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Chen RT, Nelson AJ, Tan S, Clark RA, Zoungas S, Nicholls SJ. The effectiveness of visualising plaque on cardiac computed tomography in modifying risk factors for cardiovascular disease: A systematic review. J Cardiovasc Comput Tomogr 2024; 18:223-232. [PMID: 38467535 DOI: 10.1016/j.jcct.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of disease burden worldwide, with a significant proportion of cases and deaths attributable to modifiable risk factors. Recent interest has emerged in using cardiac computed tomography (CT) imaging as a tool to enhance motivation and drive positive behavioural changes. However, the impact of providing visual feedback of plaque from CT on risk factor control and individual health behaviours remains understudied. This study aimed to assess the effects of visual feedback from cardiac CT imaging on health-related behaviours and risk factor control. A systematic search of electronic databases was conducted, yielding nine studies (five randomised controlled trials and four observational studies) for analysis. The results varied, but based on the limited low-quality data, CT imaging appears to have short-term favourable effects on cholesterol levels and systolic blood pressure reductions, and positive dietary behavioural changes. Further research is warranted to better understand the long-term impact of cardiac CT imaging on health behaviours and risk factor modification.
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Affiliation(s)
- Ruofei Trophy Chen
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Adam J Nelson
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Sean Tan
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park SA 5042, Australia.
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia.
| | - Stephen J Nicholls
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
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2
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Mszar R, Katz ME, Grandhi GR, Osei AD, Gallo A, Blaha MJ. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep 2024:10.1007/s11883-024-01202-w. [PMID: 38662272 DOI: 10.1007/s11883-024-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography. RECENT FINDINGS Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk. Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miriam E Katz
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Gowtham R Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Albert D Osei
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Antonio Gallo
- Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, APHP, INSERM UMR1166, Hôpital Pitié-Salpètriêre, Sorbonne Université, Paris, France
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Naghavi M, Yankelevitz D, Reeves AP, Budoff MJ, Li D, Atlas K, Zhang C, Atlas TL, Lirette S, Wasserthal J, Roy SK, Henschke C, Wong ND, Defilippi C, Heckbert SR, Greenland P. AI-enabled left atrial volumetry in coronary artery calcium scans (AI-CAC TM) predicts atrial fibrillation as early as one year, improves CHARGE-AF, and outperforms NT-proBNP: The multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00079-0. [PMID: 38653606 DOI: 10.1016/j.jcct.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Coronary artery calcium (CAC) scans contain actionable information beyond CAC scores that is not currently reported. METHODS We have applied artificial intelligence-enabled automated cardiac chambers volumetry to CAC scans (AI-CACTM) to 5535 asymptomatic individuals (52.2% women, ages 45-84) that were previously obtained for CAC scoring in the baseline examination (2000-2002) of the Multi-Ethnic Study of Atherosclerosis (MESA). AI-CAC took on average 21 s per CAC scan. We used the 5-year outcomes data for incident atrial fibrillation (AF) and assessed discrimination using the time-dependent area under the curve (AUC) of AI-CAC LA volume with known predictors of AF, the CHARGE-AF Risk Score and NT-proBNP. The mean follow-up time to an AF event was 2.9 ± 1.4 years. RESULTS At 1,2,3,4, and 5 years follow-up 36, 77, 123, 182, and 236 cases of AF were identified, respectively. The AUC for AI-CAC LA volume was significantly higher than CHARGE-AF for Years 1, 2, and 3 (0.83 vs. 0.74, 0.84 vs. 0.80, and 0.81 vs. 0.78, respectively, all p < 0.05), but similar for Years 4 and 5, and significantly higher than NT-proBNP at Years 1-5 (all p < 0.01), but not for combined CHARGE-AF and NT-proBNP at any year. AI-CAC LA significantly improved the continuous Net Reclassification Index for prediction of AF over years 1-5 when added to CHARGE-AF Risk Score (0.60, 0.28, 0.32, 0.19, 0.24), and NT-proBNP (0.68, 0.44, 0.42, 0.30, 0.37) (all p < 0.01). CONCLUSION AI-CAC LA volume enabled prediction of AF as early as one year and significantly improved on risk classification of CHARGE-AF Risk Score and NT-proBNP.
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Affiliation(s)
| | | | - Anthony P Reeves
- Department of Computer Engineering, Cornell University, Ithaca, NY, USA
| | | | - Dong Li
- The Lundquist Institute, Torrance, CA, USA
| | | | | | | | | | | | - Sion K Roy
- The Lundquist Institute, Torrance, CA, USA
| | | | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, CA, USA
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Groen RA, Barbero FL, Fischer SE, van Dijkman PRM, Bax JJ, Tushuizen ME, Jukema JW, Coenraad MJ, de Graaf MA. Coronary artery calcium assessment on non-gated chest CT to optimize pre-operative cardiac screening in liver transplantation. Int J Cardiol 2024:132015. [PMID: 38609053 DOI: 10.1016/j.ijcard.2024.132015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Guidelines recommend standard pre-operative cardiac screening in all liver transplantation (LT) recipients, despite the relatively low prevalence of obstructive coronary artery disease. Most LT recipients often have non-gated computed tomography (CT) performed of the chest and abdomen. This study evaluated the ability of coronary artery calcification (CAC) assessment on consecutively available scans, to identify a selection of low-risk patients, in whom further cardiac imaging can be safely withheld. METHODS LT recipients with prior non-gated CT chest-abdomen were included. CAC was visually scored on a semi-quantitative ordinal scale. Stress myocardial perfusion, coronary CT angiography (CCTA) and invasive coronary angiography (ICA) were used as golden standard. The sensitivity and specificity of CAC to exclude and predict obstructive CAD were assessed. In addition, peri- and postoperative mortality and cardiac events were analyzed. RESULTS 149 LT recipients (ranged 31-71 years) were included. In 75% of patients, no CAC and mild CAC could rule out obstructive CAD on CCTA and ICA with 100% certainty. The threshold of mild CAC had a sensitivity of 100% for both CCTA and ICA and a specificity of 91% and 68%, respectively. None of the patients with no or mild calcifications experienced peri- and post-operative cardiac events or died of cardiac causes. CONCLUSION Visual evaluation of CAC on prior non-gated CT can accurately and safely exclude obstructive CAD in LT recipients. Incorporation of these already available data can optimize cardiac screening, by safely withholding or correctly allocating dedicated cardiac imaging in LT recipients. Thereby, reducing patients' test burden and save health care expenses.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fei Lynn Barbero
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Susan E Fischer
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - Paul R M van Dijkman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten E Tushuizen
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
| | - Minneke J Coenraad
- Department of Gastro-enterology and Hepatology, Transplant Center, Leiden University Medical Centre, the Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Marcos-Mangas M, Revilla-Orodea A, Sevilla T, González-Bartol E, Sánchez-Lite I, Urueña-Martínez N, Arnold R, Gómez I, San Román JA. Different prognostic significance of coronary artery and aortic valve calcium in patients with chest pain. Eur Radiol 2024; 34:2658-2664. [PMID: 37731095 DOI: 10.1007/s00330-023-10229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/09/2023] [Accepted: 07/30/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Coronary artery calcification (CorCa) identifies high cardiovascular risk in the general population. In this setting, aortic valve calcification (AoCa) showed contradictory results. Our goal has been to assess the prognostic power of CorCa and AoCa in patients with chest pain who underwent an ECG-gated cardiac multidetector CT (cardiac-MDCT). METHODS A total of 528 patients without previous known coronary artery disease, with chest pain who underwent a cardiac-MDCT multidetector, were retrospectively recruited. The primary endpoint included death, acute coronary syndrome, stroke, and heart failure. RESULTS A total of 61 patients (11.6%) had an event during a mean follow-up of almost 6 years (5.95 ± 2.98). The most frequent event was acute coronary syndrome (6.4%). Total mortality was 4.5%. Patients with CorCa > 0 had more events than those without CorCa (17.3% versus 4.3%; p < 0.001). Likewise, when only patients without AoCa were considered (n = 118), clinical events were more frequent in those with CorCa (12.7% versus 3.6%; p = 0.004). After excluding patients with coronary artery disease, events were more frequent in those with CorCa (12.6% versus 4.3%; p = 0.004). The higher the Agatston score, the more frequent the events. Patients with AoCa > 0 had more events than those without (16.5% versus 7.3%; p < 0.001), but in patients without CorCa, no difference in events was seen (6.2% versus 3.6%; p = 0.471). A Cox regression analysis showed age, smoking, prior stroke, and CorCa but not AoCa to be independently related to events. CONCLUSIONS In summary, CorCa, but not AoCa, is related to cardiovascular events in patients with chest pain who undergo a cardiac-MDCT. CLINICAL RELEVANCE STATEMENT We show that coronary artery calcification, but not aortic valve calcification, detected in a coronary CT scan is tightly related to cardiovascular events. Although this is a message already shown by other groups in the general population, we do believe that this work is unique because it is restricted to patients with chest pain sent to coronary CT. In other words, our work deals with what we face in our routine everyday practice. KEY POINTS • The presence and the amount of coronary artery calcification are associated with cardiovascular events in patients with chest pain. • Aortic valve calcification is not associated with cardiovascular events in patients with chest pain.
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Affiliation(s)
- Marta Marcos-Mangas
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Ana Revilla-Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Teresa Sevilla
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Esther González-Bartol
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Israel Sánchez-Lite
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Noelia Urueña-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Roman Arnold
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Gómez
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Short RT, Lin F, Nair S, Terry JG, Carr JJ, Kandula NR, Lloyd-Jones D, Kanaya AM. Comparing coronary artery cross-sectional area among asymptomatic South Asian, White, and Black participants: the MASALA and CARDIA studies. BMC Cardiovasc Disord 2024; 24:158. [PMID: 38486153 PMCID: PMC10938784 DOI: 10.1186/s12872-024-03811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND South Asian individuals have high risk of atherosclerotic cardiovascular disease (ASCVD). Some investigators suggest smaller coronary artery size may be partially responsible. METHODS We compared the left anterior descending (LAD) artery cross-sectional area (CSA) (lumen and arterial wall) among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study with White and Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, adjusting for BMI, height, and other ASCVD risk factors. We used thin-slice non-contrast cardiac computed tomography to measure LAD CSA. We used linear regression models to determine whether race/ethnicity was associated with LAD CSA after adjusting for demographic factors, BMI, height, coronary artery calcium (CAC), and traditional cardiovascular risk factors. RESULTS Our sample included 3,353 participants: 513 self-identified as South Asian (44.4% women), 1286 as Black (59.6% women), and 1554 as White (53.5% women). After adjusting for age, BMI, height, there was no difference in LAD CSA between South Asian men and women compared to White men and women, respectively. After full adjustment for CVD risk factors, LAD CSA values were: South Asian women (19.9 mm2, 95% CI [18.8 - 20.9]) and men (22.3 mm2, 95% CI [21.4 - 23.2]; White women (20.0 mm2, 95% CI [19.4-20.5]) and men (23.6 mm2, 95% CI [23.0-24.2]); and Black women (21.6 mm2, 95% CI [21.0 - 22.2]) and men (26.0 mm2, 95% CI [25.3 - 26.7]). Height, BMI, hypertension, CAC, and age were positively associated with LAD CSA; current and former cigarette use were inversely associated. CONCLUSIONS South Asian men and women have similar LAD CSA to White men and women, and smaller LAD CSA compared to Black men and women, respectively, after accounting for differences in body size. Future studies should determine whether LAD CSA is associated with future ASCVD events.
