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Sonaglioni A, Caminati A, Behring G, Nicolosi GL, Rispoli GA, Zompatori M, Lombardo M, Harari S. Prognostic Role and Determinants of Ascending Aorta Dilatation in Non-Advanced Idiopathic Pulmonary Fibrosis: A Preliminary Observation from a Tertiary University Center. J Clin Med 2025; 14:1300. [PMID: 40004830 PMCID: PMC11856476 DOI: 10.3390/jcm14041300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 02/12/2025] [Accepted: 02/14/2025] [Indexed: 02/27/2025] Open
Abstract
Background: Patients with idiopathic pulmonary fibrosis (IPF) have a high prevalence of cardiovascular (CV) risk factors and an increased CV disease burden. The aim of this study was to investigate the prognostic role of the ascending aorta (AA) diameter in patients with mild-to-moderate IPF and to identify the main determinants of AA dilatation. Methods: All IPF patients without severe pulmonary hypertension who underwent a multi-instrumental evaluation, comprehensive of high-resolution computed tomography (HRCT) and transthoracic echocardiography (TTE), between September 2017 and November 2023, were retrospectively analyzed. The primary endpoint was the composite of "all-cause mortality or re-hospitalization for all causes", over a medium-term follow-up. The secondary endpoint was to evaluate the independent predictors of AA dilatation. Additionally, Bland-Altman analysis was used to assess the accuracy and precision of echocardiography-derived AA diameters compared with non-ECG gated HRCT measurements. Results: A total of 105 IPF patients and 102 age-, sex-, and CV risk factor-matched controls without IPF were evaluated retrospectively. Over a follow-up of 3.9 ± 1.9 yrs, 31 patients died and 47 were re-hospitalized. AA/height (HR 1.15, 95% CI 1.06-1.25, p < 0.001) was independently associated with the primary endpoint, whereas unindexed AA (HR 1.01, 95% CI 0.96-1.06, p = 0.83) and AA/BSA (HR 1.00, 95% CI 0.89-1.11, p = 0.39) were not. An AA/height > 20 mm/m showed 100% sensitivity and 63% specificity (AUC = 0.78) for predicting the primary endpoint. C-reactive protein (OR 1.87; 95% CI 1.21-2.89, p = 0.005) and left ventricular mass index (OR 1.13, 95% CI 1.04-1.24, p = 0.006) were independently associated with an AA/height > 20 mm/m in the whole study group. The Bland-Altman analysis revealed a bias of +2.51 mm (with the 95% limits of agreement ranging from -3.62 to 8.65 mm) for AA estimation, suggesting a general overestimation of the AA diameter by TTE in comparison to HRCT. Conclusions: AA dilatation is predictive of poor outcomes in IPF patients without advanced lung disease over a mid-term follow-up. The AA/height assessment may improve the prognostic risk stratification of IPF patients.
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Affiliation(s)
| | - Antonella Caminati
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, 20123 Milan, Italy; (A.C.); (G.B.); (S.H.)
| | - Greta Behring
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, 20123 Milan, Italy; (A.C.); (G.B.); (S.H.)
| | | | | | | | | | - Sergio Harari
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, 20123 Milan, Italy; (A.C.); (G.B.); (S.H.)
- Department of Clinical Sciences and Community Health, Università di Milano, 20122 Milan, Italy
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Lind L, Alfredsson J, Andersson JSO, Andersson T, Bergström G, Ekblom Ö, Fagman E, Fall T, Hagström E, Isholth HH, Janzon M, Jernberg T, Katsoularis I, Leander K, Leósdóttir M, Magnusson M, Malinovschi A, Rosengren A, GustavSmith J, Spaak J, Svensson P, Söderberg S, Östgren CJ, Engström G. Cardiac biomarkers for detection of coronary artery disease in the community. Sci Rep 2024; 14:30514. [PMID: 39681613 DOI: 10.1038/s41598-024-82777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 12/09/2024] [Indexed: 12/18/2024] Open
Abstract
To investigate whether coronary artery disease (CAD) burden is associated with plasma levels of the myocardial biomarkers Troponin I (TropI) and NT-proBNP in a large population-based sample using a cross-sectional design. Coronary computerized tomography (CT) angiography was performed in 25,859 subjects without a history of atherosclerotic disease from SCAPIS study (age 50-65, 52% women). TropI and NT-proBNP were measured in plasma. Segment involvement score (SIS) was the primary exposure and TropI the primary outcome. Both SIS and coronary artery calcium score, were associated with TropI levels following adjustment for age, sex and multiple confounders (p < 0.001), with similar relationships in men and women. Proximal segments from all three coronary arteries were related to TropI levels independently of one another. Adding TropI to traditional risk factors marginally increased discrimination of atherosclerosis as compared to risk factors alone (C-statistics + 0.0005, p = 0.014). SIS was related also to NT-proBNP levels, mainly in men, but with lower estimates than TropI. The burden of CAD was related to TropI levels in both men and women. All three major coronary arteries contributed to this relationship. Adding TropI to traditional risk factors resulted in only marginally improved discrimination of coronary atherosclerosis.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, SE 751 85, Sweden.
| | - Joakim Alfredsson
- Department of Cardiology, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Jonas S O Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Therese Andersson
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Erika Fagman
- Region Västra Götaland, Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Hannes Holm Isholth
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Magnus Janzon
- Department of Cardiology, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Departmentof Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ioannis Katsoularis
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Margrét Leósdóttir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - J GustavSmith
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University Diabetes Center, Lund university, Lund, Sweden
- Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Spaak
- Departmentof Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Carl Johan Östgren
- CMIV Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Yari A, Ueda P, Lundman P, Alfredsson J, Ravn-Fischer A, Söderberg S, Yndigegn T, Hagström E, Jernberg T. Eligibility for lipid-lowering therapy when applying systemic coronary risk estimation 2 according to guidelines on apparently healthy middle-aged individuals. Eur J Prev Cardiol 2024; 31:1890-1897. [PMID: 38842486 DOI: 10.1093/eurjpc/zwae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
AIMS To estimate the proportion eligible for lipid-lowering therapy (LLT) when using the systemic coronary risk estimation 2 (SCORE2) on apparently healthy individuals. METHODS AND RESULTS Individuals aged 50-64 years were randomly invited to The Swedish Cardiopulmonary Bioimage Study (n = 30 154). Participants with previous atherosclerotic cardiovascular disease (CVD), diabetes mellitus, or chronic kidney disease were excluded. The 10-year risk of CVD was estimated using the SCORE2 equation and the multicell chart. Eligibility for LLT was estimated according to the 2021 European Society of Cardiology CVD prevention guidelines. Presence of coronary atherosclerosis was determined using coronary computed tomography angiography (CCTA). Among 26 570 apparently healthy individuals, 32% had high and 4% had very high 10-year CVD risk, according to the SCORE2 equation. Among high- and very-high-risk individuals, 99% had low-density lipoprotein cholesterol levels above guideline goals making 35% of the total population eligible for LLT. Of those eligible, undergoing imaging, 38% had no signs of coronary atherosclerosis according to CCTA. Using the SCORE2 chart, 52% of the population were eligible for LLT, of which 44% had no signs of coronary atherosclerosis. In those with high or very high risk, ongoing LLT was reported in 7% and another 11% received LLT within 6 months after study participation. CONCLUSION Nearly all apparently healthy individuals with high and very high CVD risk, or 35% of the total population, were eligible for LLT according to guidelines, and a large proportion had no signs of atherosclerosis. Compared with the SCORE2 equation, the SCORE2 chart resulted in more individuals being eligible for LLT.
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Affiliation(s)
- Ali Yari
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Pia Lundman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, 413 85 Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, 901 87 Umeå, Sweden
| | - Troels Yndigegn
- Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden
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Nilsson S, Qvick A, Henriksson M, Lawesson SS, Holm AS, Leander K. Menopausal Vasomotor Symptoms and Subclinical Atherosclerotic Cardiovascular Disease: A Population-Based Study. J Am Heart Assoc 2024; 13:e033648. [PMID: 39166434 PMCID: PMC11646512 DOI: 10.1161/jaha.123.033648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/01/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Menopausal vasomotor symptoms (VMS) are increasingly emphasized as a potentially important cardiovascular risk factor, but their role is still unclear. We assessed the association between VMS and subclinical atherosclerotic cardiovascular disease in peri- and postmenopausal women. METHODS AND RESULTS Using a cross-sectional study design, questionnaire data were collected from a population-based sample of women aged 50 to 64. The questionnaire asked whether menopause was/is associated with bothersome VMS. A 4-point severity scale was used: (1) never, (2) mild, (3) moderate, and (4) severe. The VMS duration and time of onset were also assessed. Associations with subclinical atherosclerotic cardiovascular disease, detected via coronary computed tomography angiography, coronary artery calcium score, and carotid ultrasound were assessed using the outcome variables "any coronary atherosclerosis," "segmental involvement score >3," "coronary artery calcium score >100," and "any carotid plaque," using logistic regression. Covariate adjustments included socioeconomic, lifestyle, and clinical factors. Of 2995 women, 14.2% reported ever severe, 18.1% ever moderate, and 67.7% ever mild/never VMS. Using the latter as reference, ever severe VMS were significantly associated with coronary computed tomography angiography-detected coronary atherosclerosis (multivariable adjusted odds ratio, 1.33 [95% CI, 1.02-1.72]). Corresponding results for ever severe VMS persisting >5 years or beginning before the final menstrual period were 1.50 (95% CI, 1.07-2.11) and 1.66 (95% CI, 1.10-2.50), respectively. No significant association was observed with segmental involvement score >3, coronary artery calcium score >100, or with any carotid plaque. CONCLUSIONS Ever occurring severe, but not moderate, VMS were significantly associated with subclinical coronary computed tomography angiography-detected atherosclerosis, independent of a broad range of cardiovascular risk factors and especially in case of long durations or early onset.
