Abdominal Aortic Calcification Index Research Articles

Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study

Background and aimsPatients with intracranial aneurysms (IA) have excess mortality for cardiovascular diseases, but little is known on whether atherosclerotic manifestations and IA coexist. We investigated abdominal aortic calcification index (ACI) association with unruptured and ruptured IAs. MethodsThis retrospective case-control study reviews all tertiary centers patients (n = 24,660) who had undergone head computed tomography angiography (CTA), magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for any reason between January 2003 and May 2018. Patients (n = 2020) with unruptured or ruptured IAs were identified, and patients with available abdominal CT were included. IA patients were matched by sex and age to controls (available abdomen CT, no IAs) in ratio of 1:3. ACI was measured from abdomen CT scans and patient records were reviewed. Results1720 patients (216 ruptured IA (rIA), 246 unruptured IA (UIA) and 1258 control) were included. Mean age was 62.9 ± 11.9 years and 58.2% were female. ACI (OR 1.02 per increment, 95%CI 1.01–1.03) and ACI>3 (OR 5.77, 95%CI 3.29–10.11) increased risk for rIA compared to matched controls. UIA patients' ACI was significantly higher but ACI did not increase odds for UIA compared to matched controls. History of coronary artery disease was less frequent in rIA patients. There was no calcification in aorta in 8.8% rIA and 13.6% UIA patients (matched controls 25.7% and 22.6% respectively, p < 0.01). ConclusionsAortic calcification is greater in rIA and UIA patients than matched controls. ACI increases risk for rIAs.

Intracranial aneurysm rupture is predicted by abdominal aortic calcification index - a retrospective case-control study

Intracranial aneurysm rupture is predicted by abdominal aortic calcification index - a retrospective case-control study

Association between indocyanine green fluorescence blood flow speed in the gastric conduit wall and superior mesenteric artery calcification: predictive significance for anastomotic leakage after esophagectomy.

Near-infrared fluorescence using indocyanine green (ICG) has been applied as a real-time navigation tool to observe blood flow in gastric conduit wall after esophagectomy. Atherosclerosis might impair the blood flow of the systemic organs. The aim of the study was to investigate the significances of ICG blood flow speed in the gastric conduit wall and atherosclerotic calcification for the prediction of anastomotic leakage after esophagectomy. The 109 esophageal cancer patients were prospectively enrolled. ICG fluorescence blood flow speed in the gastric conduit wall and abdominal aortic calcification index (ACI), celiac artery (CA) calcification, and superior mesenteric artery (SMA) calcification were determined. Then, the correlation between ICG fluorescence blood flow speed and anastomotic leakage as well as ACI, CA, and SMA calcification were evaluated. Anastomotic leakage occurred in 15 patients. ACI ranged from 0 to 65. CA calcification and SMA calcification were present in 25 and 12 patients. Multivariate analysis demonstrated that ICG fluorescence blood flow speed in the gastric conduit wall of 2.07cm/s or less (P < 0.001) and SMA calcification (P = 0.026) were the significant independent predictors of anastomotic leakage. Only SMA calcification was significantly associated with ICG fluorescence blood flow speed in the gastric conduit wall (P = 0.026). This study demonstrated that ICG fluorescence blood flow speed in the gastric conduit wall can predict anastomotic leakage after esophagectomy and microvascular perfusion of capillary vessels of the gastric conduit might be impaired by systemic atherosclerosis.

Radial augmentation index may be an effective predictor of vascular calcification in patients on peritoneal dialysis

