Coronary Calcinosis Research Articles

Relationship of blood lipid spectrum indicators with coronary calcinosis due to statin treatment in patients with high cardiovascular risk

Relationship of blood lipid spectrum indicators with coronary calcinosis due to statin treatment in patients with high cardiovascular risk

ЗНАЧЕНИЕ ОФЭКТ/КТ В ОДНОВРЕМЕННОЙ ОЦЕНКЕ КАЛЬЦИНОЗА КОРОНАРНЫХ АРТЕРИЙ, ПЕРФУЗИИ И КОНТРАКТИЛЬНОЙ ФУНКЦИИ МИОКАРДА У МУЖЧИН С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА

Purpose: To study the frequency of calcinosis of coronary arteries and its effect on myocardial perfusion and contractile function among men’s with coronary heart disease (CHD). Material and methods: A survey was conducted among 1175 men’s aged 30 to 83 years with coronary artery disease (CHD): simultaneous assessment of coronary artery calcinosis, perfusion and contractile function with 99m Tc-MIBI using SPECT/CT with ECG-synchronization and X-ray radiation attenuation correction, as well as comparison of data with the results of electrocardiography (ECG), echocardiography (ECHO-CG), clinical and biochemical blood tests. Results: Of the 1175 men examined using SPECT/CT, coronary artery calcification was detected in 426 (35 %): in the age group over 55 years old – in 142 (12 %), in the age group 46−55 years old – in 200 (17 %), in the age group 27–45 years old – in 74 (6 %). The interval of calcium index indicators in accordance with the Agatston scale was established as follows: at the maximum degree > 400 units – in 87 males (7 % of all examined); at 101−400 units – at 121 (10 %); at 11−100 units – at 162 (14 %); at 1−10 units – in 46 (4 %); with a minimum degree − of 0 units – in 759 men (65 % of all examined). In 34 men of whom 15 had coronary calcification and 19 did not have it, perfusion index (SPB) was either normal or corresponded to the initial degree of decrease in perfusion, and contractile function was slightly impaired, the ejection fraction was not reduced. Conclusion: The use of SPECT/CT technology with ECG-synchronization and CT-attenuation correction of radiation, in 1175 men with CHD made it possible to detect coronary calcification in 35 %: at the age of 55 years in 12 %, at the age of 46–55 years in 17 %, at the age of 27–45 years – in 6 %. In men with CHD without acute coronary events, both with and without coronary calcinosis, SPB was either normal or corresponded to the initial degree of reduced perfusion, and contractile function was slightly impaired, EF was not reduced. Three years later, in men whose coronary artery calcification was moderate despite its increase to a high degree, the perfusion (SPB) and contractile function indicators did not significantly change, and such indicators did not significantly change in the absence of coronary artery calcification.

Analysis of the diagnostic and economic impact of the combined artificial intelligence algorithm for analysis of 10 pathological findings on chest computed tomography

BACKGROUND: Artificial intelligence technology can help solve the significant problem of missed findings in radiology studies. An important issue is assessing the economic benefits of implementing artificial intelligence.
 AIM: To evaluate the frequency of missed pathologies detection and the economic potential of artificial intelligence technology for chest computed tomography compared and validated by experienced radiologists.
 MATERIALS AND METHODS: This was an observational, single-center retrospective study. The study included chest computed tomography without IV contrast from June 1 to July 31, 2022, in Clinical Hospital in Yauza, Moscow. The computed tomography was processed using a complex artificial intelligence algorithm for 10 pathologies: pulmonary infiltrates, typical for viral pneumonia (COVID-19 in pandemic conditions); lung nodules; pleural effusion; pulmonary emphysema; thoracic aortic dilatation; pulmonary trunk dilatation; coronary artery calcification; adrenal hyperplasia; and osteoporosis (vertebral body height and density changes). Two experts analyzed computed tomography and compared results with artificial intelligence. Further routing was determined according to clinical guidelines for all findings initially detected and missed by radiologists. The hospital price list determined the potential revenue loss for each patient.
 RESULTS: From the final 160 computed tomographies, the artificial intelligence identified 90 studies (56%) with pathologies, of which 81 (51%) were missing at least one pathology in the report. The second-stage lost potential revenue for all pathologies from 81 patients was RUB 2,847,760 ($37,251 or CNY 256,218). Lost potential revenue only for those pathologies missed by radiologists but detected by artificial intelligence was RUB 2,065,360 ($27,017 or CNY 185,824).
 CONCLUSION: Using artificial intelligence as an assistant to the radiologist for chest computed tomography can dramatically minimize the number of missed abnormalities. Compared with the normal model without artificial intelligence, using artificial intelligence can provide 3.6 times more benefits. Using advanced artificial intelligence for chest computed tomography can save money.