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Affiliation(s)
- Sigrid Nilsson
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Angelika Qvick
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Moa Henriksson
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Anna‐Clara Spetz Holm
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Karin Leander
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
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Herraiz-Adillo Á, Ahlqvist VH, Higueras-Fresnillo S, Hedman K, Hagström E, Fortuin-de Smidt M, Daka B, Lenander C, Berglind D, Östgren CJ, Rådholm K, Ortega FB, Henriksson P. Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study. Br J Sports Med 2024; 58:bjsports-2023-107663. [PMID: 38355280 DOI: 10.1136/bjsports-2023-107663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age. METHODS This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines. RESULTS The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness. CONCLUSION This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.
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Affiliation(s)
- Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Physical Education, Sport and Human Motricity, Universidad Autónoma de Madrid, Madrid, Spain
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | | | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Cecilia Lenander
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS) and CIBEROBN Physiopathology of Obesity and Nutrition, University of Granada, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Herraiz-Adillo Á, Higueras-Fresnillo S, Ahlqvist VH, Berglind D, Syrjälä MB, Daka B, Lenander C, Sundström J, Ortega FB, Östgren CJ, Rådholm K, Henriksson P. Life's Essential 8 and Life's Simple 7 in Relation to Coronary Atherosclerosis: Results From the Population-Based SCAPIS Project. Mayo Clin Proc 2024; 99:69-80. [PMID: 37843486 DOI: 10.1016/j.mayocp.2023.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To examine the associations between the American Heart Association scores ("Life's Essential 8" [LE8] and "Life's Simple 7" [LS7]) and 2 subclinical coronary atherosclerosis indicators: coronary computed tomographic angiography (CCTA)-stenosis and coronary artery calcium (CAC). PATIENTS AND METHODS We included a population-based sample, aged 50 to 64 years, recruited between 2013 and 2018 from the Swedish Cardiopulmonary Bioimage Study (n=24,819, 50.3% women). CCTA-stenosis was graded as no stenosis, stenosis (1%-49%) or severe stenosis (≥50%), whereas CAC was graded as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. Multinomial logistic regression and receiver operating characteristic (ROC) curves were used to study the associations between cardiovascular health scores and subclinical coronary atherosclerosis. RESULTS Odds ratios (ORs) for CCTA-stenosis and severe CCTA-stenosis between the lowest (<50 points) vs the highest (≥80 points) LE8 group were 4.18 (95% CI, 3.56 to 4.91) and 11.17 (95% CI, 8.36 to 14.93), respectively. For corresponding CAC results, ORs were 3.36 (95% CI, 2.84 to 3.98), 7.72 (95% CI, 6.03 to 9.89), and 14.94 (95% CI, 10.47 to 21.31) for CAC scores of 1 to 99, 100 to 399, and ≥400, respectively. Area under ROC curves for predicting any stenosis were 0.642 (95% CI, 0.635 to 0.649) and 0.631 (95% CI, 0.624 to 0.638, P<.001) for LE8 and LS7, respectively. CONCLUSION Our data indicate that LE8 showed a strong, graded, and inverse association with CCTA-stenosis and CAC score. The capacity to predict CCTA-stenosis was comparable between LE8 and LS7, although LE8 had slightly higher prediction capacity of any stenosis. This study provides novel evidence that the LE8 score may be a useful tool for monitoring cardiovascular health.
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Affiliation(s)
- Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, SE-10431, Stockholm, Sweden
| | - Maria B Syrjälä
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Lenander
- Department for Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
| | - Carl-Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Caminati A, Zompatori M, Fuccillo N, Sonaglioni A, Elia D, Cassandro R, Trevisan R, Rispoli A, Pelosi G, Harari S. Coronary artery calcium score is a prognostic factor for mortality in idiopathic pulmonary fibrosis. Minerva Med 2023; 114:815-824. [PMID: 35671002 DOI: 10.23736/s0026-4806.22.08018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular diseases are frequent in idiopathic pulmonary fibrosis (IPF) and impact on survival. We investigated the association of coronary artery calcium (CAC) score at IPF diagnosis and during mid-term follow-up, with adverse cardiovascular events and all-cause mortality. METHODS Consecutive patients with IPF were retrospectively analyzed. Demographic data, smoking history, comorbidities and pulmonary function tests (PFTs) were recorded. All patients had at least two chest high resolution computed tomography (HRCT) performed 2 years apart. The total CAC score and visual fibrotic score were calculated, and all clinically significant cardiovascular events and deaths were reported. RESULTS The population consisted of 79 patients (57 males, mean age: 74.4±7.6 years); 67% of patients had a history of smoking, 48% of hypertension, 37% of dyslipidemia and 22.8% of diabetes. The visual score was 21.28±7.99% at T0 and 26.54±9.34% at T1, respectively (T1-T0 5.26±6.13%, P<0.001). CAC score at T0 and at T1 was 537.93±839.94 and 759.98±1027.6, respectively (T1-T0 224.66±406.87, P<0.001). Mean follow-up time was 2.47±1.1 years. On multivariate analysis, male sex (HR=3.58, 95% CI: 1.14-11.2) and CAC score at T0 (HR=1.04, 95% CI: 1.01-1.07) correlated with mortality and cardiovascular events. CAC score at T0≥405 showed 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events. CONCLUSIONS IPF patients with a CAC score at diagnosis ≥405 have a poor prognosis over a mid-term follow-up. A higher CAC score is associated with mortality and cardiovascular events.
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Affiliation(s)
- Antonella Caminati
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy -
| | - Maurizio Zompatori
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
- DIMES Department, University of Bologna, Bologna, Italy
| | - Nicoletta Fuccillo
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | | | - Davide Elia
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberto Cassandro
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberta Trevisan
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Anna Rispoli
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Pelosi
- Intercompany Service of Pathological Anatomy, Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
| | - Sergio Harari
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ekblom-Bak E, Börjesson M, Ekblom Ö, Angerås O, Bergman F, Berntsson C, Carlhäll CJ, Engström G, Engvall J, Fagman E, Flinck A, Johansson P, Jujic A, Kero T, Lind L, Mannila M, Ostenfeld E, Persson A, Persson J, Persson M, Redfors B, Sandberg C, Wennberg P, Öhlin J, Östgren CJ, Jernberg T. Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis: cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study. BMJ Open 2023; 13:e073380. [PMID: 37996228 PMCID: PMC10668326 DOI: 10.1136/bmjopen-2023-073380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours. DESIGN Cross-sectional. SETTING Multisite study at university hospitals. PARTICIPANTS A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer. PRIMARY AND SECONDARY OUTCOMES Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound. RESULTS High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73). CONCLUSIONS MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.
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Affiliation(s)
- Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Mats Börjesson
- Center for Health and Performance, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Oskar Angerås
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Frida Bergman
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
| | - Caroline Berntsson
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Carl-Johan Carlhäll
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Agneta Flinck
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Peter Johansson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital Malmö, Malmo, Sweden
| | - Tanja Kero
- Medical Image Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences and Radiology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, University Hospital, Malmö, Sweden
| | - Björn Redfors
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umea, Sweden
| | - Patrik Wennberg
- Public Health and Clinical Medicine, Family Medicine, Umeå University, Umea, Sweden
| | - Jerry Öhlin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Sonaglioni A, Caminati A, Elia D, Trevisan R, Zompatori M, Grasso E, Lombardo M, Harari S. Comparison of clinical scoring to predict mortality risk in mild-to-moderate idiopathic pulmonary fibrosis. Minerva Med 2023; 114:608-619. [PMID: 37204783 DOI: 10.23736/s0026-4806.23.08585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND During the last decade, a number of clinical scores, such as Gender-Age-Physiology (GAP) Index, TORVAN Score and Charlson Comorbidity Index (CCI), have been separately used to measure comorbidity burden in idiopathic pulmonary fibrosis (IPF). However, no previous study compared the prognostic value of these scores to assess mortality risk stratification in IPF patients with mild-to-moderate disease. METHODS All consecutive patients with mild-to-moderate IPF who underwent high-resolution computed tomography, spirometry, transthoracic echocardiography and carotid ultrasonography at our Institution, between January 2016 and December 2018, were retrospectively analyzed. GAP Index, TORVAN Score and CCI were calculated in all patients. Primary endpoint was all-cause mortality, whereas secondary endpoint was the composite of all-cause mortality and rehospitalizations for all-causes, over medium-term follow-up. RESULTS Seventy IPF patients (70.2±7.4 yrs, 74.3% males) were examined. At baseline, GAP Index, TORVAN Score and CCI were 3.4±1.1, 14.7±4.1 and 5.3±2.4, respectively. A strong correlation between coronary artery calcification (CAC) and common carotid artery (CCA) intima-media thickness (IMT) (r=0.88), CCI and CAC (r=0.80), CCI and CCA-IMT (r=0.81), was demonstrated in the study group. Follow-up period was 3.5±1.2 years. During follow-up, 19 patients died and 32 rehospitalizations were detected. CCI (HR 2.39, 95% CI: 1.31-4.35) and heart rate (HR 1.10, 95% CI: 1.04-1.17) were independently associated with primary endpoint. CCI (HR 1.54, 95% CI: 1.15-2.06) predicted secondary endpoint, also. A CCI ≥6 was the optimal cut-off for predicting both outcomes. CONCLUSIONS Due to the increased atherosclerotic and comorbidity burden, IPF patients with CCI ≥6 at an early-stage disease have poor outcome over medium-term follow-up.
