Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography

OBJECTIVES

This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients.

BACKGROUND

Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies.

METHODS

In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 +/- 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (> or =50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC).

RESULTS

During a mean follow-up of 78 +/- 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD.

CONCLUSIONS

The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

Ethnic differences of the presence and severity of coronary atherosclerosis

BACKGROUND

Although cardiovascular risk factor levels are substantially different in Caucasians, African-American, Hispanics, and Asians, the relative rates of coronary heart disease in these groups are not consistent with these differences. The objective of the study is to assess the differences in the prevalence and severity of coronary artery calcification, as a measure of atherosclerosis, in these different ethnic groups.

METHODS

Electron-beam tomography was performed in 16,560 asymptomatic men and women (Asians=1336, African-Americans=610, Hispanics=1256) aged >or=35 years referred by their physician for cardiovascular risk evaluation. The study population encompassed 70% males, aged 52+/-8 years.

RESULTS

Caucasians were more likely to present with dyslipidemia (p<0.0001), while African-Americans and Hispanics had a higher prevalence of smoking, diabetes, and hypertension (all p<0.001). After adjustment for age, gender, risk factors, and treatment for hypercholesterolemia, compared with Caucasians, the relative risks for men having coronary calcification were 0.64 (95% CI: 0.48-0.86) in African-Americans, 0.88 (95% CI: 0.67-1.15) in Hispanics, and 0.66 (95% CI: 0.55-0.80) in Asians. After similar adjustments, the relative risks for women having coronary calcification, were 1.58 (95% CI: 1.13-2.19) for African-Americans, 0.84 (95% CI: 0.66-1.06) in Hispanics, and 0.71 (95% CI: 0.56-0.89) in Asian women. After adjusting for age and risk factors using multivariable analysis, African-American men were least likely to have any coronary calcium while African-American women had significantly higher OR of any calcification. Asian men and women had significantly lower OR of any calcification. There was no significant difference in prevalence or severity of atherosclerosis between Hispanics and Caucasians, in men or women.

CONCLUSIONS

Our study results demonstrate significant difference in the presence as well as severity of calcification according to ethnicity, independent of atherosclerotic risk factors. Results from this study (physician referred) closely parallel the results from MESA (population based, measured risk factors). Ethnic specific data on the predictive value of differing coronary calcium scores are needed.

Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections

BACKGROUND

Keloids that are surgically removed commonly recur within the excision sites.

OBJECTIVE

Our purpose was to determine whether postsurgical adjunctive therapy reduces such recurrences.

METHODS

We determined the rate of recurrence after excision alone (n = 43) and postoperative injection with triamcinolone acetonide (TAC; n = 65) or interferon alfa-2b (IFN-alpha 2b; n = 16).

RESULTS

Of lesions excised without postoperative injections, 51.1% (22 of 43) recurred; 58.4% of TAC-treated lesions (38 of 65) recurred and 18.7% of IFN-alpha 2b-treated lesions (3 of 16) recurred (p = 0.025).

CONCLUSION

Postoperative TAC injections do not reduce the number of keloid recurrences. However, injection of keloid excision sites with IFN-alpha 2b offers a therapeutic advantage over keloid excision.

Tuning the conductance of single-walled carbon nanotubes by ion irradiation in the Anderson localization regime

Carbon nanotubes are a good realization of one-dimensional crystals where basic science and potential nanodevice applications merge. Defects are known to modify the electrical resistance of carbon nanotubes; they can be present in as-grown carbon nanotubes, but controlling their density externally opens a path towards the tuning of the electronic characteristics of the nanotube. In this work, consecutive Ar+ irradiation doses are applied to single-walled nanotubes (SWNTs) producing a uniform density of defects. After each dose, the room-temperature resistance versus SWNT length (R(L)) along the nanotube is measured. Our data show an exponential dependence of R(L) indicating that the system is within the strong Anderson localization regime. Theoretical simulations demonstrate that mainly di-vacancies contribute to the resistance increase induced by irradiation, and that just a 0.03% of di-vacancies produces an increase of three orders of magnitude in the resistance of a SWNT of 400 nm length.