Features of coronary calcification in patients receiving renal replacement therapy with program hemodialysis

Objective: to study the features of coronary calcification in patients with chronic kidney disease receiving renal replacement therapy with program hemodialysis. Materials and methods: in the process of an open clinical trial, a group of patients (n = 43) with end-stage chronic kidney disease (23 women and 20 men) was formed. The average age of patients was 54±13 years, the median length of dialysis therapy was 11 [6; 16] months. All patients received renal replacement therapy with program hemodialysis. The procedures were carried out on artificial kidney devices according to the standard scheme 3 times a week for 4 hours. Patients underwent traditional clinical and laboratory examination. All patients were assessed for coronary calcification by multispiral computed tomography. On the Agatston scale, the severity of coronary calcification was assessed taking into account the density and area of calcium deposition. Results: on the results of multispiral computed tomography to determine the degree of calcification of the coronary arteries, we found that 48% of patients had low and minimal calcification, 16% — insignificant calcification, 36% — measured and pronounced calcification. When comparing laboratory parameters in the groups of patients with different calcification of the coronary arteries, the level of inorganic phosphorus (1,64±0,07 mmol/L) was significantly higher in patients with insignificant, moderate and severe calcification than in patients with minimal and low calcinosis (1,35±0,12 mmol/L) (p=0.04). There was a pronounced direct correlation between age and calcium index (r=0,52, p=0,0011). With an increase in dialysis experience, an increase in calcium index is noted (r = 0,14; p = 0,045). Conclusion: in 52% of patients with end-stage chronic kidney disease receiving renal replacement therapy with program hemodialysis, coronary calcification is determined from the results of multispiral computed tomography of the coronary arteries. Patients with moderate to severe coronary calcinosis have significantly higher levels of serum phosphorus compared to patients with minimal to low calcinosis. At the same time, the age of patients and the length of dialysis therapy affect the severity of coronary calcinosis

Hyperlipoproteinemia(a) and Severe Coronary Artery Lesion Types.

Diffuse atherosclerosis and calcification of the coronary arteries (CA) create serious difficulties for coronary artery bypass grafting (CABG). The aim of this study was to compare demographic indicators, lipids, and clinical results one year after CABG in patients with different phenotypes of coronary artery (CA) disease. In total, 390 patients hospitalized for elective CABG were included in a single-center prospective study. Demographic data, lipids (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), and lipoprotein(a) (Lp(a)) concentrations were analyzed for all patients. Major adverse cardiovascular events (MACE) included myocardial infarction, stroke, percutaneous coronary intervention, and death from cardiac causes within one year after surgery. No significant outcome differences were found between the groups with diffuse vs. segmental lesions, nor the groups with and without calcinosis for all studied parameters except for Lp(a). Median Lp(a) concentrations were higher in the group of patients with diffuse compared to segmental lesions (28 vs. 16 mg/dL, p = 0.023) and in the group with calcinosis compared to the group without it (35 vs. 19 mg/dL, p = 0.046). Lp(a) ≥ 30 mg/dL was associated with the presence of diffuse lesions (OR = 2.18 (95% CI 1.34-3.54), p = 0.002), calcinosis (2.15 (1.15-4.02), p = 0.02), and its combination (4.30 (1.81-10.19), p = 0.0009), irrespective of other risk factors. The risk of MACE within one year after CABG was higher for patients with combined diffuse and calcified lesions vs. patients with a segmental lesion without calcinosis (relative risk = 2.38 (1.13-5.01), p = 0.02). Conclusion: Diffuse atherosclerosis and coronary calcinosis are associated with elevated Lp(a) levels, independent of other risk factors. The risk of MACE in the first year after surgery is significantly higher in patients with diffuse atherosclerosis and coronary calcinosis, which should be considered when prescribing postoperative treatment for such patients.