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Affiliation(s)
| | - Antonella Caminati
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy -
| | - Davide Elia
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
| | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Sergio Harari
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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10
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Sayols-Baixeras S, Dekkers KF, Baldanzi G, Jönsson D, Hammar U, Lin YT, Ahmad S, Nguyen D, Varotsis G, Pita S, Nielsen N, Eklund AC, Holm JB, Nielsen HB, Ericson U, Brunkwall L, Ottosson F, Larsson A, Ericson D, Klinge B, Nilsson PM, Malinovschi A, Lind L, Bergström G, Sundström J, Ärnlöv J, Engström G, Smith JG, Orho-Melander M, Fall T. Streptococcus Species Abundance in the Gut Is Linked to Subclinical Coronary Atherosclerosis in 8973 Participants From the SCAPIS Cohort. Circulation 2023; 148:459-472. [PMID: 37435755 PMCID: PMC10399955 DOI: 10.1161/circulationaha.123.063914] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Gut microbiota have been implicated in atherosclerotic disease, but their relation with subclinical coronary atherosclerosis is unclear. This study aimed to identify associations between the gut microbiome and computed tomography-based measures of coronary atherosclerosis and to explore relevant clinical correlates. METHODS We conducted a cross-sectional study of 8973 participants (50 to 65 years of age) without overt atherosclerotic disease from the population-based SCAPIS (Swedish Cardiopulmonary Bioimage Study). Coronary atherosclerosis was measured using coronary artery calcium score and coronary computed tomography angiography. Gut microbiota species abundance and functional potential were assessed with shotgun metagenomics sequencing of fecal samples, and associations with coronary atherosclerosis were evaluated with multivariable regression models adjusted for cardiovascular risk factors. Associated species were evaluated for association with inflammatory markers, metabolites, and corresponding species in saliva. RESULTS The mean age of the study sample was 57.4 years, and 53.7% were female. Coronary artery calcification was detected in 40.3%, and 5.4% had at least 1 stenosis with >50% occlusion. Sixty-four species were associated with coronary artery calcium score independent of cardiovascular risk factors, with the strongest associations observed for Streptococcus anginosus and Streptococcus oralis subsp oralis (P<1×10-5). Associations were largely similar across coronary computed tomography angiography-based measurements. Out of the 64 species, 19 species, including streptococci and other species commonly found in the oral cavity, were associated with high-sensitivity C-reactive protein plasma concentrations, and 16 with neutrophil counts. Gut microbial species that are commonly found in the oral cavity were negatively associated with plasma indole propionate and positively associated with plasma secondary bile acids and imidazole propionate. Five species, including 3 streptococci, correlated with the same species in saliva and were associated with worse dental health in the Malmö Offspring Dental Study. Microbial functional potential of dissimilatory nitrate reduction, anaerobic fatty acid β-oxidation, and amino acid degradation were associated with coronary artery calcium score. CONCLUSIONS This study provides evidence of an association of a gut microbiota composition characterized by increased abundance of Streptococcus spp and other species commonly found in the oral cavity with coronary atherosclerosis and systemic inflammation markers. Further longitudinal and experimental studies are warranted to explore the potential implications of a bacterial component in atherogenesis.
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Affiliation(s)
- Sergi Sayols-Baixeras
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
- CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (S.S.-B.)
| | - Koen F. Dekkers
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
| | - Gabriel Baldanzi
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
| | - Daniel Jönsson
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
- Public Dental Service of Skåne, Lund, Sweden (D.J.)
- Departments of Periodontology (D.J., B.K.), Faculty of Odontology, Malmö University, Sweden
| | - Ulf Hammar
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
| | - Yi-Ting Lin
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden (Y.-T.L., J.Ä.)
| | - Shafqat Ahmad
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
- Preventive Medicine Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA (S.A.)
| | - Diem Nguyen
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
| | - Georgios Varotsis
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
| | - Sara Pita
- Clinical Microbiomics A/S, Copenhagen, Denmark (S.P., N.N., A.C.E., J.B.H., H.B.N.)
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Lyngby, Denmark (S.P.)
| | - Nynne Nielsen
- Clinical Microbiomics A/S, Copenhagen, Denmark (S.P., N.N., A.C.E., J.B.H., H.B.N.)
| | - Aron C. Eklund
- Clinical Microbiomics A/S, Copenhagen, Denmark (S.P., N.N., A.C.E., J.B.H., H.B.N.)
| | - Jacob B. Holm
- Clinical Microbiomics A/S, Copenhagen, Denmark (S.P., N.N., A.C.E., J.B.H., H.B.N.)
| | - H. Bjørn Nielsen
- Clinical Microbiomics A/S, Copenhagen, Denmark (S.P., N.N., A.C.E., J.B.H., H.B.N.)
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
| | - Louise Brunkwall
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
- Clinical Studies Sweden, Forum Söder, Region Skåne, Lund, Sweden (L.B.)
| | - Filip Ottosson
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark (F.O.)
| | - Anna Larsson
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
| | - Dan Ericson
- Cariology (D.E.), Faculty of Odontology, Malmö University, Sweden
| | - Björn Klinge
- Departments of Periodontology (D.J., B.K.), Faculty of Odontology, Malmö University, Sweden
- Department of Dental Medicine, Karolinska Institutet, Solna, Sweden (B.K.)
| | - Peter M. Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (P.M.N.)
| | - Andrei Malinovschi
- Clinical Physiology (A.M.), Department of Medical Sciences, Uppsala University, Sweden
| | - Lars Lind
- Clinical Epidemiology (L.L., J.S.), Department of Medical Sciences, Uppsala University, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (G. Bergström)
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (G. Bergström)
| | - Johan Sundström
- Clinical Epidemiology (L.L., J.S.), Department of Medical Sciences, Uppsala University, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.)
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden (Y.-T.L., J.Ä.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
| | - J. Gustav Smith
- The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Sweden (J.G.S.)
| | - Marju Orho-Melander
- Department of Clinical Sciences in Malmö, Lund University, Sweden (D.J., U.E., L.B., F.O., A.L., P.M.N., G.E., M.O.-M.)
| | - Tove Fall
- Molecular Epidemiology and Science for Life Laboratory (S.S.-B., K.F.D., G. Baldanzi, U.H., Y.-T.L., S.A., D.N., G.V., T.F.), Department of Medical Sciences, Uppsala University, Sweden
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11
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van Velzen SGM, Dobrolinska MM, Knaapen P, van Herten RLM, Jukema R, Danad I, Slart RHJA, Greuter MJW, Išgum I. Automated cardiovascular risk categorization through AI-driven coronary calcium quantification in cardiac PET acquired attenuation correction CT. J Nucl Cardiol 2023; 30:955-969. [PMID: 35851642 PMCID: PMC10261233 DOI: 10.1007/s12350-022-03047-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND We present an automatic method for coronary artery calcium (CAC) quantification and cardiovascular risk categorization in CT attenuation correction (CTAC) scans acquired at rest and stress during cardiac PET/CT. The method segments CAC according to visual assessment rather than the commonly used CT-number threshold. METHODS The method decomposes an image containing CAC into a synthetic image without CAC and an image showing only CAC. Extensive evaluation was performed in a set of 98 patients, each having rest and stress CTAC scans and a dedicated calcium scoring CT (CSCT). Standard manual calcium scoring in CSCT provided the reference standard. RESULTS The interscan reproducibility of CAC quantification computed as average absolute relative differences between CTAC and CSCT scan pairs was 75% and 85% at rest and stress using the automatic method compared to 121% and 114% using clinical calcium scoring. Agreement between automatic risk assessment in CTAC and clinical risk categorization in CSCT resulted in linearly weighted kappa of 0.65 compared to 0.40 between CTAC and CSCT using clinically used calcium scoring. CONCLUSION The increased interscan reproducibility achieved by our method may allow routine cardiovascular risk assessment in CTAC, potentially relieving the need for dedicated CSCT.
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Affiliation(s)
- S G M van Velzen
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands.
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands.
| | - M M Dobrolinska
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - P Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R L M van Herten
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - R Jukema
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - I Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - M J W Greuter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - I Išgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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12
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Sonaglioni A, Caminati A, Re M, Elia D, Trevisan R, Granato A, Zompatori M, Lombardo M, Harari S. Prognostic role of CHA 2DS 2-VASc score for mortality risk assessment in non-advanced idiopathic pulmonary fibrosis: a preliminary observation. Intern Emerg Med 2023; 18:755-767. [PMID: 36966265 PMCID: PMC10039767 DOI: 10.1007/s11739-023-03219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 03/27/2023]
Abstract
During the last decade, the CHA2DS2-VASc score has been used for stratifying the mortality risk in both atrial fibrillation (AF) and non-AF patients. However, no previous study considered this score as a prognostic indicator in non-AF patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF). All consecutive non-AF patients with mild-to-moderate IPF, diagnosed between January 2016 and December 2018 at our Institution, entered this study. All patients underwent physical examination, blood tests, spirometry, high-resolution computed tomography and transthoracic echocardiography. CHA2DS2-VASc score, Gender-Age-Physiology (GAP) index and Charlson Comorbidity Index (CCI) were determined in all patients. Primary endpoint was all-cause mortality, while the secondary endpoint was the composite of all-cause mortality and rehospitalizations for all causes over mid-term follow-up. 103 consecutive IPF patients (70.7 ± 7.3 yrs, 79.6% males) were retrospectively analyzed. At the basal evaluation, CHA2DS2-VASc score, GAP index and CCI were 3.7 ± 1.6, 3.6 ± 1.2 and 5.5 ± 2.3, respectively. Mean follow-up was 3.5 ± 1.3 yrs. During the follow-up period, 29 patients died and 43 were re-hospitalized (44.2% due to cardiopulmonary causes). On multivariate Cox regression analysis, CHA2DS2-VASc score (HR 2.15, 95% CI 1.59-2.91) and left ventricular ejection fraction (LVEF) (HR 0.91, 95% CI 0.86-0.97) were independently associated with all-cause mortality in IPF patients. CHA2DS2-VASc score (HR 1.66, 95% CI 1.39-1.99) and LVEF (HR 0.94, 95% CI 0.90-0.98) also predicted the secondary endpoint in the same study group. CHA2DS2-VASc score > 4 was the optimal cut-off for predicting both outcomes. At mid-term follow-up, a CHA2DS2-VASc score > 4 predicts an increased risk of all-cause mortality and rehospitalizations for all causes in non-AF patients with mild-to-moderate IPF.