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Grants
- R01 HL093009 NHLBI NIH HHS
- UL1 RR024131 NCRR NIH HHS
- K24 HL112827 NHLBI NIH HHS
- P30 DK098722 NIDDK NIH HHS
- P30 DK092924 NIDDK NIH HHS
- 2R01HL093009, UL1TR001872, 5K24HL112827, HHSN268201800005I, HHSN268201800007I, HHSN268201800003I, HHSN268201800006I, HHSN268201800004I, R01-HL098445 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
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Affiliation(s)
- R T Short
- University of California San Francisco, San Francisco, USA.
| | - F Lin
- University of California San Francisco, San Francisco, USA
| | - S Nair
- Vanderbilt University Medical Center, Nashville, USA
| | - J G Terry
- Vanderbilt University Medical Center, Nashville, USA
| | - J J Carr
- Vanderbilt University Medical Center, Nashville, USA
| | | | | | - A M Kanaya
- University of California San Francisco, San Francisco, USA
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Razavi AC, Raggi P, Whelton SP. Coronary artery calcium: The canary in the coal mine. Atherosclerosis 2024:117499. [PMID: 38508916 DOI: 10.1016/j.atherosclerosis.2024.117499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Raggi
- Department of Medicine and Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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8
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Nasir K, Mszar R, Cainzos-Achirica M, Grandhi GR, Tromp TR, Alonso R, Bittencourt MS, Bruckert E, Díaz-Díaz JL, Gallo A, Hovingh GK, Miname MH, Muñiz-Grijalvo O, Pang J, de Isla LP, Sijbrands EJ, Watts GF, Mata P, Santos RD. Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study. Am J Prev Cardiol 2024; 17:100611. [PMID: 38125206 PMCID: PMC10730992 DOI: 10.1016/j.ajpc.2023.100611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1-100, 101-400, >400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1-100, 160 (16%) had CAC 101-400, and 99 (10%) had CAC >400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1-100 (8% [n = 15] vs 18% [n = 26]), CAC 101-400 (32% [n = 22] vs 40% [n = 36]), and CAC >400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50-59 years were less likely to have obstructive CAD in CAC >400 (55% [n = 6] vs 70% [n = 19]). Conclusion In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.
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Affiliation(s)
- Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Gowtham R. Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Tycho R. Tromp
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Márcio S. Bittencourt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Eric Bruckert
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - José Luis Díaz-Díaz
- Complejo Hospitalario Universitario, Hospital Abente y Lago, A Corūna, Spain
| | - Antonio Gallo
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - G. Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Marcio H. Miname
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | | | - Jing Pang
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Leopoldo Perez de Isla
- Cardiology Department, Hospital Clinico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Eric J.G. Sijbrands
- Department of Internal Medicine, Section Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerald F. Watts
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Raul D. Santos
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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9
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Ansari S, Pourafkari L, Kinninger A, Manubolu V, Budoff MJ. Risk stratifying individuals with zero, minimal, and mild coronary artery calcium for cardiovascular disease by determining coronary plaque burden. J Cardiovasc Comput Tomogr 2024; 18:137-141. [PMID: 38097409 DOI: 10.1016/j.jcct.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and > 100, while others use CAC = 0,1-10, 11-100 and > 100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment. METHODS Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC = 0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking). RESULTS 378 subjects were included, with an average age of 53.9 ± 10.7 years and 53 % female. Among them, 51 % had 0 CAC, 16 % had minimal CAC (scores 1-10), and 33 % had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC. CONCLUSION Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC = zero). Therefore, the use of CAC = 0, 1-10 and 11-100 is prudent to better categorize CVD risk.
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Affiliation(s)
- Salman Ansari
- California University of Science and Medicine - School of Medicine, Colton, CA, USA.
| | - Leili Pourafkari
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Venkat Manubolu
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
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10
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Selvam PV, Grandhi GR, Leucker TM, Arbab-Zadeh A, Gulati M, Blumenthal RS, Whelton SP. Recent advances in cardiovascular risk assessment: The added value of non-invasive anatomic imaging. J Cardiovasc Comput Tomogr 2024; 18:113-119. [PMID: 38326189 DOI: 10.1016/j.jcct.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
In 2022, multiple original research studies were conducted highlighting the utility of coronary artery calcium (CAC) imaging in young individuals and provided further evidence for the role of CAC to improve atherosclerotic cardiovascular disease (ASCVD) risk assessment. Mean calcium density was shown to be a more reliable predictor than peak density in risk assessment. Additionally, in light of the ACC/AHA/Multispecialty Chest Pain Guideline's recent elevation of coronary computed tomography angiography (CCTA) to a Class I (level of evidence A) recommendation as an index diagnostic test for acute or stable chest pain, several studies support the utility of CCTA and guided future directions. This review summarizes recent studies that highlight the role of non-invasive imaging in enhancing ASCVD risk assessment across different populations.
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Affiliation(s)
- Pooja V Selvam
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Gowtham R Grandhi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thorsten M Leucker
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Armin Arbab-Zadeh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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11
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Grinberg T, Eisen A, Talmor-Barkan Y, Kornowski R, Hamdan A, Witberg G, Ayers C, Joshi P, Rohatgi A, Khera A, de Lemos JA, Neeland IJ. Novel plasma biomarkers of coronary artery calcium incidence or progression: Insights from the prospective multi-ethnic Dallas Heart Study cohort. Atherosclerosis 2024; 390:117469. [PMID: 38342026 PMCID: PMC10988770 DOI: 10.1016/j.atherosclerosis.2024.117469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/17/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND AND AIMS Identifying the association of novel plasma biomarkers with coronary artery calcium (CAC) incidence or progression may provide insights into the pathophysiology of atherogenesis and plaque formation. METHODS Participants of the Dallas Heart Study (DHS), a multi-ethnic cohort of ambulatory individuals at low-intermediate risk for future atherosclerotic cardiovascular disease (ASCVD), who had their blood tested for 31 biomarkers reflecting multiple pathophysiological pathways, underwent 2 serial non-contrast computed tomography assessments for CAC a median ∼7 years apart. The collected biomarkers were explored for association with CAC incidence or progression using univariate and multivariate analysis. RESULTS A total of 1424 participants were included; mean age 43 years, 39 % male, and nearly half African-American. Over a 7-year interval between the two CAC measurements, 340 participants (23.9 %) had CAC incidence or progression, 105 (7.4 %) with incident CAC, and 309 (21.7 %) with CAC progression. Although several plasma biomarkers were associated with CAC incidence or progression in a univariate model, only soluble intercellular adhesion molecule-1 (sICAM-1), related to atherosclerosis by the inflammatory pathway, remained independently associated in a multivariate model adjusted for traditional risk factors. CONCLUSIONS Further studies are needed to characterize the role of sICAM-1 in CAC evolvement to establish whether it has a pivotal mechanistic contribution or is rather an innocent bystander. Alternate measures of coronary atherosclerosis may be needed to elucidate contributors to atherosclerosis incidence or progression.
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Affiliation(s)
- Tzlil Grinberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Alon Eisen
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Colby Ayers
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Anand Rohatgi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Amit Khera
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - James A de Lemos
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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12
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Krishnan S, Aldana-Bitar J, Golub I, Ichikawa K, Shabir A, Bagheri M, Hamidi H, Benzing T, Kianoush S, Budoff MJ. Testosterone therapy and the risk of cardiovascular disease in older, hypogonadal men. Prog Cardiovasc Dis 2024:S0033-0620(24)00036-7. [PMID: 38423237 DOI: 10.1016/j.pcad.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the context of aging, obesity, and endogenous sex hormones on CV disease (CVD) risk to support informed clinical decision-making. Observational studies have variably linked low endogenous testosterone with increased CVD risk, while randomized controlled trials (RCTs) demonstrate that TT yields cardiometabolic benefits without increasing short-term CV risk. The TRAVERSE trial, as the first RCT powered to assess CVD events, did not show increased major adverse cardiac events (MACE) incidence; however, its limitations - specifically the maintenance of testosterone at low-normal levels, a high participant discontinuation rate, and short follow-up - warrant a careful interpretation of its results. Furthermore, findings from the TTrials cardiovascular sub-study, which showed an increase in non-calcified plaque, indicate the need for ongoing research into the long-term CV impact of TT. The decision to initiate TT should consider the current evidence gaps, particularly for older men with known CVD. The CV effects of maintaining physiological testosterone levels through exogenous means remain to be fully explored. Until more definitive evidence is available, clinical practice should prioritize individualized care and informed discussions on the potential CV implications of TT.
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Affiliation(s)
| | | | - Ilana Golub
- The Lundquist Institute at Harbor-UCLA; David Geffen School of Medicine at University of California Los Angeles
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Gong B, Guo Y, Li Y, Wang J, Zhou G, Chen YH, Nie T, Yang M, Luo K, Zheng C, Pan F, Liang B, Yang L. Immune checkpoint inhibitors in cancer: the increased risk of atherosclerotic cardiovascular disease events and progression of coronary artery calcium. BMC Med 2024; 22:44. [PMID: 38291431 PMCID: PMC10829401 DOI: 10.1186/s12916-024-03261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have contributed to a significant advancement in the treatment of cancer, leading to improved clinical outcomes in many individuals with advanced disease. Both preclinical and clinical investigations have shown that ICIs are associated with atherosclerosis and other cardiovascular events; however, the exact mechanism underlying this relationship has not been clarified. METHODS Patients diagnosed with stages III or IV non-small cell lung cancer (NSCLC) at the Wuhan Union Hospital from March 1, 2020, to April 30, 2022, were included in this retrospective study. Coronary artery calcium (CAC) volume and score were assessed in a subset of patients during non-ECG-gated chest CT scans at baseline and 3, 6, and 12 months after treatment. Propensity score matching (PSM) was performed in a 1:1 ratio to balance the baseline characteristics between the two groups. RESULTS Overall, 1458 patients (487 with ICI therapy and 971 without ICI therapy) were enrolled in this cardiovascular cohort study. After PSM, 446 patients were included in each group. During the entire period of follow-up (median follow-up 23.1 months), 24 atherosclerotic cardiovascular disease (ASCVD) events (4.9%) occurred in the ICI group, and 14 ASCVD events (1.4%) in the non-ICI group, before PSM; 24 ASCVD events (5.4%) occurred in the ICI group and 5 ASCVD events (1.1%) in the non-ICI group after PSM. The CAC imaging study group comprised 113 patients with ICI therapy and 133 patients without ICI therapy. After PSM, each group consisted of 75 patients. In the ICI group, the CAC volume/score increased from 93.4 mm3/96.9 (baseline) to 125.1 mm3/132.8 (at 12 months). In the non-ICI group, the CAC volume/score was increased from 70.1 mm3/68.8 (baseline) to 84.4 mm3/87.9 (at 12 months). After PSM, the CAC volume/score was increased from 85.1 mm3/76.4 (baseline) to 111.8 mm3/121.1 (12 months) in the ICI group and was increased from 74.9 mm3/76.8 (baseline) to 109.3 mm3/98.7 (12 months) in the non-ICI group. Both cardiovascular events and CAC progression were increased after the initiation of ICIs. CONCLUSIONS Treatment with ICIs was associated with a higher rate of ASCVD events and a noticeable increase in CAC progression.
