Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images

Energy Technology Data Exchange (ETDEWEB)

Pavitt, Christopher W. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Harron, Katie [Institute of Child Health, UCL, Centre for Paediatric Epidemiology and Biostatistics, London (United Kingdom); Lindsay, Alistair C.; Ray, Robin [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Zielke, Sayeh; Rubens, Michael B. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Gordon, Daniel [Royal Marsden Hospital, Department of Physics, London (United Kingdom); Padley, Simon P. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom); Nicol, Edward D. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom)

2016-05-15

We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system. Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168). Bland-Altman analysis and weighted kappa for MESA centiles and Agatston risk groupings were calculated. Multivariable linear regression yielded a CF: CACS = (1.185 x CCTAS) + (0.002 x CCTAS x attenuation threshold). When applied to CCTA data sets there was excellent correlation (r = 0.95; p < 0.0001) and agreement (mean difference -10.4 [95 % limits of agreement -258.9 to 238.1]) with traditional calcium scores. Agreement was better for calcium scores below 500; however, MESA percentile agreement was better for high risk patients. Risk stratification was excellent (Agatston groups k = 0.88 and MESA centiles k = 0.91). Eliminating the dedicated CACS scan decreased patient radiation exposure by approximately one-third. CCTA calcium scores can accurately predict CACS using a simple, individualized, semiautomated approach reducing acquisition time and radiation exposure when evaluating patients for CAD. This method is not affected by the ROI location, imaging protocol, or tube voltage strengthening its clinical applicability. (orig.)

Coronary artery calcium in breast cancer survivors after radiation therapy

NARCIS (Netherlands)

Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Pilz, Lothar R; Schoenberg, Stefan O; Morris, Pamela B; Henzler, Thomas; Apfaltrer, Paul

The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ae

Calcium score of small coronary calcifications on multidetector computed tomography

DEFF Research Database (Denmark)

Groen, J M; Kofoed, K F; Zacho, M

2013-01-01

Multi detector computed tomography (MDCT) underestimates the coronary calcium score as compared to electron beam tomography (EBT). Therefore clinical risk stratification based on MDCT calcium scoring may be inaccurate. The aim of this study was to assess the feasibility of a new phantom which...

Virtual non-contrast CT using dual energy spectral CT: Feasibility of coronary artery calcium scoring

International Nuclear Information System (INIS)

Song, In Young; Yi, Jeong Geun; Park, Jeong Hee; Lee, Sung Mok; Lee, Kyung Soo; Chung, Myung Jin

2016-01-01

To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Measured coronary calcium volumes from VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Among the three VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p < 0.001 for all pairs). The use of VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC

Virtual non-contrast CT using dual energy spectral CT: Feasibility of coronary artery calcium scoring

Energy Technology Data Exchange (ETDEWEB)

Song, In Young; Yi, Jeong Geun; Park, Jeong Hee [Dept. of Radiology, Konkuk University School of Medicine, Seoul (Korea, Republic of); Lee, Sung Mok; Lee, Kyung Soo; Chung, Myung Jin [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2016-06-15

To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Measured coronary calcium volumes from VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Among the three VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p < 0.001 for all pairs). The use of VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC.

Coronary artery calcium scoring in myocardial infarction

International Nuclear Information System (INIS)

Beslic, S.; Dalagija, F.

2005-01-01

Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) S omatom Volume Zoom Siemens , and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of patients. (author)

Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring.

Science.gov (United States)

Liew, Gary; Chow, Clara; van Pelt, Niels; Younger, John; Jelinek, Michael; Chan, Jonathan; Hamilton-Craig, Christian

2017-12-01

Coronary Artery Calcium Scoring (CAC) is a non-invasive quantitation of coronary artery calcification using computed tomography (CT). It is a marker of atherosclerotic plaque burden and an independent predictor of future myocardial infarction and mortality. Coronary Artery Calcium Scoring provides incremental risk information beyond traditional risk calculators (eg. Framingham Risk Score). Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as "individualised coronary risk scoring" for those not considered to be of high or low risk. Medical practitioners should carefully counsel patients prior to CAC. Coronary Artery Calcium Scoring should only be undertaken if an alteration in therapy including embarking on pharmacotherapy is being considered based on the test result. Patient Groups to Consider Coronary Calcium Scoring: Patient Groups in Whom Coronary Calcium Scoring Should Not be Considered: Coronary Artery Calcium Scoring is not recommended for patients who are: Interpretation of CAC CAC=0 A zero score confers a very low risk of death, 75th centile. Moderately high risk, 15-20% CAC >400 High risk, >20% Management Recommendations Based on CAC Optimal diet and lifestyle measures are encouraged in all risk groups and form the basis of primary prevention strategies. Patients with moderately-high or high risk based on CAC score are recommended to receive preventative medical therapy such as aspirin and statins. The evidence for pharmacotherapy is less robust in patients at intermediate levels of CAC 100-400, with modest benefit for aspirin use; though statins may be reasonable if they are above 75th centile. Aspirin and statins are generally not recommended in patients with CAC calcium score, routine re-scanning is not currently recommended. However, an annual increase in CAC of >15% or annual increase of CAC >100 units are predictive of future myocardial infarction and mortality. Cost Effectiveness of CAC

Correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium scan

International Nuclear Information System (INIS)

Lee, Sang Hoon; Hong, Yong Kook; Park, Sung Il; Lee, Hyang Mee; Choe, Kyu Ok

1998-01-01

To determine the correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium(EBT CAC) scan and to measure the difference in calcium score according to symptoms. Materials and Methods : Fifty-six patients underwent EBT CAC scanning and either coronary angiography or stress thallium 201 scanning or the treadmill test. When the results were positive, coronary artery obstructive disease(CAOD) was assumed to be present. The patients were divided into three groups : symptomatic CAOD,asymptomatic CAOD, and asymptomatic non- CAOD; those with a previous history of myocardial ischemia or who showed positive results in any of the three tests relating to typical symptoms of angina were assigned to the symptomatic group. Results : The number of cases assigned to group to group 1,2 and 3 was 19, 16 and 21, respectively; total CAC scores were 571 ± 751, 600 ± 726 293± 401, respectively. The difference in CAC score between asymptomatic CAOD and asymptomatic non- CAOD was not statistically significant(p=0.079) but in asymptomatic CAOD, the score tended to be higher. The CAC score was not different between symptomatic and asymptomatic CAOD(p>0.1). When the CAC threshold was 1, sensitivity was 89% and specificity was 14%;when the threshold was 200, sensitivity was 60% and specificity was 67%. Conclusion : When the EBT CAC score is high, further evaluation provides early evidence of coronary artery obstructive disease

Virtual Non-Contrast CT Using Dual-Energy Spectral CT: Feasibility of Coronary Artery Calcium Scoring.

Science.gov (United States)

Song, Inyoung; Yi, Jeong Geun; Park, Jeong Hee; Kim, Sung Mok; Lee, Kyung Soo; Chung, Myung Jin

2016-01-01

To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC.

Lumen and calcium characteristics within calcified coronary lesions. Comparison of computed tomography coronary angiography versus intravascular ultrasound

OpenAIRE

Noll, Dariusz; Kruk, Mariusz; Pręgowski, Jerzy; Kaczmarska, Edyta; Kryczka, Karolina; Pracoń, Radosław; Skwarek, Mirosław; Dzielińska, Zofia; Petryka, Joanna; Śpiewak, Mateusz; Lubiszewska, Barbara; Norwa-Otto, Bożena; Opolski, Maksymilian; Witkowski, Adam; Demkow, Marcin

2013-01-01

Introduction Computed tomography coronary angiography (CTCA) is a diagnostic method used for exclusion of coronary artery disease. However, lower accuracy of CTCA in assessment of calcified lesions is a significant factor impeding applicability of CTCA for assessment of coronary atherosclerosis. Aim To provide insight into lumen and calcium characteristics assessed with CTCA, we compared these parameters to the reference of intravascular ultrasound (IVUS). Material and methods Two hundred and...

Calcium intake is not associated with increased coronary artery calcification: the Framingham Study.

Science.gov (United States)

Samelson, Elizabeth J; Booth, Sarah L; Fox, Caroline S; Tucker, Katherine L; Wang, Thomas J; Hoffmann, Udo; Cupples, L Adrienne; O'Donnell, Christopher J; Kiel, Douglas P

2012-12-01

Adequate calcium intake is known to protect the skeleton. However, studies that have reported adverse effects of calcium supplementation on vascular events have raised widespread concern. We assessed the association between calcium intake (from diet and supplements) and coronary artery calcification, which is a measure of atherosclerosis that predicts risk of ischemic heart disease independent of other risk factors. This was an observational, prospective cohort study. Participants included 690 women and 588 men in the Framingham Offspring Study (mean age: 60 y; range: 36-83 y) who attended clinic visits and completed food-frequency questionnaires in 1998-2001 and underwent computed tomography scans 4 y later in 2002-2005. The mean age-adjusted coronary artery-calcification Agatston score decreased with increasing total calcium intake, and the trend was not significant after adjustment for age, BMI, smoking, alcohol consumption, vitamin D-supplement use, energy intake, and, for women, menopause status and estrogen use. Multivariable-adjusted mean Agatston scores were 2.36, 2.52, 2.16, and 2.39 (P-trend = 0.74) with an increasing quartile of total calcium intake in women and 4.32, 4.39, 4.19, and 4.37 (P-trend = 0.94) in men, respectively. Results were similar for dietary calcium and calcium supplement use. Our study does not support the hypothesis that high calcium intake increases coronary artery calcification, which is an important measure of atherosclerosis burden. The evidence is not sufficient to modify current recommendations for calcium intake to protect skeletal health with respect to vascular calcification risk.

Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Dewey, Marc; Hamm, Bernd

2007-01-01

We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of EUR4,435 (10% likelihood) to EUR1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society. (orig.)

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

International Nuclear Information System (INIS)

Palumbo, Anselmo Alessandro; Cademartiri, Filippo; Maffei, Erica; Martini, Chiara; Tarantini, Giuseppe; Di Tanna, Gian Luca; Berti, Elena; Grilli, Roberto; Casolo, Giancarlo; Brambilla, Valerio; Cerrato, Marcella; Rotondo, Antonio; Weustink, Annick C.; Mollet, Nico R.A.

2009-01-01

We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1-10, group 3: score 11-100, group 4: score 101-400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk. (orig.)

Relationship between calcium score and myocardial scintigraphy in the diagnosis of coronary disease

Energy Technology Data Exchange (ETDEWEB)

Siqueira, Fabio Paiva Rossini; Mesquita, Claudio Tinoco; Santos, Alair Augusto Sarmet M. Damas dos; Nacif, Marcelo Souto, E-mail: fabioprs@gmail.com, E-mail: fabioprs@outlook.com [Universidade Federal Fluminense (UFF), Niterói, RJ (Brazil)

2016-10-15

Half the patients with coronary artery disease present with sudden death - or acute infarction as first symptom, making early diagnosis pivotal. Myocardial perfusion scintigraphy is frequently used in the assessment of these patients, but it does not detect the disease without flow restriction, exposes the patient to high levels of radiation and is costly. On the other hand, with less radiological exposure, calcium score is directly correlated to the presence and extension of coronary atherosclerosis, and also to the risk of cardiovascular events. Even though calcium score is a tried-and-true method for stratification of asymptomatic patients, its use is still reduced in this context, since current guidelines are contradictory to its use on symptomatic diseases. The aim of this review is to identify, on patients under investigation for coronary artery disease, the main evidence of the use of calcium score associated with functional evaluation and scintigraphy. (author)

High coronary calcium score and post-procedural CK-MB are noninvasive predictors of coronary stent restenosis

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Lee JB

2017-02-01

Full Text Available Jae-Beom Lee,1 Yun-Seok Choi,2 Woo-Baek Chung,2 Ami Kwon,2 Chul-Soo Park,2 Man-Young Lee2 1Anyang Sam Hospital, 2Division of Cardiology, Department of Internal Medicine, Youido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Purpose: High coronary calcium score (CCS and post-procedural cardiac enzyme may be related with poor outcomes in patients with coronary stent implantation. Methods: A total of 1,072 patients (63.2% male, mean age: 61.7±10.3 years who underwent coronary multi-detect computed tomography at index procedure and follow-up coronary angiography (CAG after drug-eluting stent (DES were divided into two groups: those with and without target lesion revascularization (TLR; >50% reduction in luminal stent diameter or angina symptoms on follow-up CAG. The CCSs for predicting stent revascularization were elucidated. Results: There were no significant differences between the two groups with regard to risk factors. The initial CCS was significantly higher in the TLR group (1,102.4±743.7 vs 345.8±51.05, P=0.04. After adjustment of significant factors for TLR, only CCS and post-procedural creatine kinase MB form (CK-MB elevation were significant predictors of coronary artery TLR. Receiver operation curve revealed that >800 in CCS had 69% in sensitivity and 88% in specificity about predicting the TLR. Conclusion: High CCS with post-procedural CK-MB might be the useful predictors for TLR after DES implantation. Keywords: coronary restenosis, drug-eluting stents, calcium, creatine kinase

Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

International Nuclear Information System (INIS)

Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

2010-01-01

To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography.

Science.gov (United States)

Asami, Masahiko; Yamaji, Kyohei; Aoki, Jiro; Tanimoto, Shuzou; Watanabe, Mika; Horiuchi, Yu; Furui, Koichi; Kato, Nahoko; Hara, Kazuhiro; Tanabe, Kengo

2017-10-21

Previous studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.

Assessment of calcium scoring performance in cardiac computed tomography

International Nuclear Information System (INIS)

Ulzheimer, Stefan; Kalender, Willi A.

2003-01-01

Electron beam tomography (EBT) has been used for cardiac diagnosis and the quantitative assessment of coronary calcium since the late 1980s. The introduction of mechanical multi-slice spiral CT (MSCT) scanners with shorter rotation times opened new possibilities of cardiac imaging with conventional CT scanners. The purpose of this work was to qualitatively and quantitatively evaluate the performance for EBT and MSCT for the task of coronary artery calcium imaging as a function of acquisition protocol, heart rate, spiral reconstruction algorithm (where applicable) and calcium scoring method. A cardiac CT semi-anthropomorphic phantom was designed and manufactured for the investigation of all relevant image quality parameters in cardiac CT. This phantom includes various test objects, some of which can be moved within the anthropomorphic phantom in a manner that mimics realistic heart motion. These tools were used to qualitatively and quantitatively demonstrate the accuracy of coronary calcium imaging using typical protocols for an electron beam (Evolution C-150XP, Imatron, South San Francisco, Calif.) and a 0.5-s four-slice spiral CT scanner (Sensation 4, Siemens, Erlangen, Germany). A special focus was put on the method of quantifying coronary calcium, and three scoring systems were evaluated (Agatston, volume, and mass scoring). Good reproducibility in coronary calcium scoring is always the result of a combination of high temporal and spatial resolution; consequently, thin-slice protocols in combination with retrospective gating on MSCT scanners yielded the best results. The Agatston score was found to be the least reproducible scoring method. The hydroxyapatite mass, being better reproducible and comparable on different scanners and being a physical quantitative measure, appears to be the method of choice for future clinical studies. The hydroxyapatite mass is highly correlated to the Agatston score. The introduced phantoms can be used to quantitatively assess the

Relationship between framingham risk score and coronary artery calcium score in asymptomatic Korean individuals

International Nuclear Information System (INIS)

Heo, So Young; Park, Noh Hyuck; Park, Chan Sub; Seong, Su Ok

2016-01-01

We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk

Relationship between framingham risk score and coronary artery calcium score in asymptomatic Korean individuals

Energy Technology Data Exchange (ETDEWEB)

Heo, So Young; Park, Noh Hyuck; Park, Chan Sub; Seong, Su Ok [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

2016-02-15

We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (≥1000) detected by electron beam computed tomography

International Nuclear Information System (INIS)

Almeda, Francis Q.; Shah, Rima; Senter, Shaun; Kason, Thomas T.; Haynie, Justin; Calvin, James E.; Kavinsky, Clifford J.; Snell, R. Jeffrey; Schaer, Gary L.; McLaughlin, Vallerie V.

2004-01-01

Objective: The objective of this study was to determine the clinical and angiographic profile of patients with extremely high coronary artery calcium scores (CACS; ≥1000) by electron beam computed tomography (EBCT). Methods: All patients at Rush University Medical Center who had a calcium score ≥1000 and a coronary angiogram performed from 1997 to 2002 were identified using a prospectively collected database. The baseline demographics, symptom status, and degree of coronary stenosis by angiography and subsequent rate of coronary intervention were compared with that of patients with calcium scores <1000. Results: The clinical and angiographic profile of patients with severe coronary calcification, detected by EBCT, revealed that patients with scores ≥1000 had a significantly higher prevalence of coronary stenosis ≥50% compared with patients with scores <1000 (97% vs. 57%, P<.001). The group with CACS ≥1000 was more likely to be male (90% vs. 75%, P=.027) and was older (64±8 vs. 59±10, P=.001) compared with the group with less severe calcification. Although there was a significantly higher rate of luminal stenosis detected by coronary angiography in the cohort with CACS ≥1000, there was no difference in subsequent percutaneous coronary intervention (PCI) and utilization of intracoronary stents between the two groups. Conclusions: A markedly elevated coronary calcium score (≥1000) is correlated with increasing age and is associated with an increased likelihood of coronary stenosis ≥50%. However, the decision to perform coronary angiography in patients with severe coronary calcification should not be based solely on these findings, but should remain primarily dependent on the degree of ischemia detected by clinical and functional assessment

Carotid Artery Stiffness, Digital Endothelial Function, and Coronary Calcium in Patients with Essential Thrombocytosis, Free of Overt Atherosclerotic Disease.

Science.gov (United States)

Vrtovec, Matjaz; Anzic, Ajda; Zupan, Irena Preloznik; Zaletel, Katja; Blinc, Ales

2017-06-01

Patients with myeloproliferative neoplasms (MPNs) are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET), a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects. 40 ET patients without overt vascular disease, and 42 apparently healthy, age and sex-matched control subjects with comparable classical risk factors for atherosclerosis and Framingham risk of coronary disease were enrolled. All subjects were examined by physical and laboratory testing, carotid echo-tracking ultrasound, digital EndoPat pletysmography and CT coronary calcium scoring. No significant differences were found between ET patients and controls in carotid plaque score [1 (0-1.25) vs. 0 (0-2), p=0.30], β- index of carotid stiffness [7.75 (2.33) vs. 8.44 (2,81), p=0.23], pulse wave velocity [6,21 (1,00) vs. 6.45 (1.04) m/s; p=0.46], digital reactive hyperemia index [2.10 (0.57) vs. 2.35 (0.62), p=0.07], or augmentation index [19 (3-30) vs. 13 (5-22) %, p=0.38]. Overall coronary calcium burden did not differ between groups [Agatston score 0.1 (0-16.85) vs. 0 (0-8.55), p=0.26]. However, significantly more ET patients had an elevated coronary calcium score of >160 [6/40 vs. 0/42, p 160, indicating high cardiovascular risk, not predicted by the Framingham equation.

Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

Directory of Open Access Journals (Sweden)

Marat Fudim

2016-03-01

Full Text Available The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD, to assess an individual׳s risk of future cardiovascular disease (CVD events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA is a population based study (n=6814 of White (38%, Black (28%, Chinese (22% and Hispanic (12% subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS performance across gender and ethnicities. Keywords: Risk stratification, Coronary calcium scoring, Gender, Ethnicity, MESA, {C}{C}

Evaluation of alternative methods for coronary calcium scoring in multi-detector-row computed tomography

International Nuclear Information System (INIS)

Serafin, Z.; Lasek, W.; Laskowska, K.; Marzec, M.

2005-01-01

Determining coronary artery calcifications is one of the methods of coronary heart disease screening. However, the traditional Agatston Calcium Score (CS) shows low interexamination reproducibility. The aim of this study was to evaluate the interscan variability coefficients of calcium measures based on three modifications of the original Agatston equation. Fifty adults (37 men and 13 women; mean age 46.2 ± 9.2 years) were included in the study. Each patient was examined with two consecutive, prospectively electrocardiographically triggered, multi-detector-row CT acquisitions to detect and quantify coronary artery calcifications. CS was calculated according to the method by Agatston et al. Alternative scores were calculated using a continuous weighting factor (CS-CM), the average lesion attenuation value (CS-SA), or both (CS-CA). The mean and median interscan percent variabilities of the methods were evaluated using nonparametric analysis of variance. In the 50 patients, 1315 calcified lesions were found. The alternative scores correlated well with CS (for CS vs. CS-SA, CS-CM, and CS-CA, r = 0.990, 0.840, and 0.946, respectively, P < 0.0001). The mean and median percent variabilities did not differ significantly among the methods tested (P = 0.370). For CS, CS-SA, CS-CM, and CS-CA the mean variabilities were 13.24%, 13.36%, 16.00%, and 13.62%, respectively. Except for CS-CM, the methods showed similar distributions of variability vs. score on Bland and Altman plots. None of the tested modifications of the Agatston method brought improvement in the interscan reproducibility of coronary calcium scoring. In our opinion, a significant reduction in variability may be achieved by a standardization of image acquisition and reconstruction. (author)

Comparison of coronary artery calcium screening image quality between C-150 and e-Speed electron beam scanners.

Science.gov (United States)

Budoff, Matthew J; Shinbane, Jerold S; Oudiz, Ronald J; Child, Janis; Carson, Sivi; Chau, Alex; Tseng, Philip; Gao, Yanlin; Mao, Songshou

2005-03-01

The newest generation of electron beam tomographic scanner (e-Speed) has increased spatial and temporal resolution compared with the C-150 XP scanner. The aim of this study was to evaluate coronary artery calcium screening image quality between the e-Speed and C-150 scanners (GE Imatron, San Francisco, CA). Studies from 41 patients (14 women and 27 men) who underwent serial coronary artery calcium screening with the C-150 (first study) and the e-Speed (second study) were analyzed. Individual computed tomography (CT) slices were assessed for coronary artery motion artifacts, and CT Hounsfield units (HU) and noise values (CT HU standard deviation) at 16 discrete cardiac sites were measured and averaged. With the e-Speed scanner, there were significant decreases in right coronary artery motion artifacts compared with the C-150 scanner (0.3% versus 1.8%, P Image quality is significantly improved with use of the e-Speed scanner, due to its improved temporal and spatial resolution, compared with the C-150 scanner.

Association of Genetic Variants Related to Serum Calcium Levels With Coronary Artery Disease and Myocardial Infarction.

Science.gov (United States)

Larsson, Susanna C; Burgess, Stephen; Michaëlsson, Karl

2017-07-25

Serum calcium has been associated with cardiovascular disease in observational studies and evidence from randomized clinical trials indicates that calcium supplementation, which raises serum calcium levels, may increase the risk of cardiovascular events, particularly myocardial infarction. To evaluate the potential causal association between genetic variants related to elevated serum calcium levels and risk of coronary artery disease (CAD) and myocardial infarction using mendelian randomization. The analyses were performed using summary statistics obtained for single-nucleotide polymorphisms (SNPs) identified from a genome-wide association meta-analysis of serum calcium levels (N = up to 61 079 individuals) and from the Coronary Artery Disease Genome-wide Replication and Meta-analysis Plus the Coronary Artery Disease Genetics (CardiogramplusC4D) consortium's 1000 genomes-based genome-wide association meta-analysis (N = up to 184 305 individuals) that included cases (individuals with CAD and myocardial infarction) and noncases, with baseline data collected from 1948 and populations derived from across the globe. The association of each SNP with CAD and myocardial infarction was weighted by its association with serum calcium, and estimates were combined using an inverse-variance weighted meta-analysis. Genetic risk score based on genetic variants related to elevated serum calcium levels. Co-primary outcomes were the odds of CAD and myocardial infarction. Among the mendelian randomized analytic sample of 184 305 individuals (60 801 CAD cases [approximately 70% with myocardial infarction] and 123 504 noncases), the 6 SNPs related to serum calcium levels and without pleiotropic associations with potential confounders were estimated to explain about 0.8% of the variation in serum calcium levels. In the inverse-variance weighted meta-analysis (combining the estimates of the 6 SNPs), the odds ratios per 0.5-mg/dL increase (about 1 SD) in genetically

Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Genders, Tessa S.S. [Erasmus University Medical Center, Department of Epidemiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Pugliese, Francesca; Mollet, Nico R.; Meijboom, W. Bob; Weustink, Annick C.; Mieghem, Carlos A.G. van; Feyter, Pim J. de [Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Hunink, M.G.M. [Erasmus University Medical Center, Department of Epidemiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Harvard University, Department of Health Policy and Management, Harvard School of Public Health, Boston (United States)

2010-10-15

To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS). We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as {>=}50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance. Re-analysing the variables used by Diamond and Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model. Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up. (orig.)

Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

International Nuclear Information System (INIS)

Genders, Tessa S.S.; Pugliese, Francesca; Mollet, Nico R.; Meijboom, W. Bob; Weustink, Annick C.; Mieghem, Carlos A.G. van; Feyter, Pim J. de; Hunink, M.G.M.

2010-01-01

To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS). We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as ≥50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance. Re-analysing the variables used by Diamond and Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model. Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up. (orig.)

Carotid Artery Stiffness, Digital Endothelial Function, and Coronary Calcium in Patients with Essential Thrombocytosis, Free of Overt Atherosclerotic Disease

Science.gov (United States)

Vrtovec, Matjaz; Anzic, Ajda; Zupan, Irena Preloznik; Zaletel, Katja

2017-01-01

Abstract Background Patients with myeloproliferative neoplasms (MPNs) are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET), a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects. Patients and methods 40 ET patients without overt vascular disease, and 42 apparently healthy, age and sex-matched control subjects with comparable classical risk factors for atherosclerosis and Framingham risk of coronary disease were enrolled. All subjects were examined by physical and laboratory testing, carotid echo-tracking ultrasound, digital EndoPat pletysmography and CT coronary calcium scoring. Results No significant differences were found between ET patients and controls in carotid plaque score [1 (0-1.25) vs. 0 (0-2), p=0.30], β- index of carotid stiffness [7.75 (2.33) vs. 8.44 (2,81), p=0.23], pulse wave velocity [6,21 (1,00) vs. 6.45 (1.04) m/s; p=0.46], digital reactive hyperemia index [2.10 (0.57) vs. 2.35 (0.62), p=0.07], or augmentation index [19 (3-30) vs. 13 (5-22) %, p=0.38]. Overall coronary calcium burden did not differ between groups [Agatston score 0.1 (0-16.85) vs. 0 (0-8.55), p=0.26]. However, significantly more ET patients had an elevated coronary calcium score of >160 [6/40 vs. 0/42, p 160, indicating high cardiovascular risk, not predicted by the Framingham equation. PMID:28740456

Correlation between calcium and phosphate levels to calculus accumulation on coronary heart disease patients

Science.gov (United States)

Cahaya, Cindy; Masulili, Sri Lelyati C.; Lessang, Robert; Radi, Basuni

2017-02-01

Coronary Artery Disease (CAD) or Coronary Heart Disease (CHD) is a disease that happened because of blood flow being blocked by atherosclerosis. Atherosclerosis is a process of hardening of the arteries which characterized by thickening and loss of elasticity of the intimal layer of vascular wall, by lipid deposit. Periodontitis is a chronic multifactorial inflammatory disease caused by microorganism and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss. Many studies use saliva as a valuable source for clinically information, as an asset for early diagnosis, prognostic and reviewer for pascatherapy status. Dental calculus had happened as a consequence of saliva supersaturation by calcium and phosphate. Salivary flow rate and its composition influence the formation of calculus. Increasing salivary calcium levels is characteristic of periodontitis patients. An important hipotesis in Cardiology is chronic infections contribute in atherosclerosis. Objective: To analyse the correlation between calcium and phosphate levels in saliva to calculus accumulation on CHD patients. Result: Correlation analysis between salivary calcium levels with calculus accumulation in patients with CHD and non-CHD showed no significant p value, p=0.59 and p=0.518. Correlation analysis between salivary phosphate levels and calculus accumulation showed no significant p value, p=0.836 for CHD patients and p=0.484 for non-CHD patients. Conclusion: There are no correlation between calcium levels and phosphate levels with calculus accumulation in CHD patients. Further research need to be done.

Evidence for lower variability of coronary artery calcium mineral mass measurements by multi-detector computed tomography in a community-based cohort-Consequences for progression studies

International Nuclear Information System (INIS)

Hoffmann, Udo; Siebert, Uwe; Bull-Stewart, Arabella; Achenbach, Stephan; Ferencik, Maros; Moselewski, Fabian; Brady, Thomas J.; Massaro, Joseph M.; O'Donnell, Christopher J.

2006-01-01

Purpose: To compare the measurement variability for coronary artery calcium (CAC) measurements using mineral mass compared with a modified Agatston score (AS) or volume score (VS) with multi-detector CT (MDCT) scanning, and to estimate the potential impact of these methods on the design of CAC progression studies. Materials and methods: We studied 162 consecutive subjects (83 women, 79 men, mean age 51 ± 11 years) from a general Caucasian community-based cohort (Framingham Heart Study) with duplicate runs of prospective electrocardiographically-triggered MDCT scanning. Each scan was independently evaluated for the presence of CAC by four experienced observers who determined a 'modified' AS, VS and mineral mass. Results: Of the 162 subjects, CAC was detected in both scans in 69 (42%) and no CAC was detected in either scan in 72 (45%). Calcium scores were low in the 21/162 subjects (12%) for whom CAC was present in one but not the other scan (modified AS 0.96). However, the mean interscan variability was significantly different between mineral mass, modified AS, and VS (coefficient of variation 26 ± 19%, 41 ± 28% and 34 ± 25%, respectively; p < 0.04), with significantly smaller mean differences in pair-wise comparisons for mineral mass compared with modified AS (p < 0.002) or with VS (p < 0.03). The amount of CAC but not heart rate was an independent predictor of interscan variability (r = -0.638, -0.614 and -0.577 for AS, VS, and mineral mass, respectively; all p < 0.0001). The decreased interscan variability of mineral mass would allow a sample size reduction of 5.5% compared with modified AS for observational studies of CAC progression and for randomized clinical trials. Conclusion: There is significantly reduced interscan variability of CAC measurements with mineral mass compared with the modified AS or VS. However, the measurement variability of all quantification methods is predicted by the amount of CAC and is inversely correlated to the extent of partial

Assessment of coronary calcification using calibrated mass score with two different multidetector computed tomography scanners in the Copenhagen General Population Study

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Fuchs, Andreas [Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Groen, Jaap M. [Department of Radiology, University of Groningen, University Medical Center Groningen (Netherlands); Department of Medical Physics, OLVG, Amsterdam (Netherlands); Arnold, Ben A. [Image Analysis, 1380 Burkesville Road, Columbia, KY (United States); Nikolovski, Sasho [Department of Radiology, University of Groningen, University Medical Center Groningen (Netherlands); Knudsen, Andreas D., E-mail: dehlbaek@gmail.com [Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Kühl, J. Tobias [Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Nordestgaard, Børge G. [Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen (Denmark); Greuter, Marcel J.W. [Department of Radiology, University of Groningen, University Medical Center Groningen (Netherlands); Kofoed, Klaus F. [Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark)

2017-03-15

Objective: Population studies have shown coronary calcium score to improve risk stratification in subjects suspected for cardiovascular disease. The aim of this work was to assess the validity of multidetector computed tomography (MDCT) for measurement of calibrated mass scores (MS) in a phantom study, and to investigate inter-scanner variability for MS and Agaston score (AS) recorded in a population study on two different high-end MDCT scanners. Materials and methods: A calcium phantom was scanned by a first (A) and second (B) generation 320-MDCT. MS was measured for each calcium deposit from repeated measurements in each scanner and compared to known physical phantom mass. Random samples of human subjects from the Copenhagen General Population Study were scanned with scanner A (N = 254) and scanner B (N = 253) where MS and AS distributions of these two groups were compared. Results: The mean total MS of the phantom was 32.9 ± 0.8 mg and 33.1 ± 0.9 mg (p = 0.43) assessed by scanner A and B respectively – the physical calcium mass was 34.0 mg. Correlation between measured MS and physical calcium mass was R{sup 2} = 0.99 in both scanners. In the population study the median total MS was 16.8 mg (interquartile range (IQR): 3.5–81.1) and 15.8 mg (IQR: 3.8–63.4) in scanner A and B (p = 0.88). The corresponding median total AS were 92 (IQR: 23–471) and 89 (IQR: 40–384) (p = 0.64). Conclusion: Calibrated calcium mass score may be assessed with very high accuracy in a calcium phantom by different generations of 320-MDCT scanners. In population studies, it appears acceptable to pool calcium scores acquired on different 320-MDCT scanners.

Coronary calcium scoring with MDCT: The radiation dose to the breast and the effectiveness of bismuth breast shield

International Nuclear Information System (INIS)

Yilmaz, Mehmet Halit; Yasar, Dogan; Albayram, Sait; Adaletli, Ibrahim; Ozer, Harun; Ozbayrak, Mustafa; Mihmanli, Ismail; Akman, Canan

2007-01-01

Objective: The purpose of our study was to determine the breast radiation dose during coronary calcium scoring with multidetector computerized tomography (MDCT). We also evaluated the degree of dose reduction by using a bismuth breast shield when performing coronary calcium scoring with MDCT. Materials and methods: The dose reduction achievable by shielding the adult (35 years or older) female breasts was studied in 25 women who underwent coronary calcium scoring with MDCT. All examinations were performed with a 16-MDCT scanner. To compare the shielded versus unshielded breast dose, the examinations were performed with (right breast) and without (left breast) breast shielding in all patients. With this technique the superficial breast doses were calculated. To determine the average glandular breast radiation dose, we imaged an anthropomorphic dosimetric phantom into which calibrated dosimeters were placed to measure the dose to the breast. The phantom was imaged using the same protocol. Radiation doses to the breasts with and without the breast shielding were measured and compared using the Student's t-test. Results: The mean radiation doses with and without the breast shield were 5.71 ± 1.1 mGy versus 9.08 ± 1.5 mGy, respectively. The breast shield provided a 37.12% decrease in radiation dose to the breast with shielding. The difference between the dose received by the breasts with and without bismuth shielding was significant, with a p-value of less than 0.001. Conclusion: The high radiation during MDCT greatly exceeds the recommended doses and should not be underestimated. Bismuth in plane shielding for coronary calcium scoring with MDCT decreased the radiation dose to the breast. We recommend routine use of breast shields in female patients undergoing calcium scoring with MDCT

Deep convolutional neural networks for automatic coronary calcium scoring in a screening study with low-dose chest CT

Science.gov (United States)

Lessmann, Nikolas; Išgum, Ivana; Setio, Arnaud A. A.; de Vos, Bob D.; Ciompi, Francesco; de Jong, Pim A.; Oudkerk, Matthjis; Mali, Willem P. Th. M.; Viergever, Max A.; van Ginneken, Bram

2016-03-01

The amount of calcifications in the coronary arteries is a powerful and independent predictor of cardiovascular events and is used to identify subjects at high risk who might benefit from preventive treatment. Routine quantification of coronary calcium scores can complement screening programs using low-dose chest CT, such as lung cancer screening. We present a system for automatic coronary calcium scoring based on deep convolutional neural networks (CNNs). The system uses three independently trained CNNs to estimate a bounding box around the heart. In this region of interest, connected components above 130 HU are considered candidates for coronary artery calcifications. To separate them from other high intensity lesions, classification of all extracted voxels is performed by feeding two-dimensional 50 mm × 50 mm patches from three orthogonal planes into three concurrent CNNs. The networks consist of three convolutional layers and one fully-connected layer with 256 neurons. In the experiments, 1028 non-contrast-enhanced and non-ECG-triggered low-dose chest CT scans were used. The network was trained on 797 scans. In the remaining 231 test scans, the method detected on average 194.3 mm3 of 199.8 mm3 coronary calcifications per scan (sensitivity 97.2 %) with an average false-positive volume of 10.3 mm3 . Subjects were assigned to one of five standard cardiovascular risk categories based on the Agatston score. Accuracy of risk category assignment was 84.4 % with a linearly weighted κ of 0.89. The proposed system can perform automatic coronary artery calcium scoring to identify subjects undergoing low-dose chest CT screening who are at risk of cardiovascular events with high accuracy.

What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

Directory of Open Access Journals (Sweden)

Pletcher Mark J

2004-08-01

Full Text Available Abstract Background The coronary artery calcium (CAC score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female, we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham to 6–9%; if her score were over 100, however (a 17% chance, her risk estimate would be markedly higher (25–51% in 10 years. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.

Scaling of Myocardial Mass to Flow and Morphometry of Coronary Arteries

OpenAIRE

Choy, Jenny Susana; Kassab, Ghassan S.

2008-01-01

There is no doubt that scaling relations exist between myocardial mass and morphometry of coronary vasculature. The purpose of this study is to quantify several morphological (diameter, length, and volume) and functional (flow) parameters of the coronary arterial tree in relation to myocardial mass. Eight normal porcine hearts of 117-244 g (mean of 177.5±32.7) were used in this study. Various coronary sub-trees of the Left Anterior Descending (LAD), Right Coronary (RCA) and Left Circumflex (L...