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Affiliation(s)
| | - Antonella Caminati
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy.
| | - Margherita Re
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
| | | | - Alberto Granato
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | | | | | - Sergio Harari
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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Lind L, Markstad H, Ahlström H, Angerås O, Brandberg J, Brunström M, Engström G, Engvall JE, Eriksson MJ, Eriksson M, Gottsäter A, Hagström E, Krachler B, Lampa E, Mannila M, Nilsson PM, Nyström FH, Persson A, Redfors B, Sandström A, Themudo R, Völz S, Ärnlöv J, Östgren CJ, Bergström G. Obesity is associated with coronary artery stenosis independently of metabolic risk factors: The population-based SCAPIS study. Atherosclerosis 2022; 362:1-10. [PMID: 36356325 DOI: 10.1016/j.atherosclerosis.2022.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Previous studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. METHODS In the SCAPIS study (50-65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. RESULTS The severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34-1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87-1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. CONCLUSIONS Individuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
| | - Hanna Markstad
- Center for Medical Imaging and Physiology, Skåne University Hospital Lund University, Lund, Sweden; Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Benno Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Heart and Vascular Theme, Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anette Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Raquel Themudo
- Radiology Department, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Assessing Agreement When Agreement Is Hard to Assess-The Agatston Score for Coronary Calcification. Diagnostics (Basel) 2022; 12:diagnostics12122993. [PMID: 36553000 PMCID: PMC9777110 DOI: 10.3390/diagnostics12122993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Method comparison studies comprised simple scatterplots of paired measurements, a 45-degree line as benchmark, and correlation coefficients up to the advent of Bland-Altman analysis in the 1980s. The Agatston score for coronary calcification is based on computed tomography of the heart, and it originated in 1990. A peculiarity of the Agatston score is the often-observed skewed distribution in screening populations. As the Agatston score has manifested itself in preventive cardiology, it is of interest to investigate how reproducibility of the Agatston score has been established. This review is based on literature findings indexed in MEDLINE/PubMed before 20 November 2021. Out of 503 identified articles, 49 papers were included in this review. Sample sizes were highly variable (10-9761), the main focus comprised intra- and interrater as well as intra- and interscanner variability assessments. Simple analysis tools such as scatterplots and correlation coefficients were successively supplemented by first difference, later Bland-Altman plots; however, only very few publications were capable of deriving Limits of Agreement that fit the observed data visually in a convincing way. Moreover, several attempts have been made in the recent past to improve the analysis and reporting of method comparison studies. These warrant increased attention in the future.
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15
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Bergström G, Persson M, Adiels M, Björnson E, Bonander C, Ahlström H, Alfredsson J, Angerås O, Berglund G, Blomberg A, Brandberg J, Börjesson M, Cederlund K, de Faire U, Duvernoy O, Ekblom Ö, Engström G, Engvall JE, Fagman E, Eriksson M, Erlinge D, Fagerberg B, Flinck A, Gonçalves I, Hagström E, Hjelmgren O, Lind L, Lindberg E, Lindqvist P, Ljungberg J, Magnusson M, Mannila M, Markstad H, Mohammad MA, Nystrom FH, Ostenfeld E, Persson A, Rosengren A, Sandström A, Själander A, Sköld MC, Sundström J, Swahn E, Söderberg S, Torén K, Östgren CJ, Jernberg T. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation 2021; 144:916-929. [PMID: 34543072 PMCID: PMC8448414 DOI: 10.1161/circulationaha.121.055340] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population. Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data. Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population. Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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Affiliation(s)
- Göran Bergström
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.,Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.,Departments of Internal Medicine (M.P.), Skåne University Hospital, Malmö, Sweden
| | - Martin Adiels
- Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden
| | - Elias Björnson
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden
| | - Carl Bonander
- Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden
| | - Håkan Ahlström
- Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden
| | - Joakim Alfredsson
- Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.,Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.,Cardiology (O.A.), Region Västra Götaland, Gothenburg, Sweden
| | - Göran Berglund
- Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.,Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden
| | - Mats Börjesson
- Institute of Medicine (M.B.), University of Gothenburg, Sweden.,Center for Health and Performance (M.B.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology (K.C.), Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (U.d.F.), Karolinska Institutet, Stockholm, Sweden
| | - Olov Duvernoy
- Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (Ö.E.)
| | - Gunnar Engström
- Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden
| | - Jan E Engvall
- Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.,Clinical Physiology (J.E.E.), Linköping University, Sweden.,CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.,Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden
| | - Mats Eriksson
- Department of Endocrinology, Metabolism & Diabetes and Clinical Research Center, Karolinska University Hospital Huddinge, Stockholm, Sweden (M.E.)
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.)
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden
| | - Agneta Flinck
- Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.,Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden
| | - Isabel Gonçalves
- Department of Clinical Sciences Malmö (I.G.), Lund University and Skåne University Hospital, Lund, Sweden
| | - Emil Hagström
- Cardiology (E.H.), Uppsala University, Sweden.,Department of Medical Sciences, and Uppsala Clinical Research Center (E.H.), Uppsala University, Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.,Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden
| | - Lars Lind
- Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden
| | - Eva Lindberg
- Respiratory, Allergy and Sleep Research (E.L.), Uppsala University, Sweden
| | - Per Lindqvist
- Department of Surgical and Perioperative Sciences (P.L.), Umeå University, Sweden
| | - Johan Ljungberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.,Cardiology (M. Magnusson), Skåne University Hospital, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Sweden (M. Magnusson).,North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa (M. Magnusson)
| | - Maria Mannila
- Heart and Vascular Theme, Department of Cardiology, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden (M. Mannila)
| | - Hanna Markstad
- Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö (H.M.), Lund University, Malmö, Sweden.,Center for Medical Imaging and Physiology (H.M.), Lund University and Skåne University Hospital, Lund, Sweden
| | - Moman A Mohammad
- Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.)
| | - Fredrik H Nystrom
- Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology (E.O.), Lund University and Skåne University Hospital, Lund, Sweden
| | - Anders Persson
- Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.,Radiology (A.P.), Linköping University, Sweden.,CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden
| | - Anette Sandström
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden
| | - Magnus C Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine (M.C.S.), Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden (M.C.S.)
| | - Johan Sundström
- Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.)
| | - Eva Swahn
- Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.,Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine/School of Public Health and Community Medicine (K.T.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden
| | - Carl Johan Östgren
- Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.,CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institutet, Stockholm, Sweden
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Ko E, Kang DY, Ahn JM, Kim TO, Kim JH, Lee J, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park SJ, Park DW. Association of aortic valvular complex calcification burden with procedural and long-term clinical outcomes after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2021; 23:1502-1510. [PMID: 34491331 DOI: 10.1093/ehjci/jeab180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study aimed to assess the impact of valvular/subvalvular calcium burden on procedural and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). METHODS AND RESULTS In this prospective observational cohort study, we included patients with AS undergoing TAVR between March 2010 and December 2019. Calcium burden at baseline was quantified using multidetector computed tomography and the patients were classified into tertile groups according to the amount of calcium. Procedural outcomes [paravalvular leakage (PVL) or permanent pacemaker insertion (PPI)] and 12-month clinical outcomes (composite of death, stroke, or rehospitalization, and all-cause mortality) were assessed. A total of 676 patients (age, 79.8 ± 5.4 years) were analysed. The 30-day rates of moderate or severe PVL (P-for-trend = 0.03) and PPI (P-for-trend = 0.002) proportionally increased with the tertile levels of calcium volume. The 12-month rate of primary composite outcomes was 34.2% in low-tertile, 23.9% in middle-tertile, and 25.8% in high-tertile groups (log-rank P = 0.02). After multivariable adjustment, the risk for primary composite outcomes at 12 months was not significantly different between the tertile groups of calcium volume [reference = low-tertile; middle-tertile, hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.54-1.22; P = 0.31; high-tertile, HR 0.93; 95% CI 0.56-1.57; P = 0.80]. A similar pattern was observed for all-cause mortality. CONCLUSION The rates of PVL and PPI proportionally increased according to the levels of valvular/subvalvular calcium volume, while the adjusted risks for composite outcomes and mortality at 12 months were not significantly different.
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Affiliation(s)
- Euihong Ko
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Tae Oh Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ju Hyeon Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Junghoon Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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17
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Johansen MC, Gottesman RF, Kral BG, Vaidya D, Yanek LR, Becker LC, Becker DM, Nyquist P. Association of Coronary Artery Atherosclerosis With Brain White Matter Hyperintensity. Stroke 2021; 52:2594-2600. [PMID: 34000829 DOI: 10.1161/strokeaha.120.032674] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Michelle C Johansen
- Department of Neurology (M.C.J., R.F.G., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- Department of Neurology (M.C.J., R.F.G., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian G Kral
- Department of Medicine, Division of Cardiology (B.G.K., L.C.B.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa R Yanek
- Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lewis C Becker
- Department of Medicine, Division of Cardiology (B.G.K., L.C.B.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane M Becker
- Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul Nyquist
- Department of Neurology (M.C.J., R.F.G., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Medicine, Division of General Internal Medicine, GeneSTAR Research Program (B.G.K., D.V., L.R.Y., L.C.B., D.M.B., P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
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Coronary artery calcium scoring at lower tube voltages - Dose determination and scoring mechanism. Eur J Radiol 2021; 139:109680. [PMID: 33848779 DOI: 10.1016/j.ejrad.2021.109680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Population dose has been a concern with coronary artery calcium scoring CT since it is performed in adults with borderline risk. Lower tube voltage acquisitions are appealing but there are no agreed schemes for reduced dose determination. Moreover, conventional scoring cannot be used without changing the multiple Agatston thresholds. METHODS By applying consistent calcium contrast-to-noise ratio to two anthropomorphic heart phantoms (medium and large) with 3-cm hydroxyapatite (HA) inserts, scanned using a dual-source CT, the relationship was derived between the volume CT dose index (CTDIvol) at lower tube voltages and the baseline CTDIvol at 120 kVp. The baseline CTDIvol was obtained using the noise thresholds from the images acquired at 120 kVp. To preserve the conventional Agatston thresholds, down-scaling with the found factors was applied to images acquired at lower voltages with a dynamic heart module and 1.2-5 mm inserts (50-400 mg/cc) on the coronary tracks. Scores were evaluated on the scaled images by six readers. RESULTS The CTDIvol at lower voltages was related to the baseline CTDIvol following a power form of the voltage (index 1.246), regardless of the phantom size. The baseline CTDIvol was 1.5 and 4.5 mGy, for the medium and large phantoms, respectively. Correspondingly, the reduced CTDIvol at 100-70 kVp were 1.28-0.76 mGy, and 3.57-2.32 mGy. The downscaling factors were 0.88-0.63. The calcium scores at lower voltages were found within 12 % of the ground-truths. CONCLUSION A vendor-independent approach was established to obtain the reduced dose and correct coronary calcium scores at lower tube voltages.
