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Nie Y, Zong H, Li Z, Wang P, Zhang N, Zhou B, Wang Z, Zhang L, Wang S, Huang Y, Tian Z, Chou S, Zhao X, Liu B, Meng H. Cardiovascular disease among bariatric surgery candidates: coronary artery screening and the impact of metabolic syndrome. Diabetol Metab Syndr 2024; 16:180. [PMID: 39075584 PMCID: PMC11285332 DOI: 10.1186/s13098-024-01425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Obesity is known as a risk factor for cardiovascular disease (CVD). However, there is an absence of preoperative cardiac risk assessment in bariatric surgery candidates and the incidence of CVD among these high-risk patients is still unknown. METHODS A consecutive series of bariatric surgery candidates at two Chinese tertiary hospitals received coronary CT angiography or coronary angiography from 2017 to 2023. Patients were categorized as metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) based on the presence or absence of MetS. CVD was diagnosed based on the maximum intraluminal stenosis > 1% in any of the segments of the major epicardial coronary arteries. Obstructive CVD was defined as coronary stenosis ≥ 50%. Binary multivariable logistic regression was performed to analyze the association between CVD and metabolic status. The number of principal MetS components was categorized into zero (without glycemic, lipid, and BP components), one (with one of the components), two (with any two components), and three (with all components) to explore their association with CVD. RESULTS A total of 1446 patients were included in the study. The incidence of CVD and obstructive CVD were 31.7% and 9.6%. Compared with MHO patients, MUO patients had a significantly higher incidence of mild (13.7% vs. 6.1%, P < 0.05), moderate (7.4% vs. 0.8%, P < 0.05), and severe CVD (3.1% vs. 0%, P < 0.05). Following complete adjustment, compared with zero or one component, two principal MetS components was found to be associated with a notable increase in the risk of CVD (OR 2.05, 95% CI 1.18-3.58, P < 0.05); three principal MetS components were observed to have a higher risk of CVD and obstructive CVD (OR 2.68, 95% CI 1.56-4.62, P < 0.001; OR 3.93, 95% CI 1.19-12.93, P < 0.05). Each increase in the number of principal MetS components correlated with a 1.47-fold (95% CI 1.20-1.81, P < 0.001) and 1.78-fold (95% CI 1.24-2.55, P < 0.05) higher risk of CVD and obstructive CVD, respectively. CONCLUSION This study reported the incidence of CVD based on multicenter bariatric surgery cohorts. CVD is highly prevalent in patients with obesity, especially in MUO patients. Increased number of principal MetS components will significantly elevate the risk of CVD.
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Affiliation(s)
- Yuntao Nie
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Haoyu Zong
- Eighth Clinical School, Capital Medical University, Beijing, 100069, China
| | - Zhengqi Li
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Pengpeng Wang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Nianrong Zhang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Biao Zhou
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Zhe Wang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Lei Zhang
- Department of Oncology, Sinopharm Tongmei General Hospital, Shanxi, China
| | - Siqi Wang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Yishan Huang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Ziru Tian
- School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Sai Chou
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Xingfei Zhao
- Department of General Surgery, Beijing Fuxing Hospital, Beijing, 100038, China
| | - Baoyin Liu
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China
| | - Hua Meng
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, 2 East Yinghuayuan Street, Chaoyang District, Beijing, 100029, China.
