Mild Coronary Artery Calcification Research Articles

Prognostic value of coronary artery calcium score in hospitalized COVID-19 patients

Abstract Background The association between known cardiovascular risk factors and poor prognosis of patients diagnosed with coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score assessed by computed tomography (CT) is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2). Purpose We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients. Methods We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded.Low dose non-contrast chest CT was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1–3 (mild), 4–5 (moderate) and ≥6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in–hospital treatment and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all-cause mortality and cardiovascular events (heart failure, myocarditis, arrhythmia, acute coronary syndrome, stroke, pulmonary embolism). Results Two-hundred eighty patients (63.2±16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of zero. MACE-rate was 24.2% (68 patients). Multivariate logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.264, 95% 0.071–0.981, p=0.047), with a negative predictive value (NPV) of 81.4%, sensitivity 70%, specificity 55%, independent of age, risk factors or disease severity (Table 1). Conclusion The absence of CAC translated into a low risk for MACE in COVID-19 patients, even in the presence of cardiac risk factors, which reinforces the idea that the assessment of CAC score in COVID-19 patients could be a useful marker for patients risk stratification and management. Future directions should focus on the implementation of CAC score into mid-term and long-term follow-up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

Association between coronary artery calcifications and 6-month mortality in hospitalized patients with COVID-19

PurposeThe purpose of this study was to evaluate the association between coronary artery calcium (CAC) visual score and 6-month mortality in patients with coronavirus disease 2019 (COVID-19). Material and methodsA single-center prospective observational cohort was conducted in 169 COVID-19 consecutive hospitalized patients between March 13 and April 1, 2020, and follow-up for 6-months. A four-level visual CAC scoring was assessed by analyzing images obtained after the first routine non-ECG-gated CT performed to detect COVID-19 pneumonia. ResultsAmong 169 confirmed COVID-19 patients (118 men, 51 women; mean age, 65.6 ± 18.8 [SD] years; age range: 30–95 years) 63 (37%) presented with either moderate (n = 26, 15.3%) or heavy (n = 37, 21.8%) CAC detected by CT and 20 (11.8%) had history of cardiovascular disease requiring specific preventive treatment. At six months, mortality rate (45/169; 26.6%) increased with magnitude of CAC and was 7/64 (10.9%), 11/42 (26.2%), 10/26 (38.5%), 17/37 (45.9%) for no-CAC, mild-CAC, moderate-CAC and heavy-CAC groups, respectively (P = 0.001). Compared to the no CAC group, risk of death increased after adjustment with magnitude of CAC (HR: 2.23, 95% CI: 0.73–6.87, P = 0.16; HR: 2.78, 95% CI: 0.85–9.07, P0.09; HR: 5.38, 95% CI: 1.57–18.40, P = 0.007; in mild CAC, moderate and heavy CAC groups, respectively). In patients without previous coronary artery disease (154/169; 91%), mortality increased from 10.9% to 45.8% (P = 0.001) according to the magnitude of CAC categories. After adjustment, presence of moderate or heavy CAC was associated with higher mortality (HR: 2.26, 95% CI: 1.09–4.69, P = 0.03). ConclusionBy using non-ECG-gated CT during the initial pulmonary assessment of COVID-19, heavy CAC is independently associated with 6-month mortality in patients hospitalized for severe COVID-19 pneumonia.

Serum Sortilin Is Associated with Coronary Artery Calcification and Cardiovascular and Cerebrovascular Events in Maintenance Hemodialysis Patients

Objective: To analyze the role of serum sortilin in coronary artery calcification (CAC) and cardiovascular and cerebrovascular events (CCE) in maintenance hemodialysis (MHD) patients. Methods: One hundred eleven patients with MHD ≥3 months were included in this study. The general data, clinical features, hematological data, and medication history of the patients were recorded. Eighty-five cases were examined by vascular color Doppler ultrasound, cardiac color Doppler ultrasound, lateral lumbar radiography, and coronary artery calcification score. The patients were followed up for a median time of 45 months. The primary endpoint was CCE or death from a vascular event, and the role of sortilin in this process was analyzed. Results: Among 85 MHD patients, 51 cases (60.00%) had different degrees of CAC. There were significant differences in diabetes, dialysis time, serum phosphorus, calcium-phosphorus product, medical history of phosphate binders, sortilin, and carotid artery plaque between 4 different degrees of calcification groups (p < 0.05). Logistic regression analysis showed that diabetes (OR = 5.475; 95% CI: 1.794–16.71, p = 0.003), calcium-phosphorus product (OR = 2.953; 95% CI: 1.198–7.279, p = 0.019), and sortilin (OR = 1.475 per 100 pg/mL; 95% CI: 1.170–1.858, p = 0.001) were independent risk factors for CAC. During the follow-up, 28 cases of 111 patients (25.23%) suffered from CCE. There were significant differences in CCE between mild, moderate, and severe CAC groups and noncalcification groups (p < 0.05). Cox regression analysis showed that diabetes mellitus (HR 3.424; 95% CI: 1.348–8.701, p = 0.010), CAC (HR 5.210; 95% CI: 1.093–24.83, p = 0.038), and serum sortilin (HR = 8.588; 95% CI: 1.919–38.43, p = 0.005) were independent risk factors for CCE. Besides, we proposed a cutoff value of 418 pg/mL for serum sortilin level, which was able to predict the occurrence of CCE with 75.0% sensitivity and 71.9% specificity. The area under the curve was 0.778 (95% CI: 0.673–0.883). Conclusion: Sortilin is newly found to be independently associated with CAC and CCE in MHD patients.