Vascular calcification (VC) is an important promoter of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD). Several indices can be used to evaluate VC, including the abdominal aortic calcification index (AACI) and carotid artery intima–media thickness (IMT); however, simpler and lesser expensive predictors, such as the radial augmentation index (RAI), should be investigated. A total of 101 patients undergoing PD were recruited to measure RAI, AACI, and carotid artery IMT and perform echocardiography. Fifty healthy controls (HCs) were recruited to undergo RAI measurement. RAI in patients undergoing PD was significantly higher than the RAI in HCs (86.25%±8.39% vs. 76.05%±9.81%, p < 0.05). Patients undergoing PD and who suffer with diabetic mellitus, hypertension, and CVD had more severe VC than those without the abovementioned diseases. In patients with PD, RAI was positively correlated with AACI (r = 0.671, p < 0.05) and carotid artery IMT (r = 0.596, p < 0.05). RAI was positively correlated with left ventricular end-diastolic dimensions (LVDd; r = 0.678, p < 0.05), left ventricular mass index (r = 0.595, p < 0.05), and negatively correlated with early-diastolic mitral inflow velocity/late-diastolic mitral inflow velocity (r = −0.342, p < 0.05) and left ventricular ejection fraction (r= −0.497, p < 0.05). Multiple linear regression analysis showed that RAI was associated with AACI, LVDd, age, and serum phosphate (p < 0.05). RAI might be an effective predictor of VC and cardiac structural/functional abnormalities in patients undergoing PD.

Predictive value of abdominal aortic calcification index for mid-term cardiovascular events in patients with acute coronary syndrome.

The utility of abdominal aortic calcification (AAC) for prediction of cardiovascular events (CVEs) in patients with acute coronary syndrome (ACS) remains to be determined. The aim of this prospective study was to determine the predictive value of the abdominal aortic calcification index (ACI), a semi-quantitative measure of AAC, for CVEs in patients with ACS. We evaluated 314 patients with ACS. All patients underwent successful percutaneous coronary intervention to the culprit coronary vessel without in-hospital adverse events. ACI was calculated on non-contrast computed tomography images. CVEs were defined as a composite of cardiovascular death, ACS recurrence, and stroke. During a median follow-up period of 19.1months, CVEs occurred in 29 patients (9.2%). Multivariable regression analysis after adjustment for age and gender showed a significantly higher baseline ACI in patients with CVEs than in those without [median (interquartile ranges), 42.1 (25.9-60.2) vs. 20.8 (8.8-38.6) %; P = 0.021]. The cutoff value of ACI for prediction of CVEs, estimated by receiver-operating characteristic analysis, was 29.2%, with sensitivity of 76% and specificity of 64% (area under the curve, 0.69). After adjustment for conventional cardiovascular risk factors, Cox analysis showed high ACI (≥29.2%) to be significantly associated with increased risk of CVEs (P = 0.011; hazard ratio, 1.82). Multivariate analysis identified high ACI as an independent predictor of CVEs (P = 0.012; hazard ratio, 1.80). Stepwise forward selection procedure also showed that high ACI was a significant independent determinant of CVEs (P = 0.004; R2, 0.089). Both net reclassification improvement (0.64; P = 0.001) and integrated discrimination improvement (0.04; P < 0.001) improved significantly after the addition of high ACI to conventional risk factors. Evaluation of ACI using CT seems to provide valuable clinical information for proper assessment of mid-term CVEs in patients with ACS after percutaneous coronary intervention.

Low serum butyrylcholinesterase is independently related to low fetuin-A in patients on hemodialysis: a cross-sectional study.

Fetuin-A, which plays a protective role against the atherosclerosis and progression of vascular calcification, is decreased in patients on hemodialysis (HD). Fetuin-A and serum butyrylcholinesterase (BChE) levels decrease during malnutrition. We explored whether BChE was independently related to fetuin-A in patients on HD. Laboratory data including BChE and serum fetuin-A were acquired from 230 patients on HD between August 2017 and April 2018. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). Abdominal aortic calcification index (ACI) was measured using computed tomography. Patients were stratified into two groups: low fetuin-A (< lowest quartile) and non-low fetuin-A (≥ lowest quartile) groups. Patient background, medication, and laboratory data were compared. The receiver operating characteristic analysis was conducted to determine the optimal cutoff values of BChE and GNRI for lower fetuin-A level. Factors independently related with lower fetuin-A levels were determined using multivariate logistic regression analysis. The lowest quartile value of fetuin-A and optimal cutoff values of BChE and GNRI were 0.213g/L, 200IU/L, and 92.6, respectively. The study included 57 and 173 patients in the low fetuin-A and non-low fetuin-A groups, respectively. Significant between-group differences were observed for age, C-reactive protein (CRP), history of cardiovascular disease, serum albumin, GNRI, and BChE. Multivariate analysis showed that BChE of < 200IU/L [odds ratio (OR) 3.05], CRP (OR 2.49), and GNRI of < 92.6 (OR 2.34) were independent factors for lower fetuin-A level after adjusting for confounders. BChE was a significant independent marker for fetuin-A levels in patients on HD, in addition to GNRI.