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Affiliation(s)
- Bingxin Gong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yusheng Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yi Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Guofeng Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yong-Hao Chen
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Tong Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Ming Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Kun Luo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Naghavi M, Yankelevitz D, Reeves AP, Budoff MJ, Li D, Atlas KC, Zhang C, Atlas TL, Lirette S, Wasserthal J, Henschke C, Defilippi C, Heckbert SR, Greenland P. AI-enabled Left Atrial Volumetry in Cardiac CT Scans Improves CHARGE-AF and Outperforms NT-ProBNP for Prediction of Atrial Fibrillation in Asymptomatic Individuals: Multi-Ethnic Study of Atherosclerosis. medRxiv 2024:2024.01.22.24301384. [PMID: 38343816 PMCID: PMC10854349 DOI: 10.1101/2024.01.22.24301384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Background Coronary artery calcium (CAC) scans contain actionable information beyond CAC scores that is not currently reported. Methods We have applied artificial intelligence-enabled automated cardiac chambers volumetry to CAC scans (AI-CAC), taking on average 21 seconds per CAC scan, to 5535 asymptomatic individuals (52.2% women, ages 45-84) that were previously obtained for CAC scoring in the baseline examination (2000-2002) of the Multi-Ethnic Study of Atherosclerosis (MESA). We used the 5-year outcomes data for incident atrial fibrillation (AF) and compared the time-dependent AUC of AI-CAC LA volume with known predictors of AF, the CHARGE-AF Risk Score and NT-proBNP (BNP). The mean follow-up time to an AF event was 2.9±1.4 years. Results At 1,2,3,4, and 5 years follow-up 36, 77, 123, 182, and 236 cases of AF were identified, respectively. The AUC for AI-CAC LA volume was significantly higher than CHARGE-AF or BNP at year 1 (0.836, 0.742, 0.742), year 2 (0.842, 0.807,0.772), and year 3 (0.811, 0.785, 0.745) (p<0.02), but similar for year 4 (0.785, 0.769, 0.725) and year 5 (0.781, 0.767, 0.734) respectively (p>0.05). AI-CAC LA volume significantly improved the continuous Net Reclassification Index for prediction of AF over years 1-5 when added to CAC score (0.74, 0.49, 0.53, 0.39, 0.44), CHARGE-AF Risk Score (0.60, 0.28, 0.32, 0.19, 0.24), and BNP (0.68, 0.44, 0.42, 0.30, 0.37) respectively (p<0.01). Conclusion AI-CAC LA volume enabled prediction of AF as early as one year and significantly improved on risk classification of CHARGE-AF Risk Score and BNP.
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Affiliation(s)
| | | | | | | | - Dong Li
- The Lundquist Institute, 1124 W Carson St, Torrance, CA 90502
| | | | | | - Thomas L. Atlas
- Tustin Teleradiology, 13422 Newport Ave Suite I, Tustin, CA 92780
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15
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Whitmore K, Zhou Z, Magnussen CG, Carrington MJ, Marwick TH. Influence of Repeated Plaque Visualization on Cardiovascular Risk Reduction after 3 years; a randomized controlled trial. Eur J Prev Cardiol 2024:zwae026. [PMID: 38243798 DOI: 10.1093/eurjpc/zwae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024]
Abstract
AIMS Helping people to understand their cardiovascular (CV) risk can influence the choices they make for risk reduction, including medication adherence and lifestyle modification. This study sought whether repeated visualization of coronary artery calcium (CAC) images was effective in sustaining long-term risk control in primary prevention, independent of a risk reduction program. METHODS Asymptomatic, statin-naïve participants, 40-70 years, with a family history of premature coronary artery disease and a CAC score from 1-400 were randomised to a nurse-led CV risk reduction program or standard care with bi-annual reviews. Only the intervention group (220 of 449 participants) visualised their CAC image (with repeat exposure in the first 3 months) and were initiated on statin therapy. The primary outcome was change in Framingham Risk Score (FRS) at 36 months, and the impact of CAC image recall on CV risk was assessed. RESULTS The reduction in FRS (difference in differences (DID): -3.4% [95%CI: -4.4% to -2.4%], p=<0.001 and low-density-lipoprotein-cholesterol -1.2mmol/L [95%CI: -1.4 to -1.0], p=<0.001)) over 36 months was greater in the intervention than the control group. Within the intervention group, sustained recall of CAC images at 24 months was associated with lower systolic blood pressure (DID -4.3mmHg [95%CI: -7.7 to-0.9], p=0.01) and waist circumference (DID -2.0cm [95% CI: -3.9 to -0.1], p=0.03) at 36 months compared to unsustained recall. CONCLUSION A nurse-led program, combining personalized patient visualization of CAC imaging with statin therapy, is beneficial for improving CV risk. Recalling the presentation of CAC images through repeated visual exposure may influence risk reduction.
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Affiliation(s)
- Kristyn Whitmore
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, 7000
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Melinda J Carrington
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
| | - Thomas H Marwick
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, 7000
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Acquah I, Cainzos-Achirica M, Taha MB, Lahan S, Blaha MJ, Al-Kindi SG, Khan SU, Sharma G, Budoff MJ, Nasir K. Social disadvantage, coronary artery calcium, and their interplay in the prediction of atherosclerotic cardiovascular disease events. Atherosclerosis 2024; 388:117355. [PMID: 37940398 PMCID: PMC10843574 DOI: 10.1016/j.atherosclerosis.2023.117355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDOH) are key for the identification of populations at increased risk of atherosclerotic cardiovascular disease (ASCVD). However, whether at the individual level SDOH improve current ASCVD risk prediction paradigms beyond traditional risk factors and the coronary artery calcium (CAC) score, is unknown. We evaluated the interplay between CAC and SDOH in ASCVD risk prediction. METHODS MESA is a prospective study of US adults free of clinical ASCVD at baseline. We used an SDOH index inclusive of 14 determinants from 5 domains. The index ranged 0-1 and was divided into quartiles, with higher ones representing worse SDOH. Cox regression was used to evaluate the adjusted associations between CAC, SDOH, their interplay, and ASCVD events. The C-statistic was computed to assess improvement in risk discrimination for prediction of ASCVD events. RESULTS We included 6479 MESA participants (50% with CAC = 0, 24% CAC>100). ASCVD incidence increased with increasing CAC scores across SDOH quartiles. The lowest incidence was noted in those with CAC = 0 and favourable SDOH (2/1000 person-years) and highest in those with CAC>100 and most unfavourable SDOH (20.6/1000 person-years). While CAC was strongly associated with ASCVD across SDOH quartiles, SDOH was weakly associated with ASCVD across CAC strata. CAC improved the discriminatory ability of all prediction models beyond traditional risk factors, the improvement in C-statistic ranging +0.02 - +0.05. Improvements with SDOH were smaller, and were none on top of CAC. CONCLUSIONS CAC improves ASCVD risk stratification across the spectrum of social vulnerability, while SDOH fail to improve risk prediction beyond traditional RFs and CAC.
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Affiliation(s)
- Isaac Acquah
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Barcelona, Spain; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Shubham Lahan
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Sadeer G Al-Kindi
- Department of Cardiology, Case Western University Hospitals, Cleveland, OH, USA
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Corral P, Aguilar Salinas CA, Matta MG, Zago V, Schreier L. Stratification in Heterozygous Familial Hypercholesterolemia: Imaging, Biomarkers, and Genetic Testing. Curr Atheroscler Rep 2023; 25:899-909. [PMID: 37921916 DOI: 10.1007/s11883-023-01160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW Heterozygous familial hypercholesterolemia (HeFH) is the most common monogenic autosomal dominant disorder. However, the condition is often underdiagnosed and undertreated. The objective of this review is to provide an update on the risk stratification in patients with HeFH, incorporating new cardiovascular imaging techniques, various biomarkers, and genetic studies. RECENT FINDINGS The diagnosis of HeFH places patients in a high cardiovascular risk category due to the increased incidence of premature atherosclerotic cardiovascular disease. However, the level of risk varies significantly among different individuals with HeFH. Achieving an optimal stratification of cardiovascular risk is crucial for establishing appropriate and accurate treatment and management strategies. Different new tools such as risk scores have emerged in recent years, aiding physicians in assessing the risk stratification for HeFH using imaging, biomarkers, and genetics. This review emphasizes that not all patients with HeFH face the same cardiovascular risk. By utilizing different assessment tools, we can identify those who require more intensive monitoring, follow-up, and treatment.
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Affiliation(s)
- Pablo Corral
- Universidad FASTA, Facultad de Medicina, Cátedra de Farmacología Especial y Toxicología, Mar del Plata, Argentina.
| | - Carlos A Aguilar Salinas
- Direction of Nutrition Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - María Gabriela Matta
- Universidad FASTA, Facultad de Medicina, Cátedra de Farmacología Especial y Toxicología, Mar del Plata, Argentina
| | - Valeria Zago
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Lab. de Lípidos y Aterosclerosis, Hospital de Clínicas. INFIBIOC-UBA, Buenos Aires, Argentina
| | - Laura Schreier
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Lab. de Lípidos y Aterosclerosis, Hospital de Clínicas. INFIBIOC-UBA, Buenos Aires, Argentina
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Qavi AH, Zhou G, Ward RE, Carr JJ, Ellison RC, Arnett DK, Gaziano JM, Djousse L. Association of potato consumption with calcified atherosclerotic plaques in the coronary arteries: The NHLBI Family Heart Study. Nutr Metab Cardiovasc Dis 2023; 33:2413-2418. [PMID: 37580232 PMCID: PMC10808268 DOI: 10.1016/j.numecd.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND AND AIMS While the association of potato consumption with risk factors for coronary artery disease has been inconsistent, no data are available in the literature on the influence of potato consumption on subclinical disease. Thus, we sought to examine whether baked/mashed potato consumption is associated with calcified atherosclerotic plaques in the coronary arteries. METHODS AND RESULTS In a cross-sectional design, we studied 2208 participants of the NHLBI Family Heart Study. These subjects were selected based on their elevated cardiovascular disease risk compared to the general population. Potato consumption was assessed by a semi-quantitative food frequency questionnaire. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Mean age at initial clinic visit was 58.2 years and 55% were female. Median consumption of potatoes was 2-4/week. There was no statistically significant association between frequency of potato consumption and prevalent CAC: odds ratios (95% CI) for CAC were 1.0 (reference), 0.85 (0.56-1.30), 0.85 (0.58-1.26), and 0.95 (0.60-1.53) among subjects reporting potato consumption of <1/week, 1/week, 2-4/week, and 5+/week, respectively (p for linear trend 0.83), adjusting for age, sex, BMI, smoking, exercise, diabetes, hypertension, total calories, prevalent coronary heart disease, income, education, and daily red meat intake. CONCLUSIONS We found no significant association between baked/mashed potato consumption and CAC in older adults. STUDY REGISTRATION NUMBER NCT00005136. Study registration date: 5/25/2000.
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Affiliation(s)
- Ahmed Hassaan Qavi
- Department of Cardiovascular Sciences, East Carolina University Health Medical Center and Brody School of Medicine, Greenville, NC, United States.
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Rachel E Ward
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) and Geriatric Research, Education, and Clinical Research Center, Boston Veterans Affairs Healthcare System, Boston MA, United States
| | - John Jeffrey Carr
- Department of Radiology, Cardiovascular Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - R Curtis Ellison
- Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, United States
| | - Donna K Arnett
- University of South Carolina, Columbia, SC, United States
| | - J Michael Gaziano
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Center for Clinical Investigation, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Center for Clinical Investigation, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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19
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Spilack ADM, Goulart AC, Janovsky CCPS, de Almeida-Pittito B, Lotufo PA, Sommer Bittencourt M, Generoso G, de Souza Santos I, Bensenor IM. The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Arch Endocrinol Metab 2023; 68:e220375. [PMID: 37988662 PMCID: PMC10916802 DOI: 10.20945/2359-4292-2022-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/23/2023] [Indexed: 11/23/2023]
Abstract
Objective We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.