Inverse relationship between bioavailable testosterone and subclinical coronary artery calcification in non-obese Korean men

Institute of Scientific and Technical Information of China (English)

Byoung-Jin Park; Jae-Yong Shim; Yong-Jae Lee; Jung-Hyun Lee; Hye-Ree Lee

2012-01-01

Although low testosterone levels in men have been associated with high risk for cardiovascular disease,little is known about the association between male sex hormones and subclinical coronary disease in men with apparently low cardiometabolic risk.This study was performed to investigate the association between male sex hormones and subclinical coronary artery calcification measured as coronary calcium score in non-obese Korean men.We examined the relationship of total testosterone,sex hormone-binding globulin,bioavai lable testosterone and free testosterone with coronary calcium score in 291 non-obese Korean men (mean age:52.8±9.3 years)not having a history of cardiovascular disease.Using multiple linear regression,we evaluated associations between log (sex hormone)levels and log (coronary calcium score) after adjusting for confounding variables in 105 men with some degree of coronary calcification defined as coronary calcium score ≥ 1.In multiple linear regression analysis,bioavailable testosterone was inversely associated with coronary calcium score (P=0.046) after adjusting for age,body mass index,smoking status,alcohol consumption,regular exercise,mean blood pressure,resting heart rate,C-reactive protein,fasting plasma glucose,total cholesterol,triglyceride,high-density lipoprotein (HDL) cholesterol,hypertension medication and hyperlipidemia medication,whereas total testosterone,sex hormone-binding globulin and free testosterone were not (P=0.674,P=0.121 and P=0.102,respectively).Our findings indicate that bioavailable testosterone is inversely associated with the degree of subclinical coronary artery calcification in non-obese men.

The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

International Nuclear Information System (INIS)

Bakkum, M.J.; Danad, I.; Romijn, M.A.J.; Stuijfzand, W.J.A.; Leonora, R.M.; Rossum, A.C. van; Knaapen, P.; Tulevski, I.I.; Somsen, G.A.; Lammertsma, A.A.; Kuijk, C. van; Raijmakers, P.G.

2015-01-01

Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [ 15 O]H 2 O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg x ml -1 x min -1 x g -1 , p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. (orig.)

The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

Energy Technology Data Exchange (ETDEWEB)

Bakkum, M.J.; Danad, I.; Romijn, M.A.J.; Stuijfzand, W.J.A.; Leonora, R.M.; Rossum, A.C. van; Knaapen, P. [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Tulevski, I.I.; Somsen, G.A. [Cardiology Centers of the Netherlands, Amsterdam (Netherlands); Lammertsma, A.A.; Kuijk, C. van; Raijmakers, P.G. [VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands)

2015-09-15

Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [{sup 15}O]H{sub 2}O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg x ml{sup -1} x min{sup -1} x g{sup -1}, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. (orig.)

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

OpenAIRE

Oyku Gulmez; Ilyas Atar; Bülent Ozin; Mehmet Emin Korkmaz; Asli Atar; et al

2008-01-01

Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Asli Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in pat...

[Effect of intensive pretreatment with atorvastatin calcium on outcomes of percutaneous coronary intervention in elderly patients with coronary heart disease].

Science.gov (United States)

Guo, Xiaoyan; Huang, Xuecheng; Wang, Qiwu

2015-02-01

To observe the effects of different loading doses of atorvastatin calcium on the outcomes of percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD). A total of 120 CHD patients aged over 80 years were randomly assigned into 3 equal groups to receive intensive pretreatment with statin at the doses of 20, 40, or 60 mg prior to PCI performed within 48 to 72 h after admission. The changes of postoperative cardiac biochemical markers including creatine kinase isoenzyme (CKMB), troponin I (cTNI) and high-sensitivity c-reactive protein (hs-CRP) were observed and the incidence of major adverse cardiac events (MACE, including cardiac death, myocardial infarction, and target vessel revascularization) were recorded within 30 days after PCI. Thirty-four patients in 20 mg statin group, 40 in 40 mg statin group, and 38 in 60 mg statin group completed this study. In all the 3 groups, hs-CRP level significantly increased at 12 and 24 h after PCI compared with the preoperative levels (P0.05). Intensive pretreatment with 60 mg/day atorvastatin calcium can significantly reduce myocardial infarction related to PCI with good safety in elderly patients with CHD.

Masses of exotic calcium isotopes pin down nuclear forces

CERN Document Server

Wienholtz, F; Blaum, K; Borgmann, Ch; Breitenfeldt, M; Cakirli, R B; George, S; Herfurth, F; Holt, J D; Kowalska, M; Kreim, S; Lunney, D; Manea, V; Menéndez, J; Neidherr, D; Rosenbusch, M; Schweikhard, L; Schwenk, A; Simonis, J; Stanja, J; Wolf, R N; Zuber, K

2013-01-01

The properties of exotic nuclei on the verge of existence play a fundamental part in our understanding of nuclear interactions. Exceedingly neutron-rich nuclei become sensitive to new aspects of nuclear forces. Calcium, with its doubly magic isotopes $^{40}$Ca and $^{48}$Ca, is an ideal test for nuclear shell evolution, from the valley of stability to the limits of existence. With a closed proton shell, the calcium isotopes mark the frontier for calculations with three-nucleon forces from chiral effective field theory. Whereas predictions for the masses of $^{51}$Ca and $^{52}$Ca have been validated by direct measurements$^4$, it is an open question as to how nuclear masses evolve for heavier calcium isotopes. Here we report the mass determination of the exotic calcium isotopes $^{53}$Ca and $^{54}$Ca, using the multi-reflection time-of-flight mass spectrometer of ISOLTRAP at CERN. The measured masses unambiguously establish a prominent shell closure at neutron number N = 32, in excellent agreement with our t...

Effects of Eggshell Calcium Supplementation on Bone Mass in Postmenopausal Vietnamese Women.

Science.gov (United States)

Sakai, Seigo; Hien, Vu Thi Thu; Tuyen, Le Danh; Duc, Ha Anh; Masuda, Yasunobu; Yamamoto, Shigeru

2017-01-01

Bone mass decreases along with aging, especially for women after menopause because of lower estrogen secretion together with low calcium intake. This study was conducted to study the effect of eggshell calcium supplementation on bone mass in 54 postmenopausal Vietnamese women living in a farming area about 60 km from Hanoi, Vietnam. Sets of 3 subjects matched by age, bone mass, BMI and calcium intake were divided randomly into 3 groups with 18 subjects in each group. The eggshell calcium group was administered 300 mg/d calcium from eggshell, the calcium carbonate group 300 mg/d calcium from calcium carbonate and the placebo group received no calcium supplementation. Bone mass (Speed of Sound (SOS)) was measured at the beginning (the baseline), the middle (6th month) and the end of the study (12th month) by the single blind method. SOS of the eggshell group increased significantly at 12 mo (p0.05). In conclusion, eggshell calcium was more effective in increasing bone mass than calcium carbonate in postmenopausal Vietnamese women.

Stereoselective inhibition of thromboxane-induced coronary vasoconstriction by 1,4-dihydropyridine calcium channel antagonists

International Nuclear Information System (INIS)

Eltze, M.; Boer, R.; Sanders, K.H.; Boss, H.; Ulrich, W.R.; Flockerzi, D.

1990-01-01

The biological activity of the (+)-S- and (-)-R-enantiomers of niguldipine, of the (-)-S- and (+)-R-enantiomers of felodipine and nitrendipine, and of rac-nisoldipine and rac-nimodipine was investigated in vitro and in vivo. Inhibition of coronary vasoconstriction due to the thromboxane A2 (TxA2)-mimetic U-46619 in guinea pig Langendorff hearts, displacement of (+)-[ 3 H]isradipine from calcium channel binding sites of guinea pig skeletal muscle T-tubule membranes, and blood pressure reduction in spontaneously hypertensive rats were determined. The enantiomers were obtained by stereoselective synthesis. Cross-contamination was less than 0.5% for both S- and R-enantiomers of niguldipine and nitrendipine and less than 1% for those of felodipine. From the doses necessary for a 50% inhibition of coronary vasoconstriction, stereoselectivity ratios for (+)-(S)-/(-)-(R)-niguldipine, (-)-(S)-/(+)-(R)-felodipine, and (-)-(S)-/(+)-(R)-nitrendipine of 28, 13, and 7, respectively, were calculated. The potency ratio rac-nisoldipine/rac-nimodipine was 3.5. Ratios obtained from binding experiments and antihypertensive activity were (+)-(S)-/(-)-(R)-niguldipine = 45 and 35, (-)-(S)-/(+)-(R)-felodipine = 12 and 13, (-)-(S)-/(+)-(R)-nitrendipine = 8 and 8, and rac-nisoldipine/rac-nimodipine = 8 and 7, respectively. Highly significant correlations were found between the in vitro potency of the substances to prevent U-46619-induced coronary vasoconstriction and their affinity for calcium channel binding sites as well as their antihypertensive activity

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

Directory of Open Access Journals (Sweden)

Ron Blankstein

2017-03-01

Full Text Available Over the last two decades coronary artery calcium (CAC scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300 have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year, with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

Relation of Aortic Valve and Coronary Artery Calcium in Patients With Chronic Kidney Disease to the Stage and Etiology of the Renal Disease

NARCIS (Netherlands)

Piers, Lieuwe H.; Touw, Hugo R. W.; Gansevoort, Ron; Franssen, Casper F. M.; Oudkerk, Matthijs; Zijlstra, Felix; Tio, Rene A.

2009-01-01

Patients with chronic renal failure have increased cardiac calcium loads. Previous studies have investigated the prevalence and quantitative extent of aortic valve calcium (AVC) and coronary artery calcium (CAC) in patients with various stages of chronic kidney disease (CKD). However, the impact of

High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and normal left ventricular ejection fraction

DEFF Research Database (Denmark)

Madsen, Claus Juul; Andersen, Kim F; Zerahn, Bo

2013-01-01

Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS and to id......Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS...

A fully automated multi-modal computer aided diagnosis approach to coronary calcium scoring of MSCT images

Science.gov (United States)

Wu, Jing; Ferns, Gordon; Giles, John; Lewis, Emma

2012-03-01

Inter- and intra- observer variability is a problem often faced when an expert or observer is tasked with assessing the severity of a disease. This issue is keenly felt in coronary calcium scoring of patients suffering from atherosclerosis where in clinical practice, the observer must identify firstly the presence, followed by the location of candidate calcified plaques found within the coronary arteries that may prevent oxygenated blood flow to the heart muscle. However, it can be difficult for a human observer to differentiate calcified plaques that are located in the coronary arteries from those found in surrounding anatomy such as the mitral valve or pericardium. In addition to the benefits to scoring accuracy, the use of fast, low dose multi-slice CT imaging to perform the cardiac scan is capable of acquiring the entire heart within a single breath hold. Thus exposing the patient to lower radiation dose, which for a progressive disease such as atherosclerosis where multiple scans may be required, is beneficial to their health. Presented here is a fully automated method for calcium scoring using both the traditional Agatston method, as well as the volume scoring method. Elimination of the unwanted regions of the cardiac image slices such as lungs, ribs, and vertebrae is carried out using adaptive heart isolation. Such regions cannot contain calcified plaques but can be of a similar intensity and their removal will aid detection. Removal of both the ascending and descending aortas, as they contain clinical insignificant plaques, is necessary before the final calcium scores are calculated and examined against ground truth scores of three averaged expert observer results. The results presented here are intended to show the feasibility and requirement for an automated scoring method to reduce the subjectivity and reproducibility error inherent with manual clinical calcium scoring.

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

OpenAIRE

Gulmez, Oyku

2008-01-01

Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Aslı Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in pa...

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

Energy Technology Data Exchange (ETDEWEB)

Luz, P.L. da; Coimbra, S.; Favarato, D.; Albuquerque, C. [Divisão de Cardiologia Clínica, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Mochiduky, R.I.; Rochitte, C.E. [Divisão de Radiologia, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Hojaij, E. [Serviço de Psicologia, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Gonsalves, C.R.L. [Serviço Nutricional, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Laurindo, F.R. [Laboratório de Biologia Vascular, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

2014-07-04

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

International Nuclear Information System (INIS)

Luz, P.L. da; Coimbra, S.; Favarato, D.; Albuquerque, C.; Mochiduky, R.I.; Rochitte, C.E.; Hojaij, E.; Gonsalves, C.R.L.; Laurindo, F.R.

2014-01-01

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

Directory of Open Access Journals (Sweden)

P.L. da Luz

2014-08-01

Full Text Available Observational studies suggest there are clinical benefits to moderate red wine (RW consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0, 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01. However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001. HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001, while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02. Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

OpenAIRE

Gulmez, Oyku; Atar, Ilyas; Ozin, B?lent; Korkmaz, Mehmet Emin; Atar, Asli; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun

2008-01-01

Background: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in patients undergoing elective PCI. Methods: A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. ...

Comparison of adaptive statistical iterative and filtered back projection reconstruction techniques in quantifying coronary calcium.

Science.gov (United States)

Takahashi, Masahiro; Kimura, Fumiko; Umezawa, Tatsuya; Watanabe, Yusuke; Ogawa, Harumi

2016-01-01

Adaptive statistical iterative reconstruction (ASIR) has been used to reduce radiation dose in cardiac computed tomography. However, change of image parameters by ASIR as compared to filtered back projection (FBP) may influence quantification of coronary calcium. To investigate the influence of ASIR on calcium quantification in comparison to FBP. In 352 patients, CT images were reconstructed using FBP alone, FBP combined with ASIR 30%, 50%, 70%, and ASIR 100% based on the same raw data. Image noise, plaque density, Agatston scores and calcium volumes were compared among the techniques. Image noise, Agatston score, and calcium volume decreased significantly with ASIR compared to FBP (each P ASIR reduced Agatston score by 10.5% to 31.0%. In calcified plaques both of patients and a phantom, ASIR decreased maximum CT values and calcified plaque size. In comparison to FBP, adaptive statistical iterative reconstruction (ASIR) may significantly decrease Agatston scores and calcium volumes. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Coronary artery calcifications in renal graft recipients at the time of transplantation.

Science.gov (United States)

Serafin, Zbigniew; Nawrocka, Elzbieta; Thabit, Sinjab A; Lasek, Władysław; Włodarczyk, Zbigniew

2007-05-01

Coronary artery calcifications (CACs) represent an important risk factor of coronary artery disease in the general population. The purpose of the study was to determine the amount of CAC, including calcium mass, in renal graft recipients early after transplantation. Forty-nine patients aged 43.7+/-9.8 years underwent CAC determination with multi-detector row computed tomography within two weeks after transplantation. The calcium scores were compared with the clinical and laboratory data of the subjects. CACs were detected in 73% of the subjects. The mean calcium score (CS) was 500.8+/-1100.4 and the mean calcium mass (CM) 127.0+/-228.6 mg. Presence of diabetes, duration of hypertension, and diastolic blood pressure (DBP) were significantly associated with the presence of CAC in univariate analysis. CS and CM positively correlated with duration of hypertension, time on dialysis, and pulse pressure (PP) and negatively with DBP. In multiple regression analysis the duration of hypertension, DBP, and PP were identified as independent predictors of CAC presence (p<0.01), while the time on dialysis and DBP were independent predictors of CAC severity (p<0.02). The results suggest that hypertension may play a crucial role in the development of coronary artery calcifications in end-stage renal disease patients, but the nature of the relation between CAC and blood pressure needs further investigation.

An automated multi-modal object analysis approach to coronary calcium scoring of adaptive heart isolated MSCT images

Science.gov (United States)

Wu, Jing; Ferns, Gordon; Giles, John; Lewis, Emma

2012-02-01

Inter- and intra- observer variability is a problem often faced when an expert or observer is tasked with assessing the severity of a disease. This issue is keenly felt in coronary calcium scoring of patients suffering from atherosclerosis where in clinical practice, the observer must identify firstly the presence, followed by the location of candidate calcified plaques found within the coronary arteries that may prevent oxygenated blood flow to the heart muscle. This can be challenging for a human observer as it is difficult to differentiate calcified plaques that are located in the coronary arteries from those found in surrounding anatomy such as the mitral valve or pericardium. The inclusion or exclusion of false positive or true positive calcified plaques respectively will alter the patient calcium score incorrectly, thus leading to the possibility of incorrect treatment prescription. In addition to the benefits to scoring accuracy, the use of fast, low dose multi-slice CT imaging to perform the cardiac scan is capable of acquiring the entire heart within a single breath hold. Thus exposing the patient to lower radiation dose, which for a progressive disease such as atherosclerosis where multiple scans may be required, is beneficial to their health. Presented here is a fully automated method for calcium scoring using both the traditional Agatston method, as well as the Volume scoring method. Elimination of the unwanted regions of the cardiac image slices such as lungs, ribs, and vertebrae is carried out using adaptive heart isolation. Such regions cannot contain calcified plaques but can be of a similar intensity and their removal will aid detection. Removal of both the ascending and descending aortas, as they contain clinical insignificant plaques, is necessary before the final calcium scores are calculated and examined against ground truth scores of three averaged expert observer results. The results presented here are intended to show the requirement and

Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants.

Science.gov (United States)

Van der Vijver, L P; van der Waal, M A; Weterings, K G; Dekker, J M; Schouten, E G; Kok, F J

1992-02-01

Data obtained from a general health examination in 1953-1954 of 2605 middle-aged Dutch civil servants were analysed to investigate the relation between dietary calcium and cardiovascular (CVD) and coronary heart disease (CHD) mortality. Calcium intake was assessed at baseline by a 1-week food frequency recall. Multivariate adjusted odds ratios (OR) were calculated using the highest quintile of calcium intake as the reference. No statistically significant associations were observed for low calcium intake in 15 and 28 years of follow-up in both men and women. For men, multivariate adjusted OR for the lowest quintile of calcium intake were 1.3 (95% confidence interval (CI): 0.8-1.9) and 0.9 (95% CI: 0.6-1.6) for 28-year CVD and CHD mortality, respectively. For women, corresponding OR were 1.1 (95% CI: 0.6-2.0) and 1.1 (95% CI: 0.5-2.5). Although an inverse association between calcium intake and CVD and CHD mortality, possibly mediated by blood pressure, might be hypothesized, no clear association was observed. Because dietary patterns in the 1950s were quite stable, and major calcium sources were addressed, misclassification of calcium intake may not be fully responsible for this finding.

Coronary atherosclerosis burden is not advanced in patients with β-thalassemia despite premature extracardiac atherosclerosis: a coronary artery calcium score and carotid intima-media thickness study.

Science.gov (United States)

Hahalis, George; Zacharioglou, Evangelia; Xanthopoulou, Ioanna; Koniari, Ioanna; Kalogeropoulou, Chistina; Tsota, Irene; Rigopoulou, Aspasia; Diamantopoulos, Athanasios; Gkizas, Vasilios; Davlouros, Periklis; Akinosoglou, Karolina; Leopoulou, Marianna; Gogos, Charalampos; Alexopoulos, Dimitrios

2016-02-01

Thalassemic patients demonstrate an increased rate of extracardiac vascular complications and increased carotid wall intima-media thickness (cIMT), but very low prevalence of coronary artery disease (CAD). We investigated the atheroma burden by assessing the coronary artery calcium (CAC) and cIMT in these patients. We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography (CT) and ultrasonography to determine CAC score and cIMT, respectively. Propensity score matching (C-statistic: 0.88; 95% CI: 0.83-0.93) resulted in 27 pairs of patients; severe CAC was observed in 2 (7.4%) and 0 of β-thalassemia patients and healthy volunteers respectively (P = 0.5). Median calcium score was 0 (0-0) in β-thalassemia patients and 0 (0-4) in healthy volunteers (P = 0.8). Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 (0.06-0.65) vs. 0.062 (0.054-0.086); P = 0.04]. Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study.

Science.gov (United States)

Atar, Aslı Inci; Yılmaz, Omer Cağlar; Akın, Kayıhan; Selçoki, Yusuf; Er, Okan; Eryonucu, Beyhan

2013-03-01

A link between uric acid levels and cardiovascular diseases has been previously reported. Coronary artery calcium score (CACS) is a marker of atherosclerotic disease and a predictor of cardiovascular events. We sought to determine if serum uric acid level is an independent risk factor for the presence of calcium in coronary arteries. Four hundred and forty-two patients who were evaluated in the cardiology outpatient clinic for suspected coronary heart disease with a low-moderate risk for coronary artery disease were included in this observational case-controlled study. Serum uric acid levels were measured with colorimetric methods. CACS were performed using a 64-slice CT scanner. Patients were divided to 3 groups according to their CACS value (Group 1: CACS=0, Group 2: CACS 1-100, Group 3: CACS>100). The demographical characteristics and laboratory findings of 3 groups were similar, except age, fasting glucose levels and serum uric acid levels. Serum uric acid levels were found to increase significantly with increasing CACS (p=0.001). Patients were grouped according to presence CAC (CACS=0 and CACS≥1) and in the multiple regression analysis, age (OR, 1.11, 95% CI, 1.07-1.16), smoking (OR, 3.83, 95% CI, 2.06-7.09), serum uric acid levels (OR, 1.26, 95% CI, 1.04-1.54) and average 10-year total risk of Framingham risk score (OR, 1.13, 95% CI, 1.04-1.09) appeared as independent factors predictive of presence of CAC (p<0.05). Serum uric acid level is an independent risk factor for presence of coronary calcium. Moreover, increasing levels of serum uric acid are associated with increasing CACS.

The impact of CT radiation dose reduction and iterative reconstruction algorithms from four different vendors on coronary calcium scoring

Energy Technology Data Exchange (ETDEWEB)

Willemink, Martin J.; Takx, Richard A.P.; Jong, Pim A. de; Budde, Ricardo P.J.; Schilham, Arnold M.R.; Leiner, Tim [Utrecht University Medical Center, Department of Radiology, Utrecht (Netherlands); Bleys, Ronald L.A.W. [Utrecht University Medical Center, Department of Anatomy, Utrecht (Netherlands); Das, Marco; Wildberger, Joachim E. [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands); Prokop, Mathias [Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen (Netherlands); Buls, Nico; Mey, Johan de [UZ Brussel, Department of Radiology, Brussels (Belgium)

2014-09-15

To analyse the effects of radiation dose reduction and iterative reconstruction (IR) algorithms on coronary calcium scoring (CCS). Fifteen ex vivo human hearts were examined in an anthropomorphic chest phantom using computed tomography (CT) systems from four vendors and examined at four dose levels using unenhanced prospectively ECG-triggered protocols. Tube voltage was 120 kV and tube current differed between protocols. CT data were reconstructed with filtered back projection (FBP) and reduced dose CT data with IR. CCS was quantified with Agatston scores, calcification mass and calcification volume. Differences were analysed with the Friedman test. Fourteen hearts showed coronary calcifications. Dose reduction with FBP did not significantly change Agatston scores, calcification volumes and calcification masses (P > 0.05). Maximum differences in Agatston scores were 76, 26, 51 and 161 units, in calcification volume 97, 27, 42 and 162 mm{sup 3}, and in calcification mass 23, 23, 20 and 48 mg, respectively. IR resulted in a trend towards lower Agatston scores and calcification volumes with significant differences for one vendor (P < 0.05). Median relative differences between reference FBP and reduced dose IR for Agatston scores remained within 2.0-4.6 %, 1.0-5.3 %, 1.2-7.7 % and 2.6-4.5 %, for calcification volumes within 2.4-3.9 %, 1.0-5.6 %, 1.1-6.4 % and 3.7-4.7 %, for calcification masses within 1.9-4.1 %, 0.9-7.8 %, 2.9-4.7 % and 2.5-3.9 %, respectively. IR resulted in increased, decreased or similar calcification masses. CCS derived from standard FBP acquisitions was not affected by radiation dose reductions up to 80 %. IR resulted in a trend towards lower Agatston scores and calcification volumes. (orig.)

Automatic assessment of coronary artery calcium score from contrast-enhanced 256-row coronary computed tomography angiography.

Science.gov (United States)

Rubinshtein, Ronen; Halon, David A; Gaspar, Tamar; Lewis, Basil S; Peled, Nathan

2014-01-01

The coronary artery calcium score (CS), an independent predictor of cardiovascular events, can be obtained from a stand-alone nonenhanced computed tomography (CT) scan (CSCT) or as an additional nonenhanced procedure before contrast-enhanced coronary CT angiography (CCTA). We evaluated the accuracy of a novel fully automatic tool for computing CS from the CCTA examination. One hundred thirty-six consecutive symptomatic patients (aged 59 ± 11 years, 40% female) without known coronary artery disease who underwent both 256-row CSCT and CCTA were studied. Original scan reconstruction (slice thickness) was maintained (3 mm for CSCT and 0.67 mm for CCTA). CS was computed from CCTA by an automatic tool (COR Analyzer, rcadia Medical Imaging, Haifa, Israel) and compared with CS results obtained by standard assessment of nonenhanced CSCT (HeartBeat CS, Philips, Cleveland, Ohio). We also compared both methods for classification into 5 commonly used CS categories (0, 1 to 10, 11 to 100, 101 to 400, >400 Agatston units). All scans were of diagnostic quality. CS obtained by the COR Analyzer from CCTA classified 111 of 136 (82%) of patients into identical categories as CS by CSCT and 24 of remaining 25 into an adjacent category. Overall, CS values from CCTA showed high correlation with CS values from CSCT (Spearman rank correlation = 0.95, p automatically computed from 256-row CCTA correlated highly with standard CS values obtained from nonenhanced CSCT. CS obtained directly from CCTA may obviate the need for an additional scan and attendant radiation. Copyright © 2014 Elsevier Inc. All rights reserved.

Coronary artery calcium distributions in older persons in the AGES-Reykjavik study

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Gudmundsson, Elias Freyr; Gudnason, Vilmundur; Sigurdsson, Sigurdur; Launer, Lenore J.; Harris, Tamara B.; Aspelund, Thor

2013-01-01

Coronary Artery Calcium (CAC) is a sign of advanced atherosclerosis and an independent risk factor for cardiac events. Here, we describe CAC-distributions in an unselected aged population and compare modelling methods to characterize CAC-distribution. CAC is difficult to model because it has a skewed and zero inflated distribution with over-dispersion. Data are from the AGES-Reykjavik sample, a large population based study [2002-2006] in Iceland of 5,764 persons aged 66-96 years. Linear regressions using logarithmic- and Box-Cox transformations on CAC+1, quantile regression and a Zero-Inflated Negative Binomial model (ZINB) were applied. Methods were compared visually and with the PRESS-statistic, R2 and number of detected associations with concurrently measured variables. There were pronounced differences in CAC according to sex, age, history of coronary events and presence of plaque in the carotid artery. Associations with conventional coronary artery disease (CAD) risk factors varied between the sexes. The ZINB model provided the best results with respect to the PRESS-statistic, R2, and predicted proportion of zero scores. The ZINB model detected similar numbers of associations as the linear regression on ln(CAC+1) and usually with the same risk factors. PMID:22990371

Calcium Isotope Analysis by Mass Spectrometry

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Boulyga, S.; Richter, S.

2010-12-01

The variations in the isotopic composition of calcium caused by fractionation in heterogeneous systems and by nuclear reactions can provide insight into numerous biological, geological, and cosmic processes, and therefore isotopic analysis finds a wide spectrum of applications in cosmo- and geochemistry, paleoclimatic, nutritional, and biomedical studies. The measurement of calcium isotopic abundances in natural samples has challenged the analysts for more than three decades. Practically all Ca isotopes suffer from significant isobaric interferences, whereas low-abundant isotopes can be particularly affected by neighboring major isotopes. The extent of natural variations of stable isotopes appears to be relatively limited, and highly precise techniques are required to resolve isotopic effects. Isotope fractionation during sample preparation and measurements and instrumental mass bias can significantly exceed small isotope abundance variations in samples, which have to be investigated. Not surprisingly, a TIMS procedure developed by Russell et al. (Russell et al., 1978. Geochim Cosmochim Acta 42: 1075-1090) for Ca isotope measurements was considered as revolutionary for isotopic measurements in general, and that approach is used nowadays (with small modifications) for practically all isotopic systems and with different mass spectrometric techniques. Nevertheless, despite several decades of calcium research and corresponding development of mass spectrometers, the available precision and accuracy is still not always sufficient to achieve the challenging goals. This presentation discusses figures of merits of presently used analytical methods and instrumentation, and attempts to critically assess their limitations. Additionally, the availability of Ca isotope reference materials will be discussed.

Coronary Artery Calcium Screening: Does it Perform Better than Other Cardiovascular Risk Stratification Tools?

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Irfan Zeb

2015-03-01

Full Text Available Coronary artery calcium (CAC has been advocated as one of the strongest cardiovascular risk prediction markers. It performs better across a wide range of Framingham risk categories (6%–10% and 10%–20% 10-year risk categories and also helps in reclassifying the risk of these subjects into either higher or lower risk categories based on CAC scores. It also performs better among population subgroups where Framingham risk score does not perform well, especially young subjects, women, family history of premature coronary artery disease and ethnic differences in coronary risk. The absence of CAC is also associated with excellent prognosis, with 10-year event rate of 1%. Studies have also compared with other commonly used markers of cardiovascular disease risk such as Carotid intima-media thickness and highly sensitive C-reactive protein. CAC also performs better compared with carotid intima-media thickness and highly sensitive C-reactive protein in prediction of coronary heart disease and cardiovascular disease events. CAC scans are associated with relatively low radiation exposure (0.9–1.1 mSv and provide information that can be used not only for risk stratification but also can be used to track the progression of atherosclerosis and the effects of statins.

Pronounced Coronary Arteriosclerosis in Cirrhosis

DEFF Research Database (Denmark)

Danielsen, Karen V; Wiese, Signe; Hove, Jens

2018-01-01

factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died......BACKGROUND: The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT...... and women: 136 vs. 0 HU; p alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p 

Virtual Non-Contrast CT Using Dual-Energy Spectral CT: Feasibility of Coronary Artery Calcium Scoring

OpenAIRE

Song, Inyoung; Yi, Jeong Geun; Park, Jeong Hee; Kim, Sung Mok; Lee, Kyung Soo; Chung, Myung Jin

2016-01-01

Objective To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. Materials and Methods This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated V...

Calcium en cardioplegie

NARCIS (Netherlands)

Ruigrok, T.J.C.; Meijler, F.L.

1985-01-01

Coronary perfusion with a calcium-free solution, followed by reperfusion with a calcium containing solution, may result in acute myocardial cell death and in irreversible loss of the e1ectrical and mechanical activity of the heart. This phenomenon is known as the calcium paradox. A number of

Calcium intake, body composition, and lipoprotein-lipid concentrations in adults.

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Jacqmain, Mélanie; Doucet, Eric; Després, Jean-Pierre; Bouchard, Claude; Tremblay, Angelo

2003-06-01

Recent data suggest that variations in calcium intake may influence lipid metabolism and body composition. The association between daily calcium intake and body composition and plasma lipoprotein-lipid concentrations was studied cross-sectionally in adults from phase 2 of the Québec Family Study. Adults aged 20-65 y (235 men, 235 women) were studied. Subjects who consumed vitamin or mineral supplements were excluded. Subjects were divided into 3 groups on the basis of their daily calcium intake: groups A ( 1000 mg). Daily calcium intake was negatively correlated with plasma LDL cholesterol, total cholesterol, and total:HDL cholesterol in women and men after adjustment for variations in body fat mass and waist circumference (P body fat mass and waist circumference. In women, body weight, percentage body fat, fat mass, body mass index, waist circumference, and total abdominal adipose tissue area measured by computed tomography were significantly greater (P < 0.05) in group A than in groups B and C, even after adjustments for confounding variables. Comparable trends were observed in men, but not after adjustment for the same covariates. A low daily calcium intake is associated with greater adiposity, particularly in women. In both sexes, a high calcium intake is associated with a plasma lipoprotein-lipid profile predictive of a lower risk of coronary heart disease risk compared with a low calcium intake.

Calcium isotope effects in ion exchange electromigration and calcium isotope analysis by thermo-ionization mass spectrometry

International Nuclear Information System (INIS)

Fujii, Y.; Hoshi, J.; Iwamoto, H.; Okamoto, M.; Kakihana, H.

1985-01-01

Calcium ions were made to electromigrate along a cation exchange membrane. The abundance ratios of the calcium isotopes (Ca-40, 42, 43, 44, 48) in the migrated bands were measured by thermo-ionization mass spectrometry. The lighter isotopes were enriched in the front part of the migrated band. The increments in the isotope abundance ratios were found to be proportional to the mass difference of the isotopes. The observed epsilon-values per unit mass difference (epsilon/ΔM) were 1.26 x 10 -4 (at 20 0 C), 1.85 x 10 -4 (at 25 0 C) and 2.4 x 10 -4 (at 40 0 C). The mass spectrometry was improved by using a low temperature for the evaporation of CaI 2 . (orig.)

Association between circulating vitamin K1 and coronary calcium progression in community-dwelling adults: the Multi-Ethnic Study of Atherosclerosis

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While animal studies found vitamin K treatment reduced vascular calcification, human data are limited. Using a case-cohort design, we determined the association between vitamin K status and coronary artery calcium (CAC) progression in the Multi-ethnic Study of Atherosclerosis. Serum phylloquinone (v...

External validity of a cardiovascular screening including a coronary artery calcium examination in middle-aged individuals from the general population

DEFF Research Database (Denmark)

Grønhøj, Mette H; Gerke, Oke; Mickley, Hans

2018-01-01

, and the association between coronary artery calcium and cardiovascular events. Design Multi-centre population based study. Methods Randomly selected middle-aged men and women ( N = 1751) free of cardiovascular disease were invited to the examination during 2009-2010. Participation rate in the examination was 70......%. Participants ( n = 1227) and non-participants ( n = 524) were compared regarding: cardiovascular medical treatment, Charlson comorbidity index and socioeconomic status (evaluated by cohabitation, gross income and education). Study endpoints were cardiovascular events and mortality. Results Non-participants had......). Adjusted hazard ratio was 0.90 (95% confidence interval (CI) 0.63-1.37). Among participants, the extent of coronary artery calcium was significantly associated with increased risk of cardiovascular events (hazard ratio 1.92, 95% CI 1.03-3.54, hazard ratio 3.66, 95% CI 1.82-7.32, hazard ratio 6.51, 95% CI 3...

Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups

International Nuclear Information System (INIS)

Hwang, Y.; Kim, Y.; Chung, I.-M.; Ryu, J.; Park, H.

2010-01-01

Aim: To evaluate the prevalence of coronary artery disease (CAD) in relation to risk of coronary heart disease (CHD) and assess plaque characteristics from coronary computed tomography (CT) angiography in asymptomatic and symptomatic patients. Materials and methods: Three hundred and ninety consecutive patients [asymptomatic group, n = 138; symptomatic group (atypical or non-anginal chest pain), n = 252] were retrospectively enrolled. They were subsequently classified into three CHD risk categories, based on the National Cholesterol Education Program guidelines, and 10 year risks of coronary events were calculated using Framingham risk score. CT was evaluated for stenosis, plaque composition, and coronary calcium scores. Results: CAD was observed in 42% of the asymptomatic group and 62% of the symptomatic group. In the former, the prevalence of CAD in low-, moderate- and high-risk subgroups was 21.4, 47.4 and 65%, respectively, and was 33.3, 74.4, and 72.4% in the symptomatic group. Framingham 10-year risks of coronary events were significantly higher in patients with CAD than in normal participants, and receiver operating characteristics curves showed that discriminatory power was poor in the asymptomatic group and symptomatic men, and good in symptomatic women. Of the participants in the asymptomatic group, 12% exhibited only non-calcified plaques and of the symptomatic group, 7% exhibited only non-calcified plaques. The coronary calcium score was significantly higher for significant stenosis than for non-significant stenosis in both groups. Conclusions: The prevalence of CAD was not negligible even in subgroups with low-to-moderate CHD risk. Additionally, the Framingham risk score was effective for predicting CAD only in symptomatic women. Coronary calcium scores correlated with significant stenosis; however, a sizeable percentage of both groups had only non-calcified plaques.

Combined evaluation of regional coronary artery calcium and myocardial perfusion by {sup 82}Rb PET/CT in the identification of obstructive coronary artery disease

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Zampella, Emilia; Assante, Roberta; Nappi, Carmela; Mainolfi, Ciro Gabriele; Green, Roberta; Cantoni, Valeria; Klain, Michele; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Acampa, Wanda [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Gaudieri, Valeria; Panico, Mariarosaria [National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy); Slomka, Piotr J. [Cedars-Sinai Medical Center, Department of Medicine, Los Angeles, CA (United States); UCLA, David Geffen School of Medicine, Los Angeles, CA (United States)

2018-04-15

Cardiac imaging with PET/CT allows measurement of coronary artery calcium (CAC), myocardial perfusion and coronary vascular function. We investigated whether the combined assessment of regional CAC score, ischemic total perfusion deficit (ITPD) and quantitative coronary vascular function would further improve the diagnostic accuracy of PET/CT in predicting obstructive coronary artery disease (CAD). We analyzed 113 patients with suspected CAD referred to {sup 82}Rb PET/CT myocardial perfusion imaging with available coronary angiographic data. Obstructive CAD was defined as ≥75% stenosis. The receiver operating characteristic area under curve (AUC) was applied to evaluate the ability of CAC score, ITPD, hyperemic myocardial blood flow (MBF) and coronary flow reserve (CFR) to identify CAD. Vessels with obstructive CAD (71 vessels) had higher ITPD (4.6 ± 6.2 vs. 0.6 ± 1.3) and lower hyperemic MBF (1.01 ± 0.5 vs. 1.75 ± 0.6 ml/min/g) and CFR (1.56 ± 0.6 vs. 2.38 ± 0.7; all p < 0.001) than those without. In prediction of per-vessel CAD, the AUCs for the models including CAC/ITPD/hyperemic MBF (0.869) and CAC/ITPD/CFR (0.875) were higher (both p < 0.01) than for the model including CAC/ITPD (0.790). Compared with CAC/ITPD, continuous net reclassification improvement was 0.69 (95% bootstrap confidence interval, CI, 0.365-1.088) for the CAC/ITPD/hyperemic MBF model and 0.99 (95% bootstrap CI 0.64-1.26) for the CAC/ITPD/CFR model. Hyperemic MBF and CFR provide incremental information about the presence of CAD over CAC score and perfusion imaging parameters. The combined use of CAC, myocardial perfusion imaging and quantitative coronary vascular function in may help predict more accurately the presence of obstructive CAD. (orig.)

