Extent Of Aortic Arch Calcification Research Articles

P1258CLINICAL COMPARATIVE STUDY OF AORTIC ARCH CALCIFICATION IN PATIENTS WITH MAINTENANCE PERITONEAL DIALYSIS AND HEMODIALYSIS

Abstract Background and Aims Vascular calcification is known to be an important risk factor in patients with dialysis, However, the comparative study on vascular calcification between peritoneal dialysis (PD) and hemodialysis (HD) is less. The aim of this study was to analyze the presence, risk factors of aortic arch calcification (AAC), and compare the prognosis in maintenance PD and HD patients. Method Using retrospective analysis method, 177 patients with PD and 147 patients with HD were included in the study. The extent of AAC was evaluated by chest X-ray examination. The demographic characteristics and clinical data were collected and compared between PD group and HD group. Binary logistic regression analysis was performed to evaluate risk factors associated with the aortic arch calcification. Results The incidence of AAC in HD group (59.86%) was significantly higher than that in PD group (37.29%). Multivariate analysis showed that age, residual renal function (RRF) and serum phosphate were the independent risk factors for calcification of PD patients and the odds ratio (OR) values were 1.133, 1.039, 0.762 and 18.186, respectively. Similarly, age, RRF, calcium-phosphorus product and LDL were the risk factors of HD patients and their respective OR values were 1.125, 0.509, 2.755 and 3.221. Compared with patients without AAC, the presence of moderate-severe AAC was associated with greater risk of mortality, and the OR values were 17.833 and 20.056 in PD group and HD group, respectively. Conclusion Our findings suggest that the AAC was more common in HD patients. Older age and lower RRF are common independent risk factors for AAC in PD and HD patients. Moderate to severe AAC a ppears to be associated with increased risk of mortality.

Aortic Arch Calcification Is a Strong Predictor of the Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome.

Background The purpose of this study was to investigate the correlation of the extent of aortic arch calcification (AAC) detectable on chest X-rays with the severity of coronary artery disease (CAD) as evaluated by the SYNTAX score (SS) in patients with acute coronary syndrome (ACS). MethodsA total of 1,418 patients (344 women; 59 ± 10 years) who underwent coronary angiography for ACS and were treated with coronary revascularization were included in the present study; chest X-rays were performed on admission. The AAC extent was divided into four grades (0–3). SS was calculated based on each patient's coronary angiographic findings. The relationship between the AAC extent and SS was assessed. Results The AAC extent was positively correlated with SS (ρ = 0.639, P < 0.001). In the multivariate analysis, compared with grade 0, odds ratios (ORs) of AAC grades 1, 2, and 3 in predicting SS >22 were 12.95 (95% CI, 7.85–21.36), 191.76 (95% CI, 103.17–356.43), and 527.81 (95% CI, 198.24–1405.28), respectively. Receiver operating characteristic curve analysis yielded a strong predictive ability of the AAC extent for SS >22 (area under curve = 0.840, P < 0.001). Absence of AAC had a sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of 46.7%, 95.9%, 94.1%, 56.4%, and 67.3%, respectively, for SS ≤22. AAC grades ≥2 had a sensitivity of 66.3%, specificity of 89.2%, positive prognostic value of 81.5%, negative prognostic value of 78.6%, and accuracy of 79.6% for the correct identification of SS >22. Conclusions The extent of AAC detectable on chest X-rays might provide valuable information in predicting CAD severity in ACS patients.

LB.02.18] DIFFERENCE BETWEEN CAROTID-FEMORAL AND CAROTID-RADIAL PULSE WAVE VELOCITY CAN INDICATE THE EXTENT OF AORTIC ARCH CALCIFICATION IN DIALYSIS PATIENTS