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Affiliation(s)
- Aída de Melo Spilack
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina C P S Janovsky
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bianca de Almeida-Pittito
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo A Lotufo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Giuliano Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Itamar de Souza Santos
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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20
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Crooijmans J, Singh S, Naqshband M, Bruikman CS, Pinto-Sietsma SJ. Premature atherosclerosis: An analysis over 39 years in the Netherlands. Implications for young individuals in high-risk families. Atherosclerosis 2023; 384:117267. [PMID: 37758605 DOI: 10.1016/j.atherosclerosis.2023.117267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/16/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Cardiovascular disease (CVD), especially atherosclerotic cardiovascular disease (ASCVD), is one of the most important disease problems in the world accounting for an estimated 18.6 million deaths globally. Although older individuals are more often affected, ASCVD event at a young age is of particular importance because of more healthy years lost. Therefore, it is important to identify young individuals correctly at risk of ASCVD events in an early stage. Unfortunately, current risk score algorithms underestimate ASCVD event risk at a younger age. Both coronary artery calcium scoring (CACs) and family history of premature ASCVD (FH-PASCVD) have emerged as reliable screening tools to be able to identify individuals at risk for ASCVD events. Positive FH-PASCVD is associated with higher absolute CAC scores in first-degree 'healthy' family members and the proportion of individuals above the CACs percentile threshold to warrant treatment is also higher as compared to the general population. Therefore, a positive FH-PASCVD identifies so-called high-risk families and adding CAC scoring within these families identifies individuals at increased risk for ASCVD events. In individuals from high-risk families with an elevated CAC score, ASCVD events can be prevented when treated with statins and aspirin. Therefore, we suggest assessing FH-PASCVD in young 'healthy' individuals as a first screening step and subsequently performing CAC scoring to be able to start treatment at an early stage, since not only the lower is better, but also the earlier is better.
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Affiliation(s)
- Juliette Crooijmans
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Sandeep Singh
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Massih Naqshband
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Caroline S Bruikman
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
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21
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Raygor V, Hoeting N, Ayers C, Joshi P, Canan A, Abbara S, Assadourian JN, Khera A, Peterson ED, Navar AM. Accuracy of incidental visual coronary artery calcium assessment compared with dedicated coronary artery calcium scoring. J Cardiovasc Comput Tomogr 2023; 17:453-458. [PMID: 37863760 DOI: 10.1016/j.jcct.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION CAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast. METHODS The accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC = 0, 1-99, 100-399, and ≥400, respectively. RESULTS From 2016 to 2021, 934 patients (mean age 60 ± 12 y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b = 0.76, p < 0.0001). Among those with no visual CAC, 76% had CAC = 0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist. DISCUSSION Visual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to "de-risk" patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions.
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Affiliation(s)
- Viraj Raygor
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Natalie Hoeting
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Colby Ayers
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Arzu Canan
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | | | - Amit Khera
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Eric D Peterson
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Ann Marie Navar
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA.
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22
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Silva BV, Menezes MN, Plácido R, Jorge C, Rigueira J, Garcia AB, Martins AM, Oliveira C, Abrantes A, Pinto FJ, Almeida AG. Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care. Heart Lung Circ 2023; 32:1312-1320. [PMID: 37867042 DOI: 10.1016/j.hlc.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. METHODS Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. RESULTS A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. CONCLUSION Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Miguel Nobre Menezes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Beatriz Garcia
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Margarida Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Oliveira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Abrantes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana G Almeida
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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23
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Schade DS, Hickey M, Eaton RP. Interpreting the Coronary Artery Calcium Score - Critical Information for the Practicing Physician. Am J Med 2023; 136:1070-1075. [PMID: 37660746 DOI: 10.1016/j.amjmed.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
Coronary artery calcium scanning is a routine test for assessing the severity of atherosclerosis in asymptomatic individuals. This inexpensive, noninvasive test quantifies the calcium deposition in the 4 principal coronary arteries. Correct interpretation is important to the physician (for recommending therapy) and to the patient (for determining his or her lifetime risk of a cardiovascular event). A score of 0 indicates that a cardiovascular event is extremely unlikely in the next 5 years. In contrast, a score greater than 0 portends a coronary event. The higher the score, the greater the risk. Both the arterial location of the calcium and the number of coronary arteries involved alter the interpretation of the calcium score. At any given age, females have significantly lower scores than males. One-third of individuals with scores greater than 1000 will have a cardiovascular event within 3 years. For all elevated calcium scores, aggressive treatment is warranted, including significant lifestyle changes and medications to reduce low-density lipoprotein cholesterol. Understanding the importance of the coronary artery calcium score will result in improved therapy and patient compliance.
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Affiliation(s)
- David S Schade
- University of New Mexico Health Sciences Center, Albuquerque.
| | - Martin Hickey
- University of New Mexico Health Sciences Center, Albuquerque
| | - R Philip Eaton
- University of New Mexico Health Sciences Center, Albuquerque
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24
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Foldyna B, Basmagi S, Zangeneh FA, Wagner M, Doktorov K, Matveeva A, Denecke T, Gohmann RF, Lücke C, Gutberlet M, Lehmkuhl L. CT-derived coronary artery calcium density is affected by regional lesion distribution and image reconstruction parameters. Clin Imaging 2023; 103:109980. [PMID: 37677856 DOI: 10.1016/j.clinimag.2023.109980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The prognostic relevance of coronary artery calcium (CAC) density, assessed from cardiac CT scans, is established. However, the influence of CAC distribution, volume, image reconstruction, and clinical factors on CAC density warrants further examination. METHODS In this study, 120 patients underwent non-contrast ECG-gated cardiac CT scans using a prospectively defined CAC scoring protocol with 1-, 3-, and 5-mm thick image reconstructions, both with and without a 20% image overlap. We segmented CAC in all reconstructions and assessed the relationship between CAC density, volume, and number of detected calcifications/patient. RESULTS Overall, 75/120 (63%) patients (66% men, mean age 63 ± 11 years) presented CAC across 342 segments. CAC density, CAC volume, and the number of detected calcifications decreased with increasing slice thickness (p < 0.001 for all); these effects were slightly reduced by image overlap (p < 0.001 for all). Higher CAC density correlated with greater CAC volume (ρ = 0.62; p < 0.001) and more calcified segments per person (ρ = 0.32; p = 0.006). Higher CAC density was also associated with lower patient weight (beta: -0.6, 95%CI: -1.1--0.1, p = 0.022) and increased high-density lipoprotein (HDL) levels (beta: 0.7, 95%CI: 0.0-1.4, p = 0.046). In a multivariable analysis adjusted for clinical covariates, lower CAC density was associated with broader CAC distribution (i.e., a higher number of calcified segments at a given CAC volume; beta-coefficient: -58.9; 95%CI: -84.7 to -33.1; p < 0.001). CONCLUSION CAC density is significantly impacted by regional CAC distribution and image reconstruction, potentially confounding its prognostic value. Accounting for these factors may improve patient risk assessment, management, and cardiovascular health outcomes.
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Affiliation(s)
- Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, 165 Cambridge Street, Suite 400, 02114 Boston, USA; Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany.
| | - Said Basmagi
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | | | - Matthias Wagner
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Kalin Doktorov
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Anna Matveeva
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Timm Denecke
- Clinic for Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Lukas Lehmkuhl
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
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Rozanski A, Han D, Miller RJH, Gransar H, Slomka P, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparison of coronary artery calcium scores among patients referred for cardiac imaging tests. Prog Cardiovasc Dis 2023; 81:24-32. [PMID: 37858662 DOI: 10.1016/j.pcad.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk. METHODS We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities. RESULTS Within each age group, the frequency of CAC abnormalities were relatively similar across testing modalities, despite an annualized mortality rate which varied from 0.5%/year among CAC patients to 3.8%/year among PET-MPI patients (p < 0.001). Among CCTA and PET-MPI patients, a zero CAC score was common, occurring in ~70% of patients <50 years, ~40% of patients 50-59 years, and ~ 25% of patients 60-69 years. Among CCTA patients, zero CAC was associated with a normal coronary angiogram with high frequency, ranging from 92.2% among patients <50 years to 87.9% among patients ≥70 years. Among PET-MPI patients, zero CAC was associated with a very low frequency of inducible ischemia across all age groups, ranging from 1.5% among patients <50 years to 0.9% among patients ≥70 years. CONCLUSIONS In our study, relatively similar CAC scores were noted among patients varying markedly in mortality risk. Clinically, zero CAC scores predicted both a low likelihood of obstructive CAD and inducible myocardial ischemia in all age groups and were observed with high frequency across diagnostic testing modalities.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Takahashi D, Fujimoto S, Nozaki YO, Kudo A, Kawaguchi YO, Takamura K, Hiki M, Sato E, Tomizawa N, Daida H, Minamino T. Fully automated coronary artery calcium quantification on electrocardiogram-gated non-contrast cardiac computed tomography using deep-learning with novel Heart-labelling method. Eur Heart J Open 2023; 3:oead113. [PMID: 38035036 PMCID: PMC10683040 DOI: 10.1093/ehjopen/oead113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/14/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
Aims To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) images. Methods and results Retrospectively, 560 gated CCT images (including 60 synthetic images) performed at our institution were used to train AI-model, which can automatically divide heart region into five areas belonging to left main (LM), left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), and another. Total and vessel-specific CAC score (CACS) in each scan were manually evaluated. AI-model was trained with novel Heart-labelling method via DL according to the manual-derived results. Then, another 409 gated CCT images obtained in our institution were used for model validation. The performance of present AI-model was tested using another external cohort of 400 gated CCT images of Stanford Center for Artificial Intelligence of Medical Imaging by comparing with the ground truth. The overall accuracy of the AI-model for total CACS classification was excellent with Cohen's kappa of k = 0.89 and 0.95 (validation and test, respectively), which surpasses previous research of k = 0.89. Bland-Altman analysis showed little difference in individual total and vessel-specific CACS between AI-derived CACS and ground truth in test cohort (mean difference [95% confidence interval] were 1.5 [-42.6, 45.6], -1.5 [-100.5, 97.5], 6.6 [-60.2, 73.5], 0.96 [-59.2, 61.1], and 7.6 [-134.1, 149.2] for LM, LAD, LCX, RCA, and total CACS, respectively). Conclusion Present Heart-labelling method provides a further improvement in fully automated, total, and vessel-specific CAC quantification on gated CCT.
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Affiliation(s)
- Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yui O Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko O Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Eisuke Sato
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
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Wang M, Sun M, Yu Y, Li X, Ren Y, Yin D. Predictive value of machine learning algorithm of coronary artery calcium score and clinical factors for obstructive coronary artery disease in hypertensive patients. BMC Med Inform Decis Mak 2023; 23:244. [PMID: 37904123 PMCID: PMC10617081 DOI: 10.1186/s12911-023-02352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The addition of coronary artery calcium score (CACS) to prediction models has been verified to improve performance. Machine learning (ML) algorithms become important medical tools in an era of precision medicine, However, combined utility by CACS and ML algorithms in hypertensive patients to forecast obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) is rare. METHODS This retrospective study was composed of 1,273 individuals with hypertension and without a history of CAD, who underwent dual-source computed tomography evaluation. We applied five ML algorithms, coupled with clinical factors, imaging parameters, and CACS to construct predictive models. Moreover, 80% individuals were randomly taken as a training set on which 5-fold cross-validation was done and the remaining 20% were regarded as a validation set. RESULTS 16.7% (212 out of 1,273) of hypertensive patients had obstructive CAD. Extreme Gradient Boosting (XGBoost) posted the biggest area under the receiver operator characteristic curve (AUC) of 0.83 in five ML algorithms. Continuous net reclassification improvement (NRI) was 0.55 (95% CI (0.39-0.71), p < 0.001), and integrated discrimination improvement (IDI) was 0.04 (95% CI (0.01-0. 07), p = 0.0048) when the XGBoost model was compared with traditional Models. In the subgroup analysis stratified by hypertension levels, XGBoost still had excellent performance. CONCLUSION The ML model incorporating clinical features and CACS may accurately forecast the presence of obstructive CAD on CCTA among hypertensive patients. XGBoost is superior to other ML algorithms.