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de Vos BD, Wolterink JM, Leiner T, de Jong PA, Lessmann N, Isgum I. Direct Automatic Coronary Calcium Scoring in Cardiac and Chest CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2127-2138. [PMID: 30794169 DOI: 10.1109/tmi.2019.2899534] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiovascular disease (CVD) is the global leading cause of death. A strong risk factor for CVD events is the amount of coronary artery calcium (CAC). To meet the demands of the increasing interest in quantification of CAC, i.e., coronary calcium scoring, especially as an unrequested finding for screening and research, automatic methods have been proposed. The current automatic calcium scoring methods are relatively computationally expensive and only provide scores for one type of CT. To address this, we propose a computationally efficient method that employs two convolutional neural networks: the first performs registration to align the fields of view of input CTs and the second performs direct regression of the calcium score, thereby circumventing time-consuming intermediate CAC segmentation. Optional decision feedback provides insight into the regions that are contributed to the calcium score. Experiments were performed using 903 cardiac CT and 1687 chest CT scans. The method predicted calcium scores in less than 0.3 s. The intra-class correlation coefficient between predicted and manual calcium scores was 0.98 for both cardiac and chest CT. The method showed almost perfect agreement between automatic and manual CVD risk categorization in both the datasets, with a linearly weighted Cohen's kappa of 0.95 in cardiac CT and 0.93 in chest CT. Performance is similar to that of the state-of-the-art methods, but the proposed method is hundreds of times faster. By providing visual feedback, insight is given in the decision process, making it readily implementable in clinical and research settings.
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Sex Differences in Coronary Artery and Thoracic Aorta Calcification and Their Association With Cardiovascular Mortality in Heavy Smokers. JACC Cardiovasc Imaging 2019; 12:1808-1817. [DOI: 10.1016/j.jcmg.2018.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 11/15/2022]
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Lessmann N, van Ginneken B, Zreik M, de Jong PA, de Vos BD, Viergever MA, Isgum I. Automatic Calcium Scoring in Low-Dose Chest CT Using Deep Neural Networks With Dilated Convolutions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:615-625. [PMID: 29408789 DOI: 10.1109/tmi.2017.2769839] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Heavy smokers undergoing screening with low-dose chest CT are affected by cardiovascular disease as much as by lung cancer. Low-dose chest CT scans acquired in screening enable quantification of atherosclerotic calcifications and thus enable identification of subjects at increased cardiovascular risk. This paper presents a method for automatic detection of coronary artery, thoracic aorta, and cardiac valve calcifications in low-dose chest CT using two consecutive convolutional neural networks. The first network identifies and labels potential calcifications according to their anatomical location and the second network identifies true calcifications among the detected candidates. This method was trained and evaluated on a set of 1744 CT scans from the National Lung Screening Trial. To determine whether any reconstruction or only images reconstructed with soft tissue filters can be used for calcification detection, we evaluated the method on soft and medium/sharp filter reconstructions separately. On soft filter reconstructions, the method achieved F1 scores of 0.89, 0.89, 0.67, and 0.55 for coronary artery, thoracic aorta, aortic valve, and mitral valve calcifications, respectively. On sharp filter reconstructions, the F1 scores were 0.84, 0.81, 0.64, and 0.66, respectively. Linearly weighted kappa coefficients for risk category assignment based on per subject coronary artery calcium were 0.91 and 0.90 for soft and sharp filter reconstructions, respectively. These results demonstrate that the presented method enables reliable automatic cardiovascular risk assessment in all low-dose chest CT scans acquired for lung cancer screening.
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Splendiani G, Morosetti M, Manni M, Jankovic L, Naticchia A, Sturniolo A, Tullio T, Balducci A, Coen G. Cardiac Calcium Evaluation in Hemodialysis Patients with Multisection Spiral Computed Tomography. Int J Artif Organs 2018; 27:759-65. [PMID: 15521215 DOI: 10.1177/039139880402700905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim The aim of this study is cardiac calcium content evaluation in hemodialysis patients by a new technique, based on ultrafast multisection CT (MTC). Methods The study was carried out on 30 HD patients, 14F and 16 M, average age 57.7±13.9 years, average HD age 57.3±47.4 months. The intact PTH levels were 625.4±571 pg/mL. Serum calcium, phosphate and CaxP product were 9.75±0.84 mg/mL, 6.21±1.01 mg/dL and 60.2±10.7 mg2/dL2, respectively. Results The values obtained with the MTC technique were reported in terms of Agatson scores. Score values frankly in the pathologic range (>100) were found in 24 patients (80%). Correlation analysis has shown positive and significant correlation coefficients of the score with patients’ age (p=0.003), serum calcium (p=0.012), CaxP (p=0.015), iPTH (=0.049), and borderline, to HD age (p=0.06). Conclusion Risk factors for cardiac calcification are mainly age, degree of hyperparathyroidism, increased CaxP and serum calcium levels. A control of calcium phosphate parameters in hemodialysis patients seems to be mandatory to avoid increased severity of coronary artery disease.
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Affiliation(s)
- G Splendiani
- Department of Nephrology and Dialysis Service, University Hospital Tor Vergata Rome, Italy.
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Vonder M, Pelgrim GJ, Huijsse SEM, Haubenreisser H, Meyer M, van Ooijen PMA, Oudkerk M, Henzler T, Vliegenthart R. Coronary artery calcium quantification on first, second and third generation dual source CT: A comparison study. J Cardiovasc Comput Tomogr 2017; 11:444-448. [PMID: 28943454 DOI: 10.1016/j.jcct.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/09/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Differences in coronary artery calcium (CAC) quantification of successive CT systems of one vendor could impact results of CAC screening and progression studies. The purpose of this study is to compare CAC quantification between three generations of dual-source computed tomography (DSCT) systems. METHODS Three DSCT generations were used to repeatedly scan an anthropomorphic chest phantom and three inserts. The first and second insert contained 100 small and nine large calcifications, respectively, to determine detectability, and the Agatston and (calibrated) mass score, respectively. A third insert containing a moving artificial coronary artery was used to determine impact of movement on calcium scoring. Data were acquired at 120 kVp, 90 reference mAs with prospective electrocardiographic(ECG)-gating at sequential and high-pitch spiral mode, for respectively first and second/third generation DSCT. Differences and variability in detectability and calcium scores were analyzed. RESULTS Although noise levels differed (p=<0.002), no differences in detectability were found between the three DSCT generations; median (range) for first, second and third generation were 11 (8), 11 (4) and 12 (2) out of 100 calcifications (p > 0.272). Between second and third generation no difference was found in Agatston score for the large calcification phantom (p > 0.05). The intra-scanner variability and inter-scanner median relative difference ranged for Agatston score from 2.1 to 8.3% and 0.5-12.7% and for mass score from 1.4% to 4.4% and 0.7-5.6%. Overall, intra-scanner variability was lowest for third generation DSCT. CONCLUSION The three DSCT generations have similar detectability of calcifications. Median Agatston and mass score differed by no more than 12.7% and 5.6%.
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Affiliation(s)
- Marleen Vonder
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Gert Jan Pelgrim
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Sèvrin E M Huijsse
- University Medical Center Groningen, Dept. of Radiology, Groningen, The Netherlands.
| | | | - Mathias Meyer
- University Medical Center Mannheim, Dept. of Radiology, Mannheim, Germany.
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; University Medical Center Groningen, Dept. of Radiology, Groningen, The Netherlands.
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Thomas Henzler
- University Medical Center Mannheim, Dept. of Radiology, Mannheim, Germany.
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; University Medical Center Groningen, Dept. of Radiology, Groningen, The Netherlands.
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Hansson NC, Nørgaard BL, Barbanti M, Nielsen NE, Yang TH, Tamburino C, Dvir D, Jilaihawi H, Blanke P, Makkar RR, Latib A, Colombo A, Tarantini G, Raju R, Wood D, Andersen HR, Ribeiro HB, Kapadia S, Min J, Feuchtner G, Gurvitch R, Alqoofi F, Pelletier M, Ussia GP, Napodano M, Sandoli de Brito F, Kodali S, Pache G, Canovas SJ, Berger A, Murphy D, Svensson LG, Rodés-Cabau J, Leon MB, Webb JG, Leipsic J. The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2015; 9:382-92. [DOI: 10.1016/j.jcct.2015.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/24/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
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Ohmoto-Sekine Y, Yanagibori R, Amakawa K, Ishihara M, Tsuji H, Ogawa K, Ishimura R, Ishiwata S, Ohno M, Yamaguchi T, Arase Y. Prevalence and distribution of coronary calcium in asymptomatic Japanese subjects in lung cancer screening computed tomography. J Cardiol 2015. [PMID: 26213250 DOI: 10.1016/j.jjcc.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) is associated with a risk of coronary heart disease. The prevalence and distribution of the CAC score have been examined in Western countries, but few studies have been performed in Asia, and especially in Japan. The goal of this study was to investigate CAC scores in an asymptomatic Japanese population. METHODS CAC score and risk factors were analyzed in 1834 asymptomatic subjects who underwent lung cancer screening computed tomography. RESULTS CAC was present in 26.9% of all the subjects, 29.8% of the males, and 17.1% of the females. In all age groups, the CAC score was higher in males. In multivariate analysis, male gender [odds ratio (OR) 2.461, 95% confidence interval (CI) 1.361-4.452, p=0.002], aging (OR 1.102, 95% CI 1.081-1.123, p<0.001), dyslipidemia (OR 1.740, 95% CI 1.216-2.490, p=0.002), and fasting glucose (OR 1.008, 95% CI 1.002-1.015, p=0.012) were significantly associated with a CAC score >100. CONCLUSION The results of this study provide a pattern of CAC distribution based on age and gender in asymptomatic Japanese subjects. This pattern was similar to that in Western countries, although the absolute CAC scores were lower. High CAC scores were associated with male gender, aging, dyslipidemia, and fasting glucose.