Total and individual coronary artery calcium scores as independent predictors of mortality in hemodialysis patients

Many traditional and nontraditional risk factors contribute to vascular calcification among maintenance hemodialysis (MHD) patients. It is not clear whether coronary artery calcification (CAC) delineates a higher mortality risk independent of known risk factors. We examined 6-year (10/2001-9/2007) survival of 166 MHD patients, aged 53 +/- 13 years, with baseline CAC scores. Patients were grouped into four CAC groups: 0, 1-100, 101-400, and 400+. The 101-400 and 400+ groups were associated with a significantly higher adjusted risk of death than CAC 0 with hazard ratios (HR) 8.5 (95% CI: 1.1-48.1, p = 0.02) and 13.3 (95% CI: 1.3-65.1, p = 0.01), respectively, independent of demographics, comorbidity, lipids and other cardiovascular risks, surrogates of bone disease, nutritional and inflammatory markers and dialysis dose. Total CAC [HR 6.7 (1.1-21.5, p = 0.03)] followed by the presence of CAC in the left main [4.6 (2.2-9.8, p = 0.001)] and left anterior descending artery [4.3 (2.1-14.2, p = 0.001)] were strong independent predictors of mortality even after adjusting for above covariates. Total and vessel-specific CAC predict mortality in MHD patients independent of traditional and nontraditional risk factors.

Mortality incidence of patients with non-obstructive coronary artery disease diagnosed by computed tomography angiography

It was previously reported that event-free survival rates of symptomatic patients with coronary artery disease (CAD) diagnosed by computed tomographic angiography decreased incrementally from normal coronary arteries to obstructive CAD. The aim of this study was to investigate the clinical outcomes of symptomatic patients with nonobstructive CAD with luminal stenoses of 1% to 49% on the basis of coronary plaque morphology in an outpatient setting. Among 3,499 consecutive symptomatic subjects who underwent computed tomographic angiography, 1,102 subjects with nonobstructive CAD (mean age 59 ± 14 years, 69.9% men) were prospectively followed for a mean of 78 ± 12 months. Coronary plaques were defined as noncalcified, mixed, and calcified per patient. Multivariate Cox proportional-hazards models were developed to predict all-cause mortality. The death rate of patients with nonobstructive CAD was 3.1% (34 deaths). The death rate increased incrementally from calcified plaque (1.4%) to mixed plaque (3.3%) to noncalcified plaque (9.6%), as well as from single- to triple-vessel disease (p <0.001). In subjects with mixed or calcified plaques, the death rate increased with the severity of coronary artery calcium from 1 to 9 to ≥ 400. The risk-adjusted hazard ratios of all-cause mortality in patients with nonobstructive CAD were 3.2 (95% confidence interval 1.3 to 8.0, p = 0.001) for mixed plaques and 7.4 (95% confidence interval 2.7 to 20.1, p = 0.0001) for noncalcified plaques compared with calcified plaques. The areas under the receiver-operating characteristic curve to predict all-cause mortality were 0.75 for mixed and 0.86 for noncalcified coronary lesions. In conclusion, this study demonstrates that the presence of noncalcified and mixed coronary plaques provided incremental value in predicting all-cause mortality in symptomatic subjects with nonobstructive CAD independent of age, gender, and conventional risk factors.

Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass

BACKGROUND

Smaller coronary artery diameter portends worse outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The suggestion that women have smaller coronary artery diameters than men has not been validated by a large-scale study.

HYPOTHESIS

We sought to confirm a gender difference with respect to coronary artery diameter, even after accounting for body habitus and left ventricular mass (LVM).

METHODS

From 4200 subjects evaluated for cardiovascular disease by computed tomography angiography, we selected 710 subjects (383 males, 327 females) with coronary artery calcium (CAC) scores <100, eliminating patients with artery remodeling. Diameters of the left main (LM), left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCA), were measured. Measurements were compared using a 2-sample t test and the multiple regression model, accounting for body habitus and LVM.

RESULTS

After adjusting for age, race, weight, height, body mass index, body surface index, LVM, and CAC, women have smaller diameters in the LM (males 4.35 mm, females 3.91 mm), LAD (males 3.54 mm, females 3.24 mm), CX (males 3.18, females 2.75 mm), and RCA (males 3.70 mm, females 3.26 mm) (P < 0.001). This difference is not related to body habitus or LVM.

CONCLUSIONS

Gender significantly influences artery diameter of the LM, LAD, CX, and RCA. This may warrant gender specific approaches during PCI and CABG. As neither body habitus nor LVM relate to the difference in coronary artery diameter, our study encourages a search for inherent differences between genders that can account for this difference.