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Affiliation(s)
- Minxian Wang
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China
| | - Mengting Sun
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China
| | - Yao Yu
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China
| | - Xinsheng Li
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China
| | - Yongkui Ren
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China.
| | - Da Yin
- Department of Cardiology, Shenzhen People's Hospital, 2nd clinical medical college of JINAN university, 1st affiliated hospital of the southern university of Science and Technology, No. 1017 Dongmen North Road, Luohu District, Shenzhen, Guangdong Province, China.
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Hisamatsu T, Kinuta M. Coronary Artery Calcium in Assessment of Atherosclerotic Cardiovascular Disease Risk and its Role in Primary Prevention. J Atheroscler Thromb 2023; 30:1289-1302. [PMID: 37394660 PMCID: PMC10564647 DOI: 10.5551/jat.rv22009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Coronary artery calcium (CAC), which is detected using computed tomography scanning, is a well-established indicator of subclinical atherosclerosis. The CAC score is independently associated with atherosclerotic cardiovascular disease (ASCVD) outcomes and provides improved predictive values for estimating the risk of ASCVD beyond traditional risk factors. Thus, CAC is considered to have important implications for reclassification as a decision aid among individuals in the preclinical phase and as the primary prevention of ASCVD. This review is focused on epidemiological evidence on CAC in asymptomatic population-based samples from Western countries and Japan. We also discuss the usability of CAC as a tool for assessing ASCVD risk and its role in the primary prevention of ASCVD. A lack of evidence for the CAC score in ASCVD risk assessment beyond traditional risk factors in populations other than those in Western countries (including Japan) warrants further investigation. Clinical trials are also necessary to demonstrate the usefulness and safety of CAC screening in the primary prevention of ASCVD.
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Affiliation(s)
- Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,
Okayama, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Minako Kinuta
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,
Okayama, Japan
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29
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Gao JW, Han JJ, Xiong ZC, Hao QY, You S, Zhang HF, Wang JF, Zhang SL, Liu PM. Lung Function Decline in Young Adulthood and Coronary Artery Calcium Progression in Midlife. Am J Med 2023; 136:910-917.e4. [PMID: 37225117 DOI: 10.1016/j.amjmed.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Reduced lung function has been linked to cardiovascular disease, but population-based evidence on the relationship between lung function decline and coronary artery calcium (CAC) progression is rare. METHODS A total of 2694 participants (44.7% men) with a mean ± standard deviation age of 40.4 ± 3.6 years from the Coronary Artery Risk Development in Young Adults (CARDIA) were included. The rates of decline in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) over a 20-year period were calculated for each participant and categorized into quartiles. The primary outcome was CAC progression. RESULTS During a mean follow-up of 8.9 years, 455 (16.9%) participants had CAC progression. After adjusting for traditional cardiovascular risk factors, the hazard ratios (95% confidence intervals [CIs]) for CAC progression were higher for participants in the 2nd (Q2), 3rd (Q3), and highest quartiles (Q4) of FVC decline compared with those in the lowest quartile (Q1): 1.366 (1.003-1.861), 1.412 (1.035-1.927), and 1.789 (1.318-2.428), respectively. Similar trends were observed for the association between FEV1 and CAC progression. The association remained robust across a series of sensitivity analyses and all subgroups. CONCLUSIONS A faster decline in FVC or FEV1 during young adulthood is independently associated with an increased risk of CAC progression in midlife. Maintaining optimal lung function during young adulthood may improve future cardiovascular health.
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Affiliation(s)
| | | | | | | | | | | | | | - Shao-Ling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Premyodhin N, Fan W, Arora M, Budoff MJ, Kanaya AM, Kandula N, Palaniappan L, Rana JS, Younus M, Wong ND. Association of diabetes with coronary artery calcium in South Asian adults and other race/ethnic groups: The multi-ethnic study of atherosclerosis and the mediators of atherosclerosis in South Asians living in America study. Diab Vasc Dis Res 2023; 20:14791641231204368. [PMID: 37795703 PMCID: PMC10557421 DOI: 10.1177/14791641231204368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
PURPOSE South Asian (SA) persons have increased risks for diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). We examined whether the association of DM with subclinical atherosclerosis assessed by coronary artery calcium (CAC) differs in SA versus other ethnic groups. METHODS We studied adults from the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America studies without ASCVD. CAC was examined among those normoglycemic, pre-DM and DM. Logistic regression examined pre-DM and DM with the odds of any CAC > 0 and CAC ≥ 100. RESULTS Among 7562 participants, CAC > 0 and CAC ≥ 100 in those with DM was highest in non-Hispanic White (NHW) (80% and 48%) and SA (72% and 41%) persons. Adjusted Ln (CAC + 1) was highest in NHW (3.68 ± 0.21) and SA (3.60 ± 0.23) (p < .01) DM patients. SA and NHW adults with DM (vs normoglycemic) had highest odds of CAC > 0 (2.13 and 2.27, respectively, p < .01). For CAC ≥ 100, SA and Chinese adults had the highest odds (2.28 and 2.27, respectively, p < .01). Fasting glucose and glycated hemoglobin were most strongly associated with CAC among SA. CONCLUSIONS Diabetes mellitus most strongly relates to any CAC in SA and NHW adults and CAC ≥ 100 in SA and Chinese adults, helping to explain the relation of DM with ASCVD in these populations.
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Affiliation(s)
- Ned Premyodhin
- Division of Cardiology, University of California, Irvine, Irvine, CA, USA
| | - Wenjun Fan
- Division of Cardiology, University of California, Irvine, Irvine, CA, USA
| | - Millie Arora
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Lundquist Institute, Torrance, CA, USA
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Namratha Kandula
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jamal S Rana
- Department of Cardiology, Kaiser Permanente, Oakland, CA, USA
| | - Masood Younus
- Department of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, Irvine, CA, USA
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Koska J, Hu Y, Furtado J, Billheimer D, Nedelkov D, Allison M, Budoff MJ, McClelland RL, Reaven P. Association of apolipoproteins C-I and C-II truncations with coronary heart disease and progression of coronary artery calcium: Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2023; 380:117214. [PMID: 37573768 PMCID: PMC10810047 DOI: 10.1016/j.atherosclerosis.2023.117214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND AIMS Higher truncated-to-native proteoform ratios of apolipoproteins (apo) C-I (C-I'/C-I) and C-II (C-II'/C-II) are associated with less atherogenic lipid profiles. We examined prospective relationships of C-I'/C-II and C-II'/C-II with coronary heart disease (CHD) and coronary artery calcium (CAC). METHODS ApoC-I and apoC-II proteoforms were measured by mass spectrometry immunoassay in 5790 MESA baseline plasma samples. CHD events (myocardial infarction, resuscitated cardiac arrest, fatal CHD, n = 434) were evaluated for up to 17 years. CAC was measured 1-4 times over 10 years for incident CAC (if baseline CAC = 0), and changes (follow-up adjusted for baseline) in CAC score and density (if baseline CAC>0). RESULTS C-II'/C-II was inversely associated with CHD (n = 434 events) after adjusting for non-lipid cardiovascular risk factors (Hazard ratio: 0.89 [95% CI: 0.81-0.98] per SD), however, the association was attenuated after further adjustment for HDL levels (0.93 [0.83-1.03]). There was no association between C-I'/C-I and CHD (0.98 [0.88-1.08]). C-II'/C-II was positively associated with changes in CAC score (3.4% [95%CI: 0.6, 6.3]) and density (6.3% [0.3, 4.2]), while C-I'/C-I was inversely associated with incident CAC (Risk ratio: 0.89 [95% CI: 0.81, 0.98]) in fully adjusted models that included plasma lipids. Total apoC-I and apoC-II concentrations were not associated with CHD, incident CAC or change in CAC score. CONCLUSIONS Increased apoC-II truncation was associated with reduced CHD, possibly explained by differences in lipid metabolism. Increased apoC-I and apoC-II truncations were also associated with less CAC progression and/or development of denser coronary plaques.
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Affiliation(s)
- Juraj Koska
- Phoenix VA Health Care System, 650 E Indian School Rd CS111E, Phoenix, AZ, 85012, USA.
| | - Yueming Hu
- Isoformix Inc., 9830 S. 51st Suite B-113, Phoenix, AZ, 85044, USA
| | - Jeremy Furtado
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Dean Billheimer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Dobrin Nedelkov
- Isoformix Inc., 9830 S. 51st Suite B-113, Phoenix, AZ, 85044, USA
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-University of California, Los Angeles (UCLA), 1124 W Carson St., Torrance, CA, 90502, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, 6200 NE 74th St. Bldg. 29 Suite 210, Seattle, WA, 98115, USA
| | - Peter Reaven
- College of Health Solutions, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA
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Goh YA, Lan NSR, Linn K, Wood C, Gupta A, Yeap BB, Fegan PG. Comparison of coronary artery calcium score and cardiovascular risk-stratification by European Society of Cardiology Guidelines and Steno Type 1 Risk Engine in statin-naïve adults with type 1 diabetes. J Diabetes Complications 2023; 37:108557. [PMID: 37473636 DOI: 10.1016/j.jdiacomp.2023.108557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) is a marker of atherosclerotic cardiovascular disease (CVD). However, for patients with type 1 diabetes (T1D), its relationship with T1D-specific cardiovascular (CV) risk-stratification tools is unknown. AIMS Assess prevalence of CAC and evaluate relationship between CAC and T1D-specific CV risk-stratification methods in T1D. METHODS Cross-sectional study of adults with T1D age 20-60 years, statin-naïve and no history of CVD. Data was obtained from electronic medical records and by interview. Presence of CAC was assessed using non-contrast cardiac computed tomography and quantified by Agatston Units (AU). CV risk-stratification was assessed using the 2019 European Society of Cardiology (ESC) Guidelines and the Steno T1 Risk Engine (ST1RE). RESULTS 85 patients were included with mean age 35.4 ± 10.3 years, HbA1c 8.3 ± 1.5 % and T1D duration 17.0 ± 10.1 years. 67 patients (78.9 %) had a CAC score of 0 AU, 17 (20.0 %) >0-100 AU, and one (1.2 %) >100 AU. Duration of T1D (p = 0.009), body mass index (p = 0.029), neuropathy (p = 0.016) and low-density lipoprotein cholesterol levels (p = 0.016) were independently associated with a positive CAC score on multivariate analysis. Positive predictive value for a positive CAC score was 85.7 % for the ST1RE high risk category and 31.3 % for the 2019 ESC Guidelines very high risk category. CONCLUSIONS One-fifth of this T1D cohort had a positive CAC score. The ST1RE was superior in identifying positive CAC compared to the 2019 ESC Guidelines. Further studies are required to elucidate the role of CAC in personalising CV risk-stratification and statin initiation in T1D.
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Affiliation(s)
- Yuhan A Goh
- Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia.