Proton pump inhibitor as an independent factor of progression of abdominal aortic calcification in patients on maintenance hemodialysis.

BackgroundsProton pump inhibitors (PPIs) can be associated with vascular calcification in patients undergoing dialysis through hypomagnesemia. However, only few studies have demonstrated the influence of PPIs on vascular calcification in patients on maintenance hemodialysis (HD). This study aimed to investigate whether the use of PPIs accelerates vascular calcification in patients on HD.Materials and methodsWe retrospectively evaluated 200 HD patients who underwent regular blood tests and computed tomography (CT) between 2016 and 2017. The abdominal aortic calcification index (ACI) was measured using abdominal CT. The difference in the ACI values between 2016 and 2017 was evaluated as ΔACI. Patients were divided into PPI and non-PPI groups, and variables, such as patient background, medication, laboratory data, and ΔACI were compared. Factors independently associated with higher ΔACI progression (≥ third tertile value of ΔACI in this study) were determined using multivariate logistic regression analysis.ResultsThe PPI and non-PPI groups had 112 (56%) and 88 (44%) patients, respectively. Median and third tertile value of ΔACIs were 4.2% and 5.8%, respectively. Serum magnesium was significantly lower in the PPI (2.1 mg/dL) than in the non-PPI (2.3 mg/dL) group (P <0.001). Median ΔACI was significantly higher in the PPI (5.0%) than in the non-PPI (3.8%) group (P = 0.009). A total of 77 (39%) patients had a higher ΔACI. Multivariate analysis revealed that PPIs (odds ratio = 2.23; 95% confidence interval = 1.11–4.49), annual mean calcium phosphorus product, ACI in 2016, baseline serum magnesium levels, and HD vintage were independent factors associated with higher ΔACI progression after adjusting for confounders.ConclusionPPI use may accelerate vascular calcification in patients on HD. Further studies are necessary to elucidate their influence on vascular calcification.

The relationship between poor nutritional status and progression of aortic calcification in patients on maintenance hemodialysis

BackgroundAlthough aortic calcification has a significant negative impact on prognosis in patients on hemodialysis (HD), risk factors for aortic calcification progression remain unclear. The aim of this study was to investigate the relationship between malnutrition and aortic calcification progression in patients on HD.MethodsBetween April 2015 and October 2016, we treated 232 patients on HD. Of those, we retrospectively evaluated data from 184 patients who had had regular blood tests and computed tomography (CT) scans. The abdominal aortic calcification index (ACI) was quantitatively measured by abdominal CT. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). A normalized treatment ratio of functional urea clearance was evaluated by Kt/V. The difference in ACI values between 2015 and 2016 was evaluated as a ΔACI, and patients were stratified into two groups according to ΔACI value: high (≥75th percentile, ΔACI-high group) and low (<75th percentile, ΔACI-low group). Variables such as age, sex, comorbidities, dialysis vintage, serum data, and GNRI were compared between ΔACI-high and ΔACI-low patients. Factors independently associated with a higher ΔACI progression (ΔACI ≥75th percentile) were determined using multivariate logistic analysis.ResultsMedian values of ACIs in 2015 and 2016 were 40.8 and 44.6%, respectively. Of 184 patients, 125 (68%) patients experienced ACI progression for 1 year. The median ΔACI and 75th percentile of ΔACI were 2.5% and 5.8%, respectively. The number of patients in the ΔACI-low and ΔACI-high groups were 128 (70%) and 56 (30%), respectively. There were significant differences in sex, presence of diabetic nephropathy, HD vintage, serum albumin, serum phosphate, C-reactive protein, intact parathyroid hormone, Kt/V, and GNRI. Multivariate logistic regression analysis revealed that independent factors associated with a higher ΔACI progression were male sex, serum phosphate levels, HD vintage, and GNRI of < 90.ConclusionsOur results suggest that poor nutritional status is an independent risk factor for the progression of aortic calcification. Nutrition management may have the potential to improve progression of aortic calcification in patients on HD.Trial registrationUMIN Clinical Trials Registry UMIN000028050.