Relationship of coronary calcinosis and local fat deposts in patients with coronary artery disease

Highlights. Taking into account the connection between the increase in the volume of myocardial adipose tissue and vessels with massive calcification of the coronary arteries in coronary heart disease, morphometry of epicardial and perivascular adipose tissue during routine tomographic examinations can be considered as a non-invasive technique for determining a surrogate marker of severe coronary lesion.Aim. To evaluate the relationship of coronary artery calcification (CA) and morphometric parameters of local fat depots in patients with coronary heart disease (CHD).Methods. 125 patients with stable coronary artery disease aged 59±8.9 years were examined. Visualization of local fat depots, abdominal fat depots, and coronary calcification (CC) was performed using multislice computed tomography with subsequent post-processing of images on the Siemens Leonardo workstation (Germany). Non-contrast magnetic resonance imaging of the heart was used to determine the EAT thickness.Results. Coronary calcification was detected in 95.2% of the examined patients with coronary artery disease (n = 119). There were higher indices of the EAT thickness of the right and left ventricles in case of massive CC, the thickness of the pericardial adipose tissue at the level of the trunk of the left coronary, anterior descending, circumflex arteries, and increased morphometry indices of the abdominal fat depot in comparison with the patients who had moderate and medium CC.Conclusion. An increase in the volume of adipose tissue of the myocardium and vessels in CAD is associated with massive calcification, which is reflected in the pathogenetic “adipovascular” continuum, characterized by the stimulation of adipogenesis against the background of atherocalcinosis of the coronary arteries. Morphometry of epicardial and perivascular adipose tissue during routine tomographic studies is a non-invasive technique for determining a surrogate marker of severe coronary lesions.

Assessment of distal coronary calcinosis before coronary artery bypass grafting: The role of computed tomography

Background and Aims : Coronary artery calcinosis (CAC) limits the possibilities of surgical treatment of coronary artery disease and is associated with worse clinical outcomes. There are no guidelines and algorithms for using the coronary reconstructions (endarterectomies, onlay-flap anastomoses to vessels <1,5% mm in diameter) in severe distal CAC; preoperative assessment of the severity of CAC is not included in clinical practice. Objective: To evaluate the need for preoperative computed tomography (CT) assessment of CAC in candidates for coronary artery bypass grafting (CABG).

Relationship of visceral obesity and coronary calcinosis in ischemic heart disease

To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD). 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82). The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.

Comparability of coronary risk assessment methods with chest ultra-LDCT and CT coronography with ECG synchronization

Purpose. To assess the comparability of coronary calcium values measured on ultralow-dose computed tomography studies without ECG-synchronization versus a) non-contrast computed tomography with ECG synchronization, b) CT coronography with ECG synchronization.Materials and methods. The study comprised 283 studies: 68 patients who underwent contrast-free ultra-LDCT without ECG synchronization and contrast-free CT with ECG synchronization performed in a single visit, and 49 patients with contrast-free ultra-LDCT without ECG synchronization, non-contrast CT with ECG synchronization, and CT coronography with ECG synchronization and intravenous injection of contrast agent, also carried out in one visit, meeting all inclusion and exclusion criteria of the study.Quantitative coronary calcium values were calculated with the Agatston score and the CAC-DRS scale (score of calcification degree from 0 to 3 and the number of affected arteries from 0 to 4 points). The degree of coronary artery stenosis was analyzed with CAD-RADS scale (0-5).The above parameters were compared using visual/quantitative assessment of coronary calcium on ultra-LDCT without ECG synchronization and visual/quantitative assessment for CT with ECG synchronization, as well as the degree of stenosis on CT coronography in the same patients.Results. Based on the results of accuracy indices comparison, the possibility to use quantitative scale (Agatston score, CAC-DRS quantitative scale) to assess coronary calcification in the lung cancer screening in comparison with ECG-synchronized CT was determined during interpretation of ultra-LDCT without ECG synchronization. The correlation matrix to assess correlation between visual, quantitative scales of coronary artery changes and calcification at ultra-LDCT without ECG synchronization and quantitative scale at CT with ECG synchronization vs. CT coronography identifies very strong positive statistically significant correlations.Conclusion. Methods of coronary calcinosis assessment with chest ultra-LDCT and CT with ECG synchronization are comparable, therefore it is possible to assess coronary calcium in lung cancer screening by ultra-LDCT data at a reliable-high level using both quantitative and visual CAC-DRS scales.