Host-associated coral reef microbes respond to the cumulative pressures of ocean warming and ocean acidification

Key calcifying reef taxa are currently threatened by thermal stress associated with elevated sea surface temperatures (SST) and reduced calcification linked to ocean acidification (OA). Here we undertook an 8 week experimental exposure to near-future climate change conditions and explored the microbiome response of the corals Acropora millepora and Seriatopora hystrix, the crustose coralline algae Hydrolithon onkodes, the foraminifera Marginopora vertebralis and Heterostegina depressa and the sea urchin Echinometra sp. Microbial communities of all taxa were tolerant of elevated pCO₂/reduced pH, exhibiting stable microbial communities between pH 8.1 (pCO₂ 479–499 μatm) and pH 7.9 (pCO₂ 738–835 μatm). In contrast, microbial communities of the CCA and foraminifera were sensitive to elevated seawater temperature, with a significant microbial shift involving loss of specific taxa and appearance of novel microbial groups occurring between 28 and 31 °C. An interactive effect between stressors was also identified, with distinct communities developing under different pCO₂ conditions only evident at 31 °C. Microbiome analysis of key calcifying coral reef species under near-future climate conditions highlights the importance of assessing impacts from both increased SST and OA, as combinations of these global stressors can amplify microbial shifts which may have concomitant impacts for coral reef structure and function.

Energy level alignment at metal/organic semiconductor interfaces: “Pillow” effect, induced density of interface states, and charge neutrality level

A unified model, embodying the "pillow" effect and the induced density of interface states (IDIS) model, is presented for describing the level alignment at a metal/organic interface. The pillow effect, which originates from the orthogonalization of the metal and organic wave functions, is calculated using a many-body linear combination of atomic orbitals Hamiltonian, whereby electron long-range interactions are obtained using an expansion in the metal/organic wave function overlap, while the electronic charge of both materials remains unchanged. This approach yields the pillow dipole and represents the first effect induced by the metal/organic interaction, resulting in a reduction of the metal work function. In a second step, we consider how charge is transferred between the metal and the organic material by means of the IDIS model: Charge transfer is determined by the relative position of the metal work function (corrected by the pillow effect) and the organic charge neutrality level, as well as by an interface parameter S, which measures how this potential difference is screened. In our approach, we show that the combined IDIS-pillow effects can be described in terms of the original IDIS alignment corrected by a screened pillow dipole. For the organic materials considered in this paper, we see that the IDIS dipole already represents most of the realignment induced at the metal/organic interface. We therefore conclude that the pillow effect yields minor corrections to the IDIS model.

Modelling energy level alignment at organic interfaces and density functional theory

A review of our theoretical understanding of the band alignment at organic interfaces is presented with particular emphasis on the metal/organic (MO) case. The unified IDIS (induced density of interface states) and the ICT (integer charge transfer) models are reviewed and shown to describe qualitatively and semiquantitatively the barrier height formation at those interfaces. The IDIS model, governed by the organic CNL (charge neutrality level) and the interface screening includes: (a) charge transfer across the interface; (b) the "pillow" (or Pauli) effect associated with the compression of the metal wavefunction tails; and (c) the molecular dipoles. We argue that the ICT-model can be described as a limiting case of the unified IDIS-model for weak interface screening. For a fully quantitative understanding of the band alignment at organic interfaces, use of DFT (density functional theory) or quantum chemistry methods is highly desirable. In this Perspective review, we concentrate our discussion on DFT and show that conventional LDA or GGA calculations are limited by the "energy gap problem of the organic materials", because the LDA (or GGA) Kohn-Sham energy levels have to be corrected by the self-interaction energy of the corresponding wavefunction, to provide the appropriate molecule transport energy gap. Image potential and polarization effects at MO interfaces tend to cancel these self-interaction corrections; in particular, we show that for organic molecules lying flat on Cu and Ag, these cancellations are so strong that we can rely on conventional DFT to calculate their interface properties. For Au, however, the cancellations are weaker making it necessary to go beyond conventional DFT. We discuss several alternatives beyond conventional LDA or GGA. The most accurate approach is the well-known GW-technique, but its use is limited by its high demanding computer time. In a very simple approach one can combine conventional DFT with a "scissor" operator which incorporates self-interaction corrections and polarization effects in the organic energy levels. Hybrid potentials combined with conventional DFT represent, probably, the best alternative for having a simple and accurate approach for analyzing organic interfaces. The problem then is to find an appropriate one for both the metal and the organic material in a plane-wave formulation; we show, however, how to overcome this difficulty using a local-orbital basis formulation. As examples of these alternatives, we present some DFT-calculations for several organic interfaces, using either the scissor operator or a hybrid potential, which can be interpreted in terms of the unified IDIS-model.

Comparison of a silicone gel-filled cushion and silicon gel sheeting for the treatment of hypertrophic or keloid scars

BACKGROUND

The exact mechanisms of action responsible for the effectiveness of silicone gel dressings are unknown, although it has been proposed that static electricity generated by friction could be the reason for their anti-scarring effects.

OBJECTIVE

We compared the efficacy of a cushion of silicone filled with liquid silicone gel reported to induce greater negative static-electric charge with silicone gel sheeting in the treatment of hypertrophic and keloid scars.