P670Predictive value of abdominal aortic calcification index for the mid-term cardiovascular events among patients with acute coronary syndrome

P670Predictive value of abdominal aortic calcification index for the mid-term cardiovascular events among patients with acute coronary syndrome

Impact of Renal Functional/Morphological Dynamics on the Calcification of Coronary and Abdominal Arteries in Patients with Chronic Kidney Disease.

Aim: Fast-progressing vascular calcification (VC) is accompanied by renal atrophy and functional deterioration along with atherosclerosis in patients with chronic kidney disease (CKD). However, the relationship between VC progression and renal functional and/or morphological changes remains unclear.Methods: We included 70 asymptomatic patients with CKD without hemodialysis in our study. To identify temporal variations, the coronary artery calcification score (CACS), abdominal aortic calcification index (ACI), and renal parenchymal volume index (RPVI) were determined via spiral computed tomography scans taken during the study. We investigated significant factors related to annualized variations of CACS (ΔCACS/y) and ACI (ΔACI/y).Results: During the follow-up period (4.6 years), median values of CACS [in Agatston units (AU)] and ACI increased from 40.2 to 113.3 AU (p = 0.053) and from 13.2 to 21.7% (p = 0.036), respectively. Multivariate analysis revealed that CACS at baseline (p < 0.001) and diabetes mellitus (DM) status (p = 0.037) for ΔCACS/y and ACI at baseline (p = 0.017) and hypertension (HT) status (p = 0.046) for ΔACI/y were significant independent predictors. Furthermore, annualized RPVI variation was significantly related to both ΔCACS/y and ΔACI/y (R = −0.565, p < 0.001, and R = −0.289, p = 0.015, respectively). On the other hand, independent contributions of the estimated glomerular filtration rate (eGFR) and annualized eGFR variation to VC progression were not confirmed.Conclusion: The degree of VC at baseline, DM, HT, and changes in renal volume, but not eGFR, had a strong impact on VC progression in patients with CKD.

Predictors of abdominal aortic calcification progression in patients with chronic kidney disease without hemodialysis

Background and aimsAbdominal aortic calcification (AAC) is an important predictor of cardiovascular mortality in patients with chronic kidney disease (CKD). However, little is known regarding AAC progression in these patients. This study aimed to identify risk factors associated with AAC progression in patients with CKD without hemodialysis. MethodsWe recruited 141 asymptomatic patients with CKD without hemodialysis [median estimated glomerular filtration rate (eGFR), 40.3 mL/min/1.73 m2] and evaluated the progression of the abdominal aortic calcification index (ACI) over 3 years. To identify risk factors contributing to the rate of ACI progression, the associations between baseline clinical characteristics and annual change in ACI for each CKD category were analyzed. The annual change of ACI (ΔACI/year) was calculated as follows: (second ACI − first ACI)/duration between the two evaluations. ResultsMedian ΔACI/year values significantly increased in advanced CKD stages (0.73%, 0.87%, and 2.24%/year for CKD stages G1-2, G3, and G4-5, respectively; p for trend = 0.041). The only independent risk factor for AAC progression in mild to moderate CKD (G1-3, eGFR ≥ 30 mL/min/1.73 m2) was pulse pressure level (β = 0.258, p = 0.012). In contrast, parathyroid hormone (PTH) level was significantly correlated with ΔACI/year (β = 0.426, p = 0.007) among patients with advanced CKD (G4-5, eGFR < 30 mL/min/1.73 m2). ConclusionsThis study suggests that the AAC progression rate was significantly accelerated in patients with advanced CKD. In addition, measuring PTH is useful to evaluate both bone turnover and AAC progression in patients with advanced CKD.