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Affiliation(s)
| | - Ryoko Yanagibori
- Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | | | | | - Hiroshi Tsuji
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Kyoko Ogawa
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | | | | | - Minoru Ohno
- Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | | | - Yasuji Arase
- Health Management Center, Toranomon Hospital, Tokyo, Japan
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Watanabe Y, Lefèvre T, Bouvier E, Arai T, Hayashida K, Chevalier B, Romano M, Hovasse T, Garot P, Donzeau-Gouge P, Farge A, Cormier B, Morice MC. Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation. Catheter Cardiovasc Interv 2015; 86:1105-13. [DOI: 10.1002/ccd.25986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/03/2015] [Accepted: 04/06/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Yusuke Watanabe
- Division of Cardiology; Department of Internal Medicine; Teikyo University School of Medicine; Tokyo Japan
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Thierry Lefèvre
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Erik Bouvier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Takahide Arai
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Kentaro Hayashida
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Bernard Chevalier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Mauro Romano
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Thomas Hovasse
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Philippe Garot
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Patrick Donzeau-Gouge
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Arnaud Farge
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Bertrand Cormier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
| | - Marie-Claude Morice
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Orsay France
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Radiation dose reduction at coronary artery calcium scoring by using a low tube current technique and hybrid iterative reconstruction. J Comput Assist Tomogr 2015; 39:119-24. [PMID: 25319604 DOI: 10.1097/rct.0000000000000168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the accuracy of coronary artery calcium scoring (CACS) on cardiac computed tomographic images using hybrid iterative reconstruction (hIR) and a low tube current as well as on images acquired with a filtered back projection (FBP) algorithm and a normal tube current. SUBJECTS AND METHODS Patients (N = 77) with suspected coronary artery disease were subjected to 2 CACS evaluations based on their Agatston, volume, and mass scores. One CACS evaluation was performed on images obtained with a 364-mA tube current and reconstructed with FBP; the other was performed on images obtained with a 73-mA tube current and reconstructed with hIR at iDose4. All scans were performed with the prospective electrocardiogram-triggered method using a 256-slice computed tomographic scanner (Brilliance iCT; Philips). We assessed agreement between calcium scores obtained with FBP and with IR using the percentage difference and Bland-Altman analysis. RESULTS The effective radiation doses for CACS at 80 mA s with FBP and at 16 mA s with IR were 1.20 and 0.24 mSv, respectively (k = 0.014). The mean Agatston, volume, and mass scores at 80 mA s with FBP as well as at 16 mA s with IR were 390.7, 146.5, and 63.2 as well as 377.7, 142.5, and 62.2, respectively. The percentage difference between FBP and hIR for the Agatston, volume, and mass score was 20.7%, 20.7%, and 27.1%, respectively. Bland-Altman analysis showed that there was no systemic bias. CONCLUSIONS The radiation dose for CACS can be reduced at a low tube current and hIR without affecting the calcium score.
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The association of brachial artery diameter with noncalcified coronary plaque burden in apparently healthy individuals. Coron Artery Dis 2014; 24:657-62. [PMID: 24077324 DOI: 10.1097/mca.0000000000000034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Coronary atherosclerosis has been associated with systemic arterial remodeling even in nonatherosclerotic vessels. However, it is not known whether systemic remodeling is differentially associated with the cumulative atherosclerotic process, reflected by putatively quiescent calcified plaque (CP), or with active atherosclerosis, consisting of noncalcified plaque (NCP). We thus examined the association of brachial artery diameter (BAD), an artery that does not suffer clinical atherosclerosis, with the presence and the extent of coronary CP and NCP. METHODS We studied 688 apparently healthy, asymptomatic participants from 350 families with a history of early-onset coronary artery disease (<60 years of age) by measuring coronary artery disease risk factors and coronary plaque using dual-source computed tomographic angiography. Plaque volumes were quantified using a validated automated method. BAD was measured during diastole using B-mode ultrasound. The association of resting BAD with any detectable plaque, and log-transformed CP and NCP volumes if detectable, was tested using generalized estimating equations adjusted for age, sex, race, current smoking, diabetes, hypertension, BMI, and non-HDL and HDL cholesterol. RESULTS Higher quintiles of BAD were associated with greater age and male sex (both P<0.001). In the fully adjusted analysis, CP volume was not associated with BAD (P=0.65) but a 1 ml greater NCP volume was associated with a 0.65 mm larger BAD (P=0.027). CONCLUSION Our results suggest that systemic arterial remodeling of nonatherosclerotic arteries is a dynamic process that is correlated with the extent of putatively active atherosclerotic processes in distant beds but not with inactive accumulated plaque burden.
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Arcadi T, Maffei E, Sverzellati N, Mantini C, Guaricci AI, Tedeschi C, Martini C, Grutta LL, Cademartiri F. Coronary artery calcium score on low-dose computed tomography for lung cancer screening. World J Radiol 2014; 6:381-387. [PMID: 24976939 PMCID: PMC4072823 DOI: 10.4329/wjr.v6.i6.381] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/09/2014] [Accepted: 05/08/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the feasibility of coronary artery calcium score (CACS) on low-dose non-gated chest CT (ngCCT).
METHODS: Sixty consecutive individuals (30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed tomography (gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner (Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores (Volume, Mass, Agatston) as previously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered significant.
RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT (Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high (Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2 (33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1 (33%) showed an Agatston score of 0 in the ngCCT. Overall, 23 (38%) patients were reclassified in a different cardiovascular risk category, mostly (18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT (DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).
CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.
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Dose reduction for coronary calcium scoring with hybrid and model-based iterative reconstruction: an ex vivo study. Int J Cardiovasc Imaging 2014; 30:1125-33. [DOI: 10.1007/s10554-014-0434-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/26/2014] [Indexed: 11/25/2022]
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Xie X, Greuter MJW, Groen JM, de Bock GH, Oudkerk M, de Jong PA, Vliegenthart R. Can nontriggered thoracic CT be used for coronary artery calcium scoring? A phantom study. Med Phys 2014; 40:081915. [PMID: 23927329 DOI: 10.1118/1.4813904] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Coronary artery calcium score, traditionally based on electrocardiography (ECG)-triggered computed tomography (CT), predicts cardiovascular risk. However, nontriggered CT is extensively utilized. The study-purpose is to evaluate the in vitro agreement in coronary calcium score between nontriggered thoracic CT and ECG-triggered cardiac CT. METHODS Three artificial coronary arteries containing calcifications of different densities (high, medium, and low), and sizes (large, medium, and small), were studied in a moving cardiac phantom. Two 64-detector CT systems were used. The phantom moved at 0-90 mm∕s in nontriggered low-dose CT as index test, and at 0-30 mm∕s in ECG-triggered CT as reference. Differences in calcium scores between nontriggered and ECG-triggered CT were analyzed by t-test and 95% confidence interval. The sensitivity to detect calcification was calculated as the percentage of positive calcium scores. RESULTS Overall, calcium scores in nontriggered CT were not significantly different to those in ECG-triggered CT (p>0.05). Calcium scores in nontriggered CT were within the 95% confidence interval of calcium scores in ECG-triggered CT, except predominantly at higher velocities (≥50 mm∕s) for the high-density and large-size calcifications. The sensitivity for a nonzero calcium score was 100% for large calcifications, but 46%±11% for small calcifications in nontriggered CT. CONCLUSIONS When performing multiple measurements, good agreement in positive calcium scores is found between nontriggered thoracic and ECG-triggered cardiac CT. Agreement decreases with increasing coronary velocity. From this phantom study, it can be concluded that a high calcium score can be detected by nontriggered CT, and thus, that nontriggered CT likely can identify individuals at high risk of cardiovascular disease. On the other hand, a zero calcium score in nontriggered CT does not reliably exclude coronary calcification.
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Affiliation(s)
- Xueqian Xie
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
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Kral BG, Becker LC, Vaidya D, Yanek LR, Qayyum R, Zimmerman SL, Dey D, Berman DS, Moy TF, Fishman EK, Becker DM. Noncalcified coronary plaque volumes in healthy people with a family history of early onset coronary artery disease. Circ Cardiovasc Imaging 2014; 7:446-53. [PMID: 24577355 DOI: 10.1161/circimaging.113.000980] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although age and sex distributions of calcified coronary plaque have been well described in the general population, noncalcified plaque (NCP) distributions remain unknown. This is important because NCP is a putative precursor for clinical coronary artery disease and could serve as a sentinel for aggressive primary prevention, especially in high-risk populations. We examined the distributions of NCP and calcified coronary plaque in healthy 30- to 74-year-old individuals from families with early onset coronary artery disease. METHODS AND RESULTS Participants in the GeneSTAR family study (N=805), mean age 51.1±10.8 years, 56% women, were screened for coronary artery disease risk factors and coronary plaque using dual-source computed tomographic angiography. Plaque volumes (mm(3)) were quantified using a validated automated method. The prevalence of coronary plaque was 57.8% in men and 35.8% in women (P<0.0001). NCP volume increased with age (P<0.001) and was higher in men than women (P<0.001). Although NCP, as a percentage of total plaque, was inversely related to age (P<0.01), NCP accounted for most of the total plaque volume at all ages, especially in men and women <55 years (>70% and >80%, respectively). Higher Framingham risk was associated with the number of affected vessels (P<0.01), but 44% of men and 20.8% of women considered intermediate risk had left main and 3-vessel disease involvement. CONCLUSIONS The majority of coronary plaque was noncalcified, particularly in younger individuals. These findings support the importance of assessing family history and suggest that early primary prevention interventions may be warranted at younger ages in families with early onset coronary artery disease.