Objective: Aortic arch calcification (AoAC) score evaluated on plain chest X-ray was proven to be associated with increased cardiovascular risk. We aimed to determine whether the difference between carotid-femoral pulse wave velocity (CFPWV) and carotid-radial pulse wave velocity (CRPWV) could describe the extent of AoAC in dialysis patients. Design and method: This cross-sectional study included 61 dialysis patients without previous vascular events. They all underwent chest X-ray. Two radiologists blinded to patient medical records graded aortic arch calcification (AoAC) by using a scale from 0 to 3 (grade0–no visible calcification, grade1 - < 50% calcification in the arch, grade2 - >50% calcification, grade3–circumferential calcification). These patients had their CFPWV and CRPW measured and the difference (δPWV=CFPWV-CRPWV) calculated. Biochemical blood tests included creatinine, urea, uric acid, cystatin C, ferritin, protein, albumin, C-reactive protein (CRP), calcium, phosphate, parathormone, total cholesterol, haemoglobin, platelets, white blood cells. Corrected total calcium and calcium phosphate products were calculated. According to AoAC grade patients were divided into 3 groups: group A–AoAC grade0, group B–grade1, group C–grade2, 3. Results: Patients with AoAC were significantly older, shorter in height, had higher than 25 kg/m2 body mass index (BMI), lower peripheral and central diastolic BP, lower end systolic BP, higher CRP levels. Group B had significantly lower phosphate and calcium phosphate product levels. We observed that patients with AoAC had higher CFPWV, but lower CRPWV values. δPWV was as follows: A -0,05, B 1,72, C 4,23, p = 0,115. On multivariate logistic regression models group A was significantly associated with δPWV (OR 0.48), albumin level (OR 0.69), diastolic BP (OR 1.13), BMI (OR 0.68) and time on dialysis (OR 0.99); group C–with δPWV (OR 1.73) and phosphate (OR 1.25). In group B the association was only with CRPWV (OR 0.50), BMI (OR 1.17), δPWV had no significant influence. Conclusions: The discrepancy between CFPWV and CRPWV measurement confirms different pattern of elastic vessels (Aorta) and muscular conduit arteries (radial arteries) and can describe the extent of aortic arch calcification in dialysis patients.

Mismatch between stiffness in elastic and muscular arteries as a predictor of vascular calcification in dialysis patients

Vascular calcification is one of the risk factors for arterial stiffness in patients with chronic kidney disease. We hypothesized that a mismatch between elastic and muscular arteries, represented as pulse wave velocity (PWV) ratio, could depict the extent of vascular calcification in end-stage renal disease. We also aimed to compare the predictive PWV ratio value to other factors possibly related to vascular calcification in dialysis population. In this cross-sectional study, in 60 chronic dialysis patients without previous cerebrovascular events, cardiovascular disease and events or clinically evident peripheral artery disease (ankle-brachial index >0.9), carotid-femoral and carotid-radial PWV as well as central hemodynamic parameters were measured by applanation tonometry (SphygmoCor). The PWV ratio using carotid-femoral PWV divided by carotid-radial PWV was calculated. Each patient underwent blood tests and chest X-ray for aortic arch calcification scoring. Two experienced radiologists blinded to patient's medical data evaluated chest X-rays (Cohen's kappa coefficient 0.76) and calculated how many sectors were calcified (Ogawa et al. in Hemodial Int 13:301-306, 2009). Differently scored chest X-rays were repeatedly reviewed and a consensus was reached. The study population consisted of 31 (51.7%) males and 29 (48.3%) females, mean age 52.73 ± 13.76years. Increased risk for aortic arch calcification was associated with higher PWV ratio even after adjustment for age, height, heart rate, ferritin level and C-reactive protein level (OR 2.59E+04, 95% CI 2.43E+01, 2.65E+09, p = 0.021). PWV ratio together with above-mentioned variables could predict the presence of aortic arch calcification with specificity of 93% (95% CI 78, 99%) and sensitivity of 53% (95% CI 34, 72%). The elastic and muscular arteries' stiffness mismatch was strongly associated with the extent of aortic arch calcification in this dialysis population and had better calcification predictive value compared to other demographic, hemodynamic and biochemical markers.

Aortic Arch Calcification as a Predictor of Repeated Arteriovenous Fistula Failure within 1-Year in Hemodialysis Patients.