Increased Rates of Coronary Artery Calcium Score in Patients with Non - Functioning Adrenal Incidentaloma.

We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. The participants were patients with NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score, and a non-diagnostic treadmill- exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units - mild coronary-artery calcification (n = 40) - and ≥100 Agatston units - moderate-to-severe calcification (n = 15). Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassium, adrenocorticotropic-hormone, and basal-cortisol levels were higher in those with a CAC score of ≥100. High-density-lipoprotein cholesterol estimated glomerular filtration rate and ejection fraction (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF, and glucose were the most significant variables related to CAC score in patients with NFAI, at ≥100 Agatston units. Patients with a low-intermediate CV risk profile and NFAI have a higher risk of atherosclerosis when compared to patients with a low-intermediate CV risk profile, but no NFAI. In patients with NFAI, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.

Abstract 243: Long-term Effects of ACC/AHA Cholesterol Control on Cardiac Function

Background: The impact of long term strict cholesterol control on reservoir function and outcome in heart failure is unclear. Methods: We retrospectively analyzed 2939 patients (31.9% female, mean age 65.1±11.8 years) whom strict application of ACC/AHA cholesterol management with an average length of 9.4 years of follow-up. We also evaluated the ventricular ejection fraction, mass, and Global sore (Framingham-CVD), as well as 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Results: Overall, 64.3% of patients were identified as strictly cholesterol control (case group). As compared to age-gender-race matched control group, patients in cases group have higher LV mass (152.9±34.4g vs. 143.6±34.4 g, p=0.0005) as well as an LV mass index (90.5±18.1 vs. 85 ±17 g/m2 vs. g/m2, P=0.0002) and Framingham Global CVD Risk score (18.9±17.7 vs. 8.6±17.3, P&lt;0.001), but not for LVEF (68.5%±7.5% vs. 69.1%±6.6%, p=0.263). The average percentage decrease in LVEF in patients with mild coronary artery calcification (CAC score&lt;100) in cases is 6.2%, and when CAC score&gt;400, the LVEF decreased up to 15.3% regardless of the cholesterol control status. Major coronary arteries with severe calcification are associated with increasing the risk of abnormal ejection fraction (LVEF&lt;50%) 4.84 times after adjusting for traditional CAD risk factors. Long-term ACC/AHA cholesterol control can not prevent the ASCVD risk score increase (Table 1). Conclusions: The strict long-term application of ACC/AHA cholesterol control can effectively LV mass change. However, this strategy does not adequately prevent LV systolic function attenuation. The 10-Year ASCVD risk score is one of the robust indicators of cardiac function for long-term lipid control outcomes. Abbreviations: LAD: left anterior descending, LCX: circumflex coronary arteries, RCA: right coronary artery. CTA: coronary computed tomography angiogram. LVEF:Left Ventricular Ejection Fraction

The Association Between Coronary Artery Calcification and Subclinical Cerebrovascular Diseases in Men: An Observational Study.