Does slice thickness affect diagnostic performance of 64-slice CT coronary angiography in stable and unstable angina patients with a positive calcium score?

Energy Technology Data Exchange (ETDEWEB)

Meijs, Matthijs F.L.; Vos, Alexander M. de; Cramer, Maarten J.; Doevendans, Pieter A.; Vries, Jan J.J. de; Rutten, Annemarieke; Budde, Ricardo P.J.; Prokop, Mathias (Dept. of Radiology, Univ. Medical Center Utrecht, Utrecht (Netherlands)), e-mail: m.meijs@umcutrecht.nl; Meijboom, W. Bob; Feyter, Pim J. de (Dept. of Cardiology, Erasmus Medical Center, Rotterdam (Netherlands))

2010-05-15

Background: Coronary calcification can lead to over-estimation of the degree of coronary stenosis. Purpose: To evaluate whether thinner reconstruction thickness improves the diagnostic performance of 64-slice CT coronary angiography (CTCA) in angina patients with a positive calcium score. Material and Methods: We selected 20 scans from a clinical study comparing CTCA to conventional coronary angiography (CCA) in stable and unstable angina patients based on a low number of motion artifacts and a positive calcium score. All images were acquired at 64 x 0.625 mm and each CTCA scan was reconstructed at slice thickness/increment 0.67 mm/0.33 mm, 0.9 mm/0.45 mm, and 1.4 mm/0.7 mm. Two reviewers blinded for CCA results independently evaluated the scans for the presence of significant coronary artery disease (CAD) in three randomly composed series, with =2 weeks in between series. The diagnostic performance of CTCA was compared for the different slice thicknesses using a pooled analysis of both reviewers. Significant CAD was defined as >50% diameter narrowing on quantitative CCA. Image noise (standard deviation of CT numbers) was measured in all scans. Inter-observer variability was assessed with kappa. Results: Significant CAD was present in 8% of 304 available segments. Median total Agatston calcium score was 181.8 (interquartile range 34.9-815.6). Sensitivity at 0.67 mm, 0.9 mm, and 1.4 mm slice thickness was 70% (95% confidence interval 57-83%), 74% (62-86%), and 70% (57-83%), respectively. Specificity was 85% (82-88%), 84% (81-87%), and 84% (81-87%), respectively. The positive predictive value was 30 (21-38%), 29 (21-37%), and 28 (20-36%), respectively. The negative predictive value was 97% (95-98%), 97% (96-99%), and 97% (96-99%), respectively. Kappa for inter-observer agreement was 0.56, 0.58, and 0.59. Noise decreased from 32.9 HU at 0.67 mm, to 23.2 HU at 1.4 mm (P<0.001). Conclusion: Diagnostic performance of CTCA in angina patients with a positive calcium score

Approaches to ultra-low radiation dose coronary artery calcium scoring based on 3rd generation dual-source CT : A phantom study

NARCIS (Netherlands)

McQuiston, Andrew D.; Muscogiuri, Giuseppe; Schoepf, U. Joseph; Meinel, Felix G.; Canstein, Christian; Varga-Szemes, Akos; Cannao, Paola M.; Wichmann, Julian L.; Allmendinger, Thomas; Vliegenthart, Rozemarijn; De Cecco, Carlo N.

Objectives: To investigate to what extent 3rd generation dual-source computed tomography (DSCT) can reduce radiation dose in coronary artery calcium scoring. Methods: Image acquisition was performed using a stationary calcification phantom. Prospectively electrocardiogram (ECG)-triggered 120 kV

Carotid artery stiffness, digital endothelial function, and coronary calcium in patients with essential thrombocytosis, free of overt atherosclerotic disease

Directory of Open Access Journals (Sweden)

Vrtovec Matjaz

2017-05-01

Full Text Available Patients with myeloproliferative neoplasms (MPNs are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET, a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects.

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

Directory of Open Access Journals (Sweden)

Oyku Gulmez

2008-12-01

Full Text Available Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Aslı Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs during percutaneous coronary intervention (PCI has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB levels in patients undergoing elective PCI.Methods: A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. No CCBs were given to the rest of the patients during the periprocedural period and these patients served as the control group. Blood samples for CK-MB were obtained before and at 6 h, 24 h, and 36 h after the procedure.Results: 217 patients were in the CCB group (mean age 60.2 ± 9.3 years, 162 males, and 353 were in the control group (mean age 60.0 ± 10.1 years, 262 males. CK-MB levels increased above the normal values in 41 patients (18.9% of the CCBs group and in 97 patients (27.5% of the control group (p = 0.02. Median CK-MB levels were significantly higher in the control group for all studied hours (for all p < 0.05.Conclusions: Prior oral CCB therapy may have favorable effects in preventing myocyte necrosis after elective PCI.Keywords: calcium channel blockers, myonecrosis, percutaneous coronary interventions

Coronary Artery Calcium as an Independent Surrogate Marker in the Risk Assessment of Patients With Atrial Fibrillation and an Intermediate Pretest Likelihood for Coronary Artery Disease Admitted to a German Chest Pain Unit.

Science.gov (United States)

Breuckmann, Frank; Olligs, Jan; Hinrichs, Liane; Koopmann, Matthias; Lichtenberg, Michael; Böse, Dirk; Fischer, Dieter; Eckardt, Lars; Waltenberger, Johannes; Garvey, J Lee

2016-03-01

About 10% of patients admitted to a chest pain unit (CPU) exhibit atrial fibrillation (AF). To determine whether calcium scores (CS) are superior over common risk scores for coronary artery disease (CAD) in patients presenting with atypical chest pain, newly diagnosed AF, and intermediate pretest probability for CAD within the CPU. In 73 subjects, CS was related to the following risk scores: Global Registry of Acute Coronary Events (GRACE) score, including a new model of a frequency-normalized approach; Thrombolysis In Myocardial Infarction score; European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE); Framingham risk score; and Prospective Cardiovascular Münster Study score. Revascularization rates during index stay were assessed. Median CS was 77 (interquartile range, 1-270), with higher values in men and the left anterior descending artery. Only the modified GRACE (ρ = 0.27; P = 0.02) and the SCORE (ρ = 0.39; P risk scores and calcium burden, as well as revascularization rates during index stay, were low. By contrast, the determination of CS may be used as an additional surrogate marker in risk stratification in AF patients with intermediate pretest likelihood for CAD admitted to a CPU. © 2016 Wiley Periodicals, Inc.

Inadequate increase in the volume of major epicardial coronary arteries compared with that in left ventricular mass. Novel concept for characterization of coronary arteries using 64-slice computed tomography.

Science.gov (United States)

Ehara, Shoichi; Okuyama, Takuhiro; Shirai, Nobuyuki; Sugioka, Kenichi; Oe, Hiroki; Itoh, Toshihide; Matsuoka, Toshiyuki; Ikura, Yoshihiro; Ueda, Makiko; Naruko, Takahiko; Hozumi, Takeshi; Yoshiyama, Minoru

2009-08-01

Previous studies have shown a correlation between coronary artery cross-sectional diameter and left ventricular (LV) mass. However, no studies have examined the correlation between actual coronary artery volume (CAV) and LV mass. In the present study, measurements of CAV by 64-multislice computed tomography (MSCT) were validated and the relationship between CAV and LV mass was investigated. First, coronary artery phantoms consisting of syringes filled with solutions of contrast medium moving at simulated heart rates were scanned by 64-MSCT. Display window settings permitting accurate calculation of small volumes were optimized by evaluating volume-rendered images of the segmented contrast medium at different window settings. Next, 61 patients without significant coronary artery stenosis were scanned by 64-MSCT with the same protocol as for the phantoms. Coronary arteries were segmented on a workstation and the same window settings were applied to the volume-rendered images to calculate total CAV. Significant correlations between total CAV and LV mass (r=0.660, Pconcept of "CAV" for the characterization of coronary arteries may prove useful for future research, particularly on the causes of LV hypertrophy.

The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium.

Science.gov (United States)

Wong, Nathan D; Sciammarella, Maria G; Polk, Donna; Gallagher, Amy; Miranda-Peats, Lisa; Whitcomb, Brian; Hachamovitch, Rory; Friedman, John D; Hayes, Sean; Berman, Daniel S

2003-05-07

We compared the prevalence and extent of coronary artery calcium (CAC) among persons with the metabolic syndrome (MetS), diabetes, and neither condition. The prevalence and extent of CAC has not been compared among those with MetS, diabetes, or neither condition. Of 1,823 persons (36% female) age 20 to 79 years who had screening for CAC by computed tomography, 279 had MetS, 150 had diabetes, and the remainder (n = 1,394) had neither condition. Metabolic syndrome was defined with >or=3 of the following: body mass index >or=30 kg/m(2); high-density lipoprotein cholesterol or=150 mg/dl; blood pressure >or=130/85 mm Hg or on treatment; or fasting glucose 110 to 125 mg/dl. The prevalence and odds of any and significant (>or=75th percentile) CAC among these groups and by number of MetS risk factors were determined. Those with neither MetS nor diabetes, MetS, or diabetes had a prevalence of CAC of 53.5%, 58.8%, and 75.3% (p 20% 10-year risk of CHD or CAC >or=75th percentile for age and gender. Risk factor-adjusted odds for the presence of CAC were 1.40 (95% confidence interval [CI] 1.05 to 1.87) among those with MetS and 1.67 (95% CI 1.12 to 2.50) among those with diabetes, versus those with neither condition. Those with MetS or diabetes have an increased likelihood of CAC compared with those having neither condition.

Association of Inter-Arm Systolic Blood Pressure Difference with Coronary Atherosclerotic Disease Burden Using Calcium Scoring.

Science.gov (United States)

Her, Ae Young; Cho, Kyoung Im; Garg, Scot; Kim, Yong Hoon; Shin, Eun Seok

2017-09-01

There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosis found using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Patients who had ≥3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; ≥10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measured by using coronary computed tomography angiography with the scoring system. A total of 261 patients were included in this study. Age (r=0.256, parm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, parm SBP difference (≥6 mm Hg) was significantly associated with CACS ≥300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12-4.22; p=0.022]. In multivariable analysis, the inter-arm SBP difference ≥6 mm Hg was also significantly associated with CACS ≥300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06-5.19; p=0.036). An increased inter-arm SBP difference (≥6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors. © Copyright: Yonsei University College of Medicine 2017

Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease.

Science.gov (United States)

Assante, Roberta; Zampella, Emilia; Arumugam, Parthiban; Acampa, Wanda; Imbriaco, Massimo; Tout, Deborah; Petretta, Mario; Tonge, Christine; Cuocolo, Alberto

2017-04-01

We assessed the relationship between coronary artery calcium (CAC) score, myocardial blood flow (MBF) and coronary flow reserve (CFR) in patients undergoing hybrid 82 Rb positron emission tomography (PET)/computed tomography (CT) imaging for suspected CAD. We also evaluated if CAC score is able to predict a reduced CFR independently from conventional coronary risk factors. A total of 637 (mean age 58 ± 13 years) consecutive patients were studied. CAC score was measured according to the Agatston method and patients were categorized into 4 groups (0, 0.01-99.9, 100-399.9, and ≥400). Baseline and hyperemic MBF were automatically quantified. CFR was calculated as the ratio of hyperemic to baseline MBF and it was considered reduced when <2. Global CAC score showed a significant inverse correlation with hyperemic MBF and CFR (both P < .001), while no correlation between CAC score and baseline MBF was found. At multivariable logistic regression analysis age, diabetes and CAC score were independently associated with reduced CFR (all P < .001). The addition of CAC score to clinical data increased the global chi-square value for predicting reduced CFR from 81.01 to 91.13 (P < .01). Continuous net reclassification improvement, obtained by adding CAC score to clinical data, was 0.36. CAC score provides incremental information about coronary vascular function over established CAD risk factors in patients with suspected CAD and it might be helpful for identifying those with a reduced CFR.

Impact of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in multislice Computed Tomography coronary angiography

International Nuclear Information System (INIS)

Cademartiri, Filippo; Mollet, Nico R.; Kriestin, Gabriel P.; Runza, Giuseppe; Bartolotta, Tommaso Vincenzo; Galia, Massimo; Midiri, Massimo; Belgrano, Manuel; Pozzi Mucelli, Roberto

2005-01-01

Purpose. To assess the effect of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT). Materials and methods. One hundred patients (88 males; 59±11 years) with suspected coronary artery disease who had undergone conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA, with the following protocol: collimation 16x0.75 mm, gantry rotation time 420 ms, feed/rotation 2.8 mm, kV 120, mAs 400-500. The protocol for contrast material administration was 100 ml of Iodixanol 320 mgI/nl at 4 ml/s and the scan delay was defined with a bolus tracking technique. In all patients vascular enhancement was measured in the aortic root, and the left and the right coronary arteries. The average enhancement was used to divide the population in two groups of 50 patients each, one with lower enhancement (Low), and one with higher enhancement (High). In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (≥50% lumen reduction) was evaluated in vessels ≥2mm in diameter using quantitative CA as the reference standard. The differences in diagnostic accuracy were compared with a Chi-square test and a p [it

Influence of iterative reconstruction on coronary calcium scores at multiple heart rates: a multivendor phantom study on state-of-the-art CT systems.

Science.gov (United States)

van der Werf, N R; Willemink, M J; Willems, T P; Greuter, M J W; Leiner, T

2017-12-28

The objective of this study was to evaluate the influence of iterative reconstruction on coronary calcium scores (CCS) at different heart rates for four state-of-the-art CT systems. Within an anthropomorphic chest phantom, artificial coronary arteries were translated in a water-filled compartment. The arteries contained three different calcifications with low (38 mg), medium (80 mg) and high (157 mg) mass. Linear velocities were applied, corresponding to heart rates of 0,  75 bpm. Data were acquired on four state-of-the-art CT systems (CT1-CT4) with routinely used CCS protocols. Filtered back projection (FBP) and three increasing levels of iterative reconstruction (L1-L3) were used for reconstruction. CCS were quantified as Agatston score and mass score. An iterative reconstruction susceptibility (IRS) index was used to assess susceptibility of Agatston score (IRS AS ) and mass score (IRS MS ) to iterative reconstruction. IRS values were compared between CT systems and between calcification masses. For each heart rate, differences in CCS of iterative reconstructed images were evaluated with CCS of FBP images as reference, and indicated as small ( 10%). Statistical analysis was performed with repeated measures ANOVA tests. While subtle differences were found for Agatston scores of low mass calcification, medium and high mass calcifications showed increased CCS up to 77% with increasing heart rates. IRS AS of CT1-T4 were 17, 41, 130 and 22% higher than IRS MS . Not only were IRS significantly different between all CT systems, but also between calcification masses. Up to a fourfold increase in IRS was found for the low mass calcification in comparison with the high mass calcification. With increasing iterative reconstruction strength, maximum decreases of 21 and 13% for Agatston and mass score were found. In total, 21 large differences between Agatston scores from FBP and iterative reconstruction were found, while only five large differences were found between

Coronary CT: clinical indications and future directions

International Nuclear Information System (INIS)

Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B.; Cury, Roberto C.

2011-01-01

Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

Motivational effects of coronary artery calcium scores on statin adherence and weight loss.

Science.gov (United States)

Kalia, Nove K; Cespedes, Lucas; Youssef, George; Li, Dong; Budoff, Matthew J

2015-05-01

The aim of this study was to assess the effect on adherence to statin therapy and assess the effect of beneficial changes in behavior that resulted in weight loss in patients who underwent coronary artery calcium (CAC) scoring with cardiac computed tomography. Despite convincing data demonstrating the benefits of HmGCoA inhibitors for both primary and secondary prevention of coronary heart disease, they remain underused. Also, despite convincing data demonstrating the benefits of weight loss for both primary and secondary prevention of coronary heart disease, it remains difficult to motivate behavioral changes resulting in weight loss. In this study, we assess whether higher CAC scores are associated with increased compliance with statin medication and whether higher CAC scores are associated with beneficial lifestyle behaviors resulting in weight loss. We retrospectively analyzed patients that had undergone baseline CAC testing and returned for a follow-up scan. All patients had weight documented and were administered a questionnaire regarding compliance to medications. The primary endpoint was measurable weight loss between visit one and visit two and the self-reported compliance to statin use. The study population with data regarding statin compliance consisted of 2608 individuals (72% men, mean age 58±8 years) who were followed for a mean of 4.1±3.2 years after an initial CAC scan. Overall, statin compliance was lowest (27.4%) among those with CAC=0, and gradually increased with higher CAC scores (1-99, 39.2%; 100-399, 53.6%; ≥400, 58.8%; Ptool, a higher rate of adherences with statin therapy was observed in patients with higher CAC scores.

Non-calcified coronary plaque volume inversely related to CD4 count in HIV infection

Science.gov (United States)

Duarte, Horacio; Matta, Jatin R.; Muldoon, Nancy; Masur, Henry; Hadigan, Colleen; Gharib, Ahmed M.

2013-01-01

Background Non-calcified coronary artery plaque (NCAP) may be an important predictor of cardiovascular events, however, few studies have directly measured NCAP in HIV-infected individuals. Methods We completed a prospective cross-sectional evaluation of NCAP and coronary calcium scores using CT angiography in HIV-infected subjects (n=26) without known coronary artery disease (CAD), but who had one or more CAD risk factor and compared them to controls matched on age, race, sex, body mass index and Framingham risk score (n=26). Results There was no difference in coronary calcium scores (114 ± 218 vs. 124 ± 298 p=0.89) or NCAP volume (65 ± 86 mm3 vs. 63 ± 82 mm3, p=0.38) between HIV-infected subjects and controls, respectively. Among HIV-infected subjects, lower CD4 count was associated with increased NCAP volume (r=-0.52, p=0.006). CD4 count remained a significant predictor of NCAP in a multivariate analysis that adjusted for age and duration of antiretroviral therapy. Conclusion Plaque burden is similar between HIV-infected and uninfected individuals when matched on traditional CAD risk factors, however immune function may mediate the development of atherosclerosis in HIV infection. PMID:22293714

Effects of low calcium dialysate on the progression of coronary artery calcification in hemodialysis patients: An open-label 12-month randomized clinical trial.

Science.gov (United States)

Kim, Soo Jin; Lee, Young-Ki; Oh, Jieun; Cho, AJin; Noh, Jung Woo

2017-09-15

The association between the dialysate calcium level and coronary artery calcification (CAC) has not yet been evaluated in hemodialysis patients. The objective of this study was to determine whether lowering the dialysate calcium levels would decrease the progression of coronary artery calcification (CAC) compared to using standard calcium dialysate. We conducted an open-label randomized trial with parallel groups. The patients were randomly assigned to either 12-month treatment with low calcium dialysate (LCD; 1.25mmol/L, n=36) or standard calcium dialysate (SCD; 1.5mmol/L, n=40). The primary outcome was the change in the CAC scores assessed by 64-slice multidetector computed tomography after 12months. During the treatment period, CAC scores increased in both groups, especially significant in LCD group (402.5±776.8, 580.5±1011.9, P=0.004). When we defined progressors as patients at second and third tertiles of CAC changes, progressor group had a higher proportion of LCD-treated patients than SCD-treated patients (P=0.0229). In multivariate analysis, LCD treatment is a significant risk factor for increase in CAC scores (odds ratio=5.720, 95% CI: 1.219-26.843, P=0.027). Use of LCD may accelerate the progression of CAC in patients with chronic hemodialysis over a 12-month period. Clinical Research Information Service [Internet]; Osong (Chungcheongbuk-do): Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare (Republic of Korea), 2010: KCT0000942. Available from: https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=3572&sLeft=2&type=my. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Distribution of coronary calcium score in healthy middle-aged Korean

International Nuclear Information System (INIS)

Choe, Kyu Ok; Kim, Min Jung; Choi, Byoung Wook; Kim, Jung Ho; Noh, Ki Suh; Kim, Si Yon; Ko, Heung Kyu; Suh, Il

1999-01-01

To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. A total of 289 apparently healthy personnel at Yonsei University (male: 170, female:119, age: mean(SD=54.9±7.1 years) underwent EBT (electron bean tomography). The risk factors for athero-sclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58%) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. The prevalence of CAC was 40% in men and 18.5% in women (mean score:29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141,41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6%), respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity(p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score(p=0.118). This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans

Distribution of coronary calcium score in healthy middle-aged Korean

Energy Technology Data Exchange (ETDEWEB)

Choe, Kyu Ok; Kim, Min Jung; Choi, Byoung Wook; Kim, Jung Ho; Noh, Ki Suh; Kim, Si Yon; Ko, Heung Kyu; Suh, Il [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-11-01

To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. A total of 289 apparently healthy personnel at Yonsei University (male: 170, female:119, age: mean(SD=54.9{+-}7.1 years)) underwent EBT (electron bean tomography). The risk factors for athero-sclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58%) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. The prevalence of CAC was 40% in men and 18.5% in women (mean score:29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141,41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6%), respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity(p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score(p=0.118). This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans.

Coronary calcium visualization using dual energy chest radiography with sliding organ registration

Science.gov (United States)

Wen, Di; Nye, Katelyn; Zhou, Bo; Gilkeson, Robert C.; Wilson, David L.

2016-03-01

Coronary artery calcification (CAC) is the lead biomarker for atherosclerotic heart disease. We are developing a new technique to image CAC using ubiquitously ordered, low cost, low radiation dual energy (DE) chest radiography (using the two-shot GE Revolution XRd system). In this paper, we proposed a novel image processing method (CorCalDx) based on sliding organ registration to create a bone-image-like, coronary calcium image (CCI) that significantly reduces motion artifacts and improves CAC conspicuity. Experiments on images of a physical dynamic cardiac phantom showed that CorCalDx reduced 73% of the motion artifact area as compared to standard DE over a range of heart rates up to 90 bpm and varying x-ray radiation exposures. Residual motion artifact in the phantom CCI is greatly suppressed in gray level and area (0.88% of the heart area). In a Functional Measurement Test (FMT) with 20 clinical exams, image quality improvement of CorCalDx against standard DE (measured from -10 to +10) was significantly suggested (panatomy visibility (6.1+/-3.5). CorCalDx was always chosen best in every image tested. In preliminary assessments of 12 patients with 18 calcifications, 90% of motion artifact regions in standard DE results were removed in CorCalDx results, with 100% sensitivity of calcification detection, showing great potential of CorCalDx to improve CAC detection and grading in DE chest radiography.

Quantitation of stable isotopic tracers of calcium by fast atom bombardment mass spectrometry

International Nuclear Information System (INIS)

Jiang, X.; Smith, D.L.

1987-01-01

Instrumentation and methodology developed for quantitation of stable isotopic traces in urine are described. Calcium is isolated from urine as the insoluble oxalate salt which is subsequently dissolved in hydrochloric acid. The isotopic content of the acid solution is determined by use of a conventional mass spectrometer equipped with a fast atom bombardment ion source. Calcium ions are desorbed from the sample surface by a beam of high-energy xenon atoms and detected with a high-resolution mass spectrometer. A data acquisition system has been developed to control the mass spectrometer and record the ion signals. Detailed analysis of potential sources of error indicates that the precision of the method is presently limited primarily by an isotope effect that occurs during ion desorption. Results presented here demonstrate that the relative abundances of calcium isotopes in urine can be determined with high precision (coefficient of variation < 0.2%) and that the method is a viable alternative to conventional thermal ionization mass spectrometry. The method is especially attractive because it uses a conventional high-resolution mass spectrometer which is routinely used for analysis of organic substances

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

International Nuclear Information System (INIS)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

2001-01-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

Energy Technology Data Exchange (ETDEWEB)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

2001-04-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

[Risk management of coronary artery disease--pharmacological therapy].

Science.gov (United States)

Hofmann, Thomas

2004-06-01

Treatment of coronary artery disease primarily aims at reducing the severity and frequency of cardiac symptoms and improving prognosis. Both goals can be achieved by the administration of beta-receptor blockers, which are now used as first-line therapy in these patients. Calcium channel blockers or nitrates should be given in the event of contraindications or severe intolerance to beta-receptor blocking therapy. Only long-acting calcium channel blockers should be used in this setting. Another indication for additional treatment with calcium channel blockers and nitrates is given when the efficacy of beta-blocker therapy is not sufficient to relieve symptoms. Nitroglycerin and nitrates are the drugs of choice for the treatment of the acute angina pectoris attack. Calcium channel blockers are used as first-line treatment in patients with vasospastic angina. In patients with syndrome X, nitrates as well as calcium channel blockers or beta-receptor blockers can be administered. In the absence of contraindications, every patient with coronary artery disease should be given aspirin. A daily dosage of 75 to 150 mg is sufficient to reduce the rate of future cardiac events. Clopidogrel should be given in every patient with intolerance or contraindications for aspirin. Increased plasma homocystein levels seem to be a risk factor for coronary artery disease. Homocystein levels can be reduced by dietary means as well as supplementation of folic acid or vitamin B complex. There is no evidence from controlled randomised studies that a decrease of homocystein is beneficial for the prognosis of patients with coronary artery disease.

Left ventricular diastolic function in type 2 diabetes mellitus and the association with coronary artery calcium score: a cardiac MRI study.

Science.gov (United States)

Graça, Bruno; Donato, Paulo; Ferreira, Maria João; Castelo-Branco, Miguel; Caseiro-Alves, Filipe

2014-06-01

The purpose of this study was to compare cardiac MRI-derived parameters of left ventricular (LV) diastolic function between uncomplicated type 2 diabetes mellitus (DM2) and normoglycemic control subjects and to evaluate whether these parameters of LV diastolic function are related to coronary atherosclerosis. We prospectively studied 41 subjects with DM2 and 21 normoglycemic control subjects (30 women and 32 men; mean age, 57.2 ± 7.1 [SD] years) with no evidence of overt cardiovascular disease. We used cardiac MRI to measure LV volumes, LV peak filling rate (PFR), and transmitral flow and CT to determine coronary artery calcium scores. Absolute values of the peak filling rate (PFR) were significantly lower in DM2 patients than in control subjects (mean ± SD, 293.2 ± 51.7 vs 375.7 ± 102.8 mL/s, respectively; p DM2 patients compared with control subjects. DM2 patients with coronary artery calcification showed a lower PFR normalized to stroke volume (SV) (mean ± SD, 4.4 ± 1.0 vs 5.3 ± 1.4, respectively; p = 0.038) and lower mitral peak E velocities (40.1 ± 11.3 vs 48.0 ± 7.3 cm/s; p = 0.024) than DM2 patients without coronary calcification. PFR normalized to SV was independently associated with the presence of coronary artery calcification (β = -1.5, p = 0.005). DM2 decreases cardiovascular MRI-derived parameters of LV diastolic function. Patients with DM2 and coronary atherosclerosis show a more impaired LV diastolic function than patients without coronary atherosclerosis.

Non-calcified coronary plaque volume inversely related to CD4(+) T-cell count in HIV infection.

Science.gov (United States)

Duarte, Horacio; Matta, Jatin R; Muldoon, Nancy; Masur, Henry; Hadigan, Colleen; Gharib, Ahmed M

2012-01-01

Non-calcified coronary artery plaque (NCAP) might be an important predictor of cardiovascular events; however, few studies have directly measured NCAP in HIV-infected individuals. We completed a prospective cross-sectional evaluation of NCAP and coronary calcium scores using computed tomography angiography in HIV-infected patients (n=26) without known coronary artery disease (CAD), but who had one or more CAD risk factor(s), and compared them with controls matched on age, race, sex, body mass index and Framingham Risk Score (n=26). There was no difference in coronary calcium scores (114 ± 218 versus 124 ± 298; P=0.89) or NCAP volume (65 ± 86 mm(3) versus 63 ± 82 mm(3); P=0.38) between HIV-infected patients and controls, respectively. Among HIV-infected patients, lower CD4(+) T-cell count was associated with increased NCAP volume (r=-0.52, P=0.006). The CD4(+) T-cell count remained a significant predictor of NCAP in a multivariate analysis that adjusted for age and duration of antiretroviral therapy. Plaque burden is similar between HIV-infected and uninfected individuals when matched on traditional CAD risk factors; however, immune function might mediate the development of atherosclerosis in HIV infection.

Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Yuoness, Salem A.; Goha, Ahmed M.; Romsa, Jonathan G.; Akincioglu, Cigdem; Warrington, James C.; Datta, Sudip; Gambhir, Sanjay; Urbain, Jean-Luc C.; Vezina, William C. [London Health Sciences Centre, Department of Nuclear Medicine, London, ON (Canada); Massel, David R. [London Health Sciences Centre, Division of Cardiology, London, ON (Canada); Martell, Rafael [Private Practice, London, ON (Canada)

2015-09-15

Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

Calcium Atom Trap for Atom Trap Mass Spectrometer

Energy Technology Data Exchange (ETDEWEB)

Ko, Kwang Hoon; Park, Hyun Min; Han, Jae Min; Kim, Taek Soo; Cha, Yong Ho; Lim, Gwon; Jeong, Do Young [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2012-05-15

Trace isotope analysis has been an important role in science, archaeological dating, geology, biology and nuclear industry. Artificially produced fission products such as Sr-90, Cs-135 and Kr-85 can be released to the environment when nuclear accident occurs and the reprocessing factory operates. Thus, the analysis of them has been of interest in nuclear industry. But it is difficult to detect them due to low natural abundance less then 10-10. The ultra-trace radio isotopes have been analyzed by the radio-chemical method, accelerator mass spectrometer, and laser based method. The radiochemical method has been used in the nuclear industry. But this method has disadvantages of long measurement time for long lived radioisotopes and toxic chemical process for the purification. The accelerator mass spectrometer has high isotope selectivity, but the system is huge and it has the isobar effects. The laser based method, such as RIMS (Resonance Ionization Mass Spectrometry) is a basically isobar-effect free method. Recently, ATTA (Atom Trap Trace Analysis), one of the laser based method, has been successfully demonstrated sufficient isotope selectivity with small system size. It has been applied for the detection of Kr-81 and Kr-85. However, it is not suitable for real sample detection, because it requires steady atomic beam generation during detection and is not allowed simultaneous detection of other isotopes. Therefore, we proposed the coupled method of Atom Trap and Mass Spectrometer. It consists of three parts, neutral atom trap, ionization and mass spectrometer. In this paper, we present the demonstration of the magneto-optical trap of neutral calcium. We discuss the isotope selective characteristics of the MOT (Magneto Optical Trap) of calcium by the fluorescence measurement. In addition, the frequency stabilization of the trap beam will be presented

Coronary calcium screening with dual-source CT: reliability of ungated, high-pitch chest CT in comparison with dedicated calcium-scoring CT

Energy Technology Data Exchange (ETDEWEB)

Hutt, Antoine; Faivre, Jean-Baptiste; Remy, Jacques; Remy-Jardin, Martine [CHRU et Universite de Lille, Department of Thoracic Imaging, Hospital Calmette (EA 2694), Lille (France); Duhamel, Alain; Deken, Valerie [CHRU et Universite de Lille, Department of Biostatistics (EA 2694), Lille (France); Molinari, Francesco [Centre Hospitalier General de Tourcoing, Department of Radiology, Tourcoing (France)

2016-06-15

To investigate the reliability of ungated, high-pitch dual-source CT for coronary artery calcium (CAC) screening. One hundred and eighty-five smokers underwent a dual-source CT examination with acquisition of two sets of images during the same session: (a) ungated, high-pitch and high-temporal resolution acquisition over the entire thorax (i.e., chest CT); (b) prospectively ECG-triggered acquisition over the cardiac cavities (i.e., cardiac CT). Sensitivity and specificity of chest CT for detecting positive CAC scores were 96.4 % and 100 %, respectively. There was excellent inter-technique agreement for determining the quantitative CAC score (ICC = 0.986). The mean difference between the two techniques was 11.27, representing 1.81 % of the average of the two techniques. The inter-technique agreement for categorizing patients into the four ranks of severity was excellent (weighted kappa = 0.95; 95 % CI 0.93-0.98). The inter-technique differences for quantitative CAC scores did not correlate with BMI (r = 0.05, p = 0.575) or heart rate (r = -0.06, p = 0.95); 87.2 % of them were explained by differences at the level of the right coronary artery (RCA: 0.8718; LAD: 0.1008; LCx: 0.0139; LM: 0.0136). Ungated, high-pitch dual-source CT is a reliable imaging mode for CAC screening in the conditions of routine chest CT examinations. (orig.)

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease

DEFF Research Database (Denmark)

Coutinho, Thais; Goel, Kashish; Corrêa de Sá, Daniel

2013-01-01

This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based ona combination of body mass index (BMI) with measures of central obesity.......This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based ona combination of body mass index (BMI) with measures of central obesity....

Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome.

Science.gov (United States)

Christian, Rose C; Dumesic, Daniel A; Behrenbeck, Thomas; Oberg, Ann L; Sheedy, Patrick F; Fitzpatrick, Lorraine A

2003-06-01

Polycystic ovary syndrome (PCOS), a common endocrine disorder of reproductive-aged women, is associated with multiple risk factors for coronary heart disease (CHD), such as diabetes mellitus, dyslipidemia, visceral obesity, and hypertension. However, premature coronary atherosclerosis has not been demonstrated in PCOS women. Electron beam computed tomography (EBCT) noninvasively measures coronary artery calcium (CAC), a marker for coronary atherosclerosis. We measured CAC by EBCT in 30- to 45-yr-old premenopausal PCOS women and compared the results to CAC in 1) recruited normal ovulatory volunteers matched for age and weight to the PCOS cohort, and 2) community-dwelling women of similar age in an extant coronary calcium database. Healthy, community-dwelling, ovulatory controls (n = 71) were matched by age and body mass index (BMI) to PCOS women (n = 36). Women with diabetes or known CHD were excluded. Subjects underwent EBCT scanning, oral glucose tolerance testing, and CHD risk factor assessment. PCOS women had significantly higher levels of serum total and low density lipoprotein cholesterol and testosterone levels than matched controls. PCOS and control women were obese and had a greater mean BMI than community-dwelling women (33 kg/m(2) for PCOS vs. 31 kg/m(2) for control; P PCOS women (39%) than in matched controls (21%; odds ratio, 2.4; P = 0.05) or community-dwelling women (9.9%; odds ratio, 5.9; P PCOS women than in obese or nonobese women of similar age. PCOS women are at increased risk for atherosclerosis and should be targeted for primary prevention of CHD.

Quantification of iron in the presence of calcium with dual-energy computed tomography (DECT) in an ex vivo porcine plaque model

International Nuclear Information System (INIS)

Wang Jia; Duan Xinhui; Leng Shuai; Yu Lifeng; McCollough, Cynthia H; Garg, Nitin; Liu Yu; Kantor, Birgit; Ritman, Erik L

2011-01-01

Iron deposits secondary to microbleeds often co-exist with calcium in coronary plaques. The purpose of this study was to quantify iron in the presence of calcium in an ex vivo porcine arterial plaque model using a clinical dual-energy CT (DECT) scanner. A material decomposition method to quantify the mass fractions of iron and calcium within a mixture using DECT was developed. Mixture solutions of known iron and calcium concentrations were prepared to calibrate and validate the DECT-based algorithm. Simulated plaques with co-existing iron and calcium were created by injecting the mixture solutions into the vessel wall of porcine carotid arteries and aortas. These vessel regions were harvested and scanned using a clinical DECT system and iron mass fraction was calculated for each sample. Iron- and calcium-specific staining was conducted on 5 µm thick histological sections of vessel samples to confirm the co-existence of iron and calcium in the simulated plaques. The proposed algorithm accurately quantified iron and calcium amounts in mixture solutions. Maps of iron mass fraction of 60 artery segments were obtained from CT images at two energies. The sensitivity for detecting the presence of iron was 83% and the specificity was 92% using a threshold at an iron mass fraction of 0.25%. Histological analysis confirmed the co-localization of iron and calcium within the simulated plaques. Iron quantification in the presence of calcium was feasible in excised arteries at an iron mass fraction of around 1.5% or higher using current clinical DECT scanners.

Association between short sleep and body mass index, hypertension among acute coronary syndrome patients in coronary care unit.

Science.gov (United States)

Sepahvand, Elham; Jalali, Rostam; Mirzaei, Maryam; Kargar Jahromi, Marzieh

2014-11-26

Patients with coronary diseases admitted to special care unit often suffer from sleep disorders, which may cause physiological changes and adversely affect patient's health. The relationship between sleep disorders and obesity is an important factor in studies on sleep disorders and other chronic diseases in all groups, including cardiovascular diseases. Understanding this relationship may increase the chance of progress in effective medical interventions in sleep disorders and obesity. This study was designed to evaluate the association between short sleep and Body Mass Index (BMI), hypertension among acute coronary syndrome patients. In this descriptive analytical study, 221 coronary patients admitted to coronary care unit and general wards were investigated. Data were collected through a researcher-made questionnaire whose validity and reliability had been confirmed. Data were analyzed with SPSS-16 software. A total of 221 patients with acute coronary diseases (including myocardial infarction and angina pectoris) with a mean age of 61.27 years were studied, of whom 61.5% were male and 38.5% were female. A significant association was observed between short sleep and higher BMI (P=0.000). About half the patients (49.3%) had a history of hypertension, and sleep disorders were also significantly related to hypertension (P=0.006). In this study, sleep disorders were patients' main complaint. Researchers found that patients with less than 5 hours or more than 9 hours sleep at night were more likely to have hypertension compared to patients that slept 7-8 hours. Lack of sleep affects metabolism, and daily energy expenditure reduces with increased immobility. In this study, a significant relationship was observed between BMI and sleep duration among hospitalized patients in coronary care unit (P=0.000), and sleep disorders increased with higher BMI. Short of sleep increases sympathetic tonus, cortisol level, and activation of inflammatory pathways, impairing glucose

Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis).