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia; Medical School, The University of Western Australia, Crawley, Australia
| | - Kathryn Linn
- Department of Nuclear Medicine, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
| | - Chris Wood
- Department of Radiology, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
| | - Ashu Gupta
- Department of Radiology, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia; Medical School, The University of Western Australia, Crawley, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia; Medical School, Curtin University, Bentley, Australia
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Ichikawa K, Susarla S, Budoff MJ. The use of coronary artery calcium scoring in young adults. J Cardiovasc Comput Tomogr 2023; 17:242-247. [PMID: 37198083 PMCID: PMC10524889 DOI: 10.1016/j.jcct.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/15/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
Although overall atherosclerotic cardiovascular disease (ASCVD) incidence has been declining in the United States, there is evidence that the incidence of ASCVD events in young adults is increasing. The early initiation of preventive therapies could result in a greater number of life-years saved, and therefore determining the appropriate way to identify high-risk young adults is becoming increasingly important. The coronary artery calcium (CAC) score, an established marker of coronary artery atherosclerosis, can improve discrimination for ASCVD risk beyond established risk prediction tools. Based on abundant evidence, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines currently recommend an approach of using CAC scores as a tool for risk assessment and decision-making regarding drug therapy for primary prevention in middle-aged individuals. However, CAC scoring is not recommended for universal screening in young adults, where its yield and utility for altering clinical decisions are limited. Recent studies have demonstrated the nonnegligible prevalence of CAC and its strong association with ASCVD in young adults, suggesting its potential to reclassify risk and improve selection of young adults most likely to benefit from early preventive therapies. Although convincing clinical trials have not been performed in this population yet, CAC scores should be used selectively in young adults whose ASCVD risk may be sufficiently high to warrant a CAC score assessment. This review summarizes the evidence available regarding CAC scoring in young adults, and discusses an appropriate future role of CAC scores in preventing ASCVD in this population.
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Affiliation(s)
- Keishi Ichikawa
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shriraj Susarla
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
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Jackson CL, Garg PK, Guan W, Tsai MY, Criqui MH, Tsimikas S, Bhatia HS. Lipoprotein(a) and coronary artery calcium in comparison with other lipid biomarkers: The multi-ethnic study of atherosclerosis. J Clin Lipidol 2023; 17:538-548. [PMID: 37357049 PMCID: PMC10691212 DOI: 10.1016/j.jacl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) scoring is often used for atherosclerotic cardiovascular disease (ASCVD) risk stratification in individuals with elevated lipoprotein(a) [Lp(a)]. OBJECTIVE To evaluate associations between Lp(a) and baseline CAC (volume/density) and CAC progression compared to other lipid biomarkers. METHODS We utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study of individuals without clinical ASCVD, excluding statin users. We evaluated the associations between Lp(a), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, total cholesterol, apolipoprotein B, and non-HDL-C with baseline CAC and annual CAC progression using multivariable ordinal regression with adjustment for ASCVD risk factors. Analyses were also stratified by median age. RESULTS In 5,597 participants (2,726 at median 9.5-year follow-up), Lp(a) was not associated with baseline CAC volume or density and was modestly associated with volume progression (OR 1.11, 95% CI 1.03-1.21). However, other biomarkers were positively associated with baseline volume and volume progression (LDL-C: OR 1.26, 95% CI: 1.19-1.33 and OR 1.22, 95% CI: 1.15-1.30, respectively), except HDL-C which was inversely associated. LDL-C, total cholesterol and non-HDL-C were inversely associated with baseline density. In participants <62 years of age, Lp(a) was modestly associated with baseline CAC volume (OR 1.10, 95% CI: 1.00-1.20) and volume progression (OR 1.16 95% CI: 1.04-1.30). CONCLUSIONS In contrast to other lipid biomarkers, Lp(a) was not associated with baseline CAC volume or density and was only modestly associated with volume progression. Our findings suggest that Lp(a) is not as robustly associated with CAC as other lipid biomarkers.
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Affiliation(s)
- Candace L Jackson
- Division of Cardiovascular Medicine, UC San Diego Health, San Diego, CA
| | - Parveen K Garg
- Division of Cardiology, Department of Medicine, University of Southern California, Los Angeles, CA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Michael H Criqui
- Division of Cardiovascular Medicine, UC San Diego Health, San Diego, CA; Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Sotirios Tsimikas
- Division of Cardiovascular Medicine, UC San Diego Health, San Diego, CA
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, UC San Diego Health, San Diego, CA.
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van Assen M, von Knebel Doeberitz P, Quyyumi AA, De Cecco CN. Artificial intelligence for advanced analysis of coronary plaque. Eur Heart J Suppl 2023; 25:C112-C117. [PMID: 37125298 PMCID: PMC10132604 DOI: 10.1093/eurheartjsupp/suad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The field of coronary plaque analysis is advancing including more quantitative analysis of coronary artery diseases such as plaque burden, high-risk plaque features, computed tomography-derived fractional flow reserve, and radiomics. Although these biomarkers have shown great promise for the diagnosis and prognosis of cardiac patients in a research setting, many of these advanced analyses are labour and time intensive and therefore hard to implement in daily clinical practice. Artificial intelligence (AI) is playing an increasing role in supporting the quantification of these new biomarkers. AI offers the opportunity to increase efficiency, reduce human error and reader variability and to increase the accuracy of diagnosis and prognosis by automating many processing and supporting clinicians in their decision-making. With the use of AI these novel analysis approaches for coronary artery disease can be made feasible for clinical practice without increasing cost and workload and potentially improve patient care.
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Affiliation(s)
- Marly van Assen
- Department of Radiology and Imaging Sciences, Emory University, Inc. 1365 Clifton Road NE, Suite—AT503, Atlanta, GA 30322, USA
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University, Atlanta, GA 30322, USA
| | - Philipp von Knebel Doeberitz
- Department of Radiology and Imaging Sciences, Emory University, Inc. 1365 Clifton Road NE, Suite—AT503, Atlanta, GA 30322, USA
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University, Atlanta, GA 30322, USA
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA 68167, USA
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Huang EPY, Lin HS, Chen YC, Li YH, Huang YL, Ju YJ, Yu HC, Kicska GA, Wu MT. Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque - an agatston score propensity-matched CT radiomics study. BMC Cardiovasc Disord 2023; 23:158. [PMID: 36973668 PMCID: PMC10045966 DOI: 10.1186/s12872-023-03162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radiomics could reveal. Propensity-score matching of the traditional risk factors and CAC burden between the ACS and asymptomatic groups could radically remove biases and allow the exploration of characteristic features of CAC in ACS. METHODS We retrospectively identified 77 patients with ACS who had a CAC scan before percutaneous coronary intervention between 2016 and 2019. These 77 patients were one-to-two propensity-score matched for traditional risk factors of ACS and AS ranks to select 154 subjects from 2890 asymptomatic subjects. A validation cohort of 30 subjects was also enrolled. Radiomics features of each plaque were extracted and averaged in each person. Conditional logistic regression and area-under-curve analysis were used for statistical analysis. RESULTS A higher number of coronary segments involved, lower mean, median, first quartile, and standard deviation of attenuation, and increased kurtosis of attenuation of CAC were associated with the ACS group compared to the control group (p < 0.05 for all). Multivariable analysis showed that the lower median attenuation (OR = 0.969, p < 0.001) and higher Kurtosis (OR = 18.7, p < 0.001) were associated with the ACS group. The median attenuation and kurtosis significantly increase across AS ranks 1 to 4 (p = 0.001). The AUC of kurtosis (0.727) and median attenuation (0.66) were both significantly higher than that of the standard AS (AUC = 0.502) and the number of TRF (AUC = 0.537). The best cut-off of kurtosis at 2.74 yielded an accuracy of 74%, and the cut-off of median attenuation at 196 yielded an accuracy of 68%. The accuracy of kurtosis was 64%, and the accuracy of median attenuation was 55% in the validation cohort. CONCLUSION After propensity-matching traditional risk factors and CAC burden, CT radiomics highlighted that lower median attenuation and higher kurtosis were the CAC characteristics of vulnerable plaques. These features improve the understanding of the biomechanics of CAC evolution and enhance the value of CAC scan in ACS risk assessment.
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Affiliation(s)
- Eric Po-Yu Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
- Department of Radiology, New Taipei City Hospital, No. 3, Sec. 1, New Taipei Blvd., Sanchong Dist., New Taipei City, 241204, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, 151 Chin-Hsueh Rd., Ta-Liao District, Kaohsiung, 831301, Taiwan
| | - Yi-Chun Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan
| | - Yi-He Li
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan
| | - Yi-Luan Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - Yu-Jeng Ju
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei, 10617, Taiwan
| | - Hsien-Chung Yu
- Health Management Center, Kaohsiung Veterans General Hospital, No. 386, Ta- Chung 1st Road, Kaohsiung, 813414, Taiwan
| | - Gregory A Kicska
- Section Chief of Thoracic Imaging, Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States of America
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung Dazhong 1st Road, Kaohsiung City, 813414, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan.
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Bray K, Bodduluri S, Kim YI, Sthanam V, Nath H, Bhatt SP. Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease. Respir Med 2023; 211:107195. [PMID: 36889520 PMCID: PMC10122707 DOI: 10.1016/j.rmed.2023.107195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Previous studies have shown that the population attributable risk of low forced expiratory volume in one second (FEV1) for coronary artery disease (CAD) is substantial. FEV1 can be low either because of airflow obstruction or ventilatory restriction. It is not known if low FEV1 arising from spirometric obstruction or restriction are differently associated with CAD. METHODS We analyzed high resolution computed tomography (CT) scans acquired at full inspiration in lifetime non-smoker adults with no lung disease (controls) and those with chronic obstructive pulmonary disease enrolled in the Genetic Epidemiology of COPD (COPDGene) study. We also analyzed CT scans of adults with idiopathic pulmonary fibrosis (IPF) from a cohort of patients attending a quaternary referral clinic. Participants with IPF were matched 1:1 by FEV1 %predicted to adults with COPD and 1:1 by age to lifetime non-smokers. Coronary artery calcium (CAC), a surrogate for CAD, was measured by visual quantification on CT using the Weston score. Significant CAC was defined as Weston score ≥7. Multivariable regression models were used to test the association of the presence of COPD or IPF with CAC, with adjustment for age, sex, body-mass-index, smoking status, hypertension, diabetes mellitus, and hyperlipidemia. RESULTS We included 732 subjects in the study; 244 with IPF, 244 with COPD, and 244 lifetime non-smokers. The mean (SD) age was 72.6 (8.1), 62.6 (7.4), and 67.3 (6.6) years, and median (IQR) CAC was 6 (6), 2 (6), and 1 (4), in IPF, COPD, and non-smokers, respectively. On multivariable analyses, the presence of COPD was associated with higher CAC compared to non-smokers (adjusted regression coefficient, β = 1.10 ± SE0.51; P = 0.031). The presence of IPF was also associated with higher CAC compared to non-smokers (β = 03.43 ± SE0.41; P < 0.001). The adjusted odds ratio for having significant CAC was 1.3, 95% CI 0.6 to 2.8; P = 0.53 in COPD and 5.6, 95% CI 2.9 to 10.9; P < 0.001 in IPF, compared to non-smokers. In sex stratified analyses, these associations were mainly noted in women. CONCLUSION Adults with IPF displayed higher coronary artery calcium than those with COPD after accounting for age and lung function impairment.
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Affiliation(s)
- Kevin Bray
- University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA; UAB Lung Imaging Lab, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Young-Il Kim
- Department of Preventive Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Vivek Sthanam
- Division of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA; UAB Lung Imaging Lab, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Hrudaya Nath
- Department of Radiology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA; UAB Lung Imaging Lab, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA.
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Groen RA, de Graaf MA, Stöger JL, van Dijkman PRM, Jukema JW, Schalij MJ, Geelhoed JJM, Antoni ML. Coronary calcium score in COVID-19 survivors: Association with cardiac injury and cardiac function after 6 weeks. Am Heart J Plus 2023; 27:100280. [PMID: 36852285 DOI: 10.1016/j.ahjo.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Aims Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors. Methods This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE. Results In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks. Conclusion The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.
