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Cardiac Calcification
Morteza Joorabian
Iranian Journal of Radiology , 2011,
Abstract: There is a spectrum of different types of cardiac"ncalcifications with the importance and significance"nof each type of cardiac calcification, especially"ncoronary artery calcification. Radiologic detection of"ncalcifications within the heart is quite common. The"namount of coronary artery calcification correlates"nwith the severity of coronary artery disease (CAD)."nCalcification of the aortic or mitral valve may indicate"nhemodynamically significant valvular stenosis."nMyocardial calcification is a sign of prior infarction,"nwhile pericardial calcification is strongly associated"nwith constrictive pericarditis. A spectrum of different"ntypes of cardiac calcifications (linear, annular,"ncurvilinear,...) could be seen in chest radiography and"nother imaging modalities. So a carful inspection for"ndetection and reorganization of these calcifications"nshould be necessary. Numerous modalities exist for"nidentifying coronary calcification, including plain"nradiography, fluoroscopy, intravascular ultrasound,"nMRI, echocardiography, and conventional, helical and"nelectron-beam CT (EBCT). Coronary calcifications"ndetected on EBCT or helical CT can be quantifie,"nand a total calcification score (Cardiac Calcification"nScoring) may be calculated. In an asymptomatic"npopulation and/or patients with concomitant risk"nfactors like diabetes mellitus, determination of the"npresence of coronary calcifications identifies the"npatients at risk for future myocardial infarction and"ncoronary artery disease. In patients without coronary"ncalcifications, future cardiovascular events could"nbe excluded. Therefore, detecting and recognizing"ncalcification related to the heart on chest radiography"nand other imaging modalities such as fluoroscopy, CT"nand echocardiography may have important clinical"nimplications.
Cardiovascular Risk Factors and Specific Coronary Artery Calcification in Postmenopausal Women
Siamak Sabour,Marie Louise Bartelink,Annemarieke Rutten,Diederick E Grobbee
Journal of Tehran University Heart Center , 2009,
Abstract: Background: Myocardial infarctions at different locations have been related to different sets of risk factors. This study was designed to examine the association between cardiovascular risk factors and specific coronary artery calcification (CAC).Methods: The study population comprised 573 postmenopausal women selected from a population-based cohort study. Established vascular risk factors were measured. The women underwent a multi detector-row computed tomography (16-MDCT) (Philips Mx 8000 IDT 16) to assess coronary calcium. The Agatston score was used to quantify coronary calcium. Logistic regression models were utilized to assess the relations.Results: The prevalence of coronary artery calcification (Agatston score>0) was 61.5% (n=348). CAC was most common in the left anterior descending (LAD) artery with a prevalence of 43.9%; and the rates of prevalence in the right coronary artery (RCA), the circumflex (LCX), the left main artery (LM), and the posterior descending artery (PDA) were 23.1%, 19.4%, 15.8%, and 0.3%, respectively. In the multivariate regression models, age was predominantly related to the calcification in the LAD and LCX, low density lipoprotein to calcification in the LAD, and cholesterol to the calcification of the RCA. Hypertension and systolic & diastolic blood pressures were related to the calcification of the LCX, whereas smoking was predominantly related to the calcification of both LAD and RCA. Finally, age, body mass index, and systolic blood pressure were significantly related to the calcification in the LM.Conclusion: Our findings showed that the consequences of elevated risk factor levels on the development of atherosclerosis appeared to be different across the segments of the coronary arteries.