Science.gov (United States)

Budoff, Matthew J; Nasir, Khurram; McClelland, Robyn L; Detrano, Robert; Wong, Nathan; Blumenthal, Roger S; Kondos, George; Kronmal, Richard A

2009-01-27

In this study, we aimed to establish whether age-sex-specific percentiles of coronary artery calcium (CAC) predict cardiovascular outcomes better than the actual (absolute) CAC score. The presence and extent of CAC correlates with the overall magnitude of coronary atherosclerotic plaque burden and with the development of subsequent coronary events. MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 asymptomatic participants followed for coronary heart disease (CHD) events including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death. Time to incident CHD was modeled with Cox regression, and we compared models with percentiles based on age, sex, and/or race/ethnicity to categories commonly used (0, 1 to 100, 101 to 400, 400+ Agatston units). There were 163 (2.4%) incident CHD events (median follow-up 3.75 years). Expressing CAC in terms of age- and sex-specific percentiles had significantly lower area under the receiver-operating characteristic curve (AUC) than when using absolute scores (women: AUC 0.73 versus 0.76, p = 0.044; men: AUC 0.73 versus 0.77, p better model fit with the overall score. Both methods robustly predicted events (>90th percentile associated with a hazard ratio [HR] of 16.4, 95% confidence interval [CI]: 9.30 to 28.9, and score >400 associated with HR of 20.6, 95% CI: 11.8 to 36.0). Within groups based on age-, sex-, and race/ethnicity-specific percentiles there remains a clear trend of increasing risk across levels of the absolute CAC groups. In contrast, once absolute CAC category is fixed, there is no increasing trend across levels of age-, sex-, and race/ethnicity-specific categories. Patients with low absolute scores are low-risk, regardless of age-, sex-, and race/ethnicity-specific percentile rank. Persons with an absolute CAC score of >400 are high risk, regardless of percentile rank. Using absolute CAC in standard groups performed better than age-, sex-, and race

Coronary artery calcification detected by a mobile helical CT unit in a mass screening. The frequency and relationship to coronary risk factors and coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Itani, Yasutaka; Watanabe, Shigeru; Masuda, Yoshiaki [Chiba Univ. (Japan). School of Medicine; Hanamura, Kazuhisa; Asakura, Kazuhiro; Sone, Shusuke; Sunami, Yuko; Shimura, Akimitsu; Miyamoto, Tadaaki

2001-06-01

A strong relationship is known to exist between coronary artery disease (CAD) and coronary artery calcification (CAC) detected by CT. In this study, we investigated the frequency of CAC and the relationship between coronary risk factors, CAD and CAC in a mass screening using a mobile helical CT unit. The total number of participants was 10008 people undergoing a medical examination for lung cancer and tuberculosis using a mobile helical CT unit. We measured the CT density of the coronary artery to detect CAC. The CT density threshold for determining CAC was above +110HU. The frequency of CAC was 16.0% in the overall patient population and significantly higher in males than in females (20.6% vs 10.7%). Frequency increased with age in both genders. Hypertension and diabetes mellitus were significantly related to CAC. Smoking showed a correlation with CAC only in males. A significant relationship was observed between CAD and CAC in males. In particular, the relationship between them was strongest in males under 60 years of age. Furthermore, the odds ratio of CAC in predicting CAD increased with increasing risk factors in both genders. (author)

Zero Calcium Score as a Filter for Further Testing in Patients Admitted to the Coronary Care Unit with Chest Pain.

Science.gov (United States)

Correia, Luis Cláudio Lemos; Esteves, Fábio P; Carvalhal, Manuela; Souza, Thiago Menezes Barbosa de; Sá, Nicole de; Correia, Vitor Calixto de Almeida; Alexandre, Felipe Kalil Beirão; Lopes, Fernanda; Ferreira, Felipe; Noya-Rabelo, Márcia

2017-06-12

The accuracy of zero coronary calcium score as a filter in patients with chest pain has been demonstrated at the emergency room and outpatient clinics, populations with low prevalence of coronary artery disease (CAD). To test the gatekeeping role of zero calcium score in patients with chest pain admitted to the coronary care unit (CCU), where the pretest probability of CAD is higher than that of other populations. Patients underwent computed tomography for calcium scoring, and obstructive CAD was defined by a minimum 70% stenosis on invasive angiography. In 146 patients studied, the prevalence of CAD was 41%. A zero calcium score was present in 35% of the patients. The sensitivity and specificity of zero calcium score yielded a negative likelihood ratio of 0.16. After logistic regression adjustment for pretest probability, zero calcium score was independently associated with lower odds of CAD (OR = 0.12, 95%CI = 0.04-0.36), increasing the area under the ROC curve of the clinical model from 0.76 to 0.82 (p = 0.006). Zero calcium score provided a net reclassification improvement of 0.20 (p = 0.0018) over the clinical model when using a pretest probability threshold of 10% for discharging without further testing. In patients with pretest probability zero calcium score had a negative predictive value of 95% (95%CI = 83%-99%), with a number needed to test of 2.1 for obtaining one additional discharge. Zero calcium score substantially reduces the pretest probability of obstructive CAD in patients admitted to the CCU with acute chest pain. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0). A acurácia do escore de cálcio coronário zero como um filtro nos pacientes com dor torácica aguda tem sido demonstrada na sala de emergência e nos ambulatórios, populações com baixa prevalência de doença arterial coronariana (DAC). Testar o papel do escore de cálcio zero como filtro nos pacientes com dor torácica admitidos numa unidade coronariana intensiva (UCI), na

Association of coronary heart disease with age-adjusted aortocoronary calcification in patients with familial hypercholesterolaemia

DEFF Research Database (Denmark)

Jensen, J M; Gerdes, Lars Ulrik; Jensen, H K

2000-01-01

OBJECTIVES: Existing algorithms of risk of coronary heart disease (CHD) do not pertain to patients with familial hypercholesterolaemia (FH), whose arteries have been exposed to hypercholesterolaemia since birth. We studied a cohort of FH patients to compare four diagnostic models of CHD: traditio......OBJECTIVES: Existing algorithms of risk of coronary heart disease (CHD) do not pertain to patients with familial hypercholesterolaemia (FH), whose arteries have been exposed to hypercholesterolaemia since birth. We studied a cohort of FH patients to compare four diagnostic models of CHD......: traditional risk factors of CHD (age, sex, cholesterol, hypertension, smoking and body mass index), cholesterol year score, and aortic as well as coronary calcium measured by spiral computed tomography (CT). SUBJECTS: We invited 88 individuals with molecularly defined FH of whom 80 (91%) decided...

[Childhood body mass index and the risk of coronary heart disease in adulthood

DEFF Research Database (Denmark)

Baker, Jennifer Lyn; Olsen, L.W.; Sørensen, Thorkild I.A.

2008-01-01

The severity of the long term consequences of the current childhood obesity epidemic on coronary heart disease is unknown. Therefore we investigated the association between body mass index (BMI) at ages 7-13 years and heart disease in adulthood among 276,835 Danish schoolchildren. We found...... that higher BMI during this period of childhood is associated with an increased risk of any, non-fatal and fatal heart disease in adulthood. Worldwide, as children are becoming heavier, our findings suggest that greater numbers of children are at risk of having coronary heart disease in adulthood...

Myocardial perfusion imaging and coronary calcium scoring with a two-slice SPECT/CT system: can the attenuation map be calculated from the calcium scoring CT scan?

Energy Technology Data Exchange (ETDEWEB)

Wenning, Christian; Rahbar, Kambiz; Schober, Otmar; Stegger, Lars [University of Muenster, Department of Nuclear Medicine, Muenster (Germany); Vrachimis, Alexis; Schaefers, Michael [University of Muenster, Department of Nuclear Medicine, Muenster (Germany); University of Muenster, European Institute for Molecular Imaging, Muenster (Germany)

2013-07-15

Coronary artery calcium scoring can complement myocardial perfusion imaging (MPI). The purpose of this study was to evaluate the feasibility and accuracy of using the CalciumScore-CT derived from a combined SPECT/CT device also for SPECT attenuation correction (AC). The study group comprised 99 patients who underwent both post-stress and rest MPI using a two-slice SPECT/CT system. For AC, one of the two scans was accompanied by a CalciumScore-CT scan (CalciumScore-CTAC) and the other by a conventional spiral CT (AttenCorr-CT) scan (AttenCorr-CTAC). In 48 patients the CalciumScore-CT scan was acquired with the post-stress scan and the AttenCorr-CT scan with the rest scan, and in 51 patients the order was reversed. The accuracy of the images based on AC was determined qualitatively by consensus reading with respect to the clinical diagnoses as well as quantitatively by comparing the perfusion summed stress scores (SSS) and the summed rest scores (SRS) between attenuation-corrected and uncorrected images. In comparison to the uncorrected images CalciumScore-CTAC led to regional inaccuracies in 14 of 51 of studies (27.5 %) versus 12 of 48 studies (25 %) with AttenCorr-CTAC for the stress studies and in 5 of 48 (10 %) versus 1 of 51 (2 %) for the rest studies, respectively. This led to intermediate and definite changes in the final diagnosis (ischaemia and/or scarring) in 12 % of the studies (12 of 99) and in 7 % of the studies (7 of 99) with CalciumScore-CTAC and in 9 % of the studies (9 of 99) and 4 % of the studies (4 of 99) with AttenCorr-CTAC. Differences in SSS and SRS with respect to the uncorrected images were greater for the CalciumScore-CTAC images than for the AttenCorr-CTAC images ({Delta}SSS 4.5 {+-} 5.6 and 2.1 {+-} 4.4, p = 0.023; {Delta}SRS 4.2 {+-} 4.9 and 1.6 {+-} 3.2, p = 0.004, respectively). Using the same CT scan for calcium scoring and SPECT AC is feasible. Image interpretation must, however, include uncorrected images since CT-based AC relatively

Dietary calcium intake and higher body mass index in Mexican adults aged 20 to 59 years old: cross-sectional study

Directory of Open Access Journals (Sweden)

Mario Efraín Flores-Aldana

2013-02-01

Full Text Available Background. Although energy balance is the main factor that regulates body weight, recent studies suggest that calcium metabolism can modify the energy balance and help regulate body weight. Objective. To evaluate the association between the calcium intake in the diet and high body mass index in Mexican adults in the 20-59 age group. Material and methods. A cross-sectional secondary analytical study was conducted based on the 2006 Mexican National Health and Nutritional Survey (ENSANUT 2006. Food intake questionnaires applied to 16,494 adults were analyzed. After removing biologically implausible values or incomplete information, we arrived at a final sample of 15,662 adults grouped according to their body mass index. Linear regression was used to assess association between daily dietary calcium intake and body mass index. Results. There was an inverse association between dietary calcium consumption and a high body mass index. The mean calcium intake in subjects with normal body mass index was 903.9 mg/day versus 832.0 mg/day in obese subjects (p < 0.0001. Conclusion. The study corroborates existing evidence of an inverse association between the dietary calcium intake and a high body mass index.

Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Raman, Vivek; McWilliams, Eric T.M.; Holmberg, Stephen R.M.; Miles, Ken

2012-01-01

To conduct an economic analysis (EA) of coronary calcium scoring (CCS) using a 0 score, as alternative to stress electrocardiography (sECG) in diagnosing coronary artery disease (CAD). A decision tree was constructed to compare four strategies for investigation of suspected CAD previously assessed in the formulation of clinical guidelines for the United Kingdom (UK) to two new strategies incorporating CCS. Sensitivity (96%; 95% CI 95.4-96.4%) and specificity (40%; 95% CI 38.7-41.4%) values for CCS were derived from a meta-analysis of 10,760 patients. Other input variables were obtained from a previous EA and average prices for hospital procedures in the UK. A threshold of pound 30,000/Quality-adjusted Life Year (QALY) was considered cost-effective. Using net monetary benefit calculations, CCS-based strategies were found to be cost-effective compared to sECG equivalents at all assessed prevalence of CAD. Using CCS prior to myocardial perfusion scintigraphy (MPS) and catheter angiography (CA) was found to be cost-effective at pre-test probabilities (PTP) below 30%. Adoption of CCS as an alternative to sECG in investigating suspected stable angina in low PTP population ( 30%, proceeding to MPS or CA would be more cost-effective than performing either CCS or sECG. (orig.)

Optimization of the scan protocol in the measurements of coronary artery calcium

Energy Technology Data Exchange (ETDEWEB)

Oliveira, L.C.G.; Lopes, R.T. [Coordenacao do Programa de Pos-graduacao em Engenharia (LIN/COPPE/UFRJ), RJ (Brazil). Lab. de Instrumentacao Nuclear; Gottlieb, I.; Carvalho, F.M. de [Clinica de Diagnostico por Imagem, Rio de Janeiro, RJ (Brazil); Kodlulovich, S., E-mail: simone@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Mecca, F.A. [Instituto Nacional do Cancer (INCA), Rio de Janeiro, RJ (Brazil)

2011-07-01

The aim of this study was to evaluate the influence of the tube current applied for studies of calcium score. The research was carried out in a private clinic of Rio de Janeiro, using a 64-slice MDCT scanner and an anthropomorphic cardiac CT phantom. In all images, the Agatston score, the volume and mass of the calcifications, and the noise for each current tube was determined. The average CT attenuation number obtained for all tube currents was 261.6 {+-} 3.2 HU for the CaHA density insert and -0.2 HU {+-} 2.0 for the water insert. The images obtained at lower tube currents were noisier and grainier than those obtained at higher tube currents. However no significant differences were found in the calcium measurements, which suggest a high potential of patient dose reduction, around 50%, without compromising diagnostic information. (author)

Less increase of CT-based calcium scores of the coronary arteries. Effect three years after breast-conserving radiotherapy using breath-hold

Energy Technology Data Exchange (ETDEWEB)

Mast, M.E.; Kempen-Harteveld, M.L. van; Petoukhova, A.L. [Centre West, Radiotherapy, The Hague (Netherlands); Heijenbrok, M.W. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Scholten, A.N. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands); Wolterbeek, R. [Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics, Leiden (Netherlands); Schreur, J.H.M. [Medical Center Haaglanden, Department of Cardiology, The Hague (Netherlands); Struikmans, H. [Centre West, Radiotherapy, The Hague (Netherlands); Leiden University Medical Centre, Department of Clinical Oncology, Leiden (Netherlands)

2016-10-15

The aim of this prospective longitudinal study was to compare coronary artery calcium (CAC) scores determined before the start of whole breast irradiation with those determined 3 years afterwards. Changes in CAC scores were analysed in 99 breast cancer patients. Three groups were compared: patients receiving left- and right-sided radiotherapy, and those receiving left-sided radiotherapy with breath-hold. We analysed overall CAC scores and left anterior descending (LAD) and right coronary artery (RCA) CAC scores. Between the three groups, changes of the value of the LAD minus the RCA CAC scores of each individual patient were also compared. Three years after breath-hold-based whole breast irradiation, a less pronounced increase of CAC scores was noted. Furthermore, LAD minus RCA scores in patients treated for left-sided breast cancer without breath-hold were higher when compared to LAD minus RCA scores of patients with right-sided breast cancers and those with left-sided breast cancer treated with breath-hold. Breath-hold in breast-conserving radiotherapy leads to a less pronounced increase of CT-based CAC scores. Therefore, breath-hold probably prevents the development of radiation-induced coronary artery disease. However, the sample size of this study is limited and the follow-up period relatively short. (orig.) [German] Das Ziel dieser prospektiven Langzeitstudie war der Vergleich der Coronary-Artery-Calcium-(CAC-)Werte vor Beginn der Brustbestrahlung mit den Werten nach 3 Jahren. Aenderungen der CAC-Werte wurden bei 99 Brustkrebspatienten analysiert. Drei Gruppen wurden untersucht: Patienten nach links- und rechtsseitiger Strahlentherapie sowie mit Bestrahlung unter Atemanhalt. Wir analysierten die Gesamt-CAC-Werte sowie die CAC-Werte der vorderen linken absteigenden (''left anterior descending'', LAD) und der rechten Koronararterie (''right coronary artery'', RCA). Zwischen den drei Gruppen wurden auch die Veraenderungen

Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.

Science.gov (United States)

Goldberg, Ronald B; Aroda, Vanita R; Bluemke, David A; Barrett-Connor, Elizabeth; Budoff, Matthew; Crandall, Jill P; Dabelea, Dana; Horton, Edward S; Mather, Kieren J; Orchard, Trevor J; Schade, David; Watson, Karol; Temprosa, Marinella

2017-07-04

Despite the reduced incidence of coronary heart disease with intensive risk factor management, people with diabetes mellitus and prediabetes remain at increased coronary heart disease risk. Diabetes prevention interventions may be needed to reduce coronary heart disease risk. This approach was examined in the DPP (Diabetes Prevention Program) and the DPPOS (Diabetes Prevention Program Outcome Study), a long-term intervention study in 3234 subjects with prediabetes (mean±SD age, 64±10 years) that showed reduced diabetes risk with lifestyle and metformin compared with placebo over 3.2 years. The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants with coronary artery calcium (CAC) measurements after an average of 14 years of follow-up. The CAC scores were analyzed continuously as CAC severity and categorically as CAC presence (CAC score >0) and reported separately in men and women. There were no CAC differences between lifestyle and placebo intervention groups in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity, 39.5 versus 66.9 Agatston units, P =0.04; CAC presence, 75% versus 84%, P =0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric, or metabolic factors; by the development of diabetes mellitus; or by use/nonuse of statin therapy. Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes mellitus among men. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00038727. © 2017 American Heart Association, Inc.

Relation of Dietary Glycemic Index and Glycemic Load to Coronary Artery Calcium in Asymptomatic Korean Adults.

Science.gov (United States)

Choi, Yuni; Chang, Yoosoo; Ryu, Seungho; Cho, Juhee; Kim, Mi Kyung; Ahn, Younjhin; Lee, Jung Eun; Sung, Eunju; Kim, Boyoung; Ahn, Jiin; Kim, Chan-Won; Rampal, Sanjay; Zhao, Di; Zhang, Yiyi; Pastor-Barriuso, Roberto; Lima, Joao A C; Chung, Eun Chul; Shin, Hocheol; Guallar, Eliseo

2015-08-15

The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association. Copyright © 2015 Elsevier Inc. All rights reserved.

Acute coronary hemodynamic effects of equihypotensive doses of nisoldipine and diltiazem

NARCIS (Netherlands)

H. Suryapranata (Harry); P.W.J.C. Serruys (Patrick); A.L. Soward; J. Planellas; G. Vanhaleweyk; P.G. Hugenholtz (Paul)

1985-01-01

textabstractThe hemodynamic effects of nisoldipine and diltiazem were investigated in two groups of patients undergoing investigation for suspected coronary artery disease. Emphasis was placed on the coronary hemodynamic changes. Approximately equihypotensive doses of these two calcium channel

Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Raman, Vivek [Brighton and Sussex University Hospitals, Brighton (United Kingdom); Royal Sussex County Hospital, Brighton (United Kingdom); McWilliams, Eric T.M. [Conquest Hospital, Hastings (United Kingdom); Holmberg, Stephen R.M.; Miles, Ken [Brighton and Sussex University Hospitals, Brighton (United Kingdom)

2012-03-15

To conduct an economic analysis (EA) of coronary calcium scoring (CCS) using a 0 score, as alternative to stress electrocardiography (sECG) in diagnosing coronary artery disease (CAD). A decision tree was constructed to compare four strategies for investigation of suspected CAD previously assessed in the formulation of clinical guidelines for the United Kingdom (UK) to two new strategies incorporating CCS. Sensitivity (96%; 95% CI 95.4-96.4%) and specificity (40%; 95% CI 38.7-41.4%) values for CCS were derived from a meta-analysis of 10,760 patients. Other input variables were obtained from a previous EA and average prices for hospital procedures in the UK. A threshold of pound 30,000/Quality-adjusted Life Year (QALY) was considered cost-effective. Using net monetary benefit calculations, CCS-based strategies were found to be cost-effective compared to sECG equivalents at all assessed prevalence of CAD. Using CCS prior to myocardial perfusion scintigraphy (MPS) and catheter angiography (CA) was found to be cost-effective at pre-test probabilities (PTP) below 30%. Adoption of CCS as an alternative to sECG in investigating suspected stable angina in low PTP population (<30%) would be cost-effective. In patients with PTP of CAD >30%, proceeding to MPS or CA would be more cost-effective than performing either CCS or sECG. (orig.)

Right coronary wall cmr in the older asymptomatic advance cohort: positive remodeling and associations with type 2 diabetes and coronary calcium

Directory of Open Access Journals (Sweden)

Courtney Brian K

2010-12-01

Full Text Available Abstract Background Coronary wall cardiovascular magnetic resonance (CMR is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort. Results Cross-sectional images of the proximal right coronary artery (RCA were acquired using spiral black-blood coronary CMR (0.7 mm resolution in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female. Coronary measurements (total vessel area, lumen area, wall area, and wall thickness had small intra- and inter-observer variabilities (r = 0.93~0.99, all p Conclusions Right coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.

[Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

Science.gov (United States)

Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

2009-09-01

To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

Magnetic resonance imaging of athlete's heart: myocardial mass, left ventricular function, and cross-sectional area of the coronary arteries

International Nuclear Information System (INIS)

Zandrino, F.; Sardanelli, F.; Molinari, G.; Masperone, M.A.; Smeraldi, A.; Odaglia, G.

2000-01-01

To evaluate left ventricular myocardial mass and function as well as ostial coronary artery cross-sectional area in endurance athletes, an athlete group of 12 highly trained rowers and a control group of 12 sedentary healthy subjects underwent MR examination. An ECG-gated breath-hold cine gradient-echo sequence was used to calculate myocardial mass, end-diastolic and end-systolic volumes, stroke volume, and cardiac output, all related to body surface area, as well as ejection fraction. A 3D fat-saturated ECG- and respiratory-triggered navigator echo sequence was used to evaluate coronary arteries: left main (LM), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA). Cross-sectional area was calculated and divided for body surface area. Myocardial mass was found significantly larger in athlete group than in control group (p = 0.0078), the same being for end-diastolic volume (p = 0.0078), stroke volume (p = 0.0055), LM (p = 0.0066) and LAD (p = 0.0129). No significant difference was found for all the remaining parameters. Significant correlation with myocardial mass was found for LM (p < 0.001) and LAD (p = 0.0340), not for LCx and RCA. Magnetic resonance imaging is a useful tool in evaluating the myocardial hypertrophy and function of athlete's heart. Magnetic resonance angiography is a valuable noninvasive method to visualize the correlated cross-sectional area increase of the left coronary artery system. (orig.)

Comparison of tomographic coronary artery calcification index (calcium score) and ultrasonographic measurement of intima-media complex thickness in diabetic subjects

International Nuclear Information System (INIS)

Wolski, Cyprian; Rotkiewicz, Arkadiusz; Grzelak, Piotr; Elgalal, Marcin; Stefańczyk, Ludomir

2011-01-01

At present, there is a number of diagnostic imaging procedures allowing for the evaluation of atherosclerosis. The earliest, subclinical stage of atherosclerosis can be visualized with the development of computed tomography (CT) and ultrasound (US) techniques. Therefore, the purpose of this study was to assess the degree of coronary artery calcification and carotid intima-media thickness in diabetic subjects divided into different age groups. Fifty-six men, aged from 18 to 72 were included in the study. Participants were divided into 4 groups according to age (18–30, 31–45, 46–60 and more than 60 years). Two tests were performed: coronary calcium score (CS) determination and intima-media thickness (IMT) in ultrasound. CS was performed using a multi-slice scanner. Images were analyzed using the Agatson method. Ultrasound examinations were performed using a 9–12-MHz linear transducer. The correlation coefficient between calcium score index (CSI) and age of patients was 0.52 (p<0.001). The correlation between duration of diabetes and CSI was significantly lower (r=0.3; p<0.05). The increase of IMT is associated with age to a much greater extent and the correlation coefficient was 0.63 (p<0.001). IMT depended on the duration of diabetes, but the correlation was also weak (r=0.35; p<0.01). Comparison of the findings obtained in the presented study and in the group of healthy subjects proves that influence of diabetes on vascular deterioration may be observed, even among young individuals. Obtained results allow to make the following conclusions: 1. Calcium score index remains low in the group of male patients with diabetes before the age of 45. 2. Intima-media thickness correlates well with age (r=0.6; p<0.05) and weaker with the duration of diabetes (r=0.35; p<0.05). 3. IMT assessment may be a useful tool to identify the increased predisposition to atherosclerosis, also before the age of 30

Genotype-driven identification of a molecular network predictive of advanced coronary calcium in ClinSeq® and Framingham Heart Study cohorts.

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Oguz, Cihan; Sen, Shurjo K; Davis, Adam R; Fu, Yi-Ping; O'Donnell, Christopher J; Gibbons, Gary H

2017-10-26

One goal of personalized medicine is leveraging the emerging tools of data science to guide medical decision-making. Achieving this using disparate data sources is most daunting for polygenic traits. To this end, we employed random forests (RFs) and neural networks (NNs) for predictive modeling of coronary artery calcium (CAC), which is an intermediate endo-phenotype of coronary artery disease (CAD). Model inputs were derived from advanced cases in the ClinSeq®; discovery cohort (n=16) and the FHS replication cohort (n=36) from 89 th -99 th CAC score percentile range, and age-matched controls (ClinSeq®; n=16, FHS n=36) with no detectable CAC (all subjects were Caucasian males). These inputs included clinical variables and genotypes of 56 single nucleotide polymorphisms (SNPs) ranked highest in terms of their nominal correlation with the advanced CAC state in the discovery cohort. Predictive performance was assessed by computing the areas under receiver operating characteristic curves (ROC-AUC). RF models trained and tested with clinical variables generated ROC-AUC values of 0.69 and 0.61 in the discovery and replication cohorts, respectively. In contrast, in both cohorts, the set of SNPs derived from the discovery cohort were highly predictive (ROC-AUC ≥0.85) with no significant change in predictive performance upon integration of clinical and genotype variables. Using the 21 SNPs that produced optimal predictive performance in both cohorts, we developed NN models trained with ClinSeq®; data and tested with FHS data and obtained high predictive accuracy (ROC-AUC=0.80-0.85) with several topologies. Several CAD and "vascular aging" related biological processes were enriched in the network of genes constructed from the predictive SNPs. We identified a molecular network predictive of advanced coronary calcium using genotype data from ClinSeq®; and FHS cohorts. Our results illustrate that machine learning tools, which utilize complex interactions between disease

Coffee Consumption and Coronary Artery Calcium Score: Cross-Sectional Results of ELSA-Brasil (Brazilian Longitudinal Study of Adult Health).

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Miranda, Andreia M; Steluti, Josiane; Goulart, Alessandra C; Benseñor, Isabela M; Lotufo, Paulo A; Marchioni, Dirce M

2018-03-24

Available evidence for the relationship between coffee intake and subclinical atherosclerosis is limited and inconsistent. This study aimed to evaluate the association between coffee consumption and coronary artery calcium (CAC) in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). This cross-sectional study is based on baseline data from participants of the ELSA-Brasil cohort. Only participants living in São Paulo, Brazil, who underwent a CAC measurement (n=4426) were included. Coffee consumption was collected using a food frequency questionnaire. CAC was detected with computed tomography and expressed as Agatston units. CAC was further categorized as an Agatson score ≥100 (CAC ≥100). In multiple logistic regression analysis considering intake of coffee and smoking status interaction, significant inverse associations were observed between coffee consumption (>3 cups/d) and CAC≥100 (odds ratio [OR]: 0.85 [95% confidence interval, 0.58-1.24] for ≤1 cup/d; OR: 0.73 [95% confidence interval, 0.51-1.05] for 1-3 cups/d; OR: 0.33 [95% confidence interval, 0.17-0.65] for >3 cups/d). Moreover, there was a statistically significant interaction effect for coffee consumption and smoking status ( P =0.028 for interaction). After stratification by smoking status, the analysis revealed a lower OR of coronary calcification in never smokers drinking >3 cups/d (OR: 0.37 [95% confidence interval, 0.15-0.91]), whereas among current and former smokers, the intake of coffee was not significantly associated with coronary calcification. Habitual consumption of >3 cups/d of coffee decreased odds of subclinical atherosclerosis among never smokers. The consumption of coffee could exert a potential beneficial effect against coronary calcification, particularly in nonsmokers. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Initial use of fast switched dual energy CT for coronary artery disease

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Pavlicek, William; Panse, Prasad; Hara, Amy; Boltz, Thomas; Paden, Robert; Yamak, Didem; Licato, Paul; Chandra, Naveen; Okerlund, Darin; Dutta, Sandeep; Bhotika, Rahul; Langan, David

2010-04-01

Coronary CT Angiography (CTA) is limited in patients with calcified plaque and stents. CTA is unable to confidently differentiate fibrous from lipid plaque. Fast switched dual energy CTA offers certain advantages. Dual energy CTA removes calcium thereby improving visualization of the lumen and potentially providing a more accurate measure of stenosis. Dual energy CTA directly measures calcium burden (calcium hydroxyapatite) thereby eliminating a separate non-contrast series for Agatston Scoring. Using material basis pairs, the differentiation of fibrous and lipid plaques is also possible. Patency of a previously stented coronary artery is difficult to visualize with CTA due to resolution constraints and localized beam hardening artifacts. Monochromatic 70 keV or Iodine images coupled with Virtual Non-stent images lessen beam hardening artifact and blooming. Virtual removal of stainless steel stents improves assessment of in-stent re-stenosis. A beating heart phantom with 'cholesterol' and 'fibrous' phantom coronary plaques were imaged with dual energy CTA. Statistical classification methods (SVM, kNN, and LDA) distinguished 'cholesterol' from 'fibrous' phantom plaque tissue. Applying this classification method to 16 human soft plaques, a lipid 'burden' may be useful for characterizing risk of coronary disease. We also found that dual energy CTA is more sensitive to iodine contrast than conventional CTA which could improve the differentiation of myocardial infarct and ischemia on delayed acquisitions. These phantom and patient acquisitions show advantages with using fast switched dual energy CTA for coronary imaging and potentially extends the use of CT for addressing problem areas of non-invasive evaluation of coronary artery disease.

Coronary artery calcium before and after hospitalization with pneumonia: The MESA study.

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Corrales-Medina, Vicente F; Dwivedi, Girish; Taljaard, Monica; Petrcich, William; Lima, Joao A; Yende, Sachin; Kronmal, Richard A; Chirinos, Julio A

2018-01-01

Epidemiological analyses demonstrate that pneumonia survivors have a higher risk of myocardial infarction than people with similar load of risk factors for atherosclerotic cardiovascular disease (ASCVD) but without pneumonia. This may be due to a higher baseline burden of ASCVD in patients with pneumonia that is not captured by the accounting of known ASCVD risk factors in epidemiological analyses or to unfavorable accelerating effects of pneumonia on atherosclerosis. We analyzed data from the Multi-Ethnic Study of Atherosclerosis. We identified 54 participants that were hospitalized for pneumonia during study follow-up and that also had assessment of coronary artery calcium (CAC, an objective marker of coronary atherosclerotic burden) before and after this hospitalization. We matched them to 54 participants who were not hospitalized for pneumonia but that had CAC assessments at the same study visits as the pneumonia cases. We compared baseline CAC scores and their progression between groups. Baseline CAC scores were similar in both groups (median [IQR]; 6.3 [0-356.8] in pneumonia participants vs. 10.8 [0-178.3] in controls; p = 0.25). After a median of 4.8 years, the direction and magnitude of CAC score change, and the slope of CAC score progression between groups was also similar (median change [IQR], 21.8 [0 to 287.29] in participants with pneumonia versus 15.8 [0 to 140.94] in controls, p = 0.28; difference in slope, 7.7, 95% CI -9.0 to 24.6, p = 0.18). However, among participants with high baseline ASCVD risk (i.e. ACC/AHA 10-year risk estimate ≥7.5%), participants with pneumonia showed a larger increase in CAC scores (median change [IQR]; 159.10 [38.55-407.34] versus 48.72 [0.97-246.99] in controls; p = 0.02) and a trend towards a steeper slope of CAC score progression (difference in slope, 19.7, 95% CI -6.6 to 45.6, p = 0.07). Pneumonia may accelerate the progression of atherosclerosis in people with high baseline ASCVD risk.

Comparison of calcium scoring with 4-multidetector computed tomography (4-MDCT) and 64-MDCT: a phantom study.

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Serafin, Zbigniew; Rusak, Grazyna; Strześniewski, Piotr; Laskowska, Katarzyna; Lasek, Władysław

2012-01-01

To determine differences in coronary artery calcium (CAC) measurement performed with the use of 2 generations of multidetector computed tomography (CT) scanners of the same manufacturer. Agatston Score (AS) and calcium mass (CM) were measured with a 4-row scanner (AS4 and CM4) and a 64-row scanner (AS64 and CM64) using a cardiac phantom with calcium inserts. The results of the AS measurements (mean ± SD) varied significantly between the equipment: 880.6 ± 30.1 (AS4) vs 586.5 ± 24.0 (AS64; P < 0.0001). The AS interscanner variability was 31.6% for the phantom and from 25.5% to 110.1% for particular inserts. Mean ± SD CM values were different as well: 192.8 ± 5.0 mg (CM4) vs 152.4 ± 2.6 mg (CM64; P < 0.0001). Determination of CM with 64-row CT was more accurate than that with an older scanner; the mean relative error was -9.1% and 15.0%, respectively (P < 0.0001). The CM interscanner variability was 23.3% for the phantom and from 19.0% to 122.8% for particular inserts. The interexamination variability ranged from 1.7% (CM64) to 5.6% (AS4). Coronary artery calcium scoring with the 64-row CT scanner is more accurate than with the 4-row device The difference between the results of AS and CM measurements carried out with both scanners is statistically significant.

The longitudinal effects of physical activity and dietary calcium on bone mass accrual across stages of pubertal development.

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Lappe, Joan M; Watson, Patrice; Gilsanz, Vicente; Hangartner, Thomas; Kalkwarf, Heidi J; Oberfield, Sharon; Shepherd, John; Winer, Karen K; Zemel, Babette

2015-01-01

Childhood and adolescence are critical periods of bone mineral content (BMC) accrual that may have long-term consequences for osteoporosis in adulthood. Adequate dietary calcium intake and weight-bearing physical activity are important for maximizing BMC accrual. However, the relative effects of physical activity and dietary calcium on BMC accrual throughout the continuum of pubertal development in childhood remains unclear. The purpose of this study was to determine the effects of self-reported dietary calcium intake and weight-bearing physical activity on bone mass accrual across the five stages of pubertal development in a large, diverse cohort of US children and adolescents. The Bone Mineral Density in Childhood study was a mixed longitudinal study with 7393 observations on 1743 subjects. Annually, we measured BMC by dual-energy X-ray absorptiometry (DXA), physical activity and calcium intake by questionnaire, and pubertal development (Tanner stage) by examination for up to 7 years. Mixed-effects regression models were used to assess physical activity and calcium intake effects on BMC accrual at each Tanner stage. We found that self-reported weight-bearing physical activity contributed to significantly greater BMC accrual in both sexes and racial subgroups (black and nonblack). In nonblack males, the magnitude of the activity effect on total body BMC accrual varied among Tanner stages after adjustment for calcium intake; the greatest difference between high- and low-activity boys was in Tanner stage 3. Calcium intake had a significant effect on bone accrual only in nonblack girls. This effect was not significantly different among Tanner stages. Our findings do not support differential effects of physical activity or calcium intake on bone mass accrual according to maturational stage. The study demonstrated significant longitudinal effects of weight-bearing physical activity on bone mass accrual through all stages of pubertal development. © 2014 American

Coronary CT: clinical indications and future directions; Tomografia de coronarias: indicacoes clinicas e perspectivas futuras

Energy Technology Data Exchange (ETDEWEB)

Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B., E-mail: cesarnomura@gmail.com [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Cury, Roberto C. [Hospital Samaritano, Sao Paulo, SP (Brazil)

2011-01-15

Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

Assessment of coronary atherosclerosis by cardiac image: complementary amount of the calcium score to myocardial perfusion

Energy Technology Data Exchange (ETDEWEB)

Vitola, Joao Vicente; Cerci, Rodrigo J.; Zapparoli, Marcello, E-mail: joaovitola@quantamn.com.br [Quanta Diagnostico Nuclear, Curitiba, PR (Brazil)

2011-04-15

Over the last decades we have witnessed significant advances on diagnostic tools and management of patients with or suspected cardiovascular disease, and consequently a significant reduction in mortality. Nevertheless, cardiovascular disease remains the leader cause of death in many countries, including Brazil. Identifying the high risk patient is important, so we can intensify prevention strategies. Non invasive diagnostic tools have been developed to identify the high risk patient in need of a myocardial revascularization, notably using myocardial scintigraphy. However, many clinicians still question, what is the best management for a patient with traditional risk factors, who has a positive treadmill test result and a completely normal myocardial scintigraphy? What is the literature showing in relation to the role of coronary calcium score for these patients? In this article we will reflect over these issues which are so frequently encountered in daily cardiology practice. (author)

Relation of coronary vasoreactivity and coronary calcification in asymptomatic subjects with a family history of premature coronary artery disease

International Nuclear Information System (INIS)

Pirich, Christian; Leber, Alexander; Knez, Andreas; Bengel, Frank M.; Nekolla, Stephan G.; Schwaiger, Markus; Haberl, Ralph

2004-01-01

Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0-915). The CCS was 100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g -1 min -1 , 218±54 ml 100 g -1 min -1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age. (orig.)