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Grundy SM, Wang J, Vega GL. Statin therapy for primary prevention in men: What is the role for coronary artery calcium? J Clin Lipidol 2023; 17:12-18. [PMID: 36593174 DOI: 10.1016/j.jacl.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
Current cholesterol guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) base statin treatment decisions on multiple risk factor algorithms (e.g., Pooled Cohort Equations [PCEs]). By available PCEs, most older middle-aged men are statin eligible. But several studies cast doubt on predictive accuracy of available PCEs for ASCVD risk assessment. Recent studies suggest that accuracy can be improved by measurement of coronary artery calcium (CAC). This method has the advantage of identifying men at low risk in whom statin therapy can be delayed for several years, provided they are monitored periodically for progression of CAC. Thus, there are two approaches to statin therapy in men ≥ 55 years: first all men could be treated routinely, or second, treatment can be based on the extent of coronary calcium. The latter could allow a sizable fraction of men to avoid treatment for several years or indefinitely. Whether with initial CAC scan or with periodic rescanning, a CAC score ≥ 100 Agatston units is high enough to warrant statin therapy. In otherwise high-risk men (e.g., diabetes, severe hypercholesterolemia, 10-year risk by PCE ≥ 20%), a statin is generally indicated without the need for CAC; but in special cases, CAC measurement may aid in treatment decisions.
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Affiliation(s)
- Scott M Grundy
- Departments of Internal Medicine; Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, Texas; The Veterans Administration Medical Center at North Texas Healthcare System at Dallas, Texas.
| | | | - Gloria L Vega
- Clinical Nutrition; Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, Texas; The Veterans Administration Medical Center at North Texas Healthcare System at Dallas, Texas
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Cosson E, Berkane N, Pinto S, Bihan H, Tatulashvili S, Soussan M, Sellier N, Nguyen MT, Valensi P. Clinical relevance of coronary risk classification and reclassification with coronary artery calcium score in asymptomatic people living with diabetes. An observational study. Diabetes Metab 2023; 49:101412. [PMID: 36414170 DOI: 10.1016/j.diabet.2022.101412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
AIMS To explore (i) in what proportion and direction coronary artery calcium (CAC) score reclassifies coronary risk in asymptomatic diabetic patients at high a priori coronary risk, and (ii) whether screening for asymptomatic myocardial ischemia / coronary stenosis only in patients at very high coronary risk - whether a priori or combined with those reclassified at very high risk according to their CAC score - has good sensitivity to detect these conditions. METHODS We retrospectively selected 377 asymptomatic primary prevention diabetic patients at high or very high a priori coronary risk according to national guidelines. All had their CAC score measured and underwent stress myocardial scintigraphy to detect myocardial ischemia. Those identified with ischemia then had a coronary angiography to identify coronary stenoses. RESULTS Of the selected patients, 242 and 135 patients had a high and very high a priori coronary risk, respectively. After taking into account their CAC score, the former were reclassified into three risk categories: moderate (n = 159, 66%), high (n = 38) and very high (45 patients) risk. Myocardial ischemia was identified in 35 patients and coronary stenoses in 14 of the latter. Had a stress scintigraphy been performed only in the 135 patients at very high risk a priori, 18 patients would have been detected with ischemia (sensitivity 51%), and 9 with coronary stenoses (sensitivity 64%). Had a scintigraphy also been performed on the 45 patients at very high risk after CAC-reclassification, an additional 7 and 5 patients with ischemia and coronary stenoses, respectively, would have been identified. CONCLUSION Following national guidelines, 66% of our population of asymptomatic diabetic persons at high a priori coronary risk were reclassified into the moderate risk category, translating into less stringent goals for risk factor control. Eighteen percent were reclassified into the very high-risk category, leading to 100% detection sensitivity for patients with ischemia and coronary stenoses.
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Affiliation(s)
- Emmanuel Cosson
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France; UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France.
| | - Narimane Berkane
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Sara Pinto
- AP-HP, Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
| | - Hélène Bihan
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France; Laboratoire Educations et Pratiques de Santé UR 3412, UFR Santé, Médecine, Biologie Humaine, Université Paris Sorbonne Paris Nord, 74, rue Marcel Cachin -93017 Bobigny cedex, France
| | - Sopio Tatulashvili
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France; UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Michael Soussan
- AP-HP, Department of Nuclear Medicine, Avicenne Hospital, Bobigny, France
| | - Nicolas Sellier
- AP-HP, Department of Radiology, Jean Verdier Hospital, Bondy, France
| | - Minh Tuan Nguyen
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Paul Valensi
- AP-HP, Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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Kumar P, Bhatia M. Coronary Artery Calcium Data and Reporting System (CAC-DRS): A Primer. J Cardiovasc Imaging 2023; 31:1-17. [PMID: 36693339 PMCID: PMC9880346 DOI: 10.4250/jcvi.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 01/26/2023] Open
Abstract
The Coronary Artery Calcium Data and Reporting System (CAC-DRS) is a standardized reporting method for calcium scoring on computed tomography. CAC-DRS is applied on a per-patient basis and represents the total calcium score with the number of vessels involved. There are 4 risk categories ranging from CAC-DRS 0 to CAC-DRS 3. CAC-DRS also provides risk prediction and treatment recommendations for each category. The main strengths of CAC-DRS include a detailed and meaningful representation of CAC, improved communication between physicians, risk stratification, appropriate treatment recommendations, and uniform data collection, which provides a framework for education and research. The major limitations of CAC-DRS include a few missing components, an overly simple visual approach without any standard reference, and treatment recommendations lacking a basis in clinical trials. This consistent yet straightforward method has the potential to systemize CAC scoring in both gated and non-gated scans.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
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Agarwala A, Patel J, Blaha M, Cainzos-Achirica M, Nasir K, Budoff M. Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians. Am J Prev Cardiol 2022; 13:100455. [PMID: 36636123 PMCID: PMC9830106 DOI: 10.1016/j.ajpc.2022.100455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
South Asian (SA) individuals, particularly those that reside in the United States and other Westernized countries, are at an elevated risk for ASCVD and mortality related to ASCVD. The 2018 ACC/AHA/Multi-society Cholesterol guideline listed SA as a high-risk ethnicity, underscoring the importance of treating modifiable risk factors to reduce ASCVD burden. Coronary artery calcium (CAC), a highly specific marker of subclinical atherosclerosis, may be a useful test to improve risk stratification among SA individuals. CAC testing is a cost-effective, highly reproducible, and specific marker of subclinical atherosclerosis, shown to improve ASCVD risk assessment across all racial/ethnic groups, thereby serving as a guide for initiating or deferring preventive therapies. In this White Paper we will discuss the use of CAC scoring to optimize risk stratification and delivery of preventive therapies to individuals of SA ethnicity.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, United States,Corresponding author at: Baylor Scott & White The Heart Hospital Baylor Plano, 1100 Allied Dr, Plano, TX 75093, United States.
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States,Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, United States
| | - Michael Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States,Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, United States
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, MD, United States,Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain,Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Matthew Budoff
- UCLA, School of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, United States
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Blaha MJ, Abdelhamid M, Santilli F, Shi Z, Sibbing D. Advanced subclinical atherosclerosis: A novel category within the cardiovascular risk continuum with distinct treatment implications. Am J Prev Cardiol 2022; 13:100456. [PMID: 36632617 PMCID: PMC9826921 DOI: 10.1016/j.ajpc.2022.100456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
Traditionally, guidelines divide patients into primary and secondary prevention for atherosclerotic cardiovascular disease (ASCVD) risk management. However, the modern understanding of the biological progression of atherosclerosis is inconsistent with this binary approach. Therefore, a new approach demonstrating both atherosclerosis and ASCVD risk as a continuum is needed to give clinicians a framework for better matching risk and intensity of therapy. Advances in coronary imaging have most clearly brought this problem into view, as for example coronary artery calcium (CAC) scoring has shown that some individuals in the primary prevention have equal or higher ASCVD risk as certain subgroups in secondary prevention. This article introduces "advanced subclinical atherosclerosis" as a new and distinct clinical group that sits between the traditional groups of primary and secondary prevention. Importantly, this article also introduces a new graphic to visualize this intermediate population that is explicitly based on plaque burden. The aim of the graphic is both to educate and to allow for better identification of a patient's cardiovascular risk and guide more effective risk-based management.
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Affiliation(s)
- Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Blalock 524D1, 600 N. Wolfe Street, Baltimore, MD 21287, USA,Corresponding author.
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Egypt
| | - Francesca Santilli
- Department of Medicine and Aging and Center for Advanced Studies and Technology, University of Chieti, Chieti, Italy
| | - Zhongwei Shi
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dirk Sibbing
- Ludwig-Maximilians University (LMU), Germany and Privatklinik Lauterbacher Mühle am Ostersee, Munich, Seeshaupt, Germany
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Yuan N, Kwan AC, Duffy G, Theurer J, Chen JH, Nieman K, Botting P, Dey D, Berman DS, Cheng S, Ouyang D. Prediction of Coronary Artery Calcium Using Deep Learning of Echocardiograms. J Am Soc Echocardiogr 2022; 36:474-481.e3. [PMID: 36566995 PMCID: PMC10164107 DOI: 10.1016/j.echo.2022.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary artery calcification (CAC), often assessed by computed tomography (CT), is a powerful marker of coronary artery disease that can guide preventive therapies. Computed tomographies, however, are not always accessible or serially obtainable. It remains unclear whether other widespread tests such as transthoracic echocardiograms (TTEs) can be used to predict CAC. METHODS Using a data set of 2,881 TTE videos paired with coronary calcium CTs, we trained a video-based artificial intelligence convolutional neural network to predict CAC scores from parasternal long-axis views. We evaluated the model's ability to classify patients from a held-out sample as well as an external site sample into zero CAC and high CAC (CAC ≥ 400 Agatston units) groups by receiver operating characteristic and precision-recall curves. We also investigated whether such classifications prognosticated significant differences in 1-year mortality rates by the log-rank test of Kaplan-Meier curves. RESULTS Transthoracic echocardiogram artificial intelligence models had high discriminatory abilities in predicting zero CAC (receiver operating characteristic area under the curve [AUC] = 0.81 [95% CI, 0.74-0.88], F1 score = 0.95) and high CAC (AUC = 0.74 [0.68-0.8], F1 score = 0.74). This performance was confirmed in an external test data set of 92 TTEs (AUC = 0.75 [0.65-0.85], F1 score = 0.77; and AUC = 0.85 [0.76-0.93], F1 score = 0.59, respectively). Risk stratification by TTE-predicted CAC performed similarly to CT CAC scores in prognosticating significant differences in 1-year survival in high-CAC patients (CT CAC ≥ 400 vs CT CAC < 400, P = .03; TTE-predicted CAC ≥ 400 vs TTE-predicted CAC < 400, P = .02). CONCLUSIONS A video-based deep learning model successfully used TTE videos to predict zero CAC and high CAC with high accuracy. Transthoracic echocardiography-predicted CAC prognosticated differences in 1-year survival similar to CT CAC. Deep learning of TTEs holds promise for future adjunctive coronary artery disease risk stratification to guide preventive therapies.