P1748TNF and ANXA2 gene polymorphism associated with outcome and coronary angiography features in patients with early acute coronary syndrome

Abstract Background Genetic predisposition makes a considerable contribution to premature acute coronary syndrome (ACS) development. Tumour necrosis factor (TNF) is an important proinflammatory cytokine influencing intravascular inflammation. Annexin A2 (ANXA2) is an endogenous PCSK9 inhibitor. Higher LDL level is associated with AA genotype of ANXA2 gene SNP rs17845226. Aim The aim of the study was to elucidate the association of TNF and ANXA2 gene polymorphism with coronary angiography features and outcome in patients (pts) with early ACS. Methods We analyzed data from two prospective observational trials (2004–2007; 2014–2016) - 672 pts (498 men and 174 women) with premature ACS (men≤55, women≤60 years of age). Coronary angiography (CAG) data were analyzed in 225 pts. Genotyping of SNP rs1800629 of TNF (502 pts) and rs17845226 of ANXA2 gene (235 pts) was performed by RT-PCR with allele-specific primers. The primary endpoint was calculated as a combination of all-cause mortality, recurrent ACS, stroke, and peripheral vascular disease. We also analyzed recurrent coronary events (CE) (coronary deaths &amp; recurrent ACS). The mean follow-up time: 414±347.6 days. Results Mean age was 48.6±5.8 (M), 52.7±6.3 (F) years. 298 (44.3%) pts had STEMI, 362 (53.9%) pts – history of CAD, 500 (74.4%) – arterial hypertension, 32 (4.8%) – history of stroke, 81 (12.1%) – diabetes mellitus, 241 (37.1%) – heart failure (HF). The genotype distribution did not differ from the expected Hardy–Weinberg equilibrium: GG/AG/AA=0.557/0.191/0.006 (χ2=3.34, p=0.07) for TNF and CC/AC/AA=0.86/0.136/0.004 (χ2=0.05, p=0.82) for ANXA2. Carriers of allele A of TNF gene SNP had higher frequency of no significant coronary lesion (17.6% vs 5.9%; p=0.021) and NSTEMI (69.5% vs 50.8%, p&lt;0.001). Carriers of allele A of ANXA2 gene SNP had higher frequency of coronary calcinosis (39.3% vs 19.6%; p=0.019) and HF (39.4% vs 22.3%, p=0.034). Carriers of A allele of TNF had higher frequency of CE (30.5% vs 19.5%, p=0.01, log-rank χ2=7.29, p=0.007). HF (OR, 2.686; 95% CI, 1.769–4.077; p&lt;0.001), creatinine level (OR, 1.009; 95% CI, 1.001–1.017; p=0.025) and carrying of A allele of TNF gene SNP (OR, 1.836; 95% CI, 1.163–2.898; p=0.007) and STEMI at admission (OR, 1.009; 95% CI, 1.001–1.017; p=0.025) were independent predictors of any unfavorable outcome and CE in a multivariable Cox regression model. LAD and left main coronary artery involvement (OR, 1.836; 95% CI, 1.163–2.898; p=0.007) was an independent predictor of any unfavorable outcome. Identified relationship was independent of invasive treatment of ACS. Conclusion Thus, in patients with early ACS TNF mediated inflammation is associated with NSTEMI, no significant coronary lesion and could play a significant role in the development of unfavourable outcome. Carrying of A allele of ANXA2 gene may accelerate coronary atherosclerosis in these patients and is associated with HF.

Noninvasive visualization of coronary calcinosis in patients with chronic terminal hepatopathy