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Affiliation(s)
- Brian G Kral
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Lewis C Becker
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Dhananjay Vaidya
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lisa R Yanek
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rehan Qayyum
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stefan L Zimmerman
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Damini Dey
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Taryn F Moy
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elliot K Fishman
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Diane M Becker
- From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
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Aslam A, Khokhar US, Chaudhry A, Abramowicz A, Rajper N, Cortegiano M, Poon M, Voros S. Assessment of isotropic calcium using 0.5-mm reconstructions from 320-row CT data sets identifies more patients with non-zero Agatston score and more subclinical atherosclerosis than standard 3.0-mm coronary artery calcium scan and CT angiography. J Cardiovasc Comput Tomogr 2014; 8:58-66. [DOI: 10.1016/j.jcct.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/03/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Vessel specific coronary artery calcium scoring: an automatic system. Acad Radiol 2013; 20:1-9. [PMID: 22981481 DOI: 10.1016/j.acra.2012.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/12/2012] [Accepted: 07/25/2012] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to automatically detect and quantify calcium lesions for the whole heart as well as per coronary artery on non-contrast-enhanced cardiac computed tomographic images. MATERIALS AND METHODS Imaging data from 366 patients were randomly selected from patients who underwent computed tomographic calcium scoring assessments between July 2004 and May 2009 at Erasmum MC, Rotterdam. These data included data sets with 1.5-mm and 3.0-mm slice spacing reconstructions and were acquired using four different scanners. The scores of manual observers, who annotated the data using commercially available software, served as ground truth. An automatic method for detecting and quantifying calcifications for each of the four main coronary arteries and the whole heart was trained on 209 data sets and tested on 157 data sets. Statistical testing included determining Pearson's correlation coefficients and Bland-Altman analysis to compare performance between the system and ground truth. Wilcoxon's signed-rank test was used to compare the interobserver variability to the system's performance. RESULTS Automatic detection of calcified objects was achieved with sensitivity of 81.2% per calcified object in the 1.5-mm data set and sensitivity of 86.6% per calcified object in the 3.0-mm data set. The system made an average of 2.5 errors per patient in the 1.5-mm data set and 2.2 errors in the 3.0-mm data set. Pearson's correlation coefficients of 0.97 (P < .001) for both 1.5-mm and 3.0-mm scans with respect to the calcium volume score of the whole heart were found. The average R values over Agatston, mass, and volume scores for each of the arteries (left circumflex coronary artery, right coronary artery, and left main and left anterior descending coronary arteries) were 0.93, 0.96, and 0.99, respectively, for the 1.5-mm scans. Similarly, for 3.0-mm scans, R values were 0.94, 0.94, and 0.99, respectively. Risk category assignment was correct in 95% and 89% of the data sets in the 1.5-mm and 3-mm scans. CONCLUSIONS An automatic vessel-specific coronary artery calcium scoring system was developed, and its feasibility for calcium scoring in individual vessels and risk category classification has been demonstrated.
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Comparison of calcium scoring with 4-multidetector computed tomography (4-MDCT) and 64-MDCT: a phantom study. J Comput Assist Tomogr 2012; 36:88-93. [PMID: 22261776 DOI: 10.1097/rct.0b013e31823d796c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine differences in coronary artery calcium (CAC) measurement performed with the use of 2 generations of multidetector computed tomography (CT) scanners of the same manufacturer. METHODS Agatston Score (AS) and calcium mass (CM) were measured with a 4-row scanner (AS4 and CM4) and a 64-row scanner (AS64 and CM64) using a cardiac phantom with calcium inserts. RESULTS The results of the AS measurements (mean ± SD) varied significantly between the equipment: 880.6 ± 30.1 (AS4) vs 586.5 ± 24.0 (AS64; P < 0.0001). The AS interscanner variability was 31.6% for the phantom and from 25.5% to 110.1% for particular inserts. Mean ± SD CM values were different as well: 192.8 ± 5.0 mg (CM4) vs 152.4 ± 2.6 mg (CM64; P < 0.0001). Determination of CM with 64-row CT was more accurate than that with an older scanner; the mean relative error was -9.1% and 15.0%, respectively (P < 0.0001). The CM interscanner variability was 23.3% for the phantom and from 19.0% to 122.8% for particular inserts. The interexamination variability ranged from 1.7% (CM64) to 5.6% (AS4). CONCLUSIONS Coronary artery calcium scoring with the 64-row CT scanner is more accurate than with the 4-row device The difference between the results of AS and CM measurements carried out with both scanners is statistically significant.
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Schultz C, Rossi A, van Mieghem N, van der Boon R, Papadopoulou SL, van Domburg R, Moelker A, Mollet N, Krestin G, van Geuns RJ, Nieman K, de Feyter P, Serruys PW, de Jaegere P. Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis. EUROINTERVENTION 2012; 7:564-72. [PMID: 21930460 DOI: 10.4244/eijv7i5a92] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We compared the measurement of aortic leaflet calcification on contrast and non-contrast MSCT and investigated predictors of the need for balloon post-dilatation after TAVI. METHODS AND RESULTS In 110 patients, who had TAVI with a Medtronic CoreValve prosthesis (MCS) for symptomatic aortic stenosis, calcification of the aortic root was measured on non-contrast MSCT (conventionally) and on contrast MSCT (signal attenuation >450 Houndsfield units). Calcium volume was underestimated on contrast- when compared to non-contrast MSCT: median (IQ-range)=759 (466 to 1295) vs. 2016 (1376 to 3262) and the difference between the two methods increased with higher calcium volumes (correlation coefficient r=0.90). Calcium mass was only slightly underestimated on contrast vs. non-contrast MSCT: median (IQ-range)=441 (268 to 809) vs. 555 (341 to 950) and there was no association between the differences and increasing calcium mass (r=0.17). Balloon post-dilatation was performed for significant aortic regurgitation after TAVI in 11 of 110 patients. When compared to controls, the patients who required balloon post-dilatation had higher aortic leaflet calcium on contrast CT (p<0.01), higher aortic annulus diameters (p<0.01) and higher annulus to prosthesis area ratio (p=0.01). ROC curves demonstrated that aortic root or aortic leaflet calcium measured on either contrast- or non-contrast MSCT showed excellent discrimination for the requirement of balloon post-dilatation (area under ROC >0.80 for all), whereas the discriminatory value of aortic annulus dimensions was moderate (area under ROC=0.69) and that of prosthesis to annulus ratio was poor (area under ROC=0.36). CONCLUSIONS Dense aortic leaflet calcification measured on contrast MSCT discerned well the need for balloon post-dilatation after TAVI with an MCS for significant PAR. Non-contrast MSCT may no longer be needed to quantify aortic root calcium before TAVI.
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Affiliation(s)
- Carl Schultz
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation. Am J Cardiol 2011; 108:1470-7. [PMID: 21855831 DOI: 10.1016/j.amjcard.2011.07.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 01/18/2023]
Abstract
Location of aortic valve calcium (AVC) can be better visualized on contrast-enhanced multidetector row computed tomography. The present evaluation examined whether AVC severity and its location could influence paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation. A total of 79 patients (age 80 ± 7 years, 49% men) with preprocedural multidetector row computed tomography were included. Volumetric AVC quantification and its location were assessed. Transesophageal echocardiography was performed to assess the presence and site of AR after transcatheter aortic valve implantation. Receiver operating characteristic curves were generated to evaluate the usefulness of AVC in determining paravalvular AR at a specific site. Postprocedural AR of grade 1 or more was observed in 63 patients. In most patients (n = 56, 71%), AR was of paravalvular origin. Calcium at the aortic wall of each valve cusp had the largest area under the curve (0.93, p <0.001) in predicting paravalvular AR at the aortic wall site compared to calcium at the valvular edge or body (area under the curve 0.58 and 0.67, respectively). Calcium at the valvular commissure was better than calcium at the valvular edge (area under the curve 0.94 vs 0.71) in predicting paravavular AR originating from the corresponding commissure. In conclusion, contrast-enhanced multidetector row computed tomography can be performed to quantify AVC. Both AVC severity and its exact location are important in determining paravalvular AR after transcatheter aortic valve implantation.
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Tanabe K, Kishi S, Aoki J, Tanimoto S, Onuma Y, Yachi S, Taniwaki M, Nakajima Y, Nakajima H, Hara K, Isobe M. Impact of coronary calcium on outcome following sirolimus-eluting stent implantation. Am J Cardiol 2011; 108:514-7. [PMID: 21624546 DOI: 10.1016/j.amjcard.2011.03.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
There remain a small but sizable number of patients who develop restenosis after sirolimus-eluting stent (SES) implantation. However, the cause of SES restenosis has not been fully elucidated. The study population consisted of 52 patients with 69 lesions who underwent noninvasive coronary imaging by 64-slice multidetector computed tomography before SES deployment. Agatston calcium scores in target lesions were measured. All patients underwent follow-up coronary angiography at 8 months. Three coronary segments (in stent, proximal edge, and distal edge) were analyzed by quantitative coronary angiography. Agatston calcium score in target lesions averaged 214.7. Late lumen losses in the proximal edge, stent, and distal edge were 0.16 ± 0.45, 0.47 ± 0.58, and 0.07 ± 0.29 mm, respectively. Lesions with restenosis at follow-up showed a trend to produce higher preprocedural calcium scores (629) compared to those without restenosis (153, p = 0.08). There was a significant positive correlation between lesion calcium score and in-stent late lumen loss (r = 0.47, p <0.01). In conclusion, assessment of coronary calcium by multidetector computed tomography might be useful to predict outcomes after SES implantation.
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Hacker M, Becker C. The incremental value of coronary artery calcium scores to myocardial single photon emission computer tomography in risk assessment. J Nucl Cardiol 2011; 18:700-11; quiz 712-6. [PMID: 21567284 DOI: 10.1007/s12350-011-9384-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Marcus Hacker
- Department of Nuclear Medicine, University of Munich, Ziemssenstr.1, 80336, Munich, Germany.