Aim: Coronary artery calcification (CAC) is an independent predictor of stroke and dementia, in which subclinical cerebrovascular diseases (SCVDs) play a vital pathogenetic role. However, few studies have described the association between CAC and SCVDs. Therefore, the aim of this study was to assess the clinical relationship between CAC and SCVDs in a healthy Japanese male population.Methods: In this observational study, 709 men, free of stroke, were sampled from a city in Japan from 2010 to 2014. CAC was scored using the Agatston method. The following SCVDs were assessed using magnetic resonance imaging: intracranial arterial stenosis (ICAS), lacunar infarction, deep and subcortical white matter hyperintensity (DSWMH), periventricular hyperintensity (PVH), and microbleeds. The participants were categorized according to CAC scores as follows: no CAC (0), mild CAC (1–100), and moderate-to-severe CAC (> 100). The adjusted odds ratios of prevalent SCVDs were computed in reference to the no-CAC group using logistic regression.Results: The mean (standard deviation) age of the participants was 68 (8.4) years. Participants in the moderate-to-severe CAC category showed significantly higher odds of prevalent lacunar infarction, DSWMH, and ICAS in age-adjusted and risk-factor-adjusted models. Microbleeds and PVH, in contrast, did not show any significant associations. The trends for CAC with lacunar infarction, DSWMH, and ICAS were also significant (all P-values for trend ≤ 0.02).Conclusions: Higher CAC scores were associated with higher odds of lacunar infarction, DSWMH, and ICAS. The presence and degree of CAC may be a useful indicator for SCVDs involving small and large vessels.

Predictors of Myocardial Ischemia in Preoperative Oncology Patients Who Underwent Fluorodeoxyglucose-Positron Emission Tomography Study.

Background:Coronary artery calcification (CAC) can be visually estimated on computed tomography (CT) attenuation correction (CTAC) of positron emission tomography (PET). The visual estimation of CAC from CTAC scans performed for PET/CT is comparable to the standard CAC score scan. Myocardial perfusion imaging (MPI) with single-photon emission CT (SPECT) is commonly performed for risk stratification before oncologic surgery.Objective:We investigated the value of visual estimation of CAC from CTAC of PET/CT as well as other factors such as coronary artery disease (CAD) risk factors and type of cancer as predictors of MPI ischemia.Methods:Retrospectively, we identified 268 patients who underwent PET/CT and MPI for preoperative cardiac evaluation. Visual estimation of CAC was performed and classified into four categories.Results:The results of visual CAC were as follows: 47.8% – zero CAC, 32.8% – mild CAC, 14.2% – moderate CAC, and 5.2% – severe CAC. The majority of patients (85.8%) had normal MPI, whereas 14.2% were abnormal. There was a strong association between ischemia on MPI and CAC seen on CTAC (P < 0.01), dyslipidemia (P < 0.01), family history of CAD (P < 0.05), smoking (P < 0.01), and type of malignancy (P < 0.01).Conclusion:A strong association exists between visual estimation of CAC on CTAC and MPI. Zero is highly associated with normal MPI, but moderate-to-severe CAC is associated with abnormal MPI, in addition smoking, dyslipidemia, and certain cancer are associated with ischemic MPI; subsequently, preoperative cardiac testing is warranted in these subsets of patients.

Evaluation of the association of Wnt signaling with coronary artery calcification in patients on dialysis with severe secondary hyperparathyroidism

BackgroundPatients with end-stage renal disease have a higher risk of death from cardiovascular events, which can be mainly attributed to coronary artery calcification (CAC). Wnt signaling is involved in vascular development and may play a role in vascular calcification. This study aimed to evaluate CAC prevalence in patients on dialysis with severe secondary hyperparathyroidism (SHPT) and identify CAC risk factors.MethodsThe study is a retrospective analysis of the severe hyperparathyroidism registration study that prospectively recruited patients on dialysis with severe SHPT who were candidates for parathyroidectomy, from October 2013 to May 2015. CAC and bone mineral density (BMD) were measured. Demographic and clinical data including calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, Dickkopf-related protein 1 (DKK1), and sclerostin levels were analyzed. CAC scores were reported in Agatston units (AU).ResultsA total of 61 patients were included in this study. No CAC, mild CAC (<100 AU), moderate CAC (>100 AU), and severe CAC (>400 AU) were observed in 4.9%, 11.4%, 14.8%, and 68.9% of patients, respectively. DKK1 and sclerostin were not associated with CAC. In univariate analysis, CAC was significantly correlated with age, sex (male), total cholesterol, and intravenous pulse calcitriol (p<0.05). CAC was not inversely correlated with the BMD, T scores, or Z scores of the femoral neck (p>0.05). In multivariate analysis, the stepwise forward multiple linear regression revealed that CAC was associated with age, male sex and intravenous pulse calcitriol (p<0.05). Furthermore, serum sclerostin was positively correlated with the BMD of the femoral neck but negatively associated with intact parathyroid hormone (p<0.05). Serum sclerostin was significantly associated with severely low bone mass with Z-scores<-2.5 of the femoral neck, even when adjusted for serum intact parathyroid hormone, vitamin D status, dialysis pattern, sex, and DKK-1 (p<0.05).ConclusionsThe patients on dialysis with severe SHPT have a high prevalence of vascular calcification. Although the Wnt signaling pathway could play a role in hyperparathyroid bone disease, CAC may be mainly due to the treatment modality rather than the Wnt signaling pathway associated bone metabolism in patients on dialysis with severe SHPT.