Dynamics of a coronary artery calcium index as a factor of a cardiovascular risk in chronic terminal hepatopathy patients who need transplantation is determined. A prospective single-center cohort study was done and included 250 patients who need liver transplantation. The observation time was 5.4 ± 3.29 years from the moment of putting a patient on the waiting list. In addition to the assessment of occurrence and dynamics of traditional cardiovascular risk factors, calcium index indicators were determined by the method of multispiral computer tomography at the stage of including a patient into the study and after fve years of dynamic monitoring. The calcium index indicator in chronic terminal hepatopathy patients who need transplantation exceeded the limits of the recommended norm defned by a value of the 75th percentile, in 56.3 % (n = 152) of the examined patients at the stage of putting them on the waiting list. While comparing the coronary calcinosis indicators after fve years of dynamic monitoring the recipients of the liver transplants showed higher values of the calcium index in comparison with the patients with chronic terminal hepatopathy who did not receive the donor organ (CI, AJ-130 – 223 (38; 597) and 141 (4; 176) units respectively, p &lt; 0.05; CI, Volume-130 – 314 (73; 748) and 203 (8; 284) mm2, respectively, p &lt; 0.01), and the patients with metabolic syndrome (CI, AJ-130 – 186 (78; 463) and 74 (21; 192) units respectively, p &lt; 0.01; CI, Volume-130 – 278 (74; 623) and 124 (74; 273) mm2 respectively, p &lt; 0.01) and/or ischemic heart disease (CI, AJ-130 – 274 (102; 683) and 109 (34; 246) units respectively, p &lt; 0.01; CI, Volume-130 – 382 (98; 834) and 382 (98; 834) mm2 respectively, p &lt; 0.01) from the overall population. The obtained results make it possible to suppose that in addition to the radical solution to the liver defciency problem, the performance of orthotopic liver transplantations on patients with chronic terminal diseases accelerates the development of coronary atherosclerosis in the long-term postoperative period.

Coronary calcinosis and psychological distress association, by the data from ESSE-RF study in Kemerovskaya Region

Aim. To evaluate the association of coronary arteries calcinosis with personality type D, by ESSE-RF (Epidemiology of cardiovascular diseases and risk factors in various regions of Russian Federation) trial data in Kemerovskaya Oblast.Material and methods. The study has been done under the framework of ESSE-RF trial. Standard protocol was updated with personality type assessment by DS-14 questionnaire. All patients underwent quantitative assessment of coronary calcinosis with multispiral computed tomography. The data package was analyzed with Agatstone method. Two groups of patients collected: group 1 (n=231) with type D personality, and group 2 with non-D (n=1379).Results. With the evaluation of calcium index (CaI) there were significant differences in groups: 689,3+53,7 in type D patients and 546,5+47 with none (p=0,048). Moderate and severe CaI was higher in type D patients — 10,3% and 12,5% vs 5,8% and 2,9%, respectively (p=0,043 and p=0,011). Highest differences in CaI in the left coronary artery, exactly in the left anterior descending, were 189,1+12,5 in type D vs 155,6+16,7 in non-type D (p=0,011), and circumflex artery — 121,7+30,6 vs 63,8+21,7 (p=0,032). With the logistic regression, the most influencing on moderate and severe CaI were age — hazard ratio (HR) 1,07-2,14 (p=0,023), diabetes — HR 1,32; 95% CI 1,09-1,62 (p=0,032), type D personality — HR 1,42; 95% CI 1,12-1,82 (p=0,023), coronary heart disease — HR 1,12; 95% CI 1,01-1,21 (p=0,034). By the multifactorial analysis, as independent predictors of moderate and severe CI remained such parameters as coronary heart disease — HR 1,24 95% CI 1,01-1,53 (р=0,04), diabetes — HR 1,28; 95% CI 1,80-3,24 (р=0,02) and type D — HR 1,49; 95% CI 2,01-2,29 (р=0,01).Conclusion. Screening for the influence of type D personality is worthy in persons with subclinical coronary arteries lesion to conduct on-time preventive events.

Отягощенная наследственность у больных с «ранним» развитием острого коронарного синдрома

Of 2832 patients included in ORACUL 1 and ORACUL 2 multicenter observational trials 512 pts who developed premature ACS (≤55 years for men, ≤60 years for women) and had known family history and LDL level were selected for this study. Of these patients 297 had positive family history (51 with FH, 246 no FH), 215 had negative family history. Among patients with positive family history there were more women (31 vs 20.9 %), while among patients with negative family history there were more men (79.1 vs 69 %). The fact of regular alcohol consumption was significantly more frequently observed among patients with positive family history but without FH, compared to patients with positive family history with FH (69.6 vs 47.1 %). Women with positive family history smoked more frequently than females with negative family history (51.1 vs 31.1 %). Among patients with negative family history compared with patients with positive family history there were more people who at admission had hyperglycemia exceeding 11.1 mmol / l (10.3 vs 4.4 %). Multiple vessel disease and coronary calcinosis were present in 73.2 and 24.7 %, respectively, of patients with positive family history, and in 56.9 and 9.8 %, respectively, of those with negative family history. Among patients with positive family history multivessel disease was more frequent in the subgroup with FH, while coronary calcinosis was more frequent in the subgroup without FH. Thus, premature development of ACS might be associated not only with genetic factors but also with family history ("inheritance") of adverse habits. Herewith coronary calcinosis is more prevalent in patients with FH.