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Ghadri JR, Goetti R, Fiechter M, Pazhenkottil AP, Küest SM, Nkoulou RN, Windler C, Buechel RR, Herzog BA, Gaemperli O, Templin C, Kaufmann PA. Inter-scan variability of coronary artery calcium scoring assessed on 64-multidetector computed tomography vs. dual-source computed tomography: a head-to-head comparison. Eur Heart J 2011; 32:1865-74. [PMID: 21546450 DOI: 10.1093/eurheartj/ehr157] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Coronary artery calcium (CAC) scoring has emerged as a tool for risk stratification and potentially for monitoring response to risk factor modification. Therefore, repeat measurements should provide robust results and low inter-scanner variability for allowing meaningful comparison. The purpose of this study was to investigate inter-scanner variability of CAC for Agatston, volume, and mass scores by head-to-head comparison using two different cardiac computed tomography scanners: 64-detector multislice CT (MSCT) and 64-slice dual-source CT (DSCT). METHODS AND RESULTS Thirty patients underwent CAC measurements on both 64-MSCT (GE LightSpeed XT scanner: 120 kV, 70 mAs, 2.5 mm slices) and 64-DSCT (Siemens Somatom Definition: 120 kV, 80 mAs, 3 mm slices) within <100 days (0-97). Retrospective intra-scan comparison revealed an excellent correlation. The excellent intra-scan (inter-observer) agreement was documented by narrow limits of agreement and a correlation coefficient of variation (COV) of r ≥ 0.99 (P < 0.001) for all CAC scores with a low COV for both scanners (64-MSCT/64-DSCT), i.e. Agatston (2.0/2.1%), mass (3.0/2.0%), and volume (4.7/3.9%). Inter-scanner comparison revealed larger Bland-Altman (BA) limits of agreement, despite high correlation (r ≥ 0.97) for all scores, with COV at 15.1, 21.6, and 44.9% for Agatston, mass, and volume scores. The largest BA limits were observed for volume scores (-1552.8 to 574.2), which was massively improved (-241.0 to 300.4, COV 11.5%) after reanalysing the 64-DSCT scans (Siemens) with GE software/workstation (while Siemens software/workstation does not allow cross-vendor analysis). Phantom measurements confirmed overestimation of volume scores by 'syngo Ca-Scoring' (Siemens) software which should therefore be reviewed (vendor has been notified). CONCLUSION Intra- and inter-scan agreement of CAC measurement in a given data set is excellent. Inter-scanner variability is reasonable, particularly for Agatston units in the clinically most relevant range <1000. The use of different software solutions has a greater influence particularly on volume scores than the use of different scanner types.
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Affiliation(s)
- Jelena R Ghadri
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 32, CH-8091 Zurich, Switzerland
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Abstract
Arterial calcifications as found with various imaging techniques, like plain X-ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP-2], RANKL) and inhibitory (matrix Gla protein, BMP-7, osteoprotegerin, fetuin-A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk.
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Affiliation(s)
- Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
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Rutten A, Isgum I, Prokop M. Calcium scoring with prospectively ECG-triggered CT: using overlapping datasets generated with MPR decreases inter-scan variability. Eur J Radiol 2010; 80:83-8. [PMID: 20599336 DOI: 10.1016/j.ejrad.2010.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the feasibility of reducing the inter-scan variability of prospectively ECG-triggered calcium-scoring scans by using overlapping 3-mm datasets generated from multiplanar reformation (MPR) instead of non-overlapping 3-mm or 1.5-mm datasets. PATIENTS AND METHODS Seventy-five women (59-79 years old) underwent two sequential prospectively ECG-triggered calcium-scoring scans with 16 mm×1.5mm collimation in one session. Between the two scans patients got off and on the table. We performed calcium scoring (Agatston and mass scores) on the following datasets: contiguous 3-mm sections reconstructed from the raw data (A), contiguous 3-mm sections from MPR (B), overlapping 3-mm sections from MPR (C) and contiguous 1.5-mm sections from the raw data (D). To determine the feasibility of the MPR approach, we compared MPR (B) with direct raw data reconstruction (A). Inter-scan variability was calculated for each type of dataset (A-D). RESULTS Calcium scores ranged from 0 to 1455 (Agatston) and 0 to 279 mg (mass) for overlapping 3-mm sections (C). Calcium scores (both Agatston and mass) were nearly identical for MPR (B) and raw data approaches (A), with inter-quartile ranges of 0-1% for inter-scan variability. Median inter-scan variability with contiguous 3-mm sections (B) was 13% (Agatston) and 11% (mass). Median variability was reduced to 10% (Agatston and mass) with contiguous 1.5-mm sections (D) and to 8% (Agatston) and 7% (mass) with overlapping 3-mm MPR (A). CONCLUSION Calcium scoring on MPR yields nearly identical results to calcium scoring on images directly reconstructed from raw data. Overlapping MPR from prospectively ECG-triggered scans improve inter-scan variability of calcium scoring without increasing patient radiation dose.
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Affiliation(s)
- A Rutten
- Department of Radiology, Room E01.132, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Išgum I, Rutten A, Prokop M, Staring M, Klein S, Pluim JPW, Viergever MA, van Ginneken B. Automated aortic calcium scoring on low-dose chest computed tomography. Med Phys 2010; 37:714-23. [DOI: 10.1118/1.3284211] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Coronary artery calcium quantification with non-ECG-gated low-dose CT of the chest. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bastarrika G, Alonso A, Saiz-Mendiguren R, Arias J, Cosín O. Cuantificación de la calcificación coronaria en tomografía computarizada torácica de baja dosis de radiación sin sincronización cardiaca. RADIOLOGIA 2010; 52:30-6. [DOI: 10.1016/j.rx.2009.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 09/23/2009] [Accepted: 09/27/2009] [Indexed: 11/26/2022]
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Horiguchi J, Matsuura N, Yamamoto H, Kitagawa T, Sato K, Kihara Y, Ito K. Evaluation of attenuation-based tube current control in coronary artery calcium scoring on prospective ECG-triggered 64-detector CT. Acad Radiol 2009; 16:1231-40. [PMID: 19515586 DOI: 10.1016/j.acra.2009.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/07/2009] [Accepted: 04/09/2009] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to investigate image noise (standard deviation of computed tomographic value) and to assess variability in repeated coronary artery calcium (CAC) scoring on prospective electrocardiographically triggered 64-detctor computed tomography. MATERIALS AND METHODS Patients (n = 428) suspected of having coronary artery disease were scanned twice using three protocols: with tube current modified by body mass index (BMI; group A), by BMI and body height (group B), and by attenuation at the maximal heart diameter (group C). Image noise was plotted against BMI. Interscan variability of CAC scores was determined. The effective dose was estimated by computed tomographic dose index. RESULTS The mean effective dose and image noise, respectively, were 0.9 +/- 0.2 mSv (range, 0.6-1.5 mSv) and 19 +/- 4 Hounsfield units (HU) (range, 10-32 HU) for group A; 0.8 +/- 0.2 mSv (range, 0.5-1.4 mSv) and 18 +/- 4 HU (range, 10-31 HU) for group B; and 0.8 +/- 0.4 mSv (range, 0.3-2.2 mSv) and 20 +/- 2 HU (range, 16-26 HU) for group C. Group C used a wide dose range and controlled noise within a small range. The positive slopes of image noise versus BMI, 0.81 HU/(kg/m(2)) in group A and 0.62 HU/(kg/m(2)) in group B, suggested insufficient control of the tube current. In contrast, the nearly flat slope in group C, 0.091 HU/(kg/m(2)), indicated optimal control. The interscan variability for Agatston score, volume, and mass in patients with CAC (n = 300) was 13% (median, 8%), 12% (median, 7%), and 11% (median, 6%), respectively. CONCLUSIONS CAC scoring on prospective electrocardiographically triggered 64-detector computed tomography using attenuation-based tube current control has the potential to favorably control image noise with low dose and low interscan variability.
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Affiliation(s)
- Jun Horiguchi
- Department of Clinical Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima 734-8551, Japan.
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Affiliation(s)
- Prashant Kaul
- From the Division of Cardiovascular Medicine, and Duke Clinical Research Institute (P.K., P.S.D.); Duke University Medical Center, Durham, NC
| | - Pamela S. Douglas
- From the Division of Cardiovascular Medicine, and Duke Clinical Research Institute (P.K., P.S.D.); Duke University Medical Center, Durham, NC
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Zeina AR, Barmeir E, Zaid G, Odeh M. Coronary artery disease among hypertensive patients undergoing coronary computed tomography angiography. J Cardiovasc Med (Hagerstown) 2009; 10:252-6. [DOI: 10.2459/jcm.0b013e3283240486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Horiguchi J, Matsuura N, Yamamoto H, Kiguchi M, Fujioka C, Kitagawa T, Kohno N, Ito K. Coronary artery calcium scoring on low-dose prospective electrocardiographically-triggered 64-slice CT. Acad Radiol 2009; 16:187-93. [PMID: 19124104 DOI: 10.1016/j.acra.2008.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 05/13/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this prospective study was to assess image noise and variability in repeated coronary artery calcium (CAC) scoring on low-dose prospective electrocardiographically-triggered 64-slice multidetector computed tomography. MATERIALS AND METHODS Patients (n = 115) suspected of having coronary artery disease were scanned twice, using a tube current of 10 x body mass index mA. The standard deviation (SD) of the computed tomographic value in the ascending aorta and (mean + 2 x SD) were obtained. Repeated CAC scores (Agatston, volume, and mass) were measured by two observers, and the interscan and interobserver variability were determined. RESULTS The mean tube current used was 246 +/- 36 mA. The mean tube current-time product and mean estimated effective dose were 57 +/- 8 mA and 0.9 +/- 0.2 mSv, respectively. The SD and (mean + 2 x SD) computed tomographic values in the ascending aorta were 16 +/- 3 and 75 +/- 10 Hounsfield units, respectively. Repeated CAC scores were correlated (r(2) = 0.995-0.998). The interscan variability for observer 1 and observer 2, respectively, were 13% and 13% for Agatston score, 12% and 11% for volume, and 11% and 11% for mass. The interobserver variability for scan 1 and scan 2, respectively, were 3% and 3% for Agatston score, 5% and 3% for volume, and 3% and 3% for mass. CONCLUSION Low-dose prospective electrocardiographically-triggered 64-slice multidetector computed tomography shows low interscan and interobserver variability on CAC scoring while maintaining low image noise.
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