Influence of coronary calcification on hyperemic response during fractional flow reserve measurements

AimDuring invasive fractional flow reserve (FFR) adenosine and nitrates are used to obtain maximal hyperemia. Severe coronary artery calcification (CAC) is associated with impaired vasodilation. We investigated the hyperemic response during FFR in vessels with severe versus mild CAC. Methods and resultsWe retrospectively selected 236 patients who underwent both CAC scoring and invasive FFR. FFR was performed in 304 vessels with intermediate stenoses. Delta (Δ) FFR, the pressure gradient before the administration of adenosine minus FFR after the administration of adenosine, was used to investigate the hyperemic response. Mean age of the total population was 65 ± 10 years, 65% was male. Median CAC score was 510 (range 0 to 6141). Mean pressure gradient before the administration of adenosine was comparable in vessels with severe versus mild CAC. FFR was more often ≤0.80 in vessels with severe CAC (p = 0.045). Patients with a large Δ FFR were younger (p = 0.05). There was no association between Δ FFR and severity of calcifications. Regression analysis did not demonstrate an association between CAC score and the hyperemic response (p = 0.49). ConclusionWe did not find an association between the severity of CAC and the hyperemic response during invasive FFR.

Elevated IL-37 levels in the plasma of patients with severe coronary artery calcification.

BackgroundCoronary artery calcification (CAC) is a predictor of cardiovascular events and plaque burden and is closely associated with chronic inflammation. Interleukin (IL)-37 is a newly discovered member of the IL-1 family and is considered an anti-inflammatory cytokine. Our recent study on mice indicated that IL-37 could attenuate atherosclerosis and vascular calcification, which suggests that IL-37 could be associated with the development of atherosclerosis and related diseases. The aim of this study was to investigate if IL-37 plays a role in the progression of CAC in patients.MethodsTwo hundred participants with suspected cardiovascular disease were recruited. The levels of plasma IL-37, osteoprotegerin (OPG), hypersensitive C-reactive protein (hsCRP) together with other biochemical parameters were measured, and a coronary calcium assessment was carried out by multi-detector row CT. A score of < 10 AU (Agatston units) denotes an absence of CAC, a score of 11–100 AU denotes mild CAC, 101–400 denotes moderate CAC, and > 400 AU denotes severe CAC.ResultsOur initial data showed that there were no apparent differences in plasma IL-37 levels among patients with or without mild or moderate CAC. However, IL-37 levels were significantly increased in patients with severe CAC (P < 0.001). Similar results were observed for plasma OPG and hsCRP levels. When IL-37 levels in patients with severe calcification were compared with that in all of the other non-severe CAC groups, it became apparent that there was a significant positive correlation between IL-37 level and severe CAC (r = 0.360, P < 0.001; OR = 1.033) using Spearman's correlation and binary logistic regression analysis.ConclusionsThis study demonstrates that the anti-inflammatory cytokine IL-37 is associated with high coronary calcium levels, suggesting that IL-37 expression may be caused by the activation of inflammation and that IL-37 might become a predictor of severe CAC in the future, which requires further investigation.

The role of multidetector computed tomography coronary angiography with calcium score and Framingham Risk Score in evaluation of rheumatoid arthritis patients with chest pain

ObjectivesTo evaluate diagnostic yield of coronary artery calcium (CAC) scoring using multidetector CT imaging in rheumatoid arthritis (RA) patients presented with chest pain. Patients and methodsSeventy RA patients evaluated using the 28 joint disease activity (DAS-28) score, Disability Index (DI) and radiologically for Larsen–Dale index. Patients underwent assessment for coronary artery disease (CAD) risk factors and coronary risk stratification using the Framingham Risk Score (FRS). Patients were clinically categorized according to criteria for typical anginal pain (TAP) and were scanned using a 64-row spiral CT scanner for CAC scoring and were stratified according Agatston CAC scores for calculation of total Agatston score (TAS). ResultsClinically, 32 patients had full criteria of TAP, 27 patients showed a picture of atypical anginal pain, while 11 patients had non-anginal chest pain. FRS predicted low, intermediate and high risk of CAD in 34, 18 and 18 patients, respectively. TAS defined no CAC in 4 patients, while mild, moderate and severe CAC was detected in 24, 36 and 6 patients, respectively. Regression analysis defined low HDL blood level, current smoking and high TAS, DAS-28 and FRS as significant predictor for TAP in decreasing order of significance. Receiver operating characteristic (ROC) curve analysis defined low HDL blood level and high TAS as the significant sensitive and specific tests, respectively. There was positive significant correlation between FRS and both of TAS scores and extent of coronary stenosis. However, FRS was the least significant predictor for TAP. ConclusionScreening of RA patients with combination of clinical scoring using FRS and CAC using non-invasive multidetector CT could allow early detection of patients at risk for acute cardiovascular events. However, TAS acts better for the prediction of TAP.