Abstract 11807: Impact of Abdominal Aortic Calcification on Long Term Cardiovascular Outcomes in Patients With Chronic Kidney Disease

Introduction: Abdominal aortic calcification (AAC) was related to cardiovascular (CV) events in hemodialysis patients. However, little is known about predictive value of the AAC for CV events in chronic kidney disease (CKD) patients. Hypothesis: The purpose of this study was to investigate the prevalence and the predictive value of AAC in asymptomatic CKD patients. Methods: We prospectively evaluated 347 asymptomatic CKD patients (mean estimated glomerular filtration rate: 46.6 ± 22.9 mL/min/1.73 m2). A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) as a semi-quantitative measure of aortic calcification. Major adverse cardiovascular events (MACE) were defined as the composite endpoint of cardiovascular death, myocardial infarction, stroke, heart failure, and any coronary revascularization. Results: Among the subjects, AAC was present in 296 patients (86.3%), as defined by ACI &gt; 0, and the median ACI was 11.4% (interquartile ranges; 1.38 - 30.7%). During the median follow-up of 41.5 months, a total of 33 MACEs were observed. Event-free survival rate was significantly associated with ACI tertiles, patients with the high tertile of ACI had the highest risk of MACE compared to the other two groups (high, middle and low tertile; 74.3%, 93.0%, and 96.5%, respectively, p&lt; 0.001). The Cox proportional hazard models adjusted for conventional risk factors showed that the ACI was independently associated with MACE (hazard ratio 1.032, 95% confidence interval, 1.009- 1.055, p= 0.006). Conclusions: Evaluation of the AAC may provide useful information for predicting adverse clinical outcomes among asymptomatic CKD patients.

Impact of abdominal aortic calcification on long-term cardiovascular outcomes in patients with chronic kidney disease

BackgroundThe presence of abdominal aortic calcification (AAC) can predict cardiovascular (CV) outcomes in hemodialysis patients. However, little is known about the predictive value of AAC for CV outcomes in chronic kidney disease (CKD) patients without hemodialysis. The aim of this study was to investigate the prevalence and the predictive value of AAC in asymptomatic CKD patients. MethodsWe prospectively evaluated 347 asymptomatic CKD patients without hemodialysis [median estimated glomerular filtration rate (eGFR): 43.2 mL/min/1.73 m2]. A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) as a semi-quantitative measure of AAC. The patients were divided into three groups according to the tertiles of ACI. ResultsAmong the subjects, AAC was found (ACI > 0) in 296 patients (86.3%), and the median ACI was 11.4%. During the median follow-up of 41.5 months, a total of 33 CV events were observed. Patients with the highest tertile of ACI had the highest risk of CV outcomes compared with the other two groups (96.5%, 93.0%, and 74.3%, respectively; p < 0.001). The Cox proportional hazard models showed that ACI was an independent predictor of CV outcomes (hazard ratio 1.36, 95% confidence interval 1.17–1.60, p < 0.001). The C-index was also significantly increased by adding eGFR and ACI values to the model along with the other conventional risk factors (0.79 versus 0.66, p = 0.043). ConclusionEvaluation of the AAC provides useful information for predicting adverse clinical outcomes among asymptomatic CKD patients without hemodialysis.

Relationship between abdominal aortic and coronary artery calcification as detected by computed tomography in chronic kidney disease patients.

The purpose of this study was to investigate the relationship between abdominal aortic calcification (AAC) and coronary artery calcification (CAC) in chronic kidney disease (CKD) patients. We evaluated 126 asymptomatic CKD patients (mean estimated glomerular filtration rate: 36.1±14.1mL/min/1.73m(2), mean age 70.3±10.1years). A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) and CAC score, and this relationship was investigated. Among the subjects, AAC was present in 109 patients (86.5%) as defined by ACI >0 and median ACI was 11.7%. ACI increased in accordance with advances in CAC score grades (3.0, 5.2, 17.2, and 32.8% for CAC score 0, 1-100, 101-400, and 401 or more, respectively, p<0.001). Even after multivariate adjustment, ACI was independently associated with severe CAC score as defined by CAC score >400 [odds ratio 1.08, 95% confidence interval (CI) 1.04-1.12, p<0.001]. Receiver-operating curve analysis showed that the ACI optimal cut-off value predicting severe CAC score was 16.5% (area under the curve=0.79, 95% CI 0.69-0.90, p<0.001). The C statics for predicting CAC score was significantly increased by adding ACI values to the model including other risk factors (0.853 versus 0.737, p=0.023). In conclusion, the ACI value of 16.5% allows us to predict the presence of severe CAC in CKD patients, and that the addition of ACI to the model with traditional risk factors significantly improves the predictive ability of severe CAC score. These data reinforce the utility of ACI as a screening tool in clinical practice.