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Jin GY. Use of Coronary CT Angiography as a Screening Tool for Coronary Artery Disease in Asymptomatic Healthy Individuals or Patients. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:54-69. [PMID: 36237344 PMCID: PMC9238211 DOI: 10.3348/jksr.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
심장 돌연사 환자들은 종종 흉통 또는 운동성 호흡곤란 등의 전조증상이 나타나지 않기 때문에 잠재적인 무증상 관상동맥 질환을 조기에 발견하는 것이 매우 중요하다. 관상동맥 전산화단층촬영 혈관조영술은 방사선 노출로 인한 위험성 때문에 무증상 환자에서 스크리닝 검사로 정당화되지 못했었지만 최근에 전산화단층촬영 기술의 비약적인 발전으로 방사선량을 1 mSv 미만으로 최소화함으로써 무증상 환자의 관상동맥 질환 선별 검사의 유용성에 대한 많은 연구가 진행되어 왔다. 그러나, 여전히 무증상 정상인 또는 환자의 관상동맥 질환 선별 검사에 대한 관상동맥 전산화단층촬영 혈관조영술의 유용성에 대해서는 다양한 의견들이 있다. 이 종설에서는 무증상 정상인 또는 환자들에게 관상동맥 질환 선별 검사로 관상동맥 칼슘 점수와 관상동맥 전산화단층촬영 혈관조영술 유용성에 대해서 다양한 문헌고찰을 통해서 알아보았다. 관상동맥 전산화단층촬영 혈관조영술상 무증상 정상인의 2.6%에서 70% 이상의 유의한 관상동맥 협착이 발견되었고, 선별 목적의 관상동맥 전산화단층촬영 혈관조영술이 무증상 건강한 사람의 미래의 심혈관 질환 발생을 예측할 수 있다. 그러나 현재 미국국립보건원에서 진행하고 있는 SCOT-HEART 2 연구가 끝나면 관상동맥 전산화단층촬영 혈관조영술이 무증상 성인의 심혈관 예방에 선별 검사로 적절한지 결정을 내릴 수 있을 것으로 생각된다.
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Affiliation(s)
- Gong Yong Jin
- Department of Radiology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Arch Cardiovasc Dis 2020; 114:150-172. [PMID: 33309203 DOI: 10.1016/j.acvd.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
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Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, Ernande L, Marcadet D, Mousseaux E, Rouzet F, Sultan A, Ferrières J, Vergès B, Van Belle E. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. DIABETES & METABOLISM 2020; 47:101185. [PMID: 32846201 DOI: 10.1016/j.diabet.2020.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Centre d'Investigation Clinique (CIC-CRB)-Inserm 1404, Rouen University Hospital, 76000 Rouen, France
| | - Joseph Emmerich
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, Inserm UMR1153-CRESS, 75674 Paris cedex 14, France
| | - Laura Ernande
- Service des explorations fonctionnelles, Hôpital Henri Mondor, AP-HP et Inserm U955, Université Paris-Est Créteil, France
| | - Dany Marcadet
- Centre Coeur et Santé Bernoulli - Cardiologie du sport et Réadaptation Cardiaque, 3, rue Bernoulli, 75008 Paris, France
| | - Elie Mousseaux
- Radiology Department, Hôpital Européen Georges Pompidou & Inserm U 970; Assistance Publique - Hôpitaux de Paris, University of Paris, French Society of Cardiovascular Imaging (SFICV), Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP Paris - Université de Paris, Laboratory for Vascular Translational Science, Inserm, UMR 1148, 75018 Paris, France
| | - Ariane Sultan
- Physiologie et Médecine Expérimentale du Coeur et des Muscles (PHYMEDEX), U1046 Inserm, UMR9214 CNRS, Université de Montpellier, 34295 Montpellier; Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHRU Montpellier, 34090 Montpellier, France
| | - Jean Ferrières
- Department of Cardiology and UMR Inserm 1027, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Bruno Vergès
- Service Endocrinologie-Diabétologie, CHU Dijon - Inserm LNC-UMR 1231, Dijon, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, U1011, Institut Pasteur de Lille, EGID, Lille, France; Department of Medicine, Université de Lille, Lille, France
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Messerli M, Maywald C, Wälti S, Warschkow R, Wildermuth S, Alkadhi H, Leschka S, Schiesser M. Prognostic Value of Negative Coronary CT Angiography in Severely Obese Patients Prior to Bariatric Surgery: a Follow-Up After 6 Years. Obes Surg 2017; 27:2044-2049. [DOI: 10.1007/s11695-017-2592-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Coronary artery calcium score and CT angiography in asymptomatic elderly patients with high pretest probability for coronary artery disease. Jpn J Radiol 2015; 34:140-7. [PMID: 26670593 DOI: 10.1007/s11604-015-0506-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/23/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the role of coronary artery calcium scoring (CACS) and/or coronary CT angiography (CCTA) in asymptomatic elderly patients with high pretest probability for coronary artery disease (CAD). MATERIALS