review and meta-analysis. PLoS One 2018; 13:e0204526. [PMID: 30240443 PMCID: PMC6150537 DOI: 10.1371/journal.pone.0204526] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has a pretty high incidence in dialysis patients and may be associated with their prognosis. AAC can be assessed by abdominal CT or X-ray. We determined to investigate whether the occurrence of AAC is associated with all-cause mortality and cardiovascular (CV) events in dialysis patients through this meta-analysis and systematic review. METHODS A comprehensive literature search was conducted using the PubMed, Cochrane library, Embase, Medline databases to collect cohort studies investigating whether AAC is associated with all-cause mortality and CV events of patients, and we also searched gray articles and conferences abstracts. Meta-analysis was performed by STATA software. Pooled results were expressed as hazard ratio (HR) with corresponding 95% confidence intervals (CI). Fixed-effect models were used to pool the HR of each trial. RESULTS 10 studies (2,724 dialysis patients) were identified. The presence of AAC was associated with increased risk for all-cause mortality among dialysis patients (HR, 2.84; 95% CI, 2.03-3.98; I2 = 9.8%; P = 0.354). Meanwhile, there was an association between AAC and increased risk for all CV events (fatal and non-fatal) in patients (HR, 2.04; 95% CI, 1.51-2.76, I2 = 44.6%; P = 0.125). 3 studies presented their endpoint as CV mortality, and the pooled HR was 2.46 (95%CI 1.38-4.40; I2 = 0.0%; P = 0.952). There were also 2 studies that reported their primary endpoint as all-cause mortality and CV events, and the pooled HR was 5.72 (95% CI 3.24-10.10; I2 = 0.0%; P = 0.453). CONCLUSIONS Among patients treated with dialysis, AAC is associated with adverse outcomes, including all-cause mortality and CV events (fatal and non-fatal). The abdominal X-ray or CT scan can be used as a useful added method to evaluate the patient's calcification. This may provide reasonable data for estimating the risk of adverse events in dialysis patients, which is helpful in guiding clinical treatment and improving the prognosis of dialysis patients.
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Affiliation(s)
- Qingyu Niu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Yang Hong
- Urology and Lithotripsy Center, Peking University People’s Hospital, Beijing, China
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chuncui Men
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
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