Association between epicardial fat volume and coronary plaques diagnosed by multislice computed tomography

Directory of Open Access Journals (Sweden)

José A. Morán Quijada

2016-01-01

Full Text Available Introduction: Coronary atherosclerotic disease is a major cause of death in Cuba and elsewhere. The volume of epicardial fat is considered a new cardiovascular risk factor because of its association with coronary atherogenesis.Objective: To determine, by multislice computed tomography, the association between epicardial fat volume and the presence of coronary atherosclerotic plaques.Method: A descriptive study was conducted with a universe of 130 patients with chest pain suggestive of ischemic heart disease, of which 117 were selected by opinion sampling. These patients underwent a calcium score study, a coronary angiography and a measurement of the epicardial fat volume.Results: Male patients predominated (54.7% and those aged 60-69 years (32.5%. A high volume of epicardial fat was found in 51.3% of patients, affecting 52.8% of women; 78.9% of patients with a calcium score between 100 and 399 UH had a high volume of epicardial fat, just as 71.2% of those with plaques and 100% of those with 4 or 5 plaques; 41% of patients had various types of plaque, which were mainly located in the anterior descending artery (88.1%.Conclusions: The measurement of the volume of epicardial fat is a useful tool to estimate the presence of coronary disease. When it was high, it was associated with older age, female gender and the presence of a higher calcium score, more plaques, more injuries and a greater involvement of the anterior descending artery.

Reliability analysis of visual ranking of coronary artery calcification on low-dose CT of the thorax for lung cancer screening: comparison with ECG-gated calcium scoring CT.

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Kim, Yoon Kyung; Sung, Yon Mi; Cho, So Hyun; Park, Young Nam; Choi, Hye-Young

2014-12-01

Coronary artery calcification (CAC) is frequently detected on low-dose CT (LDCT) of the thorax. Concurrent assessment of CAC and lung cancer screening using LDCT is beneficial in terms of cost and radiation dose reduction. The aim of our study was to evaluate the reliability of visual ranking of positive CAC on LDCT compared to Agatston score (AS) on electrocardiogram (ECG)-gated calcium scoring CT. We studied 576 patients who were consecutively registered for health screening and undergoing both LDCT and ECG-gated calcium scoring CT. We excluded subjects with an AS of zero. The final study cohort included 117 patients with CAC (97 men; mean age, 53.4 ± 8.5). AS was used as the gold standard (mean score 166.0; range 0.4-3,719.3). Two board-certified radiologists and two radiology residents participated in an observer performance study. Visual ranking of CAC was performed according to four categories (1-10, 11-100, 101-400, and 401 or higher) for coronary artery disease risk stratification. Weighted kappa statistics were used to measure the degree of reliability on visual ranking of CAC on LDCT. The degree of reliability on visual ranking of CAC on LDCT compared to ECG-gated calcium scoring CT was excellent for board-certified radiologists and good for radiology residents. A high degree of association was observed with 71.6% of visual rankings in the same category as the Agatston category and 98.9% varying by no more than one category. Visual ranking of positive CAC on LDCT is reliable for predicting AS rank categorization.

An evaluation of automatic coronary artery calcium scoring methods with cardiac CT using the orCaScore framework.

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Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; Coatrieux, Jean-Louis; Kelm, B Michael; Kondo, Satoshi; Salgado, Rodrigo A; Shahzad, Rahil; Shu, Huazhong; Snoeren, Miranda; Takx, Richard A P; van Vliet, Lucas J; van Walsum, Theo; Willems, Tineke P; Yang, Guanyu; Zheng, Yefeng; Viergever, Max A; Išgum, Ivana

2016-05-01

The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) events. In clinical practice, CAC is manually identified and automatically quantified in cardiac CT using commercially available software. This is a tedious and time-consuming process in large-scale studies. Therefore, a number of automatic methods that require no interaction and semiautomatic methods that require very limited interaction for the identification of CAC in cardiac CT have been proposed. Thus far, a comparison of their performance has been lacking. The objective of this study was to perform an independent evaluation of (semi)automatic methods for CAC scoring in cardiac CT using a publicly available standardized framework. Cardiac CT exams of 72 patients distributed over four CVD risk categories were provided for (semi)automatic CAC scoring. Each exam consisted of a noncontrast-enhanced calcium scoring CT (CSCT) and a corresponding coronary CT angiography (CCTA) scan. The exams were acquired in four different hospitals using state-of-the-art equipment from four major CT scanner vendors. The data were divided into 32 training exams and 40 test exams. A reference standard for CAC in CSCT was defined by consensus of two experts following a clinical protocol. The framework organizers evaluated the performance of (semi)automatic methods on test CSCT scans, per lesion, artery, and patient. Five (semi)automatic methods were evaluated. Four methods used both CSCT and CCTA to identify CAC, and one method used only CSCT. The evaluated methods correctly detected between 52% and 94% of CAC lesions with positive predictive values between 65% and 96%. Lesions in distal coronary arteries were most commonly missed and aortic calcifications close to the coronary ostia were the most common false positive errors. The majority (between 88% and 98%) of correctly identified CAC lesions were assigned to the correct artery. Linearly weighted Cohen's kappa

Prevalence of noncalcified coronary plaque in patients with calcium score of 0: the silent enemy.

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Koulaouzidis, George; Charisopoulou, Dafni; Jenkins, Paul J; Koulaouzidis, Anastasios; McArthur, Tony

2013-04-01

Noncalcified coronary artery plaques (NCAPs) are susceptible to rupture, resulting in coronary artery thrombosis. Using computer tomography coronary angiography (CTCA), we evaluated the prevalence and degree of stenosis caused by NCAP in patients without coronary artery calcification (CAC). A retrospective analysis of 447 symptomatic patients with 0 CAC score revealed negative CTCA in 400 (89.5%). Noncalcified coronary artery plaques were demonstrated in 47 (10.5%), with 4 presenting stenosis >50%. Patients with positive CTCA, compared to those with normal CTCA, had significantly higher mean age (56.2 years vs 50.6 years, P < .004) and higher pretest coronary artery disease (CAD) probability (26% vs 34%, P < .0001). Noncalcified coronary artery plaque was predominantly developed in the proximal segment of the left anterior descending artery. Noncalcified coronary artery plaque is present in up to 10% of patients with a CAC score of 0. Computer tomography coronary angiography could be of diagnostic value in symptomatic patients with multiple risk factors for CAD, even in the absence of CAC.

Relation of Anxiety and Depressive Symptoms to Coronary Artery Calcium (from the ELSA-Brasil Baseline Data).

Science.gov (United States)

Santos, Itamar S; Bittencourt, Marcio S; Rocco, Priscila T; Pereira, Alexandre C; Barreto, Sandhi M; Brunoni, André R; Goulart, Alessandra C; Blaha, Michael J; Lotufo, Paulo A; Bensenor, Isabela M

2016-07-15

Previous studies of the association between symptoms of anxiety or depression and coronary artery calcium (CAC) have produced heterogeneous results. Our aim was to investigate whether psychopathological symptoms were associated with CAC in a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. We analyzed data from 4,279 ELSA-Brasil subjects (aged 35 to 74 years) from the São Paulo site without previous cardiovascular disease who underwent CAC score assessment at baseline. Prevalent CAC was defined as a CAC score >0. Anxiety and depressive symptoms were assessed using the Clinical Interview Schedule-Revised (CIS-R). We built binary logistic regression models to determine whether CIS-R scores, anxiety, or depression were associated with prevalent CAC. Prevalent CAC was found in 1,211 subjects (28.3%). After adjustment for age and gender, a direct association between CIS-R scores and prevalent CAC was revealed (odds ratio for 1-SD increase: 1.12; 95% confidence interval [CI] 1.04 to 1.22). This association persisted after multivariate adjustment (odds ratio for 1-SD increase 1.11; 95% CI 1.02 to 1.20). No independent associations were found for specific diagnoses of anxiety or depression and prevalent CAC. In post hoc models, a significant interaction term (p = 0.019) suggested a stronger association in older subjects. In conclusion, psychopathological symptoms were directly associated with coronary atherosclerosis in the ELSA-Brasil baseline in adjusted models, and this association seems to be stronger in older subjects. Copyright © 2016 Elsevier Inc. All rights reserved.

The Severity of Fatty Liver Disease Relating to Metabolic Abnormalities Independently Predicts Coronary Calcification

International Nuclear Information System (INIS)

Lee, Ying-Hsiang; Wu, Yih-Jer; Liu, Chuan-Chuan; Hou, Charles Jia-Yin; Yeh, Hung-I.; Tsai, Cheng-Ho; Shih, Shou-Chuan; Hung, Chung-Lieh

2011-01-01

Background. Nonalcoholic fatty liver disease (NAFLD) is one of the metabolic disorders presented in liver. The relationship between severity of NAFLD and coronary atherosclerotic burden remains largely unknown. Methods and Materials. We analyzed subjects undergoing coronary calcium score evaluation by computed tomography (MDCT) and fatty liver assessment using abdominal ultrasonography. Framingham risk score (FRS) and metabolic risk score (MRS) were obtained in all subjects. A graded, semiquantitative score was established to quantify the severity of NAFLD. Multivariate logistic regression analysis was used to depict the association between NAFLD and calcium score. Results. Of all, 342 participants (female: 22.5%, mean age: 48.7 ± 7.0 years) met the sufficient information rendering detailed analysis. The severity of NAFLD was positively associated with MRS (X 2 = 6.12, trend P < 0.001) and FRS (X 2 = 5.88, trend P < 0.001). After multivariable adjustment for clinical variables and life styles, the existence of moderate to severe NAFLD was independently associated with abnormal calcium score (P < 0.05). Conclusion. The severity of NAFLD correlated well with metabolic abnormality and was independently predict coronary calcification beyond clinical factors. Our data suggests that NAFLD based on ultrasonogram could positively reflect the burden of coronary calcification

Gender differences in coronary plaque composition by coronary computed tomography angiography.

Science.gov (United States)

Blaha, Michael J; Nasir, Khurram; Rivera, Juan J; Choi, Eue-Keun; Chang, Sung-A; Yoon, Yeonyee E; Chun, Eun Ju; Choi, Sang-il; Agatston, Arthur; Blumenthal, Roger S; Chang, Hyuk-Jae

2009-12-01

Coronary computed tomography angiography allows the differentiation of non-calcified (NCAP), calcified (CAP), and mixed coronary artery plaques (MCAP). Although males are thought to have a higher prevalence of atherosclerosis for a given age, there are currently few data regarding age-adjusted sex differences in plaque morphology and composition. We studied 1015 consecutive asymptomatic South Korean patients (49+/-10 years, 64% men) who underwent 64-slice coronary computed tomography angiography during a routine health evaluation. Coronary plaque characteristics were analyzed on a per-segment basis according to the modified AHA classification. Plaques with more than 50% calcified tissue were classified as CAP, plaques with less than 50% calcified tissue were classified as MCAP, and plaques without calcium were classified as NCAP. Multiple regression analysis was used to describe the cross-sectional association between sex and plaque-type burden (>or=2 affected segments) after adjustment for age and other cardiovascular risk factors. There was a greater prevalence of coronary plaque among men (13 vs. 4%, PNCAP was similar across sex (2 vs. 1%, P = 0.28). After multivariable adjustment, men have six to seven times greater odds of having an increased burden of CAP and MCAP, whereas no sex difference was observed in the burden of NCAP. In this population of asymptomatic middle-aged Korean individuals, males had a significantly greater burden of MCAP and CAP. Future studies will determine whether these differences contribute to the accelerated cardiovascular risk observed in men.

Associations between Tobacco, Alcohol, and Drug Use with Coronary Artery Plaque among HIV-Infected and Uninfected Men in the Multicenter AIDS Cohort Study.

Directory of Open Access Journals (Sweden)

Sean G Kelly

Full Text Available We characterized associations between smoking, alcohol, and recreational drug use and coronary plaque by HIV serostatus within the Multicenter AIDS Cohort Study (MACS.MACS participants (N = 1005, 621 HIV+ and 384 HIV- underwent non-contrast CT scanning to measure coronary artery calcium; 764 underwent coronary CT angiograms to evaluate plaque type and extent. Self-reported use of alcohol, tobacco, smoked/inhaled cocaine, methamphetamine, ecstasy, marijuana, inhaled nitrites, and erectile dysfunction drugs was obtained at semi-annual visits beginning 10 years prior to CT scanning. Multivariable logistic and linear regression models were performed, stratified by HIV serostatus.Among HIV+ men, current smoking, former smoking, and cumulative pack years of smoking were positively associated with multiple coronary plaque measures (coronary artery calcium presence and extent, total plaque presence and extent, calcified plaque presence, and stenosis >50%. Smoking was significantly associated with fewer plaque measures of comparable effect size among HIV- men; current smoking and calcified plaque extent was the only such association. Heavy alcohol use (>14 drinks/week was associated with stenosis >50% among HIV+ men. Among HIV- men, low/moderate (1-14 drinks/week and heavy alcohol use were inversely associated with coronary artery calcium and calcified plaque extent. Few significant associations between other recreational drug use and plaque measures were observed.Smoking is strongly associated with coronary plaque among HIV+ men, underscoring the value of smoking cessation for HIV+ persons. Alcohol use may protect against coronary artery calcium and calcified plaque progression in HIV- (but not HIV+ men. Few positive associations were observed between recreational drug use and coronary plaque measures.

Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography.

Science.gov (United States)

Kang, WonYang; Park, Won-Ju; Jang, Keun-Ho; Kim, Soo-Hyeon; Gwon, Do-Hyeong; Lim, Hyeong-Min; Ahn, Ji-Sung; Moon, Jai-Dong

2016-08-01

The aim of this study was to investigate whether shift work is related to elevated risk of coronary artery disease (CAD) by determining the coronary artery calcium (CAC) score and the presence of coronary artery stenosis by using coronary artery CT angiography (CCTA). In this study, 110 male workers participated and underwent a CCTA examination for CAC scoring, which represents coronary artery plaque, and were evaluated for luminal stenosis. All of the participants were working in the same chemical plant, of whom 70 worked day shifts and 40 worked rotating shifts. In a multivariate logistic regression analysis, including age, smoking status, alcohol consumption, regular exercise and waist circumference, shift work was associated with a 2.89-fold increase in the odds of developing coronary plaque compared with day work (OR, 2.89; 95% CI 1.07 to 7.82). The association between shift work and coronary plaque was strong after adjustment for age, low-density lipoprotein cholesterol, hypertension and diabetes mellitus (OR, 2.92; 95% CI 1.02 to 8.33). In addition, the number of years of shift work employment was associated with coronary plaque. However, no association was found between shift work and coronary artery stenosis. Shift work could induce CAD onset via the atherosclerotic process, and shift work employment duration was associated with an increased risk of atherosclerosis in male workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Effects of Dietary Calcium and/or Iron Deficiency upon Murine Intestinal Calcium Binding Protein Activity and Calcium Absorption

OpenAIRE

McDonald, Catherine M.

1980-01-01

Iron deficiency has been shown to impair calcium absorption, leading to decreased bone mass. Vitamin D3-dependent calcium binding protein (CaBP) has been demonstrated to be necessary for the active transport of calcium in the intestine of numerous species. Iron deficiency might affect the activity of the calcium binding protein. Four experimental diets were formulated as follows: Diet 1, iron adequate, calcium adequate; Diet 2, iron deficient, calcium adequate; Diet 3, iron adequate, calci...

Assessment of coronary calcification using calibrated mass score with two different multidetector computed tomography scanners in the Copenhagen General Population Study

DEFF Research Database (Denmark)

Fuchs, Andreas; Groen, Jaap M; Arnold, Ben A

2017-01-01

MS of the phantom was 32.9±0.8mg and 33.1±0.9mg (p=0.43) assessed by scanner A and B respectively - the physical calcium mass was 34.0mg. Correlation between measured MS and physical calcium mass was R2=0.99 in both scanners. In the population study the median total MS was 16.8mg (interquartile range...

Effect of simvastatin on vascular tone in porcine coronary artery: Potential role of the mitochondria

International Nuclear Information System (INIS)

Almukhtar, H.; Garle, M.J.; Smith, P.A.; Roberts, R.E.

2016-01-01

Statins induce acute vasorelaxation which may contribute to the overall benefits of statins in the treatment of cardiovascular disease. The mechanism underlying this relaxation is unknown. As statins have been shown to alter mitochondrial function, in this study we investigated the role of mitochondria in the relaxation to simvastatin. Relaxation of porcine coronary artery segments by statins was measured using isolated tissue baths. Mitochondrial activity was determined by measuring changes in rhodamine 123 fluorescence. Changes in intracellular calcium levels were determined in freshly isolated smooth muscle cells with Fluo-4 using standard epifluorescent imaging techniques. Simvastatin, but not pravastatin, produced a slow relaxation of the coronary artery, which was independent of the endothelium. The relaxation was attenuated by the mitochondrial complex I inhibitor rotenone (10 μM) and the complex III inhibitor myxothiazol (10 μM), or a combination of the two. The complex III inhibitor antimycin A (10 μM) produced a similar time-dependent relaxation of the porcine coronary artery, which was attenuated by rotenone. Changes in rhodamine 123 fluorescence showed that simvastatin (10 μM) depolarized the membrane potential of mitochondria in both isolated mitochondria and intact blood vessels. Simvastatin and antimycin A both inhibited calcium-induced contractions in isolated blood vessels and calcium influx in smooth muscle cells and this inhibition was prevented by rotenone. In conclusion, simvastatin produces an endothelium-independent relaxation of the porcine coronary artery which is dependent, in part, upon effects on the mitochondria. The effects on the mitochondria may lead to a reduction in calcium influx and hence relaxation of the blood vessel. - Highlights: • Simvastatin produces a relaxation of the porcine coronary artery. • This relaxation is inhibited by mitochondrial complex inhibitors. • Simvastatin alters mitochondrial membrane potential

Effect of simvastatin on vascular tone in porcine coronary artery: Potential role of the mitochondria

Energy Technology Data Exchange (ETDEWEB)

Almukhtar, H.; Garle, M.J.; Smith, P.A.; Roberts, R.E., E-mail: richard.roberts@nottingham.ac.uk

2016-08-15

Statins induce acute vasorelaxation which may contribute to the overall benefits of statins in the treatment of cardiovascular disease. The mechanism underlying this relaxation is unknown. As statins have been shown to alter mitochondrial function, in this study we investigated the role of mitochondria in the relaxation to simvastatin. Relaxation of porcine coronary artery segments by statins was measured using isolated tissue baths. Mitochondrial activity was determined by measuring changes in rhodamine 123 fluorescence. Changes in intracellular calcium levels were determined in freshly isolated smooth muscle cells with Fluo-4 using standard epifluorescent imaging techniques. Simvastatin, but not pravastatin, produced a slow relaxation of the coronary artery, which was independent of the endothelium. The relaxation was attenuated by the mitochondrial complex I inhibitor rotenone (10 μM) and the complex III inhibitor myxothiazol (10 μM), or a combination of the two. The complex III inhibitor antimycin A (10 μM) produced a similar time-dependent relaxation of the porcine coronary artery, which was attenuated by rotenone. Changes in rhodamine 123 fluorescence showed that simvastatin (10 μM) depolarized the membrane potential of mitochondria in both isolated mitochondria and intact blood vessels. Simvastatin and antimycin A both inhibited calcium-induced contractions in isolated blood vessels and calcium influx in smooth muscle cells and this inhibition was prevented by rotenone. In conclusion, simvastatin produces an endothelium-independent relaxation of the porcine coronary artery which is dependent, in part, upon effects on the mitochondria. The effects on the mitochondria may lead to a reduction in calcium influx and hence relaxation of the blood vessel. - Highlights: • Simvastatin produces a relaxation of the porcine coronary artery. • This relaxation is inhibited by mitochondrial complex inhibitors. • Simvastatin alters mitochondrial membrane potential

Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

Energy Technology Data Exchange (ETDEWEB)

Maffei, Erica; Seitun, Sara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Nieman, Koen; Weustink, Annick C.; Mollet, Nico R. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Martini, Chiara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Guaricci, Andrea Igoren [Azienda Ospedaliero-Universitaria di Foggia, Department of Cardiology, Foggia (Italy); Tedeschi, Carlo [Ospedale San Gennaro, Department of Cardiology, Naples (Italy); Berti, Elena; Grilli, Roberto [Regione Emilia-Romagna, Healthcare and Social Agency, Bologna (Italy); Messalli, Giancarlo [SDN Foundation, IRCCS, Naples (Italy); Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria - Parma, Department of Radiology, Parma (Italy)

2011-05-15

To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). 147 diabetic (mean age: 65 {+-} 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 {+-} 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Diabetics showed a higher number of diseased segments (4.1 {+-} 4.2 vs. 2.1 {+-} 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS {<=} 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS {<=} 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics. (orig.)

Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging.

Science.gov (United States)

Bybee, Kevin A; Lee, John; Markiewicz, Richard; Longmore, Ryan; McGhie, A Iain; O'Keefe, James H; Hsu, Bai-Ling; Kennedy, Kevin; Thompson, Randall C; Bateman, Timothy M

2010-04-01

A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS). Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was > or =100, > or =400, and > or =1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC. Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.

Reduced dental calcium expression and dental mass in chronic sleep deprived rats: Combined EDS, TOF-SIMS, and micro-CT analysis

Science.gov (United States)

Kuo, Yi-Jie; Huang, Yung-Kai; Chou, Hsiu-Chu; Pai, Man-Hui; Lee, Ai-Wei; Mai, Fu-Der; Chang, Hung-Ming

2015-08-01

Teeth are the hardest tissue in the body. The growth of teeth is closely regulated by circadian rhythmicity. Considering that sleep deprivation (SD) is a severe condition that disrupts normal circadian rhythmicity, this study was conducted to determine whether calcium expression (the major element participating in teeth constitution), and dental mass would be significantly impaired following SD. Adolescent rats subjected to 3 weeks of SD were processed for energy dispersive spectrum (EDS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), and micro-computed tomography (micro-CT) analyses. The EDS and TOF-SIMS results indicated that high calcium intensity was detected in both the upper and lower incisors of untreated rats. Micro-CT analysis corresponded closely with spectral data in which an enhanced dental mass was calculated in intact animals. However, following SD, both calcium expression and the dental mass were remarkably decreased to nearly half those of the untreated values. Because SD plays a detrimental role in impairing dental structure, establishing satisfactory sleep behavior would therefore serve as a crucial strategy for preventing or improving prevalent dental dysfunctions.

The calcium oxide influence on formation of manganese, calcium pyrovanadate solid solutions

International Nuclear Information System (INIS)

Vatolin, N.A.; Volkova, P.I.; Sapozhnikova, T.V.; Ovchinnikova, L.A.

1988-01-01

The X-ray graphic, derivatographic, microscopic and chemical methods are used to study solid solutions of manganese, calcium pyrovanadates containing 1-10 mass% CaO and the products of interaction of reprocessing charges of vanadium-containing converter slags intended for he formation of manganese and calcium pyrovanadates with additions of calcium oxide within 10-90 mass%. It is established that in the case of 1-6 mass% CaO content in manganese pyrovanadate solid interstitial solutions appear, while at 6-20 mass% CaO - solid substitution solutions form. The results of calculating elementary cell parameters as well as melting temperatures and pyrovanadate solid solution solubility depending on CaO content are presented. The best solubility of introduction solid solutions during vanadium extraction according to the lime technology is found

Evaluation of coronary calcifications with 64-slice CT - variability of the scores and the influence of the reconstruction interval

International Nuclear Information System (INIS)

Weininger, M.; Ritter, C.O.; Beer, M.; Hahn, D.; Beissert, M.

2007-01-01

Purpose: To evaluate the variability of coronary calcium scores depending on the image reconstruction interval using a 64-slice CT scanner. Materials and Methods: 30 patients (18 male, 12 female; mean age 57 ± 9 yrs; mean heart rate 66 ± 10 bpm) underwent coronary calcium scoring using a 64-slice CT scanner (Somatom Sensation 64, Siemens Medical Solutions, Erlangen) and a standardized scanning protocol. Oral β-blockers were administered to 12 patients with a baseline heart rate > 70 bpm. Images were reconstructed in 10 % increments from 10 - 100 % of the RR interval. Two blinded experienced observers independently calculated Agatston (AS), calcium mass (MS) and volume scores (VS) for every reconstructed image series. The results were compared to similar studies for 16-slice CT scanners. Results: The mean values and mean coefficients of variation among all patients were as follows: AS, 397 ± 829, 109 % MS, 88 ± 225, 154 % VS, 335 ± 669, 100 %. Regarding the reconstruction intervals, the mean coefficients of variation were as follows: 107 % (AS), 97 % (VS), 116 % (MS). No specific image reconstruction interval with statistically significant lower variability for each score could be identified. High inter-observer agreement was achieved (K = 0.98). With statistical significance (p < 0.05) 10/30 patients (pts) were able to be allocated to more than one risk group (RG): 6 pts = 2 RG; 3 pts 3 RG; 1 pts = 4 RG. The scores for 5/30 patients were zero for at least one reconstruction interval, but further reconstructions revealed calcifications. The number of patients assignable to different risk groups was significantly lower compared to published data using a 16-slice scanner (p < 0.05). Conclusion: Coronary calcium scores determined using a 64-slice scanner display a wide range of variability depending on the image reconstruction interval as already described for 16-slice CT scanners. However, compared to previous studies, our data indicate that this vendor

Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease

International Nuclear Information System (INIS)

Meng, Lingdong; Cui, Lianqun; Cheng, Yuntao; Wu, Xiaoyan; Tang, Yuansheng; Wang, Yong; Xu, Fayun

2009-01-01

To evaluate the diagnostic accuracy of a dual-source computed tomography (DSCT) coronary angiography, with a particular focus on the effect of heart rate and calcifications. One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate ( 400). Next, the effect of heart rate and calcification on the accuracy of coronary artery stenosis detection was analyzed by using an invasive coronary angiography as a reference standard. Coronary segments of less than 1.5 mm in diameter in an American Heart Association (AHA) 15-segment model were independently assessed. The mean heart rate during the scan was 71.8 bpm, whereas the mean Agatston score was 226.5. Of the 1,588 segments examined, 1,533 (97%) were assessable. A total of 17 patients had calcium scores above 400 Agatston U, whereas 50 had heart rates ≥ 70 bpm. Overall the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for significant stenoses were: 95%, 91%, 65%, and 99% (by segment), respectively and 97%, 90%, 81%, and 91% (by artery), respectively (n = 475). Heart rate showed no significant impact on lesion detection; however, vessel calcification did show a significant impact on accuracy of assessment for coronary segments. The specificity, PPV and accuracy were 96%, 80%, and 96% (by segment), respectively for an Agatston score less than 100% and 99%, 96% and 98% (by artery). For an Agatston score of greater to or equal to 400 the specificity, PPV and accuracy were reduced to 79%, 55%, and 83% (by segment), respectively and to 79%, 69%, and 85% (by artery), respectively. The DSCT provides a high rate of accuracy for the detection of significant coronary artery disease, even in patients with high heart rates and evidence of coronary calcification. However, patients with severe coronary calcification (> 400 U) remain a challenge to diagnose

Coronary artery calcium and physical function in older adults: the Cardiovascular Health Study.

Science.gov (United States)

Inzitari, Marco; Naydeck, Barbara L; Newman, Anne B

2008-10-01

In older adults without clinical cardiovascular disease, coronary artery calcium (CAC) is associated with other subclinical vascular diseases, which, in turn, predict physical dysfunction. However, the association between CAC and physical function is unstudied. In 387 older community-dwellers from the Cardiovascular Health Study without clinical cardiovascular diseases (mean age +/- standard deviation = 78.7 +/- 3.7, 35% men, 22% African Americans), CAC was measured using electron beam tomography, and physical performance was assessed by usual pace gait speed, chair stand, and tandem stand. Differences in physical performance across CAC quartiles were investigated in the whole cohort and by gender. Associations with gait speed (m/s) were assessed in multivariable models using both the continuous form of CAC score (log(CAC)) and quartiles of CAC, adjusting for demographics and comorbidities. No differences in physical performance were observed across CAC quartiles in the whole group. In gender-stratified analyses, a significant association was shown among women, who had progressively lower gait speed across CAC quartiles: Those with CAC > 220 walked more than 0.1 m/s slower than those with CAC or = 660) had a more than twofold odds of walking slower than 1 m/s, compared to the lowest CAC quartile (< 35; p =.021). In this sample of older community-dwellers without overt cardiovascular disease, CAC was inversely related to gait speed in women, but not in men.

Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study.

Science.gov (United States)

Blaha, Michael J; Budoff, Matthew J; DeFilippis, Andrew P; Blankstein, Ron; Rivera, Juan J; Agatston, Arthur; O'Leary, Daniel H; Lima, Joao; Blumenthal, Roger S; Nasir, Khurram

2011-08-20

The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata. Median follow-up was 5·8 years (IQR 5·7-5·9). 444 (47%) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74% of all coronary events were in the 239 (25%) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95% CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment. CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources. National Institutes of Health-National Heart, Lung, and Blood Institute. Copyright © 2011 Elsevier Ltd. All rights

Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects.

Science.gov (United States)

Bachar, Gil N; Dicker, Dror; Kornowski, Ran; Atar, Eli

2012-08-15

This study sought to elucidate the relation between epicardial adipose tissue (EAT) thickness measured by multidetector computed tomography and presence of coronary artery atherosclerosis. Recent studies have suggested that fat disposition in visceral organs and epicardial tissue could serve as a predictor of coronary artery disease (CAD). The sample included 190 asymptomatic subjects with ≥ 1 cardiovascular risk factor who were referred for cardiac computed tomographic angiography. Body mass index, blood pressure, fasting glucose level, and lipid profile were measured. Multidetector computed tomographic results were analyzed for atherosclerosis burden, calcium Agatston score, and EAT thickness: mean EAT values were 3.54 ± 1.59 mm in patients with atherosclerosis and 1.85 ± 1.28 mm in patients without atherosclerosis (p 50% diameter) coronary artery stenosis. There was a significant difference in EAT values between patients with and without metabolic syndrome (2.58 ± 1.63 vs 2.04 ± 1.46 mm, p 400 and <400 (3.38 ± 1.58 vs 2.02 ± 1.42 mm, p <0.0001). In conclusion, asymptomatic patients with CAD have significantly more EAT than patients without CAD. An EAT thickness of 2.4 mm is the optimal cutoff for prediction of presence of significant CAD. Copyright © 2012 Elsevier Inc. All rights reserved.

Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

International Nuclear Information System (INIS)

Sun Zhonghua; Aziz, Yang Faridah Abdul; Ng, Kwan-Hoong

2012-01-01

Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.

The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults

Directory of Open Access Journals (Sweden)

Jung-Hee Yu

2013-03-01

Full Text Available BackgroundWe investigated the association of coronary artery calcium score (CACS with body composition and insulin resistance in apparently healthy Korean adults.MethodsNine hundred forty-five participants (mean age, 48.9 years; 628 men in a medical check-up program were selected for analysis. Body composition was assessed by bioelectrical impedance analysis (BIA. Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR. The CACS was assessed by multidetector computed tomography.ResultsOne hundred forty-six subjects (15.4% showed coronary artery calcification and 148 subjects (15.7% had metabolic syndrome. CACS showed a significant positive correlation with age, fasting glucose level, waist circumference (WC, blood pressure, hemoglobin A1c, HOMA-IR, and waist-hip ratio (WHR assessed by BIA. CACS had a negative correlation with high density lipoprotein cholesterol (HDL-C. Subjects with high CACS showed significantly higher mean WHRs and lower mean values for lean body mass compared with subjects without coronary artery calcification. In logistic regression analyses with coronary artery calcification as the dependent variable, the highest quartile of WHR showed a 3.125-fold increased odds ratio for coronary artery calcification compared with the lowest quartile after adjustment for confounding variables. When receiver operating characteristics analyses were performed with coronary artery calcification as the result variable, WHR showed the largest area under the curve (AUC value among other variables except for age and WC in women (AUC=0.696 for WHR, 0.790 for age, and 0.719 for WC in women.ConclusionIn our study population of apparently healthy Korean adults, WHR was the most significant predictor for coronary artery calcification among other confounding factors, suggesting that it may have implication as a marker for early atherosclerosis.

Noninvasive imaging in the assessment and prevention of coronary heart disease

International Nuclear Information System (INIS)

Llerena Rojas, Luis Roberto; Peix Gonzalez, Amalia; Valiente Mustelier, Juan

2011-01-01

Echocardiography, multidetector computed tomography, magnetic resonance imaging, and nuclear cardiology can all help prevent coronary heart disease. Echocardiography can identify asymptomatic individuals who are at risk of coronary disease and who should receive aggressive preventative therapy by providing data on the carotid intima-media thickness, arterial stiffness and flow-mediated dilatation of the brachial artery. The calcium score is an independent predictor of cardiac events that influences clinical risk scores such as the Framingham risk score. By using multidetector computed tomography or magnetic resonance imaging for coronary angiography, it is possible to visualize both the lumen and vessel walls of coronary arteries and to discriminate between calcified and noncalcified atherosclerotic plaque before invasive coronary angiography is performed. With nuclear cardiology, the functional effects of atherosclerotic lesions can be evaluated by assessing perfusion and ventricular function simultaneously

Detection of coronary artery calcification with non triggered computed tomography of the chest

Energy Technology Data Exchange (ETDEWEB)

Pelandré, Gustavo Lemos; Sanches, Nathália Martins Pereira, E-mail: gustavo.pelandre@ufsc.br [Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC (Brazil); Nacif, Marcelo Souto [Universidade Federal Fluminense (UFF), Niterói, RJ (Brazil); Marchiori, Edson [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil)

2018-01-15

Objective: To evaluate the accuracy of visual analysis and of the coronary artery calcium (CAC) score in non triggered computed tomography (CT), in comparison with that of the CAC score in electrocardiogram-triggered CT, in identifying coronary calcification. Materials and methods: A total of 174 patients for whom CT was indicated for CAC scoring underwent non triggered and triggered CT in a 64-channel multislice scanner, in a single session without a change in position. The images were interpreted by a radiologist with seven years of experience in thoracic and cardiovascular radiology. The measurement of coronary calcium was carried out by three methods: CAC score with dedicated software in non triggered CT, CAC score with dedicated software in triggered CT, and visual analysis without dedicated software in non triggered CT. Results: In non triggered CT, the CAC score presented an accuracy of 95.98% (95% CI: 91.93 - 98.04). The visual analysis showed an accuracy of 97.13% (95% CI: 93.45 - 98.77). Conclusion: Non triggered CT showed excellent accuracy in the identification and exclusion of coronary calcification, either the CAC score was determined with dedicated software or through visual analysis. (author)

Reduced dental calcium expression and dental mass in chronic sleep deprived rats: Combined EDS, TOF-SIMS, and micro-CT analysis

Energy Technology Data Exchange (ETDEWEB)

Kuo, Yi-Jie [Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan (China); Huang, Yung-Kai [School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Chou, Hsiu-Chu; Pai, Man-Hui; Lee, Ai-Wei [Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Mai, Fu-Der [Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Chang, Hung-Ming, E-mail: taiwanzoo@gmail.com [Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (China)

2015-08-01

Highlights: • The growth of teeth is closely regulated by the circadian rhythmicity. • Sleep deprivation significantly disrupts the circadian regulation. • Sleep deprivation reduces the dental calcium level and impairs dental intensity. • This study highlights for the first time that sleep is essential for dental structure. • Establishing satisfactory sleep behavior may be a helpful strategy to prevent dental disability. - Abstract: Teeth are the hardest tissue in the body. The growth of teeth is closely regulated by circadian rhythmicity. Considering that sleep deprivation (SD) is a severe condition that disrupts normal circadian rhythmicity, this study was conducted to determine whether calcium expression (the major element participating in teeth constitution), and dental mass would be significantly impaired following SD. Adolescent rats subjected to 3 weeks of SD were processed for energy dispersive spectrum (EDS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), and micro-computed tomography (micro-CT) analyses. The EDS and TOF-SIMS results indicated that high calcium intensity was detected in both the upper and lower incisors of untreated rats. Micro-CT analysis corresponded closely with spectral data in which an enhanced dental mass was calculated in intact animals. However, following SD, both calcium expression and the dental mass were remarkably decreased to nearly half those of the untreated values. Because SD plays a detrimental role in impairing dental structure, establishing satisfactory sleep behavior would therefore serve as a crucial strategy for preventing or improving prevalent dental dysfunctions.