Digital radiography in the diagnosis of coronary calcinosis: capabilitites and perspectives

Aim. To study the capabilities of digital radiography in the diagnosis of coronary calcifications and to perform a comparative analysis of the received results with the results of multidetector computed tomography. &#x0D; Methods. We analyzed in a comparative aspect the results of examination of 90 patients who underwent both types of diagnostic procedures. Among the patients, 46 were males, 34 were females, the average age was 59±4.3 years, and the age of male patients was significantly higher than that of female patients. Statistical analysis was performed using variational, discriminant, correlation methods, evidence-based medicine methods and ROC-analysis. &#x0D; Results. A comparative analysis of the results showed that the reason, why coronary calcifications visualized in all arteries at multidetector computed tomography are not visible on digital X-ray, is their decreased firmness, so these calcifications were soft enough. Visualization of calcifications on digital chest X-ray is limited to certain calcium score values, which for anterior interventricular branch of left coronary artery is 355, for circumflex branch of the left coronary artery - 385, for right coronary artery - 367, for left main coronary artery - 393, for aortic arch - 396. Coronary calcifications with similar and higher calcium score values can be detected with digital radiography, which allows integrating this method in screening for cardiovascular diseases risk. The sensitivity, specificity and overall value of digital radiography for the detection of coronary calcifications were 59.5±3.3, 85.5±2.9 and 70.0±2.4, respectively. &#x0D; Conclusion. Detection of coronary calcifications in digital radiography is limited to certain calcium score values; in all coronary arteries at multidetector computed tomography, as the calcium score of coronary calcifications increases, the sensitivity and spesifity of their visualization in digital X-ray examination increase as well.

Calcium — a Neglected Key Factor in Arteriosclerosis. The Pathogenetic Role of Arterial Calcium Overload and Its Prevention by Calcium Antagonists

Using specific calcium antagonists as experimental tools, both the physiological messenger and current carrying function of calcium ions as well as their pathogenetic potencies could be elucidated. Notably, excess intracellular calcium signalling and intra- and extracellular calcium overload turned out to be pathogenetic principles of general importance. In this context, progressive calcium overload of arteriosclerotic vascular walls and the antiarteriosclerotic effects of calcium antagonists, deserve particular interest. In fact, with the help of calcium antagonists, arterial calcium overload as decisive component of various types of experimental arteriosclerosis became accessible to a direct therapeutic intervention. According to their responsiveness to calcium antagonists, two pathophysiologically different types of experimental coronary plaques could be characterized: (1) The calcium type, i.e. coronary calcinosis of vitamin D3-intoxicated rats highly sensitive to calcium antagonist treatment, (2) the cholesterol type, represented by coronary atheromata of cholesterol-intoxicated rabbits; this primary coronary cholesterol accumulation could not be inhibited by calcium antagonists. The formation of conventional human coronary artery plaques is characterized from the very early lesion onwards by a progressive local uptake of calcium, finally leading to lethal consequences. Conversely, the analysis of the mural cholesterol does not allow to discriminate arteriosclerotic from normal coronary artery segments. Thereby, conventional human coronary plaques typically represent a calcium-dominated type of human arteriosclerosis and differ widely from plaques produced in cholesterol-fed rabbits. The results indicate the decisive pathophysiological role of calcium and calcium overload in both calcium-dominated types of experimental arteriosclerosis and conventional human coronary artery plaques. Moreover, the antiarteriosclerotic effects of calcium antagonists are demonstrated to be based--in various types of experimental arteriosclerosis--on the inhibition of intra- and extracellular calcium overload of arterial walls evoked by various risk factors (vitamin D3 intoxication, hypertension, nicotine, diabetes).

Death from coronary calcinosis occurring in the baby of a mother presenting with pseudoxanthoma elasticum.

SUMMARYThis paper reports the case of a baby with coronary calcinosis born to a mother suffering from pseudoxanthoma elasticum.The aetiology of infantile coronary calcification is discussed, and the point is made that the dystrophic type is a disease of elastic tissue.Both conditions are rare genetic diseases and show dystrophic changes of the elastic tissue.