Objectives The aim of the study was to identify the factors associated with repeated arteriovenous fistula (AVF) failure within 1-year, especially the impact of aortic arch calcification (AAC) on patency of AVF. Materials and Methods We retrospectively assessed chest radiography in hemodialysis patients who had undergone initial AVF. The extent of AAC was categorized into four grades (0–3). The association between AAC grade, other clinical variables, and repeated failure of AVF was then analyzed by binary logistic regression analysis. Results This study included 284 patients (158 males, mean age 61.7 ± 13.1 years). Patients with higher AAC grade were older, had more frequently diabetes mellitus and cardiovascular disease, had lower diastolic blood pressure, and had higher corrected calcium and lower intact parathyroid hormone levels. In multivariate analysis, the presence of higher AAC grade (odds ratio (95% confidence interval): 2.98 (1.43–6.23); p = 0.004), lower mean corrected calcium (p = 0.017), and mean serum albumin level (p = 0.008) were associated with repeated failure of AVF. Conclusions The presence of higher AAC grade, lower mean corrected calcium and mean serum albumin level were independently associated with repeated AVF failure within 1 year in hemodialysis patients.

Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina.

BackgroundThe coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina.MethodsA total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3.ResultsDuring the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score.ConclusionsAs AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.

Abstract W P122: Cerebral Small Vessel Diseases May be Associated With Aortic Arch Calcification in Patients With Acute Stroke

Background: Aortic arch calcification (AoAC) on chest X-ray represents systemic atherosclerosis and is associated with ischemic cardiovascular diseases. However, the relationship between ischemic stroke and AoAC has yet to be fully elucidated. This study focused on the relationship between AoAC and stroke subtype, and the factors linked with AoAC in patients with acute ischemic stroke were investigated. Methods: This study prospectively enrolled patients with acute ischemic stroke who were undergoing chest X-ray, blood examinations, and brain MRI. Classification of ischemic stroke subtype was based on the Trial of Org 10172 in Acute Stroke Treatment classification with minor modification. The extent of AoAC on chest X-ray was divided into four grades: no visible calcification (grade 0); small spots or a single thin area of calcification (grade 1); one or more areas of thick calcification (grade 2); and circumferential calcification (grade 3). Clinical characteristics, biochemical findings, and extent of AoAC in each stroke subtype were assessed. Results: 175 patients (age, 70 ± 13 years; 115 males) were enrolled in the study. 33 patients (19%) had small artery occlusion (SAO), 42 (24%) had large artery atherosclerosis, 49 (28%) had cardioembolism, 24 (14%) had stroke with other determined etiologies, and 27 (17%) had stroke with undetermined etiologies. Among stroke subtypes, the extent of AoAC was the highest in patients with SAO (p=0.036). Multinomial logistic regression analysis showed that the extent of AoAC was negatively correlated to other stroke subtypes compared to SAO (all p&lt;0.05). Age (OR: 1.14; 95% CI: 1.08 to 1.19; p&lt;0.001), hypertension, (OR: 3.44; 95% CI: 1.23 to 9.66; p=0.019), diabetes mellitus (OR: 2.19; 95% CI: 0.99 to 4.85; p=0.054), white matter lesions (OR: 1.54; 95% CI: 1.00 to 2.36; p=0.048), and SAO (OR: 1.38; 95% CI: 1.02 to 1.89; p=0.040) were significantly associated with high-grade AoAC. Conclusions: SAO was closely associated with AoAC. Age, hypertension, and possibly diabetes mellitus can increase the risk of cerebral small artery diseases including SAO and white matter lesions, and aortic arch calcification in patients with acute ischemic stroke.

Cerebral small artery diseases may be associated with aortic arch calcification in stroke patients.