Reduced dental calcium expression and dental mass in chronic sleep deprived rats: Combined EDS, TOF-SIMS, and micro-CT analysis

International Nuclear Information System (INIS)

Kuo, Yi-Jie; Huang, Yung-Kai; Chou, Hsiu-Chu; Pai, Man-Hui; Lee, Ai-Wei; Mai, Fu-Der; Chang, Hung-Ming

2015-01-01

Highlights: • The growth of teeth is closely regulated by the circadian rhythmicity. • Sleep deprivation significantly disrupts the circadian regulation. • Sleep deprivation reduces the dental calcium level and impairs dental intensity. • This study highlights for the first time that sleep is essential for dental structure. • Establishing satisfactory sleep behavior may be a helpful strategy to prevent dental disability. - Abstract: Teeth are the hardest tissue in the body. The growth of teeth is closely regulated by circadian rhythmicity. Considering that sleep deprivation (SD) is a severe condition that disrupts normal circadian rhythmicity, this study was conducted to determine whether calcium expression (the major element participating in teeth constitution), and dental mass would be significantly impaired following SD. Adolescent rats subjected to 3 weeks of SD were processed for energy dispersive spectrum (EDS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), and micro-computed tomography (micro-CT) analyses. The EDS and TOF-SIMS results indicated that high calcium intensity was detected in both the upper and lower incisors of untreated rats. Micro-CT analysis corresponded closely with spectral data in which an enhanced dental mass was calculated in intact animals. However, following SD, both calcium expression and the dental mass were remarkably decreased to nearly half those of the untreated values. Because SD plays a detrimental role in impairing dental structure, establishing satisfactory sleep behavior would therefore serve as a crucial strategy for preventing or improving prevalent dental dysfunctions

Risk of coronary artery disease in individuals infected with human immunodeficiency virus

OpenAIRE

Vilela, Felippe Dantas; Lorenzo, Andrea Rocha de; Tura, Bernardo Rangel; Ferraiuoli, Giovanna Ianini; Hadlich, Marcelo; Barros, Marcelo Viana de Lima; Lima, Ana Beatriz Ribeiro; Meirelles, Vanderson

2011-01-01

Current treatment for human immunodeficiency virus (HIV) infection has improved survival and allowed infected patients to develop atherosclerotic coronary artery disease (CAD). Specific strategies to reduce cardiovascular risk in the infected population have not been developed. It is necessary to know the magnitude of cardiovascular risk in this population. OBJECTIVES: This study aimed to assess cardiovascular risk using a well-known clinical score and to investigate coronary artery calcium s...

'Variant' angina: Evidence for small vessel coronary artery spasm

International Nuclear Information System (INIS)

Pfisterer, M.; Mueller-Brand, J.; Cueni, T.; Luetold, B.; Burkart, F.; Basel Univ.

1980-01-01

A unique case of 'variant' angina pectoris has been observed in a patient with normal coronary arteries and typical chest pain appearing spontaneously at rest, and repeatedly provoked by ergonovine maleate (0.1 mg iv) associated with large transmural perfusion defects on 201 TI-imaging (after ergonovine) and a marked increase in T wave voltage despite no demonstrable spasm of a major coronary artery after the same doses of ergonovine. While saline solution could not provoke chest pain and treatment with a beta-blocking agent increased the frequency of ischemic attacks, a calcium antangonist therapy reduced and eventually eliminated the attacks. Thus, this case provides evidence for yet another aspect of a 'variant' form of angina pectoris: small vessel coronary artery spasm. (orig.) [de

Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

DEFF Research Database (Denmark)

Ravkilde, J; Nissen, H; Mickley, H

1994-01-01

The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

Feasibility of coronary calcium and stent image subtraction using 320-detector row CT angiography

DEFF Research Database (Denmark)

Fuchs, Andreas; Kühl, J Tobias; Chen, Marcus Y

2015-01-01

BACKGROUND: The reader confidence and diagnostic accuracy of coronary CT angiography (CCTA) can be compromised by the presence of calcified plaques and stents causing blooming artifacts. Compared to conventional invasive coronary angiography (ICA), this may cause an overestimation of stenosis....... We defined target segments on CCTAconv as motion-free coronary segments with calcification or stent and low reader confidence. The effect of CCTAsub was assessed. No approval from the ethics committee was required according to Danish law. RESULTS: A total of 76 target segments were identified...

Relationship between coronary atherosclerosis and 'sudden cardiac death'

International Nuclear Information System (INIS)

Lundholm, C.E.; Sundbom, L.; Lundholm, L.

1989-01-01

Coronary arteriosclerosis in mini-pigs was produced by combination of hypercholesterolemia and twofold X irradiation of the cardiac region. 15-21 weeks following irradiation 40% of the adult animals and 58% of the juvenils died of 'sudden cardiac death'. The mortality rate decreased significantly after application of the calcium-channel blocking agent nifedipine

Alveolar bone mass in pre- and postmenopausal women with serum calcium as a marker: A comparative study

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Amitha Ramesh

2011-01-01

Conclusion: Postmenopausal women exhibit a reduced alveolar bone mass and lowered levels of serum total calcium with the increasing age. These changes may be useful indicators for low skeletal bone mineral density or osteoporosis.

[Role of melatonin in calcium overload-induced heart injury].

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Kong, Lingheng; Wei, Ming; Sun, Na; Zhu, Juanxia; Su, Xingli

2017-06-28

To investigate the role of melatonin in calcium overload-induced heart injury.
 Methods: Thirty-two rats were divided into 4 groups: a control group (Control), a melatonin control group (Mel), a calcium overload group (CaP), and a calcium overload plus melatonin group (Mel+CaP). Isolated Sprague Dawley male rat hearts underwent Langendorff perfusion. Left ventricular developed pressure (LVDP) was calculated to evaluate the myocardial performance. Triphenyltetrazolium chloride staining was used to measure the infarct size of myocardium. Lactate dehydrogenase (LDH) activity in the coronary flow was determined. The expressions of caspase-3 and cytochrome c were determined by Western blot. The pathological morphological changes in myocardial fiber were analyzed by HE staining.
 Results: Compared with the control group, calcium overload significantly induced an enlarged infarct size (Poverload-induced heart injury.

Topographic association of angioscopic yellow plaques with coronary atherosclerotic plaque: assessment with quantitative colorimetry in human coronary artery autopsy specimens.

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Ishibashi, Fumiyuki; Lisauskas, Jennifer B; Kawamura, Akio; Waxman, Sergio

2008-01-01

Yellow plaques seen during coronary angioscopy are thought to be the surrogates for superficial intimal lipids in coronary plaque. Given diffuse and heterogeneous nature of atherosclerosis, yellow plaques in coronaries may be seen as several yellow spots on diffuse coronary plaque. We examined the topographic association of yellow plaques with coronary plaque. In 40 non-severely stenotic ex-vivo coronary segments (average length: 52.2 +/- 3.1 mm), yellow plaques were examined by angioscopy with quantitative colorimetry. The segments were cut perpendicular to the long axis of the vessel at 2 mm intervals, and 1045 slides with 5 microm thick tissue for whole segments were prepared. To construct the plaque surface, each tissue slice was considered to be representative of the adjacent 2 mm. The circumference of the lumen and the lumen border of plaque were measured in each slide, and the plaque surface region was constructed. Coronary plaque was in 37 (93%) of 40 segments, and consisted of a single mass [39.9 +/- 3.9 (0-100) mm, 311.3 +/- 47.4 (0.0-1336.2) mm2]. In 30 (75%) segments, multiple (2-9) yellow plaques were detected on a mass of coronary plaque. The number of yellow plaques correlated positively with coronary plaque surface area (r = 0.77, P colorimetry, some of them are associated with lipid cores underneath thin fibrous caps, may be used to assess the extent of coronary plaque. Further research using angioscopy could be of value to study the association of high-risk coronaries with acute coronary syndromes.

The influence of body mass index and gender on coronary arterial attenuation with fixed iodine load per body weight at dual-source CT coronary angiography

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Zhu, Xiaomei; Zhu, Yinsu; Xu, Hai; Tang, Lijun; Xu, Yi

2012-01-01

Background. Most of current coronary CT angiography protocols are not adapted to body weight (BW) or cardiac output and no literature about influence of gender on coronary attenuation are reported with administration of a fixed iodine load per BW. Purpose. To determine the influence of body mass index (BMI) and gender on coronary arterial attenuation if contrast material dose is linearly adjusted to a patient's BW at dual-source CT coronary angiography (DSCT-CA). Material and Methods. A total of 207 consecutive patients (mean age 60.6 years) undergoing DSCT-CA were included. Contrast material (370 mg I/mL) dose calculation was randomly categorized into two groups (Group1: 1.10 mL/kg for men and women; Group 2: men 1.10 mL/kg, women 0.99 mL/kg) and flow rate was calculated as dose was divided by scan time plus 8 s. Mean arterial attenuations between men and women were compared with respect to attenuations of ascending aorta (AA) above coronary ostia, left main coronary artery (LM), proximal segments of right coronary artery (RCA), left anterior descending (LAD), and left circumflex artery (LCX) in two groups, respectively. Attenuations of coronary arteries were correlated with BW and BMI with simple linear regression. Results. The mean attenuations of AA, LM, RCA, LAD, and LCX were 407.8 ± 53.6 HU, 412.6 ± 55.4 HU, 411.4 ± 64.3 HU, 399.1 ± 56.7 HU, and 399.1 ± 60.2 HU, respectively, and there were no significant differences between men and women in group 1 (AA, P = 0.571; LM, P = 0.670; RCA, P = 0.737; LAD, P = 0.439, and LCX, P = 0.888). In group 2, the mean attenuations of AA, LM, RCA, LAD, and LCX in men were significantly higher than those in women (AA, P = 0.008; LM, P = 0.025; RCA, P = 0.017; LAD, P = 0.015, and LCX, P = 0.002). Positive linear regression between BW and attenuations of AA (R 2 = 0.047, P = 0.02), LM (R 2 = 0.036, P = 0.04), RCA (R 2 = 0.080, P 2 = 0.078, P 2 = 0.033, P = 0.05) was found in group 1, suggesting that attenuations of coronary

Impact of hybrid iterative reconstruction on Agatston coronary artery calcium scores in comparison to filtered back projection in native cardiac CT; Einfluss der hybriden iterativen Rekonstruktion bei der nativen CT des Herzens auf die Agatston-Kalziumscores der Koronararterien

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Obmann, V.C.; Heverhagen, J.T. [Inselspital - University Hospital Bern (Switzerland). University Inst. for Diagnostic, Interventional and Pediatric Radiology; Klink, T. [Wuerzburg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Stork, A.; Begemann, P.G.C. [Roentgeninstitut Duesseldorf, Duesseldorf (Germany); Laqmani, A.; Adam, G. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology

2015-05-15

To investigate whether the effects of hybrid iterative reconstruction (HIR) on coronary artery calcium (CAC) measurements using the Agatston score lead to changes in assignment of patients to cardiovascular risk groups compared to filtered back projection (FBP). 68 patients (mean age 61.5 years; 48 male; 20 female) underwent prospectively ECG-gated, non-enhanced, cardiac 256-MSCT for coronary calcium scoring. Scanning parameters were as follows: Tube voltage, 120 kV; Mean tube current time-product 63.67 mAs (50 - 150 mAs); collimation, 2 x 128 x 0.625 mm. Images were reconstructed with FBP and with HIR at all levels (L1 to L7). Two independent readers measured Agatston scores of all reconstructions and assigned patients to cardiovascular risk groups. Scores of HIR and FBP reconstructions were correlated (Spearman). Interobserver agreement and variability was assessed with k-statistics and Bland-Altmann-Plots. Agatston scores of HIR reconstructions were closely correlated with FBP reconstructions (L1, R = 0.9996; L2, R = 0.9995; L3, R = 0.9991; L4, R = 0.986; L5, R = 0.9986; L6, R = 0.9987; and L7, R = 0.9986). In comparison to FBP, HIR led to reduced Agatston scores between 97% (L1) and 87.4% (L7) of the FBP values. Using HIR iterations L1-L3, all patients were assigned to identical risk groups as after FPB reconstruction. In 5.4% of patients the risk group after HIR with the maximum iteration level was different from the group after FBP reconstruction. There was an excellent correlation of Agatston scores after HIR and FBP with identical risk group assignment at levels 1 - 3 for all patients. Hence it appears that the application of HIR in routine calcium scoring does not entail any disadvantages. Thus, future studies are needed to demonstrate whether HIR is a reliable method for reducing radiation dose in coronary calcium scoring.

Relationships between coronary heart disease risk factors and serum ionized calcium in Kennedy Space Center Cohort

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Goodwin, Lisa Ann; Frey, Mary Anne Bassett; Merz, Marion P.; Alford, William R.

1987-01-01

Kennedy Space Center (KSC) employees are reported to be at high risk for coronary heart disease (CHD). Risk factors for CHD include high serum total cholesterol levels, low levels of high-density lipoprotein cholesterol (HDLC), elevated triglyceride, smoking, inactivity, high blood pressure, being male, and being older. Higher dietary and/or serum calcium Ca(++) may be related to a lower risk for CHD. Fifty men and 37 women participated. Subjects were tested in the morning after fasting 12 hours. Information relative to smoking and exercise habits was obtained; seated blood pressures were measured; and blood drawn. KCS men had higher risk values than KCS women as related to HDLC, triglycerides, systolic blood pressure, and diastolic blood pressure. Smoking and nonsmoking groups did not differ for other risk factors or for serum Ca(++) levels. Exercise and sedentary groups differed in total cholesterol and triglyceride levels. Serum Ca(++) levels were related to age, increasing with age in the sedentary group and decreasing in the exercisers, equally for men and women. It is concluded that these relationships may be significant to the risk of CHD and/or the risk of bone demineralization in an aging population.

Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain).

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Budoff, Matthew J; Mayrhofer, Thomas; Ferencik, Maros; Bittner, Daniel; Lee, Kerry L; Lu, Michael T; Coles, Adrian; Jang, James; Krishnam, Mayil; Douglas, Pamela S; Hoffmann, Udo

2017-11-21

Coronary artery calcium (CAC) is an established predictor of future major adverse atherosclerotic cardiovascular events in asymptomatic individuals. However, limited data exist as to how CAC compares with functional testing (FT) in estimating prognosis in symptomatic patients. In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain (or dyspnea) and intermediate pretest probability for obstructive coronary artery disease were randomized to FT (exercise electrocardiography, nuclear stress, or stress echocardiography) or anatomic testing. We evaluated those who underwent CAC testing as part of the anatomic evaluation (n=4209) and compared that with results of FT (n=4602). We stratified CAC and FT results as normal or mildly, moderately, or severely abnormal (for CAC: 0, 1-99 Agatston score [AS], 100-400 AS, and >400 AS, respectively; for FT: normal, mild=late positive treadmill, moderate=early positive treadmill or single-vessel ischemia, and severe=large ischemic region abnormality). The primary end point was all-cause death, myocardial infarction, or unstable angina hospitalization over a median follow-up of 26.1 months. Cox regression models were used to calculate hazard ratios (HRs) and C statistics to determine predictive and discriminatory values. Overall, the distribution of normal or mildly, moderately, or severely abnormal test results was significantly different between FT and CAC (FT: normal, n=3588 [78.0%]; mild, n=432 [9.4%]; moderate, n=217 [4.7%]; severe, n=365 [7.9%]; CAC: normal, n=1457 [34.6%]; mild, n=1340 [31.8%]; moderate, n=772 [18.3%]; severe, n=640 [15.2%]; P 0), whereas fewer than half of events occurred in patients with mildly, moderately, or severely abnormal FT (n=57 of 132, 43%; P fair for both CAC and FT (C statistic, 0.67 versus 0.64). Coronary computed tomographic angiography provided significantly better prognostic information compared with FT and CAC testing (C index

Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1

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Aline R. Wageck

2017-10-01

Full Text Available Objective: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS in individuals with bipolar disorder type 1. Methods: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0 or positive (CCS > 0. Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. Results: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001 and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04 when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001. Conclusion: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

Automatic coronary artery calcium scoring in cardiac CT angiography using paired convolutional neural networks.

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Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; van Hamersvelt, Robbert W; Viergever, Max A; Išgum, Ivana

2016-12-01

The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. CAC is clinically quantified in cardiac calcium scoring CT (CSCT), but it has been shown that cardiac CT angiography (CCTA) may also be used for this purpose. We present a method for automatic CAC quantification in CCTA. This method uses supervised learning to directly identify and quantify CAC without a need for coronary artery extraction commonly used in existing methods. The study included cardiac CT exams of 250 patients for whom both a CCTA and a CSCT scan were available. To restrict the volume-of-interest for analysis, a bounding box around the heart is automatically determined. The bounding box detection algorithm employs a combination of three ConvNets, where each detects the heart in a different orthogonal plane (axial, sagittal, coronal). These ConvNets were trained using 50 cardiac CT exams. In the remaining 200 exams, a reference standard for CAC was defined in CSCT and CCTA. Out of these, 100 CCTA scans were used for training, and the remaining 100 for evaluation of a voxel classification method for CAC identification. The method uses ConvPairs, pairs of convolutional neural networks (ConvNets). The first ConvNet in a pair identifies voxels likely to be CAC, thereby discarding the majority of non-CAC-like voxels such as lung and fatty tissue. The identified CAC-like voxels are further classified by the second ConvNet in the pair, which distinguishes between CAC and CAC-like negatives. Given the different task of each ConvNet, they share their architecture, but not their weights. Input patches are either 2.5D or 3D. The ConvNets are purely convolutional, i.e. no pooling layers are present and fully connected layers are implemented as convolutions, thereby allowing efficient voxel classification. The performance of individual 2.5D and 3D ConvPairs with input sizes of 15 and 25 voxels, as well as the performance of ensembles of these Conv

Relation between the left ventricular mass and the left coronary artery dimensions as determined by 16-channel multidetector CT: comparison between the normotensive group and the hypertensive group

International Nuclear Information System (INIS)

Kang, Doo Kyung; Park, Kyung Joo; Tahk, Seung Jea; Kim, Sun Yong

2006-01-01

The purpose of this study is to determine the left ventricular mass (LVM) and the left coronary artery dimension and to investigate the relationship between the two values in the normotensive group and hypertensive group with using 16-channel multidetector CT (MDCT). Among the patients who underwent a CT coronary angiogram procedure using 16-channel MDCT at Ajou University Hospital from October 2004 to February 2005, 33 patient became the subjects of this study. These 33 patients showed normal findings without calcification or stenosis of the coronary arteries. The total volume of the left ventricular wall was calculated using work-in-progress cardiac CT reconstruction software. The LVM could then be directly calculated by multiplying the left ventricular muscle volume by the myocardial tissue density, which was assumed to be 1.05 g/cm 3 . The coronary diameter was measured by a fixed threshold method from the transverse reformation images obtained along the long-axis of each coronary artery. We calculated the cross-sectional area (CSA) of the coronary arteries from the equation of π D2/4 (D = diameter). Regression analysis was performed for the relationship between LVM and the left coronary artery dimensions with using a linear least-squares method. Comparison between the normotensive group and the hypertensive group was done using the Student test. The average LVM was 127.9 ± 36.2 g (mean ± standard deviation) and the average left ventricular mass index (LVMI) was 74.7 ± 15.5 g in this study population. The average diameter of the coronary arteries was 4.38 ± 0.69 mm for the left coronary artery. In all the subjects (n = 33, r = 0.67, ρ = 0.000) and the normotensive group (n = 21, r = 0.68, ρ = 0.000), the LVM was significantly correlated with the CSA of the left coronary artery, but not in the hypertensive group (n= 12, r = 0.57, ρ = 0.062). In the hypertensive group, the CSA of the left coronary arteries per 100 g of muscle mass tended to decrease as

Alloxan-induced diabetes exacerbates coronary atherosclerosis and calcification in Ossabaw miniature swine with metabolic syndrome.

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Badin, Jill K; Kole, Ayeeshik; Stivers, Benjamin; Progar, Victor; Pareddy, Anisha; Alloosh, Mouhamad; Sturek, Michael

2018-03-09

There is a preponderance of evidence implicating diabetes with increased coronary artery disease (CAD) and calcification (CAC) in human patients with metabolic syndrome (MetS), but the effect of diabetes on CAD severity in animal models remains controversial. We investigated whether diabetes exacerbates CAD/CAC and intracellular free calcium ([Ca 2+ ] i ) dysregulation in the clinically relevant Ossabaw miniature swine model of MetS. Sixteen swine, eight with alloxan-induced diabetes, were fed a hypercaloric, atherogenic diet for 6 months. Alloxan-induced pancreatic beta cell damage was examined by immunohistochemical staining of insulin. The metabolic profile was confirmed by body weight, complete blood panel, intravenous glucose tolerance test (IVGTT), and meal tolerance test. CAD severity was assessed with intravascular ultrasound and histology. [Ca 2+ ] i handling in coronary smooth muscle (CSM) cells was assessed with fura-2 ratiometric imaging. Fasting and post-prandial blood glucose, total cholesterol, and serum triglycerides were elevated in MetS-diabetic swine. This group also exhibited hypoinsulinemia during IVGTT and less pancreatic beta cell mass when compared to lean and MetS-nondiabetic swine. IVUS analysis revealed that MetS-diabetic swine had greater percent wall coverage, percent plaque burden, and calcium index when compared to lean and MetS-nondiabetic swine. Fura-2 imaging of CSM [Ca 2+ ] i revealed that MetS-nondiabetic swine exhibited increased sarcoplasmic reticulum Ca 2+ store release and Ca 2+ influx through voltage-gated Ca 2+ channels compared to lean swine. MetS-diabetic swine exhibited impaired Ca 2+ efflux. Diabetes exacerbates coronary atherosclerosis and calcification in Ossabaw miniature swine with MetS, accompanied by progression of [Ca 2+ ] i dysregulation in advanced CAD/CAC. These results recapitulate increased CAD in humans with diabetes and establish Ossabaw miniature swine as an animal model for future Met

Location-dependent coronary artery diffusive and convective mass transport properties of a lipophilic drug surrogate measured using nonlinear microscopy.

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Keyes, Joseph T; Simon, Bruce R; Vande Geest, Jonathan P

2013-04-01

Arterial wall mass transport properties dictate local distribution of biomolecules or locally delivered dugs. Knowing how these properties vary between coronary artery locations could provide insight into how therapy efficacy is altered between arterial locations. We introduced an indocarbocyanine drug surrogate to the lumens of left anterior descending and right coronary (LADC; RC) arteries from pigs with or without a pressure gradient. Interstitial fluorescent intensity was measured on live samples with multiphoton microscopy. We also measured binding to porcine coronary SMCs in monoculture. Diffusive transport constants peaked in the middle sections of the LADC and RC arteries by 2.09 and 2.04 times, respectively, compared to the proximal and distal segments. There was no statistical difference between the average diffusivity value between LADC and RC arteries. The convection coefficients had an upward trend down each artery, with the RC being higher than the LADC by 3.89 times. This study demonstrates that the convective and diffusive transport of lipophilic molecules changes between the LADC and the RC arteries as well as along their length. These results may have important implications in optimizing drug delivery for the treatment of coronary artery disease.

Concordance of coronary artery calcium estimates between MDCT and electron beam tomography.

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Daniell, Anthony L; Wong, Nathan D; Friedman, John D; Ben-Yosef, Nachum; Miranda-Peats, Romalisa; Hayes, Sean W; Kang, Xingping; Sciammarella, Maria G; de Yang, Ling; Germano, Guido; Berman, Daniel S

2005-12-01

The objective of our study was to compare MDCT with electron beam tomography (EBT) for the quantification of coronary artery calcification (CAC). Sixty-eight patients underwent both MDCT and EBT within 2 months for the quantification of CAC. The images were scored in a blinded fashion and independently by two observers with a minimum of 7 days between the interpretations of images obtained from one scanner type to the other. Presence versus absence of CAC was discordant by EBT versus MDCT in 6% (n = 4) of the cases by observer 1, with one of these cases also discordant by observer 2. All cases except one (aortic calcium misidentified as CAC) were among those with a mean Agatston score of less than 5 present on EBT but absent on MDCT. EBT and MDCT scores correlated well (r = 0.98-0.99). The relative median variability between EBT and MDCT for the Agatston score was 24% for observer 1 and 27% for observer 2 and was 18% and 14%, respectively, for volume score (average for both observers: 27% for Agatston score and 16% for volume score). Scores were higher for EBT than MDCT in approximately half of the cases, with little systematic difference between the two (median EBT-MDCT difference: Agatston score, -0.55; volume score, 3.4 mm3). The absolute median difference averaged for the two observers was 28.75 for the Agatston score and 15.4 mm3 for the volume score. Differences in CAC measurements using EBT and MDCT are similar to interscan differences in CAC measurements previously reported for EBT or for other MDCT scanners individually.

Determination of human coronary artery composition by Raman spectroscopy.

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Brennan, J F; Römer, T J; Lees, R S; Tercyak, A M; Kramer, J R; Feld, M S

1997-07-01

We present a method for in situ chemical analysis of human coronary artery using near-infrared Raman spectroscopy. It is rapid and accurate and does not require tissue removal; small volumes, approximately 1 mm3, can be sampled. This methodology is likely to be useful as a tool for intravascular diagnosis of artery disease. Human coronary artery segments were obtained from nine explanted recipient hearts within 1 hour of heart transplantation. Minces from one or more segments were obtained through grinding in a mortar and pestle containing liquid nitrogen. Artery segments and minces were excited with 830 nm near-infrared light, and Raman spectra were collected with a specially designed spectrometer. A model was developed to analyze the spectra and quantify the amounts of cholesterol, cholesterol esters, triglycerides and phospholipids, and calcium salts present. The model provided excellent fits to spectra from the artery segments, indicating its applicability to intact tissue. In addition, the minces were assayed chemically for lipid and calcium salt content, and the results were compared. The relative weights obtained using the Raman technique agreed with those of the standard assays within a few percentage points. The chemical composition of coronary artery can be quantified accurately with Raman spectroscopy. This opens the possibility of using histochemical analysis to predict acute events such as plaque rupture, to follow the progression of disease, and to select appropriate therapeutic interventions.

Dataset of calcified plaque condition in the stenotic coronary artery lesion obtained using multidetector computed tomography to indicate the addition of rotational atherectomy during percutaneous coronary intervention

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Yasushi Akutsu

2016-06-01

Full Text Available Our data shows the regional coronary artery calcium scores (lesion CAC on multidetector computed tomography (MDCT and the cross-section imaging on MDCT angiography (CTA in the target lesion of the patients with stable angina pectoris who were scheduled for percutaneous coronary intervention (PCI. CAC and CTA data were measured using a 128-slice scanner (Somatom Definition AS+; Siemens Medical Solutions, Forchheim, Germany before PCI. CAC was measured in a non-contrast-enhanced scan and was quantified using the Calcium Score module of SYNAPSE VINCENT software (Fujifilm Co. Tokyo, Japan and expressed in Agatston units. CTA were then continued with a contrast-enhanced ECG gating to measure the severity of the calcified plaque condition. We present that both CAC and CTA data are used as a benchmark to consider the addition of rotational atherectomy during PCI to severely calcified plaque lesions.

Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease

International Nuclear Information System (INIS)

Houghton, J.L.; Frank, M.J.; Carr, A.A.; von Dohlen, T.W.; Prisant, L.M.

1990-01-01

Invasive Doppler catheter-derived coronary flow reserve, echocardiographic measurements of left ventricular hypertrophy and intravenous dipyridamole-limited stress thallium-201 scintigraphy were compared in 48 patients (40 were hypertensive or diabetic) with clinical ischemic heart disease and no or minor coronary artery disease. Abnormal vasodilator reserve (ratio less than 3:1) occurred in 50% of the study group and markedly abnormal reserve (less than or equal to 2:1) occurred in 27%. Coronary vasodilator reserve was significantly lower (2.2 +/- 0.8 versus 3.5 +/- 1.3, p = 0.003) and indexed left ventricular mass significantly higher (152.6 +/- 42.2 versus 113.6 +/- 24.0 g, p = 0.0007) in patients with a positive (n = 11) versus a negative (n = 32) thallium perfusion scan. Coronary flow reserve was linearly related in coronary basal flow velocity as follows: y = -0.17x + 4.59; r = -0.57; p = 0.00002. The decrement in flow reserve was not linearly related to the degree of left ventricular hypertrophy. Abnormal vasodilator reserve subsets found in hypertensive patients were defined on the basis of basal flow velocity, indexed left ventricular mass and clinical factors. In this series, diabetes did not cause a detectable additional decrement in flow reserve above that found with hypertension alone. These findings demonstrate that thallium perfusion defects are associated with depressed coronary vasodilator reserve in hypertensive patients without obstructive coronary artery disease. Left ventricular hypertrophy by indexed mass criteria is predictive of which hypertensive patients are likely to have thallium defects

Pericardial and thoracic peri-aortic adipose tissues contribute to systemic inflammation and calcified coronary atherosclerosis independent of body fat composition, anthropometric measures and traditional cardiovascular risks

International Nuclear Information System (INIS)

Yun, Chun-Ho; Lin, Tin-Yu; Wu, Yih-Jer; Liu, Chuan-Chuan; Kuo, Jen-Yuan; Yeh, Hung-I.; Yang, Fei-Shih; Chen, Su-Chiu; Hou, Charles Jia-Yin; Bezerra, Hiram G.; Hung, Chung-Lieh; Cury, Ricardo C.

2012-01-01

Background: Coronary atherosclerosis has traditionally been proposed to be associated with several cardiovascular risk factors and anthropometric measures. However, clinical data regarding the independent value of visceral adipose tissue in addition to such traditional predictors remains obscure. Materials and methods: We subsequently studied 719 subjects (age: 48.1 ± 8.3 years, 25% females) who underwent multidetector computed tomography (MDCT) for coronary calcium score (CCS) quantification. Baseline demographic data and anthropometric measures were taken with simultaneous body fat composition estimated. Visceral adipose tissue of pericardial and thoracic peri-aortic fat was quantified by MDCT using TeraRecon Aquarius workstation (San Mateo, CA). Traditional cardiovascular risk stratification was calculated by metabolic (NCEP ATP III) and Framingham (FRS) scores and high-sensitivity CRP (Hs-CRP) was taken to represent systemic inflammation. The independent value of visceral adipose tissue to systemic inflammation and CCS was assessed by utilizing multivariable regression analysis. Results: Of all subjects enrolled in this study, the mean values for pericardial and peri-aortic adipose tissue were 74.23 ± 27.51 and 7.23 ± 3.69 ml, respectively. Higher visceral fat quartile groups were associated with graded increase of risks for cardiovascular diseases. Both adipose burdens strongly correlated with anthropometric measures including waist circumference, body weight and body mass index (all p < 0.001). In addition, both visceral amount correlates well with ATP and FRS scores, all lipid profiles and systemic inflammation marker in terms of Hs-CRP (all p < 0.001). After adjustment for baseline variables, both visceral fat were independently related to Hs-CRP levels (all p < 0.05), but only pericardial fat exerted independent role in coronary calcium deposit. Conclusion: Both visceral adipose tissues strongly correlated with systemic inflammation beyond traditional

Evaluation of chemical stability of polymers of XIENCE everolimus-eluting coronary stents in vivo by pyrolysis-gas chromatography/mass spectrometry.

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Kamberi, Marika; Pinson, David; Pacetti, Stephen; Perkins, Laura E L; Hossainy, Syed; Mori, Hiroyoshi; Rapoza, Richard J; Kolodgie, Frank; Virmani, Renu

2017-09-07

The polymers poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) and poly(n-butyl methacrylate) (PBMA) are employed in manufacturing the XIENCE family of coronary stents. PBMA serves as a primer and adheres to both the stent and the drug coating. PVDF-HFP is employed in the drug matrix layer to hold the drug everolimus on the stent and control its release. Chemical stability of the polymers of XIENCE stents in the in-vivo environment was evaluated by pyrolysis-gas chromatography with mass spectrometry (Py-GC/MS) detection. For this evaluation, XIENCE stents explanted from porcine coronary arteries and from human coronary artery specimens at autopsy after 2-4 and 5-7 years of implantation, respectively, were compared to freshly manufactured XIENCE stents (controls). The comparison of pyrograms of explanted stent samples and controls showed identical fragmentation fingerprints of polymers, indicating that PVDF-HFP and PBMA maintained their chemical integrity after multiple years of XIENCE coronary stent implantation. The findings of the present study demonstrate the chemical stability of PVDF-HFP and PBMA polymers of the XIENCE family of coronary stents in the in-vivo environment, and constitute a further proof of the suitability of PVDF-HFP as a drug carrier for the drug eluting stent applications. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

Brachial-ankle pulse wave velocity is associated with coronary calcium in young and middle-aged asymptomatic adults: The Kangbuk Samsung Health Study.

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Cainzos-Achirica, Miguel; Rampal, Sanjay; Chang, Yoosoo; Ryu, Seungho; Zhang, Yiyi; Zhao, Di; Cho, Juhee; Choi, Yuni; Pastor-Barriuso, Roberto; Lim, So Yeon; Bruguera, Jordi; Elosua, Roberto; Lima, Joao A C; Shin, Hocheol; Guallar, Eliseo

2015-08-01

To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. The prevalence of CAC > 0 and CAC > 100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC > 0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend  100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend  100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the discrimination and calibration of models for detecting prevalent CAC > 0 and CAC > 100. BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.

Science.gov (United States)

Nel, Karen; Nam, Michael C Y; Anstey, Chris; Boos, Christopher J; Carlton, Edward; Senior, Roxy; Kaski, Juan Carlos; Khattab, Ahmed; Shamley, Delva; Byrne, Christopher D; Stanton, Tony; Greaves, Kim

2017-12-01

Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation. Copyright © 2017 Elsevier B.V. All rights

Spontaneous bacterial coronary sinus septic thrombophlebitis treated successfully medically.

Science.gov (United States)

Fournet, Maxime; Behaghel, Albin; Pavy, Carine; Flecher, Erwan; Thebault, Christophe

2014-03-01

A 38-year-old farmer was hospitalized for fever, chills, cough, and chest pain lasting for 7 days. Due to persistent symptoms, patient was referred to hospital. Blood cultures identified oxacillin-sensitive Staphylococcus aureus (OSSA). Transthoracic echocardiography (TTE) showed large pericardial effusion, a mobile heterogeneous mass originating from the coronary sinus ostium, no sign of valvular endocarditis. Pericardiocentesis was done carrying out purulent fluid, microbiological culture isolating an OSSA. Parenteral penicillin M was administered for 6 weeks. At the end of this antibiotherapy regimen, TTE showed no coronary sinus mass with complete vacuity of the coronary sinus vein and no pericardial effusion.

Myocardial Ischaemia, Coronary Atherosclerosis and Pulmonary Pressure Elevation in Antiphospholipid Syndrome Patients.

Science.gov (United States)

Padjas, Agnieszka; Płazak, Wojciech; Celińska-Lowenhoff, Magdalena; Mazurek, Adam; Perricone, Carlo; Podolec, Piotr; Musiał, Jacek

2016-01-01

Thrombotic events in antiphospholipid syndrome (APS) involve venous and arterial circulation with the possible involvement of coronary or pulmonary microcirculation. To evaluate the influence of antiphospholipid antibodies (aPL) and on myocardial ischaemia assessed by single-photon emission computerized tomography (SPECT), coronary atherosclerosis assessed by multidetector computerized tomography (MDCT) and pulmonary pressure assessed by transthoracic echocardiography (TTE) in patients with primary antiphospholipid syndrome (PAPS). TTE, SPECT (Tc 99m sestamibi) and MDCT-based coronary calcium scoring were performed in 26 consecutive PAPS patients (20 females, 6 males, aged 20-61, mean 39.7) without any signs of other autoimmunological disease and without clinical symptoms of heart disease. Out of 26 patients, TEE showed normal left and right ventricle function in 25 (96.2%) and elevated (≥ 30 mm Hg) right ventricle systolic pressure in 7 (26.9%) patients. SPECT revealed myocardial perfusion defects in 15 (57.7%) patients: exercise-induced in 6 (23.1%) and persistent in 11 (42.3%). MDCT revealed coronary calcifications in 4 (15.4%) patients. The number of plaques ranged from 1 to 11 (median 2), volume 3-201.7 mm³ (median 7), calcium scores 1.3-202.6 (median 5.7). In the group with perfusion defects or coronary calcifications (n = 15), all the patients showed elevated aCL IgG. In most of the relatively young APS patients, without any symptoms of ischemic heart disease, SPECT showed myocardial perfusion defects, and coronary calcifications in 1/6 of them. Right ventricle systolic pressure was elevated in 1/4 of APS patients. These pathologies, well known as cardiovascular risk markers, were associated with elevated levels of the IgG class of both anti-cardiolipin and antiB2 GPI antibodies. Thus, in a high percentage of APS patients, clinically silent myocardial ischaemia, pulmonary pressure elevation and coronary atherosclerosis are present and related to the

Whole-heart 320-row computed tomography. Reduction of radiation dose via prior coronary calcium scanning

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Zimmermann, E.; Dewey, M. [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

2011-01-15

Purpose: The whole heart can be scanned in one rotation using 320-row coronary computed tomography angiography (CCTA), which covers up to 16 cm. Since most hearts are smaller, the total radiation dose may be reduced by adjusting the CCTA range to the individual heart size defined on a low-dose calcium scan (CACS). Materials and Methods: Forty-five patients with suspected coronary artery disease (13 women, 32 men; mean 61 {+-} 10 years) underwent CCTA preceded by low-dose CACS on a 320-row scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation, 120 kV, 350 - 450 mA) with 16-cm z-axis coverage (120 kV, 150 mA). The subsequent CCTA was performed over an adjusted scan range calculated as the individual heart size on CACS ({+-} 1 cm above and below). The total radiation dose of 16-cm CACS and the individually adjusted CCTA was compared with that of a calculated single CCTA using full 16-cm z-axis coverage. Results: CCTA could be performed with a reduced scan length in the z-axis in all patients. None of the scans had to be performed over the whole range of 16 cm. The adjusted scan length was 14 cm in 2 patients, 12.8 cm in 3 patients, and 12 cm in 40 patients. The effective CCTA scan range was 12.1 {+-} 0.5 cm based on mean individual heart sizes of 9.6 {+-} 1.1 cm. The mean total effective radiation dose of the entire cardiac CT examination (individually adapted CCTA and CACS) was significantly smaller than the exposure calculated for 16-cm CCTA without CACS (8.5 {+-} 4.7 vs. 9.1 {+-} 6.0 mSv, p = 0.006). The dose reduction was most relevant in patients with heart rates above 65 beats/min (n = 10) in whom 2 or 3 heartbeats were necessary for CCTA (17.7 {+-} 6.5 vs. 21.1 {+-} 8.4 mSv, p = 0.001). Conclusion: 320-row CCTA with an individually adjusted scan range based on prior CACS significantly reduces the radiation exposure compared with full 16-cm CCTA. (orig.)