PD47-08 CORONARY ARTERY CALCIUM SCORE AND ASSOCIATION WITH RECURRENT NEPHROLITHIASIS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2016PD47-08 CORONARY ARTERY CALCIUM SCORE AND ASSOCIATION WITH RECURRENT NEPHROLITHIASIS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS Ryan Hsi, Andrew Spieker, Marshall Stoller, David Jacobs, Alex Reiner, Robyn McClelland, Arnold Kahn, Thomas Chi, Moyses Mzklo, and Mathew Sorensen Ryan HsiRyan Hsi More articles by this author , Andrew SpiekerAndrew Spieker More articles by this author , Marshall StollerMarshall Stoller More articles by this author , David JacobsDavid Jacobs More articles by this author , Alex ReinerAlex Reiner More articles by this author , Robyn McClellandRobyn McClelland More articles by this author , Arnold KahnArnold Kahn More articles by this author , Thomas ChiThomas Chi More articles by this author , Moyses MzkloMoyses Mzklo More articles by this author , and Mathew SorensenMathew Sorensen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2696AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney stone disease is linked to systemic conditions including hypertension, obesity, diabetes mellitus, and coronary heart disease. Therefore, biologic pathways that result in coronary artery calcification may also lead to the development of nephrolithiasis. Subclinical coronary artery calcification (CAC) is an established predictor of cardiovascular events. CAC is quantified noninvasively by computed tomography, and the calculated CAC score reflects the presence and extent of atherosclerotic disease. While a history of kidney stones has been linked to subclinical carotid atherosclerosis, no study has examined its relationship with CAC. We studied the association between kidney stone history and prevalent CAC from the MESA study. METHODS The Multi-Ethnic Study of Atherosclerosis is a multi-site cohort study of participants aged 45-84 without known cardiovascular disease at baseline (2000-2002). At follow up in 2010-2012, 3,282 participants underwent computed tomography to determine CAC and had kidney stone history assessed by self-report. CAC scores were categorized as none, mild (<100), moderate (101-400), or severe (>400). A cross-sectional analysis was performed adjusting for demographic and dietary factors related to kidney stones. RESULTS Prevalence of kidney stone disease history was approximately 9%, mean age was 69.5±9.3 years, 39% of participants were Caucasian, 47% were men, and 69% had detectable (CAC score >0). Of the stone formers, 129 (44.6%) reported a history of 2 or more stones in the past. Mean±SD CAC score among non-stone formers and stone formers was 279±595 and 380±602, respectively. No difference in CAC score was seen between single stone formers and non-stone formers. Recurrent kidney stone formation was associated with moderate or severe CAC on multivariable logistic regression (versus none or mild CAC) (OR 1.80, 95% CI 1.22-2.67). When CAC scores were separated into none, mild, moderate, and severe CAC, recurrent stone formation was associated with higher CAC score category on multivariable ordinal logistic regression (OR per category 1.44, 95% CI 1.04- 2.01). CONCLUSIONS Recurrent kidney stone formation is associated with subclinical coronary atherosclerosis. This association appeared stronger with CAC severity than with CAC presence. The clinical significance of these findings is that a recurrent stone former, who has no prior cardiac history and is otherwise asymptomatic, may have higher levels of coronary calcification and be at risk for future cardiovascular events. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1173 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ryan Hsi More articles by this author Andrew Spieker More articles by this author Marshall Stoller More articles by this author David Jacobs More articles by this author Alex Reiner More articles by this author Robyn McClelland More articles by this author Arnold Kahn More articles by this author Thomas Chi More articles by this author Moyses Mzklo More articles by this author Mathew Sorensen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Relationship between coronary artery calcification and osteopenic syndrome in men with coronary heart disease