METHODS

The size, volume, symptoms (tenderness and itching), and signs (color and induration) of hypertrophic (10 patients) or keloid scars (22 patients) were measured at baseline at 16 weeks following use of either the silicone gel cushion or silicone gel sheeting, as determined by random assignment.

RESULTS

Both the silicone gel cushion and the silicone gel sheeting treatments were effective in decreasing scar volume, 53.0% and 36.3%, respectively. The percentages of keloids and hypertrophic scars benefiting from the silicone cushion and the silicone sheeting were similar with respect to reduction in tenderness (36.3% vs 33.3%), itching (45.5% vs 33.3%), and redness (0.1% vs 0.1%), and in the degree of softening (45.5 vs 25.0%).

CONCLUSIONS

Both the silicone gel cushion and the silicone gel sheeting treatments were effective in the treatment of keloids and hypertrophic scars, although no statistically significant differences were found between the two treatment modalities.

Thoracic Quantitative Computed Tomography (QCT) Can Sensitively Monitor Bone Mineral Metabolism: Comparison of Thoracic QCT vs Lumbar QCT and Dual-energy X-ray Absorptiometry in Detection of Age-relative Change in Bone Mineral Density

RATIONALE AND OBJECTIVE

Sensitive detection of bone mineral density (BMD) change is a key issue to monitor and evaluate the individual bone health status, as well as bone metabolism and bone mineral status. The ability to use thoracic quantitative computed tomography (QCT) to detect the annual change of BMD remains unclear. We aimed to investigate the sensitivity in detecting age-related bone mineral loss using the thoracic QCT from the electrocardiographically gated heart scans in comparison to whole-body dual-energy X-ray absorptiometry (DXA) and standard lumbar QCT.

MATERIALS AND METHODS

A total of 121 asymptomatic patients' imaging data, including DXA whole body scan, cardiac CT scan, and abdomen scans were analyzed. The BMD of the thoracolumbar spine, upper, and lower extremities were measured using QCT and DXA, respectively. The age-related annual rate of bone density loss was computed and compared to the thoracic and lumbar QCT, as well DXA measures.

RESULTS

The age-related annual rate of bone loss with QCT was -0.70 mg/mL³ (-0.75%/y) in women, -0.83 mg/mL³ (-0.86%/y) in men in the thoracic and the lumbar trabecular QCT, respectively. Compared to the QCT, DXA demonstrates a lower annual rate of bone loss in the area of BMD measurement (P < .05 in all, excluding legs of women) in -0.45, -0.42, -0.67, and -0.46 in women, in -0.32, -0.02, -0.12, and -0.08 in men for thoracic, lumbar, leg, and arm, respectively.

CONCLUSION

We conclude that the thoracic and the lumbar QCT provide a similar and more sensitive method for detecting bone mineral loss when compared to DXA.

Effects of sevelamer and calcium-based phosphate binders on lipid and inflammatory markers in hemodialysis patients

INTRODUCTION

Cardiovascular disease accounts for almost half of all deaths in individuals with chronic kidney disease stage 5 despite advances in both dialysis treatment and cardiology. A combination of lipid-lowering and anti-inflammatory effects along with avoidance of hypercalcemia should be taken into account when choosing phosphorus binders for maintenance hemodialysis (MHD) patients.

METHODS

We examined the association of sevelamer versus calcium-based phosphorus binders with lipid profile, inflammatory markers including C-reactive protein (CRP), and mineral metabolism in MHD patients who participated in the Nutritional and Inflammatory Evaluation of Dialysis Patients (NIED) study from October 2001 to July 2005.

RESULTS

Of the 787 MHD patients in the NIED study, 697 were on either sevelamer, a calcium-based binder, or both and eligible for this study. We compared the groups based on taking sevelamer monotherapy (n = 283) or calcium binder monotherapy (n = 266) for serum phosphate control. There were no differences between the groups on dialysis vintage. There were significant differences in age, serum calcium and phosphorus levels, as well as intact parathyroid hormone levels. Using a logistic regression models, the sevelamer group had a higher odds of serum CRP <10 mg/l [odds ratio (OR): 1.06, 95% CI: 1.02-1.11] and LDL cholesterol <70 mg/dl (OR: 1.33, 95% CI: 1.19-1.47) when compared to the calcium binder group independent of age, vintage, body mass index, statin use or other variables.

CONCLUSION

The improvements in multiple surrogate markers of inflammation and lipids in the NIED study make sevelamer a promising therapy for treatment in MHD patients with high risk of cardiovascular disease and mortality.