Correlation study on waist circumference-triglyceride (WT) index and coronary artery scores in patients with coronary heart disease.

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Yang, R-F; Liu, X-Y; Lin, Z; Zhang, G

2015-01-01

Coronary disease is analyzed through common lipid profiles, but these analyses fail to account for residual risk due to abdominal weight and elevated TG levels. We aimed to investigate the relationship between the waist circumference × triglyceride index (WT index) and the Coronary Artery Score (CAS) in patients with coronary heart disease. 346 patients in our Cardiology Department were recruited from September 2007 to August 2011 and divided into two groups according to whether the patients presented with metabolic syndrome. We performed coronary angiography using the standard Judkins method. The severity of coronary artery stenosis and the CAS were calculated and analyzed with a computerized quantitative analysis system. The signs index, which includes the body mass index (BMI), waist circumference, hip circumference, waist-hip-ratio, and waist-height-ratio, the blood glucose and blood lipid index of all the patients were collected and used to calculate the WT index (waist circumference x triglyceride index. We performed a correlative analysis with age, gender, body mass index, blood glucose and blood lipid, blood pressure and other risk indicators of all patients as the dependent variables and the CAS as the independent variable. We show that the CAS is positively correlated to the WT index. Several lipid profiles and waist circumference were significantly associated with the CAS. The WT index is correlated to the CAS and is a good predictor for the development of coronary artery disease; it can be applied in the clinic for early intervention in populations at risk for coronary heart disease.

X-ray dual energy spectral parameter optimization for bone Calcium/Phosphorus mass ratio estimation

International Nuclear Information System (INIS)

Sotiropoulou, P I; Martini, N D; Koukou, V N; Nikiforidis, G C; Fountos, G P; Michail, C M; Valais, I G; Kandarakis, I S

2015-01-01

Calcium (Ca) and Phosphorus (P) bone mass ratio has been identified as an important, yet underutilized, risk factor in osteoporosis diagnosis. The purpose of this simulation study is to investigate the use of effective or mean mass attenuation coefficient in Ca/P mass ratio estimation with the use of a dual-energy method. The investigation was based on the minimization of the accuracy of Ca/P ratio, with respect to the Coefficient of Variation of the ratio. Different set-ups were examined, based on the K-edge filtering technique and single X-ray exposure. The modified X-ray output was attenuated by various Ca/P mass ratios resulting in nine calibration points, while keeping constant the total bone thickness. The simulated data were obtained considering a photon counting energy discriminating detector. The standard deviation of the residuals was used to compare and evaluate the accuracy between the different dual energy set-ups. The optimum mass attenuation coefficient for the Ca/P mass ratio estimation was the effective coefficient in all the examined set-ups. The variation of the residuals between the different set-ups was not significant. (paper)

Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography

International Nuclear Information System (INIS)

Cademartiri, Filippo; Krestin, Gabriel P.; Mollet, Nico R.; Feyter, Pim J. de; Runza, Giuseppe; Midiri, Massimo; Bruining, Nico; Hamers, Ronald; Somers, Pamela; Knaapen, Michiel; Verheye, Stefan

2005-01-01

Assessment of attenuation (measured in Hounsfield units, HU) of human coronary plaques was performed using multislice computed tomography (MSCT) in an ex vivo model. In three ex vivo specimens of left coronary arteries in oil, MSCT was performed after intracoronary injection of four solutions of contrast material (400 mgI/ml iomeprol). The four solutions were diluted as follows: 1/∞, 1/200, 1/80, and 1/20. All scans were performed with the following parameters: slices/collimation 16/0.75 mm, rotation time 375 ms. Each specimen was scored for the presence of atherosclerotic plaques. In each plaque the attenuation was measured in four regions of interest for lumen, plaque (non-calcified thickening of the vessel wall), calcium, and surrounding (oil surrounding the vessel). The results were compared with a one-way analysis of variance test and were correlated with Pearson's test. There were no significant differences in the attenuation of calcium and oil in the four solutions. The mean attenuation in the four solutions for lumen (35±10, 91±7, 246±18, 511±89 HU) and plaque (22±22, 50±26, 107±36, 152±67 HU) was significantly different between each decreasing dilution (p<0.001). The mean attenuation of lumen and plaque of coronary plaques showed high correlation, while the values were significantly different (r=0.73; p<0.001). Intracoronary attenuation modifies significantly the attenuation of plaques assessed with MSCT. (orig.)

Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

LENUS (Irish Health Repository)

Rodríguez-Granillo, Gastón A

2012-01-05

Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

Analysis of arsenic and calcium in soil samples by laser ablation mass spectrometry

International Nuclear Information System (INIS)

Beccaglia, Ana M.; Rinaldi, Carlos A.; Ferrero, Juan C.

2006-01-01

We present an analytical procedure based on laser ablation mass spectrometry (LAMS) in order to detect and quantify arsenic and calcium in soil samples and we analyze the diverse factors that influence the precision of LAMS, such as laser fluence and matrix effect. The results indicate that a Zn matrix is a good choice for the analysis of those metals in soil samples. This work also provides a method for the direct determination of As in soil samples whose concentrations are lower than 100 ppm with a 70 ppm minimum detection limits (MDL)

Quantitative coronary plaque analysis predicts high-risk plaque morphology on coronary computed tomography angiography: results from the ROMICAT II trial.

Science.gov (United States)

Liu, Ting; Maurovich-Horvat, Pál; Mayrhofer, Thomas; Puchner, Stefan B; Lu, Michael T; Ghemigian, Khristine; Kitslaar, Pieter H; Broersen, Alexander; Pursnani, Amit; Hoffmann, Udo; Ferencik, Maros

2018-02-01

Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm 3 , 95% CI 1.04-1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10-1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08-2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.

Measured versus self-reported body height and body mass in patients after an acute coronary syndrome

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Domagała Zygmunt

2017-12-01

Full Text Available The basic anthropometric data describing a person in the broadest context are body weight and height, two of the most frequently analyzed somatometric parameters. The same is true I in relation to clinical patients. The aim of the present study was to compare the self-reported and actual body weight, height and BMI in patients suffering from coronary artery disease and undergoing cardiac rehabilitation. The study sample consisted of 100 patients treated for coronary artery disease. The patients were asked to state their body weight and height. At the same time a three-person study team took measurements, which were later the basis for verification and objective assessment of the data provided by the patients. Statistical analysis was performed with Statistics 11.0 PL software. The analysis of mean results for the assessed group of patients has shown the presence of statistically significant differences between declared and actual data. The differences were observed for both male and female study population. It has been proven that the subjects declare greater body height (mean value 1.697 m vs. 1.666 m and lower body weight (80.643 kg vs. 82.051 kg. Based on the data from surveys and direct measurements, the body mass index for the self-reported and actual data was calculated. A comparison of these values has shown considerable statistically significant differences. The differences between declared and actual data point to highly subjective self-assessment, which disqualifies the declared data in the context of monitoring of treatment and rehabilitation processes. The authors believe that actual data should be used in direct trial examination of patients suffering from coronary artery disease who presented with acute coronary syndrome.

Limitations of 64-Detector-Row Computed Tomography Coronary Angiography: Calcium and Motion but not Short Experience

International Nuclear Information System (INIS)

Mir-Akbari, H.; Ripsweden, J.; Jensen, J.; Pichler, P.; Sylven, C.; Cederlund, K.; Rueck, A.

2009-01-01

Background: Recently, 64-detector-row computed tomography coronary angiography (CTA) has been introduced for the noninvasive diagnosis of coronary artery disease. Purpose: To evaluate the diagnostic capacity and limitations of a newly established CTA service. Material and Methods: In 101 outpatients with suspected coronary artery disease, 64-detector-row CTA (VCT Lightspeed 64; GE Healthcare, Milwaukee, WI., USA) was performed before invasive coronary angiography (ICA). The presence of >50% diameter coronary stenosis on CTA was rated by two radiologists recently trained in CTA, and separately by an experienced colleague. Diagnostic performance of CTA was calculated on segment, vessel, and patient levels, using ICA as a reference. Segments with a proximal reference diameter <2 mm or with stents were not analyzed. Results: In 51 of 101 patients and 121 of 1280 segments, ICA detected coronary stenosis. In 274 of 1280 (21%) segments, CTA had non-diagnostic image quality, the main reasons being severe calcifications (49%), motion artifacts associated with high or irregular heart rate (45%), and low contrast opacification (14%). Significantly more women (43%) had non-diagnostic scans compared to men (20%). A heart rate above 60 beats per minute was associated with significantly more non-diagnostic patients (38% vs. 18%). In the 1006 diagnostic segments, CTA had a sensitivity of 78%, specificity of 95%, positive predictive value (PPV) of 54%, and negative predictive value (NPV) of 98% for detecting significant coronary stenosis. In 29 patients, CTA was non-diagnostic. In the remaining 72 patients, sensitivity was 100%, specificity 65%, PPV 79%, and NPV 100%. The use of a more experienced CTA reader did not improve diagnostic performance. Conclusion: CTA had a very high negative predictive value, but the number of non-diagnostic scans was high, especially in women. The main limitations were motion artifacts and vessel calcifications, while short experience in CTA did not

Chapter 15. Measurement of the main calcium metabolism processes

International Nuclear Information System (INIS)

Milhaud, G.

1975-01-01

A method of measuring the chief calcium metabolism processes in man is described and is based on the following techniques and theory: intraveinous injection of 45 Ca; determination of the specific radioactivity of serum calcium, total radioactivity of urine and stools, ingested and excreted calcium; mathematical analysis of the specific radioactivity decay curve for serum calcium. The following data were obtained in this way: intestinal absorption fraction of calcium in the chemical state in which it is found in foods; quantity of calcium excreted by the intestin, as distinct from the non-absorbed fraction; physiological turnover rates in the skeleton by osteolysis and osteoblastosis; mass of rapidly exchangeable calcium in the organism, i.e. the calcium pool; rates of exchange with serum calcium of calcium from the different pool components, mass of bone calcium subjected to recrystallisation. Some applications of the method in man and the verification of the theory in rats are reported [fr

Calcium carbonate scaling kinetics determined from radiotracer experiments with calcium-47

International Nuclear Information System (INIS)

Turner, C.W.; Smith, D.W.

1998-01-01

The deposition rate of calcium carbonate on a heat-transfer surface has been measured using a calcium-47 radiotracer and compared to the measured rate of thermal fouling. The crystalline phase of calcium carbonate that precipitates depends on the degree of supersaturation at the heat-transfer surface, with aragonite precipitating at higher supersaturations and calcite precipitating at lower supersaturations. Whereas the mass deposition rates were constant with time, the thermal fouling rates decreased throughout the course of each experiment as a result of densification of the deposit. It is proposed that the densification was driven by the temperature gradient across the deposit together with the retrograde solubility of calcium carbonate. The temperature dependence of the deposition rate yielded an activation energy of 79 ± 4 kJ/mol for the precipitation of calcium carbonate on a heat-transfer surface. (author)

Anatomy and function relation in the coronary tree: from bifurcations to myocardial flow and mass.

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Kassab, Ghassan S; Finet, Gerard

2015-01-01

The study of the structure-function relation of coronary bifurcations is necessary not only to understand the design of the vasculature but also to use this understanding to restore structure and hence function. The objective of this review is to provide quantitative relations between bifurcation anatomy or geometry, flow distribution in the bifurcation and degree of perfused myocardial mass in order to establish practical rules to guide optimal treatment of bifurcations including side branches (SB). We use the scaling law between flow and diameter, conservation of mass and the scaling law between myocardial mass and diameter to provide geometric relations between the segment diameters of a bifurcation, flow fraction distribution in the SB, and the percentage of myocardial mass perfused by the SB. We demonstrate that the assessment of the functional significance of an SB for intervention should not only be based on the diameter of the SB but also on the diameter of the mother vessel as well as the diameter of the proximal main artery, as these dictate the flow fraction distribution and perfused myocardial mass, respectively. The geometric and flow rules for a bifurcation are extended to a trifurcation to ensure optimal therapy scaling rules for any branching pattern.

Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease

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Assante, Roberta; Zampella, Emilia; Nappi, Carmela; Mainolfi, Ciro Gabriele; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Acampa, Wanda [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Arumugam, Parthiban; Tonge, Christine M. [Central Manchester University Teaching Hospitals, Nuclear Medicine Center, Manchester (United Kingdom); Gaudieri, Valeria; Panico, Mariarosaria; Magliulo, Mario [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy)

2017-12-15

To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). We studied 436 patients undergoing hybrid {sup 82}Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). CFR was calculated as the ratio of hyperemic to baseline myocardial blood flow, and it was considered reduced when <2. Follow-up was 94% complete during a mean period of 47±15 months. During follow-up, 17 events occurred (4% cumulative event rate). Event-free survival decreased with worsening of CAC score category (p < 0.001) and in patients with reduced CFR (p < 0.005). At multivariable analysis, CAC score ≥400 (p < 0.01) and CFR (p < 0.005) were independent predictors of events. Including CFR in the prognostic model, continuous net reclassification improvement was 0.51 (0.14 in patients with events and 0.37 in those without). At classification and regression tree analysis, the initial split was on CAC score. For patients with a CAC score < 400, no further split was performed, while patients with a CAC score ≥400 were further stratified by CFR values. Decision curve analyses indicate that the model including CFR resulted in a higher net benefit across a wide range of decision threshold probabilities. In patients with suspected CAD, CFR provides significant incremental risk stratification over established cardiac risk factors and CAC score for prediction of adverse cardiac events. (orig.)

Dietary calcium but not elemental calcium from supplements is associated with body composition and obesity in Chinese women.

Directory of Open Access Journals (Sweden)

Lina Huang

Full Text Available We assessed whether dietary calcium intake or calcium supplements associated with body composition and obesity in a Chinese population.A cross-sectional survey was performed in a population of 8940, aged 20 to 74 y. 8127 participants responded (90.9%. Height, weight, fat mass (FM, waist circumference (WC and hip circumference were measured. Obesity definition: body mass index (BMI ≥28 kg/m(2 (overall obesity; WC ≥85 cm for men or ≥80 cm for women (abdominal obesity І and waist hip ratio (WHR ≥0.90 for men or ≥0.85 for women (abdominal obesity П. The data on dietary calcium and calcium supplements were collected using food-frequency questionnaire and self-report questionnaire. Multivariate linear and multivariable logistic regressions were used to examine the associations between dietary calcium intake or calcium supplements and body composition and obesity.The average dietary calcium intake of all subjects was 430 mg/d. After adjusting for potential confounding factors, among women only, negative associations were observed between habitual dietary calcium intake and four measures of body composition (β, -0.086, P0.05. Similarly, among both men and women, we did not observe significant associations between calcium supplements and any measures of body composition or abdominal obesity (P>0.05.Dietary calcium from food rather than elemental calcium from calcium supplements has beneficial effects on the maintenance of body composition and preventing abdominal obesity in Chinese women.

Statin eligibility and cardiovascular risk burden assessed by coronary artery calcium score: comparing the two guidelines in a large Korean cohort.

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Rhee, Eun-Jung; Park, Se Eun; Oh, Hyung Geun; Park, Cheol-Young; Oh, Ki-Won; Park, Sung-Woo; Blankstein, Ron; Plutzky, Jorge; Lee, Won-Young

2015-05-01

To investigate the statin eligibility and the predictabilities for cardiovascular disease between AHA/ACC and ATPIII guidelines, comparing those results to concomitant coronary artery calcium scores (CACS) in a large cohort of Korean individuals who met statin-eligibility criteria. Among 19,920 participants in a health screening program, eligibility for statin treatment was assessed by the two guidelines. The presence and extent of coronary artery calcification (CAC) was measured by multi-detector computed tomography and compared among the various groups defined by the two guidelines. Applying the new ACC/AHA guideline to the health screening cohort increased the statin-eligible population from 18.7% (as defined by ATP III) to 21.7%. Statin-eligible subjects as defined only by ACC/AHA guideline manifested a higher proportion of subjects with CAC compared with those meeting only ATP-III criteria even after adjustment for age and sex (47.1 vs. 33.8%, pguideline showed higher odds ratio for the presence of CACS>0 compared with those meeting ATP-III criteria {3.493 (3.245∼3.759) vs. 2.865 (2.653∼3.094)}, which was attenuated after adjusted for age and sex. In this large Korean cohort, more subjects would have qualified for statin initiation under the new ACC/AHA guideline as compared with the proportion recommended for statin treatment by ATP III guideline. Among statin-eligible Korean health screening subjects, the new ACC/AHA guideline identified a greater extent of atherosclerosis as assessed by CACS as compared to ATP III guideline assessment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prevalence of asymptomatic coronary disease in fibrosing idiopathic interstitial pneumonias

International Nuclear Information System (INIS)

Cassagnes, Lucie; Gaillard, Vianney; Monge, Emmanuel; Faivre, Jean-Baptiste; Delhaye, Cédric; Molinari, Francesco; Petyt, Grégory; Hossein-Foucher, Claude; Wallaert, Benoit; Duhamel, Alain; Remy, Jacques; Remy-Jardin, Martine

2015-01-01

Background: Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischaemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. Methods: Forty-two patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect >5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect >10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. Results: Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischaemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). Conclusion: In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%

Prevalence of asymptomatic coronary disease in fibrosing idiopathic interstitial pneumonias

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Cassagnes, Lucie; Gaillard, Vianney [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Monge, Emmanuel [Department of Pulmonology, Center of Competence for Rare Pulmonary Diseases, Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Faivre, Jean-Baptiste [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Delhaye, Cédric [Department of Cardiology, Cardiology Hospital, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Molinari, Francesco [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Petyt, Grégory; Hossein-Foucher, Claude [Department of Nuclear Medicine, Hospital Salengro, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Wallaert, Benoit [Department of Pulmonology, Center of Competence for Rare Pulmonary Diseases, Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Duhamel, Alain [Department of Medical Statistics (EA 2694), Univ Lille Nord de France, F-59000 Lille (France); Remy, Jacques [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Remy-Jardin, Martine, E-mail: martine.remy@chru-lille.fr [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France)

2015-01-15

Background: Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischaemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. Methods: Forty-two patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect >5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect >10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. Results: Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischaemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). Conclusion: In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%.

Influence of a small field-of-view size on the detection of coronary artery calcifications with MSCT: in vitro and in vivo study

International Nuclear Information System (INIS)

Mahnken, Andreas H.; Muehlenbruch, Georg; Das, Marco; Pohl, Saskia; Guenther, Rolf W.; Wildberger, Joachim E.; Koos, Ralf; Stanzel, Sven

2006-01-01

The purpose of this study is to asses the impact of small field-of-view (FOV) sizes on the detection of coronary artery calcifications using multislice-spiral computed tomography (MSCT). First, a static chest phantom containing calcium inserts was scanned 10 times using a standardized scan protocol. Secondly, 50 patients (28 male, 63.6±10.6 years) underwent cardiac MSCT using the same protocol. Images were reconstructed with three different FOV sizes (180 x 180, 220 x 220, 380 x 380 mm 2 ). Coronary calcium scoring and risk stratification were performed for each image series. In the phantom study, the Agatston score calculated with a FOV size of 180 x 180 mm 2 was 657.80±20.05. At a FOV of 220 x 220 mm 2 and 380 x 380 mm 2 , the corresponding values were 657.04±21.36 and 655.04±20.74, respectively. The corresponding values in the patient study were 541.65±869.87, 541.91±872.57 and 536.61±867.81. No statistically significant differences in the calcium score were found comparing different FOV sizes. Significantly more lesions (p=0.00149) were detected in the patient study. Comparing the different FOV sizes of 180 x 180 mm 2 and 220 x 220 mm 2 (380 x 380 mm 2 ), four (six) patients had to be assigned to different risk groups. The use of small FOV sizes resulted in an improved detection of coronary calcifications influencing the risk stratification for further cardiac events in MSCT coronary calcium scoring. (orig.)

Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

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Dedic, Admir; Ten Kate, Gert-Jan R; Roos, Cornelis J; Neefjes, Lisan A; de Graaf, Michiel A; Spronk, Angela; Delgado, Victoria; van Lennep, Jeanine E Roeters; Moelker, Adriaan; Ouhlous, Mohamed; Scholte, Arthur J H A; Boersma, Eric; Sijbrands, Eric J G; Nieman, Koen; Bax, Jeroen J; de Feijter, Pim J

2016-03-01

At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD. Copyright © 2016 Elsevier Inc. All rights reserved.

Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

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Pereira, Alexandre C; Gomez, Luz M; Bittencourt, Marcio Sommer; Staniak, Henrique Lane; Sharovsky, Rodolfo; Foppa, Murilo; Blaha, Michael J; Bensenor, Isabela M; Lotufo, Paulo A

2016-06-01

Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Percentiles of CAC distribution were estimated with nonparametric techniques. The analysis included 3616 individuals (54% female; mean age, 50 years). As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. © 2016 Wiley Periodicals, Inc.

Reproducibility of coronary calcification detection with electron-beam computed tomography

International Nuclear Information System (INIS)

Hernigou, A.; Challande, P.; Boudeville, J.C.; Sene, V.; Grataloup, C.; Plainfosse, M.

1996-01-01

If coronary calcification scores obtained with electron-beam computed tomography (EBT) were proved to be correlated to coronary atherosclerosis, the reproducibility of the technique had to be assessed before being useed for patient follow-up. A total of 150 patients, selected as a result of a cholesterol screening programme, were studied by EBT. Twelve contiguous 3-mm-thick transverse slices beginning on the proximal coronary arteries were obtained through the base of the heart. The amount of calcium was evaluated as the calcified area weighted by a coefficient depending on the density peak level. The value was expressed as a logarithmic scale. Intra-observer, inter-observer and inter-examination reproducibilities were calculated. They were 1.9, 1.3 and 7.2%, respectively. These results were good enough to allow the use of EBT for longitudinal studies. The influence of acquisition and calculation conditions on score computation were also analysed. (orig.)

Calcium scoring with dual-energy CT in men and women: an anthropomorphic phantom study

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Li, Qin; Liu, Songtao; Myers, Kyle; Gavrielides, Marios A.; Zeng, Rongping; Sahiner, Berkman; Petrick, Nicholas

2016-03-01

This work aimed to quantify and compare the potential impact of gender differences on coronary artery calcium scoring with dual-energy CT. An anthropomorphic thorax phantom with four synthetic heart vessels (diameter 3-4.5 mm: female/male left main and left circumflex artery) were scanned with and without female breast plates. Ten repeat scans were acquired in both single- and dual-energy modes and reconstructed at six reconstruction settings: two slice thicknesses (3 mm, 0.6 mm) and three reconstruction algorithms (FBP, IR3, IR5). Agatston and calcium volume scores were estimated from the reconstructed data using a segmentation-based approach. Total calcium score (summation of four vessels), and male/female calcium scores (summation of male/female vessels scanned in phantom without/with breast plates) were calculated accordingly. Both Agatston and calcium volume scores were found comparable between single- and dual-energy scans (Pearson r= 0.99, pwomen and men in calcium scoring, and for standardizing imaging protocols for improved gender-specific calcium scoring.

Calcification remodeling index characterized by cardiac CT as A novel parameter to predict the use of rotational atherectomy for coronary intervention of lesions with moderate to severe calcification

International Nuclear Information System (INIS)

Yu, Meng Meng; Li, Yue Hua; Li, Wen Bin; Lu, Zhi Gang; Wei, Meng; Zhang, Jia Yin

2017-01-01

To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.

Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification

Science.gov (United States)

Yu, Mengmeng; Li, Yuehua; Li, Wenbin; Lu, Zhigang; Wei, Meng

2017-01-01

Objective To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation. PMID:28860893

Calcification remodeling index characterized by cardiac CT as A novel parameter to predict the use of rotational atherectomy for coronary intervention of lesions with moderate to severe calcification

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Yu, Meng Meng; Li, Yue Hua; Li, Wen Bin; Lu, Zhi Gang; Wei, Meng; Zhang, Jia Yin [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China)

2017-09-15

To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.

Discovery and Development of Calcium Channel Blockers

Directory of Open Access Journals (Sweden)

Théophile Godfraind

2017-05-01

Full Text Available In the mid 1960s, experimental work on molecules under screening as coronary dilators allowed the discovery of the mechanism of calcium entry blockade by drugs later named calcium channel blockers. This paper summarizes scientific research on these small molecules interacting directly with L-type voltage-operated calcium channels. It also reports on experimental approaches translated into understanding of their therapeutic actions. The importance of calcium in muscle contraction was discovered by Sidney Ringer who reported this fact in 1883. Interest in the intracellular role of calcium arose 60 years later out of Kamada (Japan and Heibrunn (USA experiments in the early 1940s. Studies on pharmacology of calcium function were initiated in the mid 1960s and their therapeutic applications globally occurred in the the 1980s. The first part of this report deals with basic pharmacology in the cardiovascular system particularly in isolated arteries. In the section entitled from calcium antagonists to calcium channel blockers, it is recalled that drugs of a series of diphenylpiperazines screened in vivo on coronary bed precontracted by angiotensin were initially named calcium antagonists on the basis of their effect in depolarized arteries contracted by calcium. Studies on arteries contracted by catecholamines showed that the vasorelaxation resulted from blockade of calcium entry. Radiochemical and electrophysiological studies performed with dihydropyridines allowed their cellular targets to be identified with L-type voltage-operated calcium channels. The modulated receptor theory helped the understanding of their variation in affinity dependent on arterial cell membrane potential and promoted the terminology calcium channel blocker (CCB of which the various chemical families are introduced in the paper. In the section entitled tissue selectivity of CCBs, it is shown that characteristics of the drug, properties of the tissue, and of the stimuli are

Calcium isotope fractionation between soft and mineralized tissues as a monitor of calcium use in vertebrates

Science.gov (United States)

Skulan, Joseph; DePaolo, Donald J.

1999-01-01

Calcium from bone and shell is isotopically lighter than calcium of soft tissue from the same organism and isotopically lighter than source (dietary) calcium. When measured as the 44Ca/40Ca isotopic ratio, the total range of variation observed is 5.5‰, and as much as 4‰ variation is found in a single organism. The observed intraorganismal calcium isotopic variations and the isotopic differences between tissues and diet indicate that isotopic fractionation occurs mainly as a result of mineralization. Soft tissue calcium becomes heavier or lighter than source calcium during periods when there is net gain or loss of mineral mass, respectively. These results suggest that variations of natural calcium isotope ratios in tissues may be useful for assessing the calcium and mineral balance of organisms without introducing isotopic tracers. PMID:10570137

Lipoprotein subclasses in the Monitored Atherosclerosis Regression Study (MARS). Treatment effects and relation to coronary angiographic progression.

Science.gov (United States)

Mack, W J; Krauss, R M; Hodis, H N

1996-05-01

Accumulating evidence suggests that triglyceride-rich lipoproteins contribute to coronary artery disease. Using data from the Monitored Atherosclerosis Regression Study, an angiographic trial of middle-aged men and women randomized to lovastatin or placebo, we investigated relationships between lipoprotein subclasses and progression of coronary artery atherosclerosis. Coronary artery lesion progression was determined by quantitative coronary angiography in low-grade ( or = 50% diameter stenosis), and all coronary artery lesions in 220 baseline/2-year angiogram pairs. Analytical ultracentrifugation was used to measure lipoprotein masses that were statistically evaluated for treatment group differences and relationships to progression of coronary artery atherosclerosis. All low density lipoprotein (LDL), intermediate density lipoprotein (IDL), and very low density lipoprotein (VLDL) masses were significantly lowered and all high density lipoprotein (HDL) masses were significantly raised with lovastatin therapy. The mass of smallest LDL (Svedberg flotation rate [Sf] 0 to 3), IDL (Sf 12 to 20), all VLDL subclasses (Sf 20 to 60, Sf 60 to 100, and Sf 100 to 400), and peak LDL flotation rate were significantly related to the progression of coronary artery lesions, specifically low-grade lesions. Greater baseline levels of HDL3, were related to a lower likelihood of coronary artery lesion progression. In multivariate analyses, small VLDL (Sf 20 to 60) and HDL3 mass were the most important correlates of coronary artery lesion progression. These results provide further evidence for the importance of triglyceride-rich lipoproteins in the progression of coronary artery disease. In addition, these results present new evidence for the possible protective role of HDL3 in the progression of coronary artery lesions. More specific information on coronary artery lesion progression may be obtained through the study of specific apolipoprotein B-containing lipoproteins.

Waist Circumference as a Marker of Obesity Is More Predictive of Coronary Artery Calcification than Body Mass Index in Apparently Healthy Korean Adults: The Kangbuk Samsung Health Study.

Science.gov (United States)

Park, Jongsin; Lee, Eun Seo; Lee, Da Young; Kim, Jihyun; Park, Se Eun; Park, Cheol Young; Lee, Won Young; Oh, Ki Won; Park, Sung Woo; Rhee, Eun Jung

2016-12-01

We aimed to assess the risk for coronary artery calcification (CAC) according to groups subdivided by body mass index (BMI) and waist circumference (WC) in apparently healthy Korean adults. Thirty-three thousand four hundred and thirty-two participants (mean age, 42 years) in a health screening program were divided into three groups according to BMI: 25 kg/m² (obese). In addition, the participants were divided into two groups according to WC. Coronary artery calcium score (CACS) was measured with multi-detector computed tomography in all participants. Presence of CAC was defined as CACS >0. When logistic regression analysis was performed with the presence of CAC as the dependent variable, the risk for CAC increased as BMI increased after adjusting for confounding variables (1.102 [95% confidence interval (CI), 1.000 to 1.216]; 1.284 [95% CI, 1.169 to 1.410]; in the overweight and obese groups vs. the normal weight group). When the participants were divided into six groups according to BMI and WC, the subjects with BMI and WC in the obese range showed the highest risk for CAC (1.321 [95% CI, 1.194 to 1.461]) and those with BMI in the overweight range and WC in the obese range showed the second highest risk for CAC (1.235 [95% CI, 1.194 to 1.461]). Participants with obesity defined by both BMI and WC showed the highest risk for CAC. Those with BMIs in the overweight range but with WC in the obese range showed the second highest risk for CAC, suggesting that WC as a marker of obesity is more predictive of CAC than BMI.

Potentiation of phorbol ester-induced coronary vasoconstriction in dogs following endothelium disruption

International Nuclear Information System (INIS)

Roberts, R.B.; Ku, D.D.

1986-01-01

In the present study, the effect of phorbol ester, 12-0-tetradecanoylphorbol 13-acetate (TPA), activation of protein kinase C on coronary vascular reactivity was studied in isolated dog coronary arteries. Addition of TPA (10-100 nM) produced a slow, time- and dose-dependent contraction reaching a maximum at approx 2-3 hrs and was essentially irreversible upon washing. Disruption of the endothelium(EC) greatly accelerated the development as well as increase the magnitude of TPA contraction (50-100%). Prior treatment of vessels with phentolamine (1μM), cyproheptadine (1μH) and ibuprofen (1μg/ml) did not alter the TPA contraction. Furthermore, in contrast to previously reported calcium-dependence of TPA contraction in other vessels, complete removal of extracellular calcium (Ca 0 ) or addition of 1μM nimodipine after TPA(30nM) resulted in only 32 +/- 4% and 25 +/- 3% reversal of TPA contraction, respectively. Addition of amiloride (10μM to 1mM), however, resulted in a dose-dependent reversal of TPA contraction. The results of the present study indicate that a similar activation of protein kinase C by TPA leads to potent coronary vasoconstriction, which is not completely dependent on Ca 0 . More importantly, these results further support their hypothesis that EC also functions as an inhibitory barrier to prevent circulating vasoconstrictors from exerting their deleterious constrictory effects

Fitness attenuates the prevalence of increased coronary artery calcium in individuals with metabolic syndrome.

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Ekblom-Bak, Elin; Ekblom, Örjan; Fagman, Erika; Angerås, Oskar; Schmidt, Caroline; Rosengren, Annika; Börjesson, Mats; Bergström, Göran

2018-02-01

Background The association between cardiorespiratory fitness, physical activity and coronary artery calcium (CAC) is unclear, and whether higher levels of fitness attenuate CAC prevalence in subjects with metabolic syndrome is not fully elucidated. The present study aims to: a) investigate the independent association of fitness on the prevalence of CAC, after adjustment for moderate-to-vigorous physical activity and sedentary time, and b) study the possible attenuation of increased CAC by higher fitness, in participants with metabolic syndrome. Design Cross-sectional. Methods In total 678 participants (52% women), 50-65 years old, from the SCAPIS pilot study were included. Fitness (VO 2 max) was estimated by submaximal cycle ergometer test and moderate-to-vigorous physical activity and sedentary time were assessed using hip-worn accelerometers. CAC score (CACS) was quantified using the Agatston score. Results The odds of having a significant CACS (≥100) was half in participants with moderate/high fitness compared with their low fitness counterparts. Further consideration of moderate-to-vigorous physical activity, sedentary time and number of components of the metabolic syndrome did only slightly alter the effect size. Those with metabolic syndrome had 47% higher odds for significant CAC compared with those without metabolic syndrome. However, moderate/high fitness seems to partially attenuate this risk, as further joint analysis indicated an increased odds for having significant CAC only in the unfit metabolic syndrome participants. Conclusions Being fit is associated with a reduced risk of having significant CAC in individuals with metabolic syndrome. While still very much underutilized, fitness should be taken into consideration in everyday clinical risk prediction in addition to the traditional risk factors of the metabolic syndrome.

Relation of body mass index to outcome in patients with known or suspected coronary artery disease.

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Galal, Wael; van Domburg, Ron T; Feringa, Harm H H; Schouten, Olaf; Elhendy, Abdou; Bax, Jeroen J; Awara, Adel M M; Klein, Jan; Poldermans, Don

2007-06-01

Increased body mass index (BMI), a parameter of total body fat content, is associated with an increased mortality in the general population. However, recent studies have shown a paradoxic relation between BMI and mortality in specific patient populations. This study investigated the association of BMI with long-term mortality in patients with known or suspected coronary artery disease. In a retrospective cohort study of 5,950 patients (mean age 61 +/- 13 years; 67% men), BMI, cardiovascular risk markers (age, gender, hypertension, diabetes, current smoking, angina pectoris, old myocardial infarction, heart failure, hypercholesterolemia, and previous coronary revascularization), and outcome were noted. The patient population was categorized as underweight, normal, overweight, and obese based on BMI according to the World Health Organization classification. Mean follow-up time was 6 +/- 2.6 years. Incidences of long-term mortality in underweight, normal, overweight, and obese were 39%, 35%, 24%, and 20%, respectively. In a multivariate analysis model, the hazard ratio (HR) for mortality in underweight patients was 2.4 (95% confidence interval [CI] 1.7 to 3.7). Overweight and obese patients had a significantly lower mortality than patients with a normal BMI (HR 0.65, 95% CI 0.6 to 0.7, for overweight; HR 0.61, 95% CI 0.5 to 0.7, for obese patients). In conclusion, BMI is inversely related to long-term mortality in patients with known or suspected coronary artery disease. A lower BMI was an independent predictor of long-term mortality, whereas an improved outcome was observed in overweight and obese patients.

Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers

DEFF Research Database (Denmark)

Rasmussen, Thomas; Køber, Lars; Pedersen, Jesper Holst

2013-01-01

Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk...... factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers....

Coronary vascular age: An alternate means for predicting stress-induced myocardial ischemia in patients with suspected coronary artery disease.

Science.gov (United States)

Nappi, Carmela; Gaudieri, Valeria; Acampa, Wanda; Arumugam, Parthiban; Assante, Roberta; Zampella, Emilia; Mannarino, Teresa; Mainolfi, Ciro Gabriele; Imbriaco, Massimo; Petretta, Mario; Cuocolo, Alberto

2018-01-22

Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year's scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD). A total of 717 subjects referred to CAC scoring and 82 Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied. CAC score was measured according to the Agatston method and coronary vascular age by equating estimated CAD risk for chronological age and CAC using the formula 39.1 + 7.25 × ln(CAC + 1). Stress-induced ischemia was present in 105 (15%) patients. Mean chronological age, CAC score, and coronary vascular age were higher (all P age was added to clinical variables. Including vascular age in the model, the global Chi square further increased from 68.77 to 106.38 (P age to clinical data, continuous net reclassification improvement (cNRI) was 0.57, while adding vascular age to clinical data and chronological age cNRI was 0.62. At decision curve analysis, the model including vascular age was associated with the highest net benefit compared to the model including only clinical data, to the model including chronological age and clinical data, and to a strategy considering that all patients had ischemia. The model including vascular age also showed the largest reduction in false-positive rate without missing any ischemic patients. In subjects with suspected CAD, coronary vascular age is strongly associated with stress-induced ischemia. The communication of a given vascular age would have a superior emotive impact improving observance of therapies and healthier lifestyles.

Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

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Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Bello, Juliana Hiromi Silva Matsumoto [Instituto do Coracao (InCor/FM/USP), Sao paulo, SP (Brazil); Magalhaes, Tiago Augusto [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil); Moreira, Valeria de Melo; Carlos Eduardo Rochitte, E-mail: rochitte@gmail.com, E-mail: crochitte@hcor.com.br [Hospital do Coracao (HCOR), Sao Paulo, SP (Brazil)

2012-10-15

Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

[Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification].