AND METHODS Forty-eight consecutive asymptomatic elderly (>65 years) subjects who had a high pretest probability and underwent CACS/CCTA were included. Each CCTA was evaluated for adequacy for assessment of coronary stenosis. Significant stenosis (>50% diameter narrowing) was assessed on evaluable CT images and by invasive catheter angiography (ICA). RESULTS All subjects were men with mean CACS of 880 ± 1779. Among those with low (0-99), intermediate (100-399), and high (400-999) CACS, ICA-verified significant stenosis was present in 8% (1/13), 23% (2/13), and 67% (8/12), respectively. Among those with very high CACS (≥ 1000) (n = 10), 90% of CCTAs were not evaluable for stenosis. CONCLUSION In asymptomatic elderly subjects with high pretest probability, CACS followed by CCTA may be considered for those with intermediate to high CACS.
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Alluri K, McEvoy JW, Dardari ZA, Jones SR, Nasir K, Blankstein R, Rivera JJ, Agatston AA, Kaufman JD, Budoff MJ, Blumenthal RS, Blaha MJ. Distribution and burden of newly detected coronary artery calcium: Results from the Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr 2015; 9:337-344.e1. [PMID: 26088381 PMCID: PMC4476056 DOI: 10.1016/j.jcct.2015.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The transition from no coronary artery calcium (CAC) to detectable CAC is important, as even mild CAC is associated with increased cardiovascular events. We sought to characterize the anatomic distribution and burden of newly detectable CAC over 10-year follow-up. METHODS We evaluated 3112 participants (mean age, 58 years; 64% female) with baseline CAC = 0 from the Multi-Ethnic Study of Atherosclerosis. Participants underwent repeat CAC testing at different time intervals (between 2-10 years after baseline) per the Multi-Ethnic Study of Atherosclerosis protocol. Among participants who developed CAC on a follow-up scan, we used logistic regression and marginal probability modeling to describe the coronary distribution and burden of new CAC by age, sex, and race after adjustment for cardiovascular risk factors and time to detection. RESULTS A total of 1125 participants developed detectable CAC during follow-up with a mean time to detection of 6.1 ± 3 years. New CAC was most commonly isolated to 1 vessel (72% of participants), with the left anterior descending artery (44% of total) most commonly affected followed by the right coronary (12%), left circumflex (10%), and left main (6%). These patterns were similar across age, sex, and race. In multivariate models, residual predictors of multivessel CAC (28% of total) included male sex, African American or Hispanic race, hypertension, obesity, and diabetes. At the first detection of CAC >0, burden was usually low with median Agatston CAC score of 7.1 and <5% with CAC scores >100. CONCLUSION New-onset CAC most commonly involves just 1 vessel, occurs in the left anterior descending artery, and has low CAC burden. New CAC can be detected at an early stage when aggressive preventive strategies may provide benefit.
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Affiliation(s)
- Krishna Alluri
- Department of Internal Medicine, UPMC McKeesport Hospital, McKeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - John W McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Zeina A Dardari
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Steven R Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan J Rivera
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA; South Beach Preventive Cardiology Center, University of Miami, Miami, FL, USA
| | - Arthur A Agatston
- South Beach Preventive Cardiology Center, University of Miami, Miami, FL, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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Renker M, Geyer LL, Krazinski AW, Silverman JR, Ebersberger U, Schoepf UJ. Iterative image reconstruction: a realistic dose-saving method in cardiac CT imaging? Expert Rev Cardiovasc Ther 2014; 11:403-9. [DOI: 10.1586/erc.12.178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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