Aortic arch calcification (AoAC) on chest X-rays represents systemic atherosclerosis and it is associated with ischemic cardiovascular diseases. However, the relationship between ischemic stroke and AoAC has yet to be fully elucidated. Patients with acute ischemic stroke who were undergoing chest X-ray, blood, and brain magnetic resonance imaging (MRI) examinations were prospectively studied. The extent of AoAC on chest X-ray was divided into four grades (0-3). Clinical characteristics, biochemical findings, white matter lesions on MRI, and AoAC extent were assessed in each stroke subtype, and the factors associated with AoAC were investigated. A total of 175 patients (age, 70 ± 13 years; 115 men) were enrolled in the study. According to the Trial of Org 10172 in Acute Stroke Treatment classification with minor modification, 33 patients (19%) had small artery occlusion (SAO), 42 (24%) had large artery atherosclerosis, 49 (28%) had cardioembolism, 24 (14%) had stroke with other determined etiologies, and 27 (17%) had stroke with undetermined etiologies. Compared to other stroke subtypes, the extent of AoAC was independently correlated with SAO (all p<0.05). Age (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.08 to 1.19, p<0.001), hypertension, (OR: 3.44, 95% CI: 1.23 to 9.66, p=0.019), diabetes mellitus (OR: 2.19, 95% CI: 0.99 to 4.85, p=0.054), white matter lesions (OR: 1.54, 95% CI: 1.00 to 2.36, p=0.048), and SAO (OR: 1.38, 95% CI: 1.02 to 1.89, p=0.040) were significantly associated with AoAC. Age, hypertension, cerebral small artery disease, and possibly diabetes mellitus appear to be closely associated with AoAC in patients with acute ischemic stroke.

Aging, Aortic Arch Calcification, and Multiple Brain Infarcts Are Associated with Aortogenic Brain Embolism

Background: Mobile or ulcerated aortic plaques (MUAPs) on transesophageal echocardiography (TEE) can cause aortogenic brain embolism. Aortic arch calcification (AoAC) on chest X-ray represents systemic atherosclerosis. This study focused on AoAC on chest X-ray and its link with atheromatous aortic plaques (AAPs) on TEE in stroke patients. The aim of the present study was to assess the relationship between AoAC and AAPs in unexplained stroke patients. Methods: A total of 178 patients (mean age: 64 ± 15 years; 115 males) with ischemic stroke who underwent TEE were enrolled. The patients were classified based on TEE findings: (1) AAPs <4 mm; (2) AAPs ≥4 mm, and (3) MUAPs. The extent of AoAC on chest X-ray was divided into 4 grades (0-3). Clinical characteristics including AoAC were compared among the 3 groups. Multiple logistic regression analysis was performed to identify the independent factors associated with MUAPs. An original diagnostic criterion was defined as a potential indicator of MUAPs in unexplained stroke patients. Results: 104 (58%) patients had AAPs <4 mm, 46 (26%) had AAPs ≥4 mm, and 28 (16%) had MUAPs. Older age (OR: 1.14; 95% CI: 1.06-1.24; p = 0.001), AoAC (OR: 2.35; 95% CI: 1.30-4.24; p = 0.005), and multiple infarctions in multiple vascular territories (VTs) demonstrated on diffusion-weighted imaging (DWI) (OR: 2.58; 95% CI: 1.35-4.92; p = 0.004) were independently associated with MUAPs. The CAM score was defined as consisting of the degree of AoAC (0-3 points), age (≥70 years: 1 point), and DWI findings (multiple infarctions in 1 VT: 1 point; 2 VTs: 2 points; more than 3 VTs: 3 points). The prevalence of MUAPs was substantially increased in patients with medium risk (CAM score 3-4, OR: 7.68; 95% CI: 2.89-20.44; p < 0.001) and high risk (CAM score 5-7, OR: 20.63; 95% CI: 5.12-83.06; p < 0.001). Conclusions: Older age, advanced AoAC, and multiple infarctions in multiple VTs are associated with aortogenic brain embolism. The CAM score can be useful for the diagnosis of aortogenic brain embolism.

Aortic arch calcification evaluated on chest X-ray is a strong independent predictor of cardiovascular events in chronic hemodialysis patients