Successful Kidney Transplantation Ameliorates Arterial Stiffness in End-Stage Renal Disease Patients

PurposeSuccessful kidney transplantation (KTx) can ameliorate bodily damage caused by end-stage renal disease (ESRD). Arterial stiffness (AS) is one of the critical factors that shorten the survival of patients due to cardiovascular events. KTx may reduce AS as well; however, this has not been investigated well. We therefore conducted a retrospective study using noninvasive pulse wave velocity (PWV), which is a useful index of aortic damage. Patients and methodsFifty-eight consecutive kidney recipients (34 men, 24 women) were enrolled in this study. Mean age at transplantation was 40.5 ± 12.3 years and the dialysis period was 73.1 ± 95.8 months. The brachial-ankle PWV was measured preoperatively and 6 months postoperatively. First, we investigated the relationship between the PWV and the other parameters related to AS. Second, we studied the pre- to posttransplant change in PWV to evaluate the amelioration of AS after successful KTx. ResultsPWV showed significant positive correlations with age, systolic blood pressure (BP), diastolic BP, and abdominal aortic calcification index. After successful KTx, PWV significantly decreased (P < .01). In addition, systolic and diastolic BP significantly decreased (P < .01 and P < .05, respectively). ConclusionSuccessful KTx ameliorates AS in ESRD patients. This might explain the improved cardiovascular prognosis of ESRD patients who undergo KTx.

The Relationship of the Abdominal Aortic Calcification Index to Carotid Intima Media Thickness for Early Diagnosis of Ischemic Cerebral Disease

Poster: RANZCR-AOCR 2012 / R-0060 / Relation of Abdominal Aortic Calcification Index to Carotid Intima Media Thickness for Early Diagnosis of Ischemic Cerebral Disease by: Kim, J. H. Choi

Chronic hemodialysis patients with visceral obesity have a higher risk for cardiovascular events.

The risk of cardiovascular disease is substantially high in hemodialysis patients. The risk factors for cardiovascular disease in dialysis patients include age, malnutrition, duration of dialysis, diabetes mellitus and hyperphosphatemia. However, it is not clear whether cardiovascular disease is associated with abdominal obesity in dialysis patients. The aim of the present study was to clarify the relationship among visceral fat area and cardiovascular complications in chronic dialysis patients. Area of visceral fat was measured using computed tomography scan in 94 patients. The abdominal aortic calcification index (ACI), blood lipid profile and complication of cardiovascular disease were evaluated in these patients. Compared to patients with smaller visceral fat area (<100 cm2), those with larger visceral fat area (≥100 cm2) showed significantly higher cardiovascular complication and higher serum levels of triglyceride and significantly lower serum levels of HDL-cholesterol. Patients with larger visceral fat area and longer duration of dialysis showed severer calcification by ACI analysis, and showed higher incidences of ischemic heart disease. This study suggested that chronic dialysis patients with higher visceral fat area have a higher risk for vascular events, especially ischemic heart disease.

Assessment and significance of abdominal aortic calcification in chronic kidney disease