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Affiliation(s)
- Neal Yuan
- School of Medicine, University of California, San Francisco, California; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California.
| | - Alan C Kwan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Grant Duffy
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - John Theurer
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jonathan H Chen
- Department of Medicine, Stanford University, Stanford, California
| | - Koen Nieman
- Department of Medicine, Stanford University, Stanford, California; Department of Radiology, Stanford University, Stanford, California
| | - Patrick Botting
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Ouyang
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Division of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Shah H, Garacci E, Behuria S, Cainzos-Achirica M, Kandula NR, Kanaya AM, Shah NS. Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study. Am J Prev Cardiol 2023; 13:100453. [PMID: 36636125 DOI: 10.1016/j.ajpc.2022.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives The 2018 and 2019 U.S. guidelines for the management of cholesterol and primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of cardiovascular risk-enhancing factors (REFs), including South Asian ancestry, to refine ASCVD risk estimation. However, the associations of REFs with atherosclerosis are unclear in South Asian American adults, who have a disproportionately elevated premature coronary heart disease risk. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we investigated associations of individual REFs, or the number of REFs, with coronary artery calcium (CAC). Methods Using baseline and follow-up data from MASALA, we evaluated the association of REFs (family history of ASCVD, low-density lipoprotein cholesterol ≥160 mg/dL, triglycerides ≥175 mg/dL, lipoprotein(a) >50 mg/dL, high-sensitivity C-reactive protein [hsCRP] ≥2.0 mg/dL, ankle-brachial index <0.9, chronic kidney disease, metabolic syndrome), individually and combined, with baseline prevalent CAC, any CAC progression (including incident CAC and CAC progression), and annual CAC progression rates using multivariable logistic regression and generalized linear models. Results Among 866 adults, mean age was 55 [SD 9] years and 47% were female. There were no significant associations of REFs with baseline prevalent CAC or any CAC progression (incident CAC and CAC progression at Exam 2) after adjustment. Among the 56% of participants who had any CAC progression, having 3+ REFs was associated with a significantly higher annual CAC progression rate (adjusted rate ratio [aRR] 1.94, 95% CI 1.39-2.72) vs. having 0 REFs. The annual CAC progression rate was 20% higher per additional REF (aRR 1.20, 95% CI 1.09-1.32). Findings were similar after excluding statin users, and among those with low 10-year ASCVD risk (<5%). Conclusions Among South Asian American adults, we found no association of REFs with prevalent CAC at baseline or having any CAC progression. Among those with any CAC progression, a higher number of REFs was associated with higher annual CAC progression rates.
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Divakaran S, Caron JP, Zhou W, Hainer J, Bibbo CF, Skali H, Taqueti VR, Dorbala S, Blankstein R, Groarke JD, Nohria A, Di Carli MF. Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer. J Nucl Cardiol 2022; 29:3072-3081. [PMID: 34820770 PMCID: PMC9126993 DOI: 10.1007/s12350-021-02825-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/17/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Impaired MFR in the absence of flow-limiting CAD is associated with adverse events. Cardiovascular disease is an important cause of morbidity and mortality in patients with breast cancer. We sought to test the utility of MFR to predict outcomes in a cohort of patients with breast cancer. METHODS We retrospectively studied consecutive patients with breast cancer or breast cancer survivors who underwent cardiac stress PET imaging from 2006 to 2017 at Brigham and Women's Hospital. Patients with a history of clinically overt CAD, LVEF < 45%, or abnormal myocardial perfusion were excluded. Subjects were followed from time of PET to the occurrence of a first major adverse cardiovascular event (MACE) and all-cause death. RESULTS The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile. CONCLUSIONS In patients with breast cancer, coronary vasomotor dysfunction was associated with incident cardiovascular events. MFR may have potential as a risk stratification biomarker among patients with/survivors of breast cancer.
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Affiliation(s)
- Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse P Caron
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wunan Zhou
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
| | - Courtney F Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Groarke
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anju Nohria
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA.
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Al-Kindi S, Dong T, Chen W, Tashtish N, Neeland IJ, Nasir K, Rajagopalan S. Relation of coronary calcium scoring with cardiovascular events in patients with diabetes: The CLARIFY Registry. J Diabetes Complications 2022; 36:108269. [PMID: 36170785 DOI: 10.1016/j.jdiacomp.2022.108269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/30/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Coronary artery calcium (CAC) scoring is not routinely performed in patients with diabetes based on an existing class I indication for statin therapy in these patients. However, CAC scoring may improve risk classification and prediction of atherosclerotic cardiovascular disease (ASCVD) events beyond risk scores in asymptomatic individuals with prediabetes and diabetes, warranting CAC assessment in this population. The routine availability through provision of no-charge CAC as an alternative to routine probabilistic risk scores may improve utilization of preventive therapies especially in traditionally underserved populations. METHODS Prospective observational study in a large health system offering no-charge CAC scoring for primary prevention risk prediction with available glycosylated hemoglobin (HbA1c) measurements between June 2015 and March 2019 were divided according to no diabetes (HbA1c <5.7 %), prediabetes (HbA1c 5.7 %-6.4 %), or diabetes (HbA1c ≥ 6.5 % or charted history) and followed for major adverse cardiovascular events [myocardial infarction, stroke, death (MACE) or coronary revascularization]. Patient characteristics, health history, laboratory data, and statin prescription rates were measured at baseline and at one year after CAC scoring. RESULTS A total of 12,194 subjects with available HbA1c underwent CAC scoring during the study period (6462 diabetes, 2062 prediabetes, and 3670 without diabetes). At a median follow-up of 1.2 years, there were 458 MACE events (71 patients without diabetes, 66 patients with prediabetes, and 321 patients with diabetes). Among patients with diabetes or prediabetes, increased CAC was associated with MACE (HR 1.38 [1.26-1.51], p < 0.001) and MACE or revascularization (HR 1.70 [1.57-1.85], p < 0.001). In patients with diabetes, CAC category was associated with greater statin initiation (89.6 % for CAC≥400 vs 60.1 % for CAC = 0, p < 0.001) and high intensity statin initiation (42.2 % for CAC≥400 vs 16.8 % for CAC = 0, p < 0.001) at one year post CAC scoring. Patients with diabetes had greater reductions in systolic blood pressure, LDL-C, total cholesterol, and triglycerides from baseline with a CAC ≥400 compared to a lower CAC category (p = 0.007). CONCLUSIONS CAC burden is associated with ASCVD risk in patients with diabetes. CAC scoring increases statin prescriptions and reduces ASCVD risk in patients with diabetes, potentially warranting routine CAC assessment in this population.
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Affiliation(s)
- Sadeer Al-Kindi
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America.
| | - Tony Dong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Wenjing Chen
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Nour Tashtish
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Khurram Nasir
- Houston Methodist Hospital, Houston, TX, United States of America
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
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Garg PK, Tressel W, McClelland RL, Criqui MH, Stein JH, Yvan-Chavret L, Tall AR, Shea S. Cholesterol mass efflux capacity and coronary artery calcium: The Multi-Ethnic Study of Atherosclerosis. J Clin Lipidol 2022; 16:895-900. [PMID: 36153282 DOI: 10.1016/j.jacl.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 12/30/2022]
Abstract
We assessed the cross-sectional and longitudinal relationships of high-density lipoprotein (HDL)-mediated cholesterol mass efflux capacity (CMEC) with coronary artery calcium (CAC) score and CAC density. CMEC was measured in 1626 Multi-Ethnic Study of Atherosclerosis (MESA) participants in samples obtained between 2000 and 2002 as part of two nested case-control studies, one with cases of incident cardiovascular disease and the other with cases of carotid plaque progression by ultrasound. Cardiac CT examinations for the presence of CAC were performed at baseline and at two additional examinations. CAC scores (Agatston and volume) and density scores (for those with positive CAC) were calculated. Multivariable linear regression modeling per SD increment of CMEC was used to estimate the associations of CMEC with each of these CAC measures. We found no association between higher CMEC and either lower CAC scores or a higher CAC density. We also found no association between higher CMEC and progression of any of these CAC measures. These findings suggest that HDL-mediated cholesterol efflux may be associated with cardiovascular risk via mechanisms unrelated to burden of calcified plaque.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, 1510 San Pablo St. Suite 322, Los Angeles, CA 90033, United States.
| | - William Tressel
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Michael H Criqui
- Division of Preventive Medicine, San Diego School of Medicine, University of California, San Diego, CA, United States
| | - James H Stein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Laurent Yvan-Chavret
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Institut National de la Santé et de la Recherche Médicale (Inserm) U1065, Centre Méditerranéen de Médecine Moléculaire (C3M), Atip-Avenir, Université Côte d'Azur, Fédération Hospitalo-Universitaire (FHU) OncoAge, Nice 06204 France
| | - Alan R Tall
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Steven Shea
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Kilbo Edlund K, Sallsten G, Molnár P, Andersson EM, Ögren M, Segersson D, Fagman E, Fagerberg B, Barregard L, Bergström G, Stockfelt L. Long-term exposure to air pollution, coronary artery calcification, and carotid artery plaques in the population-based Swedish SCAPIS Gothenburg cohort. Environ Res 2022; 214:113926. [PMID: 35868579 DOI: 10.1016/j.envres.2022.113926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
Long-term exposure to air pollution is associated with cardiovascular events. A main suggested mechanism is that air pollution accelerates the progression of atherosclerosis, yet current evidence is inconsistent regarding the association between air pollution and coronary artery and carotid artery atherosclerosis, which are well-established causes of myocardial infarction and stroke. We studied associations between low levels of long-term air pollution, coronary artery calcium (CAC) score, and the prevalence and area of carotid artery plaques, in a middle-aged population-based cohort. The Swedish CArdioPulmonary bioImage Study (SCAPIS) Gothenburg cohort was recruited during 2013-2017 and thoroughly examined for cardiovascular risk factors, including computed tomography of the heart and ultrasonography of the carotid arteries. In 5070 participants (age 50-64 years), yearly residential exposures to air pollution (PM2.5, PM10, PMcoarse, NOx, and exhaust-specific PM2.5 1990-2015) were estimated using high-resolution dispersion models. We used Poisson regression to examine associations between long-term (26 years' mean) exposure to air pollutants and CAC score, and prevalence of carotid artery plaques, adjusted for potential confounders. Among participants with carotid artery plaques, we also examined the association with plaque area using linear regression. Mean exposure to PM2.5 was low by international standards (8.5 μg/m3). There were no consistent associations between long-term total PM2.5 exposure and CAC score or presence of carotid artery plaques, but an association between total PM2.5 and larger plaque area in participants with carotid plaques. Associations with traffic-related air pollutants were consistently positive for both a high CAC score and bilateral carotid artery plaques. These associations were independent of road traffic noise. We found stronger associations among men and participants with cardiovascular risk factors. The results lend some support to atherosclerosis as a main modifiable pathway between low levels of traffic-related ambient air pollution and cardiovascular disease, especially in vulnerable individuals.
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Affiliation(s)
- Karl Kilbo Edlund
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter Molnár
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Mikael Ögren
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Leo Stockfelt
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
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50
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Haddad F, Cauwenberghs N, Daubert MA, Kobayashi Y, Bloomfield GS, Fleischman D, Koweek L, Maron DJ, Rodriguez F, Liao YJ, Moneghetti K, Amsallem M, Mega J, Hernandez A, Califf R, Mahaffey KW, Shah SH, Kuznetsova T, Douglas PS. Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study. J Cardiovasc Comput Tomogr 2022; 16:498-508. [PMID: 35872137 PMCID: PMC10870833 DOI: 10.1016/j.jcct.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear. METHODS In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n = 560). We also classified LVDD using the American Society of Echocardiography recommendations. RESULTS The mean age of the participants was 51 ± 17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e', E/e', and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e' and E/e', the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e' and E/e' included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds. CONCLUSION In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function. CLINICALTRIALS GOV IDENTIFIER NCT03154346.
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Affiliation(s)
- Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Nicholas Cauwenberghs
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Melissa A Daubert
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Yukari Kobayashi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Dominik Fleischman
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynne Koweek
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - David J Maron
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Prevention Research Center, Stanford University, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yaping Joyce Liao
- Departments of Ophthalmology and Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Adrian Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Kenneth W Mahaffey
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Center for Clinical Research (SCCR); Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Svati H Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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