Vascular calcification is associated with cardiovascular disease in hemodialysis (HD) patients. Some reports have previously shown that simple assessment of aortic calcification using plain radiography is associated with cardiovascular (CV) events; however, these studies simply assessed whether aortic calcification was present or absent only, without considering its extent. Here, we evaluated the validity of grading aortic arch calcification (AoAC) to predict new CV events. We retrospectively reviewed chest X-rays in 212 asymptomatic HD patients who underwent measurement of pulse wave velocity (PWV) in 2006 without a past history of CV events. The extent of AoAC was divided into four grades (0-3). Among these subjects, the follow-up of CV events in 197 patients was completed. At baseline, AoAC grade was positively associated with age, dialysis vintage, PWV and parathyroid hormone levels, and negatively correlated with body weight and body mass index. Arterial stiffness, as determined by PWV, was also correlated with increasing AoAC grade. Eighty-nine CV events in total occurred during a mean follow-up period of 69±45months. With multivariate adjustment, Kaplan-Meier analysis showed that the incidence was significantly higher in patients with higher AoAC grade (grades 2 and 3) than in those with grade 0 or 1 (p=0.013, log-rank test). Multivariate Cox proportional hazards analyses showed the predictive values of AoAC grade were significant (hazard ratio 1.512; p=0.0351). AoAC detectable on chest X-ray is a strong independent predictor of CV events in accordance with PWV. Risk stratification by assessment of AoAC may provide important information for management of atherosclerotic disease in HD patients.

Aortic arch calcification detectable on chest X-ray is a strong independent predictor of cardiovascular events beyond traditional risk factors

ObjectivesArterial calcification makes the management of hemodynamics more difficult. Some reports have previously shown that simple assessment of aortic calcification using plain radiography is associated with cardiovascular (CV) events; however, these studies simply assessed whether aortic calcification was present or absent only, without considering its extent. Here, we evaluated validity of grading aortic arch calcification (AAC) to predict new CV events. Methods and resultsWe retrospectively reviewed chest X-rays in 239 asymptomatic out-patients who underwent measurement of endothelial function at the 1994–2000 without past history of CV events. The extent of AAC was divided into four grades (0–3). Among these subjects, the follow-up of CV events in 209 patients was completed. At baseline, AAC grade was positively related to age, pulse pressure, diabetes and renal dysfunction. Impairment of endothelial function, as determined by flow-mediated dilation (FMD), was also correlated to increasing AAC grade. Fifty-seven CV events in total occurred during a mean follow-up period of 69±45 months. With multivariate adjustment, Kaplan–Meier analysis showed that the incidence was significantly higher in patients with higher AAC grade (grades 2 and 3) than in those with grade 0 or 1 (p<0.01, log-rank test). Two kinds of multivariate Cox-proportional hazards analyses showed the predictive values of AAC grade were significant (hazard ratio, 2.49; p=0.01, 2.56; p<0.01, respectively), and the predictive power was superior to that of renal dysfunction or FMD. In addition, the prediction was valuable even in patients without CKD. ConclusionsAAC detectable on chest X-ray is a strong independent predictor of CV events beyond traditional risk factors including endothelial dysfunction. Risk stratification by assessment of AAC may provide important information for management of atherosclerotic disease.

Validity and Usefulness of Aortic Arch Calcification in Chest X-Ray

Arterial calcification is associated with cardiovascular (CV) disease, to be leading to vessel wall stiffness and causing the management of hemodynamics in the elderly more difficult. Here, we compared the extent of calcification in the aortic arch by reviewing chest X-rays to that in the abdominal aorta as assessed by more detailed examinations. In addition, the validity of the grading and the relationship of this useful grading to clinical risk factors were evaluated. The extent of aortic arch calcification (AAC) on a postero-anterior plain chest X-ray was divided into four grades (0 to 3). First, AAC grade was assessed in patients who underwent two quantitative examinations for abdominal aortic calcification; lateral radiograph of lumbar spine and/or computer tomography, and was positively correlated with the abdominal aortic calcification level. Subsequently, AAC grade in 239 out-patients (115 men; mean age, 61.9 years) was also evaluated, and was 0, 1, 2, and 3 in 46%, 22%, 29%, and 4% of the population, respectively, was significantly associated with pulse pressure and intima-media thickness. AAC grade in patients with diabetes or renal dysfunction was significantly higher than in those without each risk, but there was no association with other risk factors. In addition, AAC grade was positively correlated with risk factor clustering. Assessment of AAC detectable on a chest X-ray is very useful and its grade reflects the magnitude of calcified change in the whole aorta. In addition, AAC evaluation may provide supportive information for atherosclerotic risk stratification.