Serum Uric Acid as a Marker of Coronary Calcification in Patients with Asymptomatic Coronary Artery Disease with Preserved Left Ventricular Pump Function  [PDF]
A. E. Berezin,A. A. Kremzer
Cardiology Research and Practice , 2013, DOI: 10.1155/2013/129369
Abstract: Objective. To evaluate the interrelation between serum uric acid and artery calcification in asymptomatic coronary artery disease subjects. Design and Methods. 126 subjects with previously documented asymptomatic coronary artery disease were enrolled in the study. Results. Mean value of serum uric acid level was 23.84?mmol/L (95% confidence interval (CI)? = ?15.75–31.25?mmol/L). In multivariate Cox regression analysis, the results showed that serum uric acid levels (odds ratio , 95% CI?=?1.20–1.82; ), osteopontin ( , 95% CI?=?1.12–1.25; ), osteoprotegerin ( , 95% CI??=??1.20–1.89; ), type 2 diabetes mellitus ( , 95% CI??=??1.20–1.72; ), and total cholesterol ( , 95% CI?=?1.10–1.22; ) were factors that independently associated with coronary artery calcification. The Cox models suggested that high quartile of serum uric acid level is very significant in predicting Agatston score index. In conclusion, we suggested that high quartile of serum uric acid level (cutoff point equaled 35.9?mmol/L) was a very significant predictor of coronary calcification examined by Agatston score index in subjects with asymptomatic coronary artery disease. 1. Background Hyperuricemia is frequently present in patients with symptomatic heart failure, acute coronary syndromes, arterial hypertension, and atrial fibrillation and in patients with type 2 diabetes mellitus [1–3]. Current evidence suggests that serum uric acid could be a marker of oxidative damage [4]. Serum uric acid is also considered a useful biomarker for mortality and an indicator of a poor prognosis in high-risk patients with several cardiovascular diseases [5–7]. Recently clinical studies have shown that serum uric acid inversely correlates with left ventricular ejection fraction, serum creatinine, and blood urea nitrogen in patients with heart failure [1]. There is a significant association between serum uric acid and circulating levels of proinflammatory cytokines among subjects with chronic heart failure [8]. Serum uric acid is often discussed as a risk factor for acute kidney injury, which adversely affects renal blood flow autoregulation, glomerular filtration rate, and promotes inflammation and angiogenesis [9]. However, the principal mechanism that contributes to biological effects of serum uric acid in patients with asymptomatic coronary artery disease without reducing left ventricular pump function is still to be understood. It has been postulated that serum uric acid plays a pivotal role in the pathogenesis of cardiovascular diseases affecting xanthine oxidase pathway that contributes to the production
Associations of epicardial fat with coronary calcification, insulin resistance, inflammation, and fibroblast growth factor-23 in stage 3-5 chronic kidney disease  [cached]
Kerr Jasmine D,Holden Rachel M,Morton Alexander R,Nolan Robert L
BMC Nephrology , 2013, DOI: 10.1186/1471-2369-14-26
Abstract: Background Epicardial fat, quantified in a single multi-slice computed tomography (MSCT) slice, is a reliable estimate of total epicardial fat volume (EFV). We sought to determine risk factors for EFV detected in a single-slice MSCT measurement (ssEFV) in pre-dialysis chronic kidney disease (CKD) patients. Our primary objective was to determine the association between ssEFV and coronary artery calcification (CAC). Methods 94 pre-dialysis stage 3–5 CKD patients underwent MSCT to measure ssEFV and CAC. ssEFV was quantified at the level of the left main coronary artery. Measures of inflammation, traditional and kidney-related cardiovascular disease risk factors were collected. Results Mean age: 63.7 ± 14 years, 56% male, 39% had diabetes, and mean eGFR: 25.1 ± 11.9 mL/min/1.73 m2. Mean ssEFV was 5.03 ± 2.4 cm3. By univariate analysis, body mass index (BMI) (r = 0.53; P = <0.0001), abdominal obesity (r = 0.51; P < 0.0001), high density lipoprotein (HDL) cholesterol (r = 0.39; P = <0.0001), insulin resistance (log homeostasis model assessment of insulin resistance (log HOMA-IR)) (r = 0.38, P = 0.001), log interleukin-6 (IL-6) (r = 0.34; P = 0.001), and log urinary albumin to creatinine ratio (UACR) (r = 0.30, P = 0.004) demonstrated the strongest associations with ssEFV. Log coronary artery calcification (log CAC score) (r = 0.28, P = 0.006), and log fibroblast growth factor-23 (log FGF-23) (r = 0.23, P = 0.03) were also correlated with ssEFV. By linear regression, log CAC score (beta =0.40; 95% confidence interval (CI), 0.01-0.80; P = 0.045), increasing levels of IL-6 (beta = 0.99; 95% CI, 0.38 – 1.61; P = 0.002), abdominal obesity (beta = 1.86; 95% CI, 0.94 - 2.8; P < 0.0001), lower HDL cholesterol (beta = 2.30; 95% CI, – 3.68 to 0.83; P = 0.002) and albuminuria (log UACR, beta = 0.81; 95% CI, 0.2 to 1.4; P = 0.01) were risk factors for increased ssEFV. Conclusions In stage 3–5 CKD, coronary calcification and IL-6 and were predictors of ssEFV. Further studies are needed to clarify the mechanism by which epicardial fat may contribute to the pathogenesis of coronary disease, particularly in the CKD population.