Objective: to investigate the relationship between coronary artery calcification (CAC) and osteopenic syndrome in men with coronary heart disease (CHD). Subjects and methods. A total of 102 men aged 51 to 75 years (mean age 61 (55; 65) years) with verified CHD were examined. Bone mineral density (BMD) and its T-score of LI–IV and femoral neck were determined by dual-energy X-ray absorptiometry. According to the T-score, the men were divided into 3 groups: 1) 33 (32.4%) patients with osteoporosis (OP) (T-score 400). Results and discussion . Severe CAC was detected in 57.8% of the men; moderate CAC was in 25.5%; mild CAC was in 6.9; minimal CAC was in 2.0%; and none CAC was in 7.8%. In the OP group, the majority (69.7%) of the patients had severe CAC; 15.1% had moderate CAC, 6.1% had mild CAC; 3.0% had minimal CAC; CAC was undetected in 6.1% of cases. In the OSP group, there was severe CAC in 60.4%, moderate CAC in 33.3%, mild CAC in 4.2%, and minimal CAC in 2.1%. The patients without CAC were absent in this group. In the NBMD group, 33.3% of the examinees were recorded to have severe CAC; 23.8% had moderate CAC; 14.3% had mild CAC; CAC was undetected in 28.6%. Minimal CAC was also undetected in the patients of this group. There was a preponderance of patients with severe CAC in all the groups of those identified by the T-score. The extent of CAC was significantly lower in the NBMD group than in the OSP group (p<0.05). CAC was significantly more frequently absent in the NBMD group than in the low BMD group (p<0.05). There was an inverse correlation between Agatston CAC scores and T-scores of the femoral neck (r=-0.25; p=0.01), T-scores of LI–IV (r=-20; p=0.04), and the BMD of the femoral neck (r=0.23; p=0.02) and LI–IV (r=-0.19; p=0.04). Low BMD was associated with severe CAC, which lends credence to the relationship between vascular wall calcification and osteopenic syndrome in the men with CHD.

Correlation between polymorphisms in the visfatin gene and its expression in the serum and coronary artery calcification.

We investigated the association between serum visfatin levels and single nucleotide polymorphisms (SNPs; rs61330082, rs2058539) in the visfatin gene and coronary artery calcification (CAC) in patients from Wenzhou, China. CAC patients (N = 206) were divided into two groups: mild CAC (MCAC) and moderate and severe CAC (MSCAC). Volunteers without CAC (N = 70) were included in the control group. The serum visfatin level was analyzed by enzyme-linked immunosorbent assay. SNPs (rs61330082, rs2058539) in the visfatin gene were analyzed by polymerase chain reaction-restriction fragment length polymorphism. Clinical data, serum visfatin levels, and genotype and allele frequencies of rs61330082 and rs2058539 were compared among the three groups. MSCAC patients expressed significantly higher serum visfatin levels (30.58 ± 6.12 ng/mL) than individuals in the MCAC (29.03 ± 1.87 ng/mL) and control (24.45 ± 5.44 ng/mL) groups (P < 0.05). The genotype distributions and frequencies of rs61330082 differed significantly among the groups (P < 0.05), while those of rs2058539 did not. The serum visfatin level was positively correlated with the body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), and insulin resistance index (IRI), and negatively correlated with the triglyceride (TG) levels (P < 0.05) of patients. Serum visfatin is associated with the development of CAC. The T allele of the rs61330082 SNP in the visfatin gene had a cardioprotective effect on patients with CAC; the SNP at rs2058539 was not significantly associated with CAC. The BMI, HDL-C, IRI, and TG levels influenced the development of CAC.

Subclinical Atherosclerosis and Relationship With Risk Factors of Coronary Artery Disease in a Rural Population

BackgroundAnnually, over 150,000 cardiovascular events occur among individuals <65 years old in the United States, including asymptomatic ones. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), enhances risk stratification among asymptomatic individuals. This study assessed the prevalence of CAC in a rural population and determined relationships between traditional risk factors for CAD and CAC scores. MethodsDuring January 2011 to December 2012, asymptomatic individuals from central Appalachia were screened for CAC in the largest tertiary cardiovascular institute. Based on Agatston scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1–99), moderate (CAC = 100–399) and severe (CAC ≥ 400). Multinomial logistic regression was used to examine associations between potential risk factors of CAD and CAC score. ResultsOf 1,674 participants, 55.4% had positive CAC score (CAC > 0). Increasing age and being male were positively associated with higher CAC scores. Although there was significant association between mild CAC and hypertension and family history of CAD, moderate CAC was positively associated with smoking status. Except hypercholesterolemia and sedentary lifestyle, severe CAC was significantly associated with major health conditions (obesity, diabetes and hypertension), lifestyle (smoking) and family history of CAD. ConclusionsMore than half of participants in the CAC screening had subclinical CAD (CAC score > 0). The association between CAC score and CAD risk factors suggests that education about subclinical atherosclerosis among asymptomatic individuals in this region with high cardiovascular disease prevalence is needed because CAC improves CAD risk stratification, and the knowledge of CAC enhances medication adherence and motivates individuals towards beneficial behavioral/lifestyle modification.