Abdominal aortic calcification is a common complication and a predictor of cardiovascular mortality in dialysis patients. However, abdominal aortic calcification in pre-dialysis chronic kidney disease (CKD) is poorly understood. A cohort study of 101 adult Japanese patients (mean age 66.6 +/- 11.3 years old) with pre-dialysis CKD (18, 29 and 54 in stages 3, 4 and 5, respectively) was performed. At entry, a non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI). Clinical characteristics and laboratory variables were also assessed. The patients were followed for a mean period of 48 +/- 12 months. Among the subjects, 82% had abdominal aortic calcification (50, 83 and 91% for CKD stages 3, 4 and 5, respectively), and the median ACI was 16.7% (8.5, 20.0 and 21.4%, respectively). Multivariate logistic regression analyses identified older age, presence of diabetes and decreased estimated glomerular filtration rate (e-GFR) as independent predictors of the presence (ACI > 0%) and extent (ACI >or= 20%) of aortic calcification. Multivariate Cox proportional hazards analysis identified ACI >or= 20% and diabetes as independent predictors for de novo cardiovascular events in CKD stages 4 and 5. Decreased GFR may be associated with the presence and extent of abdominal aortic calcification, and a high level of calcification may be associated with de novo cardiovascular events in pre-dialysis CKD, suggesting that elucidation of the mechanism through which CKD contributes to vascular calcification may lead to an improved prognosis in patients with pre-dialysis CKD.

Radial Augmentation Index is Related to Cardiovascular Risk in Hemodialysis Patients

Cardiovascular accidents related to atherosclerosis are the leading cause of death among hemodialysis patients, which makes continuous monitoring of their cardiovascular status crucial. Recently, a handy device for monitoring the augmentation index (AIx) in the radial artery was introduced in Japan, enabling the use of the AIx in addition to pulse wave velocity (PWV) in the management of hemodialysis patients. In this study the AIx, PWV, abdominal aortic calcification index (ACI), and left ventricular mass index (LVMI) were serially assessed in 108 hemodialysis patients. The radial AIx was monitored using a newly introduced tonometer (HEM-9010AI), and the interrelationships among the measured parameters and their contributions to the risk of cardiovascular accidents were evaluated. The radial AIx was significantly higher in hemodialysis patients than in healthy subjects (N = 50) and was well correlated with risk markers such as LVMI (r = 0.30, P = 0.019) and ACI (r = 0.38, P < 0.001), but not with PWV. Multiregression analysis showed that radial AIx was also significantly associated with LVMI, ACI and blood pressure; PWV was associated with other parameters such as age, blood pressure, and ACI. The AIx and ACI were both significantly increased in patients with cardiovascular complications. Although PWV was strongly increased in the hemodialysis patients, it failed to discriminate between these subgroups of high-risk patients. The radial AIx is closely associated with aortic calcification, cardiac hypertrophy, and a history of cardiovascular accidents in hemodialysis patients, and could be a useful marker for management of these patients.

Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study.

Vascular calcification and osteoporosis are common age-related processes that are prominently displayed on routine lateral lumbar spine radiographs as dense calcium mineral deposits of the aorta that lie adjacent to osteopenic vertebrae. Using a population-based cohort of older men and women, we tested the hypothesis that the progression of vascular calcification of the abdominal aorta should be greatest in those individuals with the greatest amount of bone loss. From the original population-based Framingham Heart Study cohort, 364 women and 190 men had lateral lumbar spine and hand radiographs performed between 1966 and 1970 and repeated between 1992 and 1993. The lateral lumbar films were read for the presence of aortic calcification using a semiquantitative method, and the hand films were read for second metacarpal relative cortical area (MCA). Using multivariate regression techniques, the 25-year progression of the abdominal aortic calcification index was examined in relation to the change in the MCA, while adjusting for recognized risk factors for atherosclerotic cardiovascular disease. During the 25 years of follow-up, the MCA decreased by 22.4% in women (from 79.6 +/- 7.8 (SD) to 61.8 +/- 10.3) and by 13.3% in men (from 80.6 +/- 6.9 to 69.9 +/- 8.3). The aortic calcification score increased over eightfold in women (from 1.2 +/- 2.7 (SD) to 9.9 +/- 6.7) and sixfold in men (from 1.6 +/- 2.8 to 9.6 +/- 6.3). There was a significant association between percent change in MCA and change in aortic calcification index (P = 0.01) in women after controlling for all potential confounders. No association was observed in men (P = 0.50), including the 50% of men with the greatest bone loss. This is the first longitudinal study to show that women with the greatest magnitude of bone loss also demonstrate the most severe progression of abdominal aortic calcification, suggesting that the two processes may be related.