Elevated Antibodies to Oxidized Low Density Lipoprotein are Positively Related with a Severity of Coronary Artery Disease
Elmir Jahic,Fahir Barakovic,Zumreta Kusljugic,Farid Ljuca
Acta Medica Saliniana , 2010, DOI: 10.5457/ams.120.10
Abstract: Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p<0.001), as well as compared with control group (1342.1±581.5 mIU/ml vs. 246.5±114.3, p<0.001). Similarly, significant difference in anti-oxLDL levels was found between the patients with APCAS and control group (p<0.001). Conclusions: The present study showed that elevated levels of anti-oxLDL are positively related with a severity of coronary artery disease. Hence, elevated levels of anti-oxLDL may identify patients with unstable coronary heart disease. Oxidized LDL in circulating plasma could serve as a marker of cardiovascular events.
Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study  [cached]
Levent Korkmaz,Ay?a Ata Korkmaz,Ali R?za Akyüz,Mustafa Tar?k A?a?
Anadolu Kardiyoloji Dergisi , 2012,
Abstract: Objective: Platelets have an important role in the pathogenesis of atherothrombosis. It has been shown that platelet size measured by mean platelet volume (MPV), correlates with their reactivity and is still regarded as an easy, useful tool for indirect monitoring of platelet activity in different situations. Coronary artery calcification (CAC) has long been known to occur as a part of the atherosclerotic process. The aim of this study was to determine whether an association exists between MPV and CAC.Methods: In this observational study, we enrolled 259 participants with at least one cardiac risk factor but with unknown cardiovascular disease. Coronary calcification was assessed by multislice computerized tomography and MPV was measured in a blood sample collected in EDTA tubes. Statistical analysis was performed using Kruskal-Wallis, Chi-square, correlation tests and multiple regression analysis.Results: Calcium scores ranged from 0 to 735. There was a significant relation between CAC and MPV (r=0.24, p=0.02), age (r=0.32, p<0.001), hypertension (r=0.19, p=0.03), diabetes (r=0.16, p=0.005), smoking (r=0.17, p=0.001). In linear regression analysis, MPV (β=0.4, 95%CI 19.8- 31.1, p<0.001), age (β=0.13, 95%CI 0.23-2.4, p=0.01) and smoking (β=0.12, 95%CI 3.2-15.1, p=0.02) independently associated with CAC. In addition, there were significant differences in MPV between significant CAC group compared to the minimal and none (10.2±2.4 versus 8.1±0.9 and 7.6±1.3; p<0.001).Conclusion: We have found significant association between MPV and CAC. Although this study is purely correlative and no causative conclusions can be drawn, it may suggest that higher MPV may reflect increased atherosclerotic burden and cardiovascular risk.
Detection of coronary artery disease based on the calcification index obtained by helical computed tomography
Feldman, Carlos Jader;Vitola, Domingos;Schiavo, Nádia;
Arquivos Brasileiros de Cardiologia , 2000, DOI: 10.1590/S0066-782X2000001200002
Abstract: objective: to assess the relation between coronary artery disease and the calcification index on helical computed tomography. method: we studied 22 patients (ages ranging from 40 to 70 years) who underwent coronary angiography because of chest pain suggestive of angina pectoris. findings on coronary angiography were classified as follows: significant obstructive disease (stenosis 350%), nonobstructive disease (stenosis <50%), and no disease. with no previous knowledge of the results of the coronary angiography and within 7 days, helical computed tomography of the chest was performed. then, data of the coronary angiography were correlated with the calcification index obtained by helical computed tomography.results: the sensitivity of helical computed tomography to the presence of significant obstructive lesions on coronary angiography was 87.5%, specificity was 100%, and negative and positive predictive values were 75% and 100%, respectively. the mean calcification index was greater in patients with severe coronary lesions, mainly when involvement of 2 or 3 vessels occurred, than that in patients with no coronary artery disease or with nonobstructive coronary artery lesions (p<0.05). conclusion: helical computed tomography is an effective method for detecting and quantifying coronary artery calcification, and it has proved to be sensitive to and specific for the noninvasive diagnosis of coronary artery stenosis.