Distribution and burden of newly detected coronary artery calcium: Results from the Multi-Ethnic Study of Atherosclerosis

BackgroundThe transition from no coronary artery calcium (CAC) to detectable CAC is important, as even mild CAC is associated with increased cardiovascular events. We sought to characterize the anatomic distribution and burden of newly detectable CAC over 10-year follow-up. MethodsWe evaluated 3112 participants (mean age, 58 years; 64% female) with baseline CAC = 0 from the Multi-Ethnic Study of Atherosclerosis. Participants underwent repeat CAC testing at different time intervals (between 2–10 years after baseline) per the Multi-Ethnic Study of Atherosclerosis protocol. Among participants who developed CAC on a follow-up scan, we used logistic regression and marginal probability modeling to describe the coronary distribution and burden of new CAC by age, sex, and race after adjustment for cardiovascular risk factors and time to detection. ResultsA total of 1125 participants developed detectable CAC during follow-up with a mean time to detection of 6.1 ± 3 years. New CAC was most commonly isolated to 1 vessel (72% of participants), with the left anterior descending artery (44% of total) most commonly affected followed by the right coronary (12%), left circumflex (10%), and left main (6%). These patterns were similar across age, sex, and race. In multivariate models, residual predictors of multivessel CAC (28% of total) included male sex, African American or Hispanic race, hypertension, obesity, and diabetes. At the first detection of CAC >0, burden was usually low with median Agatston CAC score of 7.1 and <5% with CAC scores >100. ConclusionNew-onset CAC most commonly involves just 1 vessel, occurs in the left anterior descending artery, and has low CAC burden. New CAC can be detected at an early stage when aggressive preventive strategies may provide benefit.

Coronary calcification with no flow limiting lesions: A potential cause for ischaemic dysfunction in syndrome X patients

AimExertional angina in patients with no coronary flow limiting lesions remains a clinical puzzle. We aimed to assess the extent of coronary artery calcification (CAC) and its relationship to ventricular wall motion function using stress echocardiography in a group of patients limited by exertional angina, but no obstructive lesions. MethodsWe compared CT coronary calcium score (CACS) and dobutamine stress echocardiography in 55 patients (age 64.7±7.7years), divided into Group 1 (CACS≤100) and Group 2 (CACS>100). No patient had LV ejection fraction-EF<55%, pulmonary hypertension, arrhythmia, renal failure or parathyroid disease. Multiple linear regression analysis was used to test the association between gender-standardized continuous echocardiographic parameters and patient groups adjusted for age, body surface area, osteoporosis and CV risk factors and CACS. ResultsAt rest, LV long axis ‘subendocardial’ function was reduced (amplitude: β −1.11 SD, p<0.05, R2 0.6 and systolic velocity: β −1.08 SD, p<0.05, R2 0.44), left atrial (LA) indexed volume was raised (β 1.06 SD, p<0.05, R2 0.37) and its systolic velocity decreased (β −1.05 SD, p<0.05, R2 0.35) in Group 2. With stress, wall motion score index increased (p<0.05) and long axis disturbances worsened only in the same group. Multivariate analysis demonstrated clear relationship between ischaemic LV disturbances, reduced long axis amplitude, global longitudinal systolic strain and early diastolic strain rate. Resting and stress RV lengthening velocity also correlated with CAC score. ConclusionIn symptomatic patients with no obstructive coronary lesions and with more than mild CAC, long axis disturbances and wall motion score index rise occur with stress, at the time of symptom development and correlate with severity of arterial calcification. These findings suggest CAC as a potential mechanism for coronary wall stiffness and consequently exertional ischaemic changes as a result of limited flow reserve.

Coronary calcium in patients with and without diabetes: first manifestation of acute or chronic coronary events is characterized by different calcification patterns

BackgroundCoronary artery calcification (CAC) is closely related to coronary atherosclerosis. However, less is known about the clinical significance of extensive CAC (ECAC) in regard to types of first coronary events (acute vs. chronic). Diabetes mellitus (DM) represents a strong risk factor for CAD although its association with CAC is controversial. Aiming to elucidate these controversies we investigated the long-term outcome of coronary artery disease (CAD) in relation to degree of CAC in patients with and without DM from our annual cheek-up outpatient clinic.MethodsCoronary artery computed tomography (CT) was performed in 667 patients who were yearly evaluated during a mean follow-up period of 6.3 ±3.4 year. The following 4 CAC categories were established: calcium absence; total calcium score (TCS): 1–100 AU; TCS: 101–600 AU and ECAC: TCS above 600 AU. Acute event was defined as first acute myocardial infarction (MI) or a new unstable angina. First chronic event was defined as a positive stress test with a consequent elective percutaneous coronary intervention or coronary artery bypass grafting.Results628 subjects (94%) were free from any cardiac events, 39 (6%) experienced first cardiac event: 18 of them suffered acute and 21 chronic events. There were 67 patients with and 600 patients without DM: 78% of patients with DM presented CAC vs. 50% of patients without DM (p < 0.001).The mean TCS was 17 times higher in the chronic than in the acute events group: 914 vs. 55 AU, p < 0.001. In 95% of the patients with chronic events more than one calcified vessel was found, compared to 67% of the patients with acute events and only 30% of those without events (p < 0.001). Incidence of CAD events (all types pooled together) rose consequently from 2% in subjects without CAC to 34% in subjects with ECAC (p < 0.001). However, among the 32 subjects with ECAC, 11 (34%) developed chronic event while none of them had acute event. In contrast, none of subjects with TCS =0 or TCS 1–100 AU presented with chronic events. Subjects with TCS 101–600 AU presented 10 (9%) chronic and 5 (4.5%) acute events (p < 0.001).ConclusionsAsymptomatic subjects with ECAC are not firstly manifested as acute coronary events but presented a high level of chronic CAD-related events during the 6.3 ±3.4 year follow-up. In contrast, first acute CAD-related events occurred mostly in subjects with mild and moderate CAC score.

Coronary artery calcification and cardiovascular risk factors in 3477 asymptomatic and symptomatic individuals

Purpose: To compare coronary artery calcification (CAC) and cardiovascular risk factors (CRF) in asymptomatic persons and symptomatic individuals with suspected coronary artery disease (CAD). Methods: In 1220 randomly selected asymptomatic individuals aged 49-61 years data on CAC, gender, family history of CAD, tobacco use, treatment of hypertension, hyperlipidemia, and diabetes were compared to 2257 age-matched symptomatic individuals referred for cardiac computed tomography with suspected CAD. Results: No significant difference in CAC was observed between asymptomatic and symptomatic individuals: mild CAC (Agatston score 10-99); 17% vs. 18% (p=0.31), moderate CAC (100-400); 10% vs. 12% (p=0.07), and severe CAC (>400); 5% vs. 6% (p=0.36). There was no difference in gender and tobacco use between the cohorts, however, symptomatic individuals were more often treated for hypertension (38% vs. 21%, p<0.001), hyperlipidemia (42% vs. 12%, p<0.001), diabetes (6% vs. 5%, p=0.05), and more frequently had a family history of CAD (47% vs. 23%, p<0.001). As opposed to age, male gender, family history of CAD, tobacco use, treatment of hypertension and hyperlipidemia, symptoms were not significantly associated to mild, moderate or severe CAC. View this table: Multivariate analyses for the association of CAC and CRF Conclusion: No difference in the amount of coronary calcification was observed between middle-aged asymptomatic and symptomatic individuals. Adjusting for cardiovascular risk factors, the presence of symptoms was not associated with the severity of coronary artery calcification.

What is the role of calcium scoring in the age of coronary computed tomographic angiography?

Non-contrast-enhanced CT for coronary artery calcification (CAC) as a marker of coronary atherosclerosis has been studied extensively in the primary prevention setting. With rapidly evolving multidetector CT technology, contrast-enhanced coronary CT angiography (CCTA) has emerged as the non-invasive method of choice for detailed imaging of the coronary tree. In this review, we systematically evaluate the role of CAC testing in the age of CCTA in both asymptomatic and symptomatic patients, across varying levels of risk. Although the role of CAC testing is well established in asymptomatic subjects, its use in evaluating those with stable symptoms that represent possible obstructive coronary artery disease is controversial. Nevertheless, available data suggest that in low-to-intermediate risk symptomatic patients, CAC scanning may serve as an appropriate gatekeeper to further testing with either CCTA (if no or only mild CAC present) versus functional imaging or invasive coronary angiography (when moderate or severe CAC present). Given the strong short-term prognostic value of CAC = 0, studies are needed to further evaluate the role of CAC scanning in low-risk patients with acute chest pain presenting to the emergency room.