Detection of coronary artery disease based on the calcification index obtained by helical computed tomography
Feldman Carlos Jader,Vitola Domingos,Schiavo Nádia
Arquivos Brasileiros de Cardiologia , 2000,
Abstract: OBJECTIVE: To assess the relation between coronary artery disease and the calcification index on helical computed tomography. METHOD: We studied 22 patients (ages ranging from 40 to 70 years) who underwent coronary angiography because of chest pain suggestive of angina pectoris. Findings on coronary angiography were classified as follows: significant obstructive disease (stenosis > or = 50%), nonobstructive disease (stenosis <50%), and no disease. With no previous knowledge of the results of the coronary angiography and within 7 days, helical computed tomography of the chest was performed. Then, data of the coronary angiography were correlated with the calcification index obtained by helical computed tomography. RESULTS: The sensitivity of helical computed tomography to the presence of significant obstructive lesions on coronary angiography was 87.5%, specificity was 100%, and negative and positive predictive values were 75% and 100%, respectively. The mean calcification index was greater in patients with severe coronary lesions, mainly when involvement of 2 or 3 vessels occurred, than that in patients with no coronary artery disease or with nonobstructive coronary artery lesions (p<0.05). CONCLUSION: Helical computed tomography is an effective method for detecting and quantifying coronary artery calcification, and it has proved to be sensitive to and specific for the noninvasive diagnosis of coronary artery stenosis.
Metabolic Health Is More Closely Associated with Coronary Artery Calcification than Obesity  [PDF]
Eun-Jung Rhee, Mi Hae Seo, Jong Dae Kim, Won Seon Jeon, Se Eun Park, Cheol-Young Park, Ki-Won Oh, Sung-Woo Park, Won-Young Lee
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074564
Abstract: Background Recent studies have suggested that metabolic health may contribute more to the atherosclerosis than obesity. The aim of this study is to compare coronary artery calcium scores (CACS) among patients with different metabolic health and obesity status. Methods A health-screening program of 24,063 participants (mean age 41 years) was conducted, and CACS was assessed by multi-detector computerized tomography (MDCT). Being metabolically healthy was defined as having fewer than two of the following risk factors: high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol, highest decile of homeostasis model assessment-insulin resistance (HOMA-IR) index, and highest decile of high-sensitivity C-reactive protein (hs-CRP). Obesity status was defined as body mass index (BMI) higher than 25 kg/m2. Analyses were performed in four groups divided according to metabolic health and obesity: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUHNO), and metabolically unhealthy obese (MUHO). Results Mean values of CACS in the four groups were significantly different, except those between MHNO and MHO and between MUHNO and MUHO. When multinomial logistic regression analysis was performed with five CACS categories as the dependent variables and after adjusting for age, sex, and smoking status, the MHO, MUHNO, and MUHO groups showed significantly increased odds ratio for increasing CACS categories compared with no calcification status (5.221 for CACS >400 in MUHO group with 95% CI 2.856~5.032 with MHNO group as the reference). When other variables including the metabolic parameters were included in the same model, the risks were attenuated. Conclusion Metabolic health is more closely associated with subclinical atherosclerosis than obesity as assessed by CACS.
Renal Function Is Related to Severity of Coronary Artery Calcification in Elderly Persons: The Rotterdam Study  [PDF]
Abdelilah el Barzouhi,Suzette Elias-Smale,Abbas Dehghan,Rozemarijn Vliegenthart-Proen?a,Matthijs Oudkerk,Albert Hofman,Jacqueline C. M. Witteman
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0016738
Abstract: Coronary artery calcification (CAC) has been proposed to be the underlying mechanism of the increased risk of coronary heart disease with reductions in glomerular filtration rate (GFR). Since renal function diminishes with aging we examined the association between GFR and CAC in the Rotterdam Study, a population-based study of elderly individuals.
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