Science.gov (United States)

Rico Martín, S; de Nicolás Jiménez, J M; Moyano Calvente, S L; Mogollón Jiménez, M V; Vega Fernández, J; Calderón García, J F; Bacaicoa Lopez de Sabando, M A; Tardio, M; Sánchez Muñoz-Torrero, J F

2016-05-01

The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Association between neutrophil/lymphocyte ratio and coronary collateral circulation

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Mustafa Oylumlu

2012-03-01

Full Text Available Objectives: To investigate relation between neutrophil/lymphocyte ratio and coronary collateral flow.Material and methods: Eighty-two patients admittedDicle University Medical Faculty Hospital Cardiology Departmentwith diagnosis of coronary artery disease anddetected significant stenosis or occlusion at least one ofthe coronary arteries, were included to study. Age, sex,presence of diabetes mellitus and hypertension, acute/stable coronary disease, body mass index, neutrophil/lymphocyte ratio, white blood count, Rentrop scores andnumber of diseased vessel were recorded.Results: Well-developed coronary collateral circulationwas found in 33 of the patients. Forty-nine patients hadpoor coronary collateral circulation. Mean age, sex, bodymass index, presence of diabetes mellitus and hypertensionwere similar in two groups. Mean neutrophil/lymphocyteratio was lower in well-developed coronary collateralcirculation group than poor coronary collateral circulationgroup, but there was no significant differences (2.78 vs2.89, p=0.12.Conclusions: There was no association between neutron/hil lymphocyte ratio and coronary collateral circulationaccording to our data. J Clin Exp Invest 2012; 3(1:29-32

Calcium and vitamin D for bone health in adults

Science.gov (United States)

The calcium intake requirement is challenging to determine, and the IOM recommendations are based largely on calcium balance studies. The IOM recommends a calcium intake of 1000-1200 mg per day for older adults to support the preservation of bone mass. Food sources of calcium are preferred because h...

Phosphorus and Calcium Metabolism in Postmenopausal Women with Diabetes Mellitus: Effects of the Type and Duration of the Disease, Time of Menopause and Body Mass

Directory of Open Access Journals (Sweden)

M.L. Kyryliuk

2016-02-01

Full Text Available The article deals with the impact of diabetes mellitus (DM on the phosphorus and calcium metabolism in postmenopausal women, depending on the type and duration of the disease, duration of menopause, body mass and type of hypoglycemic therapy. The state of phosphorus and calcium metabolism in 86 women with type 1 DM (13 patients and type 2 DM (73 patients was studied. In all patients, the concentration of calcium and phosphorus in the blood was within normal limits. It was found that the concentration of ionized calcium, total calcium and inorganic phosphorus in the blood can not be the main criterion for the state of bone mineral density in postmenopausal women with DM. Sulfonylureas and insulin in combination with biguanides have no effect on the status of phosphorus and calcium metabolism in postmenopausal women with type 2 DM.

Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis.

Science.gov (United States)

Criqui, Michael H; Knox, Jessica B; Denenberg, Julie O; Forbang, Nketi I; McClelland, Robyn L; Novotny, Thomas E; Sandfort, Veit; Waalen, Jill; Blaha, Michael J; Allison, Matthew A

2017-08-01

This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Multidetector CT of the coronary imaging: assessment of image quality and accuracy in detecting stenoses

International Nuclear Information System (INIS)

Huang Meiping; Liu Qishun; Liu Hui; Liang Changhong; Zhang Shaobin

2006-01-01

Objective: To evaluate the image quality of 64-multi detector computed tomography (MDCT) and the clinical accuracy in detecting coronary artery lesions. Methods: One hundred and five patients were studied by MDCT. The results were compared with invasive coronary angiography (ICA). Patients were excluded for atrial fibrillation, but not for high heart rate, coronary calcification, or obesity. MDCT was analyzed with regard to image quality and presence of coronary artery lesions. Results: The data evaluation of the image quality was based on a total of 1365 segments (13 coronary segments for each patient), of which 1144 segments were considered to have diagnostic image quality, but 221 segments (16.2%) could not be sufficiently evaluated because of severe calcifications (153 segments) and motion artifacts (68 segments). The median calcium score [Agatston score equivalent (ASE)] was 154 (range 0--1983). 87 of the 105 patients had an ASE of less than 1,000 [median 105 (range 0-994)], and 18 patients had an ASE greater than 1000 [median 1477 (range 1115-1983)]. For detecting lesions with 50% or greater narrowing (without any exclusion criteria), the overall sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 97.9%, 93.0%, and 95.5%, respectively. When limiting the number of patients to those with a calcium score of less than 1000 ASE, the threshold- corrected sensitivity for lesions with 50% or greater narrowing was 96.0%; specificity, 98.9%; positive predictive value, 95.3%; and negative predictive value, 99.0%. Conclusion: Our results indicate high quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum of patients. (authors)

Current role of MDCT in the diagnosis of coronary artery disease (2011). A clinical guideline of the Austrian Societies of Cardiology and Radiology

International Nuclear Information System (INIS)

Hergan, K.; Globits, S.; Loewe, C.

2011-01-01

The clinical guideline of the Austrian Societies for Cardiology and Radiology on the actual role of MDCT in the diagnosis of coronary artery diseases includes the following issues: CT calcium scoring; CT angiography (CTA) of the coronaries; actually recommended application of MDCR; generally inappropriate use of the technique for specific patients; radiation exposure; structural and organizational framework.

Determination of serum calcium levels by 42Ca isotope dilution inductively coupled plasma mass spectrometry.

Science.gov (United States)

Han, Bingqing; Ge, Menglei; Zhao, Haijian; Yan, Ying; Zeng, Jie; Zhang, Tianjiao; Zhou, Weiyan; Zhang, Jiangtao; Wang, Jing; Zhang, Chuanbao

2017-11-27

Serum calcium level is an important clinical index that reflects pathophysiological states. However, detection accuracy in laboratory tests is not ideal; as such, a high accuracy method is needed. We developed a reference method for measuring serum calcium levels by isotope dilution inductively coupled plasma mass spectrometry (ID ICP-MS), using 42Ca as the enriched isotope. Serum was digested with 69% ultrapure nitric acid and diluted to a suitable concentration. The 44Ca/42Ca ratio was detected in H2 mode; spike concentration was calibrated by reverse IDMS using standard reference material (SRM) 3109a, and sample concentration was measured by a bracketing procedure. We compared the performance of ID ICP-MS with those of three other reference methods in China using the same serum and aqueous samples. The relative expanded uncertainty of the sample concentration was 0.414% (k=2). The range of repeatability (within-run imprecision), intermediate imprecision (between-run imprecision), and intra-laboratory imprecision were 0.12%-0.19%, 0.07%-0.09%, and 0.16%-0.17%, respectively, for two of the serum samples. SRM909bI, SRM909bII, SRM909c, and GBW09152 were found to be within the certified value interval, with mean relative bias values of 0.29%, -0.02%, 0.10%, and -0.19%, respectively. The range of recovery was 99.87%-100.37%. Results obtained by ID ICP-MS showed a better accuracy than and were highly correlated with those of other reference methods. ID ICP-MS is a simple and accurate candidate reference method for serum calcium measurement and can be used to establish and improve serum calcium reference system in China.

Relationship of aortic valve calcification with coronary artery calcium severity: the Multi-Ethnic Study of Atherosclerosis (MESA).

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Nasir, Khurram; Katz, Ronit; Al-Mallah, Mouaz; Takasu, Junichiro; Shavelle, David M; Carr, Jeffery J; Kronmal, Richard; Blumenthal, Roger S; O'Brien, Kevin; Budoff, Matthew J

2010-01-01

Aortic valve calcification (AVC) and atherosclerosis share causative and pathologic features. We evaluated the relationship between AVC and coronary artery calcium (CAC) severity in the Multi-Ethnic Study of Atherosclerosis (MESA). Men and women aged 45-84 years (n=6809; mean age, 62 years) were studied. The presence and burden of AVC and CAC were determined by noncontrast cardiac computed tomography. Relative risk regression was used to model the probability of AVC as a function of CAC > 0 as well as CAC categories (0, 1-99, 100-399, and > or = 400) with the reference group being CAC=0. The prevalence of AVC and CAC was 13% and 50%, respectively. Among those without CAC, the prevalence of AVC was 5% and increased across levels of CAC severity such that 14%, 25%, and 38% had AVC with increasing CAC scores of 1-99, 100-399, and > or = 400, respectively (P for trendAVC among those with mild CAC (1-99) was 1.83 (95% CI, 1.45-2.31) and increased to 3.36 (95% CI, 2.56-4.42) for CAC > or = 400. Similar statistically significant increased risk of AVC was found when CAC was assessed as a continuous variable. Our study shows that AVC is independently associated with increasing severity of CAC. 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study.

Science.gov (United States)

Gaibazzi, Nicola; Rigo, Fausto; Facchetti, Rita; Carerj, Scipione; Giannattasio, Cristina; Moreo, Antonella; Mureddu, Gian Francesco; Salvetti, Massimo; Grolla, Elisabetta; Faden, Giacomo; Cesana, Francesca; Faggiano, Pompilio

2016-09-01

According to recent data, more accurate selection of patients undergoing coronary angiography for suspected coronary artery disease (CAD) is needed. From the Active PREvention Study multicentre prospective study, we further analyse whether carotid intima-media thickness (cIMT), carotid plaques (cPL), and echocardiographic cardiac calcium score (eCS) have incremental discriminatory and reclassification predictive value for CAD over clinical risk score in subjects undergoing coronary angiography, specifically depending on their low, intermediate, or high class of clinical risk. In eight centres, 445 subjects without history of prior CAD but with chest pain of recent onset and/or a positive/inconclusive stress test for ischaemia prospectively underwent clinically indicated elective coronary angiography after cardiac and carotid ultrasound assessments with measurements of cIMT, cPL, and eCS. The study population was divided into subjects at low (10%), intermediate (10-20%), and high (>20%) Framingham risk score (FRS). Ultrasound parameters were tested for their incremental value to predict CAD over FRS, in each pre-test risk category. No significant difference could be appreciated between the discrimination value of FRS and Diagnostic Imaging for Coronary Artery Disease score for the presence of CAD. eCS or cPL demonstrated significant incremental prediction over FRS, consistently in the three FRS categories (P risk subjects, in whom cPL was apparently not incremental over FRS, and eCS was only of borderline significance for better discrimination. Ultrasound eCS and cPL assessments were significant predictors of angiographic CAD in patients without prior CAD but with signs or symptoms suspect for CAD, independently and incrementally to FRS, across all pre-test risk probability strata, although in high-risk subjects, only eCS maintained an incremental value. The use of cIMT was not significantly incrementally useful in any FRS risk category. Published on behalf of the

Volume and dimensions of angiographically normal coronary arteries assessed by multidetector computed tomography

DEFF Research Database (Denmark)

Sørensen, Samuel Kiil; Kühl, Jørgen Tobias; Fuchs, Andreas

2017-01-01

BACKGROUND: The objective of this study was to determine normal values for coronary artery volume (CAV) and individual vasculature and segment dimensions. METHODS: We examined 200 healthy volunteers with an Agatston score of 0 and a normal, high quality coronary CTA. Using 320 slice multidetector...... administration and left ventricular mass. The respective contribution of the left and right coronary vascularture is influenced by coronary dominance....

Exercise restriction is not associated with increasing body mass index over time in patients with anomalous aortic origin of the coronary arteries.

Science.gov (United States)

Meza, James M; Elias, Matthew D; Wilder, Travis J; O'Brien, James E; Kim, Richard W; Mavroudis, Constantine; Williams, William G; Brothers, Julie; Cohen, Meryl S; McCrindle, Brian W

2017-10-01

Anomalous aortic origin of the coronary arteries is associated with exercise-induced ischaemia, leading some physicians to restrict exercise in patients with this condition. We sought to determine whether exercise restriction was associated with increasing body mass index over time. From 1998 to 2015, 440 patients ⩽30 years old were enrolled into an inception cohort. Exercise-restriction status was documented in 143 patients. Using linear mixed model repeated-measures regression, factors associated with increasing body mass index z-score over time, including exercise restriction and surgical intervention as time-varying covariates, were investigated. The 143 patients attended 558 clinic visits for which exercise-restriction status was recorded. The mean number of clinic visits per patient was 4, and the median duration of follow-up was 1.7 years (interquartile range (IQR) 0.5-4.4). The median age at first clinic visit was 10.3 years (IQR 7.1-13.9), and 71% (101/143) were males. All patients were alive at their most recent follow-up. At the first clinic visit, 54% (78/143) were exercise restricted, and restriction status changed in 34% (48/143) during follow-up. The median baseline body mass index z-score was 0.2 (IQR 0.3-0.9). In repeated-measures analysis, neither time-related exercise restriction nor its interaction with time was associated with increasing body mass index z-score. Surgical intervention and its interaction with time were associated with decreasing body mass index z-score. Although exercise restriction was not associated with increasing body mass index over time, surgical intervention was associated with decreasing body mass index z-score over time in patients with anomalous aortic origin of the coronary arteries.

A case report of congenital coronary artery fistula to the left ventricle

International Nuclear Information System (INIS)

Lee, Byung Hee; Yu, Shi Joon; Moon, Eon Soo; Kim, Sam Hyun; Choi, Young Hi

1987-01-01

Congenital coronary artery fistula is a rare malformation with an incidence of 0.4% of congenital heart disease. Among the various subtypes, fistula to the left ventricle is extremely rare with 6 reported cases till 1983. We present a case of coronary artery fistula between the right coronary artery and the left ventricle. The dilated right coronary artery formed a mass like bulging the right lower heart border in the plain chest PA, we think this is first case with a coronary artery fistula to the left ventricle, reported in Korea

Relationship between the level of essential metal elements in human hair and coronary heart disease

International Nuclear Information System (INIS)

Bor-Tsung Hsieh; Kai-Yuan Cheng; Ying-Chen Chang

2011-01-01

Studies on epidemics have demonstrated the relationship between coronary heart disease (CHD) and mineral substances, such as selenium, calcium, magnesium, sodium, potassium, copper, zinc, iron, manganese, and vanadium, in human bodies. In this study, instrumental neutron activation analysis (INAA) and flame atomic absorption spectrophotometry (FAAS) were applied to evaluate the levels of selenium, calcium, magnesium, sodium, potassium, copper, zinc, and iron in healthy individuals and CHD patients. Hair samples were collected from 42 healthy participants and 28 diagnosed CHD patients. Calcium, magnesium, copper, and zinc levels in healthy individuals are significantly higher than the levels found in the patients (p < 0.01). Calcium/selenium ratio is also significantly higher in healthy individuals (p < 0.05). Based on the possible synergies and/or antagonisms of elements and their absorption and metabolism, magnesium/calcium, zinc/copper, and sodium/potassium ratios showed positive relevance (p < 0.01). (author)

Study Of Calcium And Potassium Different Nature Strength Gel Kappa-Carrageenan

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Петро Васильович Гурський

2015-07-01

Full Text Available The influence of certain organic and mineral salts of potassium and calcium for strength gel kappa-carrageenan. The influence of the mass concentration of individual calcium for strength gels with different content kappa-carrageenan. Grounded mass concentration of some calcium salts for use in the composition of the jelly for sweet and savory dishes based on kappa-carrageenan

Sarcopenia, but not excess weight or increased caloric intake, is associated with coronary subclinical atherosclerosis in the very elderly.

Science.gov (United States)

Campos, Alessandra M; Moura, Filipe A; Santos, Simone N; Freitas, Wladimir M; Sposito, Andrei C

2017-03-01

Excess weight is a widespread condition related to increased risk of coronary heart disease (CHD). Sarcopenia is a catabolic pathway common of the aging process and also associated with CHD. In the elderly, both changes occur concurrently and it remains unclear the relative contribution on CHD risk. We aimed to investigate whether sarcopenia, excess weight, or both are associated with subclinical atherosclerosis and/or endothelial dysfunction in very elderly individuals. We performed a cross-sectional study of cohort enrolled individuals, aged 80 years or older (n = 208), who had never manifested cardiovascular diseases. Blood tests, medical and nutritional evaluations, cardiac computed tomography, flow-mediated dilation (FMD) and physical performance tests were obtained at the study admission. Odds ratio (OR) was calculated by multivariate regression models using coronary calcium score (CCS) categories and FMD as dependent variables. Adjustment for potential confounders was done. Muscle mass, but not fatty mass, was inversely associated with CCS categories [OR:2.54(1.06-6.06); p = 0.018]. The lowering of gait speed was negatively related to CCS>100 [OR:2.36 (1.10-5.06); p = 0.028] and skeletal muscle index was directly associated with FMD [OR:5.44 (1.22-24.24); p = 0.026]. Total caloric intake was positively related to fatty mass [OR:2.71 (1.09-6.72); p = 0.031], but was not related to CCS. This study reveals that sarcopenia - comprised by reduction of muscle mass and its strength - is associated with subclinical atherosclerosis and endothelial dysfunction. Surprisingly, the excess of fatty mass seems not to be related to atherosclerotic burden in very elderly individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma

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Ganti Somsekhar

2009-02-01

Full Text Available Abstract Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed.

Coronary triglyceride deposition in contemporary advanced diabetics.

Science.gov (United States)

Ikeda, Yoshihiko; Zaima, Nobuhiro; Hirano, Ken-ichi; Mano, Masayuki; Kobayashi, Kunihisa; Yamada, Sohsuke; Yamaguchi, Satoshi; Suzuki, Akira; Kanzaki, Hideaki; Hamasaki, Toshimitsu; Kotani, Jun-ichi; Kato, Seiya; Nagasaka, Hironori; Setou, Mitsutoshi; Ishibashi-Ueda, Hatsue

2014-07-01

It is of importance to clarify pathophysiology of diabetic heart diseases such as heart failure and coronary artery disease. We reported a novel clinical phenotype called triglyceride deposit cardiomyovasculopathy (TGCV), showing aberrant TG accumulation in both coronary arteries and myocardium, in a cardiac transplant recipient. Here, we examined autopsied diabetics for TG deposition in cardiovasculature. Consecutive series of hearts from advanced diabetes mellitus (DM) subjects (DM group: DMG, n = 20) and those from age- and sex-matched non-diabetic controls (non DM group: NDMG, n = 20) were examined. The diagnostic criteria of 'advanced DM' was made based on 2014 Clinical Practice Recommendations proposed by the American Diabetes Association. The mean duration of DM was 15.8 years. All DMG suffered from heart diseases including coronary artery diseases and 14 subjects had multi-vessel disease. Tissue TG contents were measured biochemically. Coronary arterial TG contents was significantly higher in DMG compared with NDMG. Spatial distribution of TG in transverse sections of coronary arteries showed TG deposition mainly in smooth muscle cells by Imaging Mass Spectrometry. Abundant TG deposition in coronary artery might be associated with advanced DM. © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

f antihypertensive of coronary heart disease Hypertension in a rural

African Journals Online (AJOL)

1990-07-21

Jul 21, 1990 ... a high body mass index, a high uric acid level, a high prevalence of coronary ... Little information exists on the prevalence of hypertension in white South ... selective ,B-blockers have adverse effects on lipid metabolism. Research ..... importance of attention to other coronary risk factors before and during ...

The association between calcium consumption and students body composition

Directory of Open Access Journals (Sweden)

Przemysław Zając

2017-09-01

Full Text Available Introduction: The consumption of calcium in the Polish population is insufficient, which may negatively influence the occurrence of osteoporosis, as well as cause overweight and obesity. Aim of the research : To analyse the relationship between calcium consumption and body composition of the participants of this study. Material and methods : The study was carried out on a sample group of 103 nursing students. The study group consisted of 91 (88.3% women and 12 (11.7% men, aged from 19 to 33 years. The participants of the study had their body composition analysed, the body mass index (BMI was calculated, and the authors carried out a survey involving the Dairy Products Frequency Questionnaire (ADOS-Ca as well as their own questionnaire to evaluate the socio-economic status of the subjects. Results : The students who had the lowest calcium consumption also had the lowest BMI (p = 0.0015 and the lowest amount of visceral fat (p = 0.0260. Individuals who consumed the lowest amount of calcium also had the lowest muscle mass (p = 0.007 and bone mass (p = 0.004. However, the authors did not notice a significant statistical difference between the level of calcium consumption and the percentage of adipose tissue (p = 0.5000 as well as body water percentage (p = 0.3200. Conclusions: The results of the research do not confirm the hypothesis that high calcium consumption is associated with a lower probability of the occurrence of excess body mass and adipose tissue.

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights.

Science.gov (United States)

Sozzi, Fabiola B; Maiello, Maria; Pelliccia, Francesco; Parato, Vito Maurizio; Canetta, Ciro; Savino, Ketty; Lombardi, Federico; Palmiero, Pasquale

2016-09-01

Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three-dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image-guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography. © 2016, Wiley Periodicals, Inc.

[Percutaneous approach for the treatment of unprotected left main coronary stenosis. New perspectives with the use of coronary stents].

Science.gov (United States)

Pessanha, A V; Rodrigues, C; Fuks, V; Murad, H; Murad, M

1997-03-01

We describe a case of coronary stenosis located in an unprotected left main coronary artery, treated primarily and electively with the placement of a coronary stent. As a function of the large mass of myocardium involved, this patient would be considered a classical candidate for direct surgery, because the inherent risk involved with conventional balloon angioplasty, mainly due to the eventual occurrence of acute closure during the procedure. Since the previsibility of the immediate results with the use of coronary stents was significantly improved, we propose this new therapeutic approach for this traditionally surgical case, that has been performed with success and without any complication. This strategy for the treatment of unprotected left main lesions with the elective placement of Palmaz-Schatz stents, has not yet been proposed or applied in our country, and may represent a new universe of indication of percutaneous treatment of coronary artery disease, no longer approaching the left main stem only in special or emergency situations, usually a result of complications of left main manipulation during angioplasty of the coronary system. The patient involved in this case did not show any contraindication for the treatment with conventional open heart surgery.

PROLONGED MULTIPLE SPASMS OF SMOOTH CORONARY ARTERIES PRESENTING AS ACUTE MIOCARDIAL INFARCTION, COMPLETE AV BLOCK AND SYNCOPE

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Franci Cesar

2004-11-01

Full Text Available Background. A variant form of angina pectoris (VAP is caused by coronary vessel spasm and occures in patients with and without varying degrees of obstructive coronary artery disease. Although the prognosis of VAP without significant organic stenosis is generally good, multivessel spasm is associated with a high risk of life-threatening abnormalities of rhythm and conduction.Patient and methods. We describe a patient who presented with prolonged chest pain, associated with hypotension, lost of consciousness, complete AV block and widespread ST segment elevations consistent with inferoanterior acute myocardial infarction. Urgent selective coronary angiography revealed spasms in right coronary artery and in left circumflex artery that were relieved by intracoronary injection of nitroglycerin. All coronary arteries were otherwise patient, without signs of atherosclerosis. The patient was treated with diltiazem and nitrates. She made a complete recovery and resumed her normal activities.Conclusions. Simultaneous multiple spasms of native coronary arteries represent a rare syndrome characterized by significantly higher incidence of potentially life-threatening arrhythmia. Less commonly, prolonged coronary spasm may mimic acute myocardial infarction. Modern management of acute coronary syndromes, including urgent coronarography, enables a prompt differentiation between prolonged coronary spasm and atherosclerotic coronary disease, warranting different treatment strategies. Medical treatment with nitrates and calcium channel blockers in most cases prevents recurrence of vasospasms and arrhythmias.

Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

International Nuclear Information System (INIS)

Moon, Seong-Su; Choi, Yeon-Kyung; Seo, Hyun-Ae

2010-01-01

To test the hypothesis that cardiovascular autonomic neuropathy (CAN) in Type 2 diabetes is a risk factor of coronary artery calcification (CAC), in this cross-sectional study, 118 patients (60 males, 58 females) with type 2 diabetes mellitus were randomly selected from the diabetes clinic of Kyungpook National University Hospital, Daegu, Korea, between January, 2008 and September, 2008. The subjects, whose mean age was 56.9±1.1 years, were tested for CAN by Ewing's method which employs five non-invasive tests of autonomic function. The coronary calcium score (CCS) was determined by Multi Detector-row Computed Tomography (MDCT). Statistical analysis was performed by using SPSS 13.0 (SPSS, Inc., Chicago, Illinois). CAN was found in 31/118 (26.3%) patients. Compared to the patients without CAN, the patients with CAN were significantly older and had significantly higher triglyceride levels, blood pressure, pulse pressure, fasting c-peptide levels, CAN scores, and log-transformed coronary calcium scores [ln(CCS+1)]. The CAN scores correlated positively with ln(CCS+1) values (r=0.214; P=0.028). Multiple regression analysis using ln(CCS+1) as a dependent variable showed that CAN score (β coefficient 0.623, 95% confidence interval (CI) 0.059-1.188, P=0.031) associated independently with ln(CCS+1). In conclusion, CAN was associated independently with CAC, which suggests that CAN is a risk factor of coronary atherosclerosis in patients with type 2 diabetes. This may help to explain the excess cardiovascular mortality seen in diabetic patients with CAN. (author)

Quantification of breast arterial calcification using full field digital mammography

International Nuclear Information System (INIS)

Molloi, Sabee; Xu Tong; Ducote, Justin; Iribarren, Carlos

2008-01-01

Breast arterial calcification is commonly detected on some mammograms. Previous studies indicate that breast arterial calcification is evidence of general atherosclerotic vascular disease and it may be a useful marker of coronary artery disease. It can potentially be a useful tool for assessment of coronary artery disease in women since mammography is widely used as a screening tool for early detection of breast cancer. However, there are currently no available techniques for quantification of calcium mass using mammography. The purpose of this study was to determine whether it is possible to quantify breast arterial calcium mass using standard digital mammography. An anthropomorphic breast phantom along with a vessel calcification phantom was imaged using a full field digital mammography system. Densitometry was used to quantify calcium mass. A calcium calibration measurement was performed at each phantom thickness and beam energy. The known (K) and measured (M) calcium mass on 5 and 9 cm thickness phantoms were related by M=0.964K-0.288 mg (r=0.997 and SEE=0.878 mg) and M=1.004K+0.324 mg (r=0.994 and SEE=1.32 mg), respectively. The results indicate that accurate calcium mass measurements can be made without correction for scatter glare as long as careful calcium calibration is made for each breast thickness. The results also indicate that composition variations and differences of approximately 1 cm between calibration phantom and breast thickness introduce only minimal error in calcium measurement. The uncertainty in magnification is expected to cause up to 5% and 15% error in calcium mass for 5 and 9 cm breast thicknesses, respectively. In conclusion, a densitometry technique for quantification of breast arterial calcium mass was validated using standard full field digital mammography. The results demonstrated the feasibility and potential utility of the densitometry technique for accurate quantification of breast arterial calcium mass using standard digital

Treatment of Angina and Microvascular Coronary Dysfunction

Science.gov (United States)

Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

2014-01-01

Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment

Low Body Mass Index, Serum Creatinine, and Cause of Death in Patients Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Goel, Kashish; Gulati, Rajiv; Reeder, Guy S; Lennon, Ryan J; Lewis, Bradley R; Behfar, Atta; Sandhu, Gurpreet S; Rihal, Charanjit S; Singh, Mandeep

2016-10-31

Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause-specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. We determined long-term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow-up of 4.2 years (interquartile range 1.8-7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all-cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1-1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0-1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06-1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67-0.88; obese: HR 0.80, 95% CI 0.70-0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74-0.97; obese: HR 0.82, 95% CI 0.72-0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all-cause mortality (HR 1.8, 95% CI 1.3-2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4-3.8) compared with patients with normal creatinine (0.71-1.0 mg/dL); however, this was not observed in other BMI categories. We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all-cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight-gain strategies may have potential roles for these patients undergoing

Estimation of bone Calcium-to-Phosphorous mass ratio using dual-energy nonlinear polynomial functions

International Nuclear Information System (INIS)

Sotiropoulou, P; Koukou, V; Martini, N; Nikiforidis, G; Michail, C; Kandarakis, I; Fountos, G; Kounadi, E

2015-01-01

In this study an analytical approximation of dual-energy inverse functions is presented for the estimation of the calcium-to-phosphorous (Ca/P) mass ratio, which is a crucial parameter in bone health. Bone quality could be examined by the X-ray dual-energy method (XDEM), in terms of bone tissue material properties. Low- and high-energy, log- intensity measurements were combined by using a nonlinear function, to cancel out the soft tissue structures and generate the dual energy bone Ca/P mass ratio. The dual-energy simulated data were obtained using variable Ca and PO 4 thicknesses on a fixed total tissue thickness. The XDEM simulations were based on a bone phantom. Inverse fitting functions with least-squares estimation were used to obtain the fitting coefficients and to calculate the thickness of each material. The examined inverse mapping functions were linear, quadratic, and cubic. For every thickness, the nonlinear quadratic function provided the optimal fitting accuracy while requiring relative few terms. The dual-energy method, simulated in this work could be used to quantify bone Ca/P mass ratio with photon-counting detectors. (paper)

Role of coronary CT angiography in asymptomatic patients with type 2 diabetes mellitus

International Nuclear Information System (INIS)

Kamimura, Munehiro; Moroi, Masao; Hiroe, Michiaki; Isobe, Mitsuaki

2012-01-01

Diabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis >70%. High-risk plaque was defined as plaque having both a CT density <30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P=0.022). We found significant stenosis even in patients whose CAC score =0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P=0.033) and current smoking (P=0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (author)

Coronary ligation reduces maximum sustained swimming speed in Chinook salmon, Oncorhynchus tshawytscha

DEFF Research Database (Denmark)

Farrell, A P; Steffensen, J F

1987-01-01

The maximum aerobic swimming speed of Chinook salmon (Oncorhynchus tshawytscha) was measured before and after ligation of the coronary artery. Coronary artery ligation prevented blood flow to the compact layer of the ventricular myocardium, which represents 30% of the ventricular mass, and produced...

Influence of dose reduction and iterative reconstruction on CT calcium scores : a multi-manufacturer dynamic phantom study

NARCIS (Netherlands)

van der Werf, N R; Willemink, M J; Willems, T P; Greuter, M J W; Leiner, T

To evaluate the influence of dose reduction in combination with iterative reconstruction (IR) on coronary calcium scores (CCS) in a dynamic phantom on state-of-the-art CT systems from different manufacturers. Calcified inserts in an anthropomorphic chest phantom were translated at 20 mm/s

Calcium absorption from fortified ice cream formulations compared with calcium absorption from milk.

Science.gov (United States)

van der Hee, Regine M; Miret, Silvia; Slettenaar, Marieke; Duchateau, Guus S M J E; Rietveld, Anton G; Wilkinson, Joy E; Quail, Patricia J; Berry, Mark J; Dainty, Jack R; Teucher, Birgit; Fairweather-Tait, Susan J

2009-05-01

Optimal bone mass in early adulthood is achieved through appropriate diet and lifestyle, thereby protecting against osteoporosis and risk of bone fracture in later life. Calcium and vitamin D are essential to build adequate bones, but calcium intakes of many population groups do not meet dietary reference values. In addition, changes in dietary patterns are exacerbating the problem, thereby emphasizing the important role of calcium-rich food products. We have designed a calcium-fortified ice cream formulation that is lower in fat than regular ice cream and could provide a useful source of additional dietary calcium. Calcium absorption from two different ice cream formulations was determined in young adults and compared with milk. Sixteen healthy volunteers (25 to 45 years of age), recruited from the general public of The Netherlands, participated in a randomized, reference-controlled, double-blind cross-over study in which two test products and milk were consumed with a light standard breakfast on three separate occasions: a standard portion of ice cream (60 g) fortified with milk minerals and containing a low level (3%) of butter fat, ice cream (60 g) fortified with milk minerals and containing a typical level (9%) of coconut oil, and reduced-fat milk (1.7% milk fat) (200 mL). Calcium absorption was measured by the dual-label stable isotope technique. Effects on calcium absorption were evaluated by analysis of variance. Fractional absorption of calcium from the 3% butterfat ice cream, 9% coconut oil ice cream, and milk was 26%+/-8%, 28%+/-5%, and 31%+/-9%, respectively, and did not differ significantly (P=0.159). Results indicate that calcium bioavailability in the two calcium-fortified ice cream formulations used in this study is as high as milk, indicating that ice cream may be a good vehicle for delivery of calcium.

Coronary flow reserve/diastolic function relationship in angina-suffering patients with normal coronary angiography.

Science.gov (United States)

Anchisi, Chiara; Marti, Giuliano; Bellacosa, Ilaria; Mary, David; Vacca, Giovanni; Marino, Paolo; Grossini, Elena

2017-05-01

Coronary blood flow and diastolic function are well known to interfere with each other through mechanical and metabolic mechanisms. We aimed to assess the relationship between coronary flow reserve (CFR) and diastolic dysfunction in patients suffering from angina but with normal coronary angiography. In 16 patients with chest pain and angiographically normal coronary arteries, CFR was measured using transthoracic echo-Doppler by inducing hyperemia through dipyridamole infusion. Diastolic function (E/A, deceleration time, isovolumetric relaxation time [IVRT], propagation velocity [Vp]) and left ventricular mass were evaluated by means of two-dimensional transthoracic echocardiography. The patients were initially divided into two groups on the grounds of CFR only (ACFR: altered CFR, n = 9; NACFR: unaltered CFR, n = 7). Thereafter they were divided into four groups on the grounds of CFR and diastolic function (NN: normal; AA: altered CFR/diastole; AN: altered CFR/normal diastole; NA: normal CFR/altered diastole). Most of the subjects were scheduled in AA (n = 8) or NA (n = 5) groups, which were taken into consideration for further analysis. Patients were not different regarding various risk factors. ACFR and AA patients were older with normal body weight in comparison with NACFR and NA patients (P relationship between altered CFR and diastole.

Calcium and bone health in children: a review.

Science.gov (United States)

Stallings, V A

1997-01-01

The recent national survey shows that dietary calcium intake is variable in children and adolescents, with about half consuming less than the intake recommended by the Recommended Dietary Allowances or the National Institutes of Health Consensus Panel on Optimal Calcium Intake. Osteoporosis is a major disease in adults, resulting in 1.5 million fractures and over $10 billion in medical expenditures annually. Osteoporosis is of growing interest in the research, public health, and health consumer-lay communities and to the many primary care and specialty physicians and other health care professionals who work directly with patients with osteoporosis. Treatment of osteoporosis to prevent fracture is improving with newly introduced medications and approaches, but it is not as effective as needed. Effective prevention strategies are critical to decreasing the morbidity and mortality of the disease. Peak bone mass, obtained during childhood and adolescent growth, is one of the major determinants for the risk of developing osteoporosis and fracture. Genetic potential, gender, ethnic origins, nutritional factors such as calcium and vitamin D intake, growth patterns, and physical activity influence the accretion of bone mineral during childhood and determine the peak bone mass. Randomized, placebo-controlled intervention trials conducted in healthy children who are consuming amounts of dietary calcium in accordance with the US recommendations show that bone mass can be increased by calcium supplementation. Retrospective studies in adults suggest that childhood calcium intake is associated with risk of later osteoporosis and fracture. In addition, common childhood clinical conditions, such as low calcium intake related to lactose intolerance or the use of glucocorticoid medications for chronic illness, are risk factors for the development of osteoporosis in childhood, not just in adulthood. An approach for physicians and other pediatric care providers for screening children

Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study.

Science.gov (United States)

Kaufman, Joel D; Adar, Sara D; Barr, R Graham; Budoff, Matthew; Burke, Gregory L; Curl, Cynthia L; Daviglus, Martha L; Diez Roux, Ana V; Gassett, Amanda J; Jacobs, David R; Kronmal, Richard; Larson, Timothy V; Navas-Acien, Ana; Olives, Casey; Sampson, Paul D; Sheppard, Lianne; Siscovick, David S; Stein, James H; Szpiro, Adam A; Watson, Karol E

2016-08-13

Long-term exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) and traffic-related air pollutant concentrations are associated with cardiovascular risk. The disease process underlying these associations remains uncertain. We aim to assess association between long-term exposure to ambient air pollution and progression of coronary artery calcium and common carotid artery intima-media thickness. In this prospective 10-year cohort study, we repeatedly measured coronary artery calcium by CT in 6795 participants aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) in six metropolitan areas in the USA. Repeated scans were done for nearly all participants between 2002 and 2005, for a subset of participants between 2005 and 2007, and for half of all participants between 2010 and 2012. Common carotid artery intima-media thickness was measured by ultrasound in all participants at baseline and in 2010-12 for 3459 participants. Residence-specific spatio-temporal pollution concentration models, incorporating community-specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM2.5 and nitrogen oxides (NOX) between 1999 and 2012. The primary aim was to examine the association between both progression of coronary artery calcium and mean carotid artery intima-media thickness and long-term exposure to ambient air pollutant concentrations (PM2.5, NOX, and black carbon) between examinations and within the six metropolitan areas, adjusting for baseline age, sex, ethnicity, socioeconomic characteristics, cardiovascular risk factors, site, and CT scanner technology. In this population, coronary calcium increased on average by 24 Agatston units per year (SD 58), and intima-media thickness by 12 μm per year (10), before adjusting for risk factors or air pollutant exposures. Participant-specific pollutant concentrations averaged over the years 2000-10 ranged from 9.2-22.6 �

Automated aortic calcium scoring on low-dose chest computed tomography

International Nuclear Information System (INIS)

Isgum, Ivana; Rutten, Annemarieke; Prokop, Mathias; Staring, Marius; Klein, Stefan; Pluim, Josien P. W.; Viergever, Max A.; Ginneken, Bram van

2010-01-01

Purpose: Thoracic computed tomography (CT) scans provide information about cardiovascular risk status. These scans are non-ECG synchronized, thus precise quantification of coronary calcifications is difficult. Aortic calcium scoring is less sensitive to cardiac motion, so it is an alternative to coronary calcium scoring as an indicator of cardiovascular risk. The authors developed and evaluated a computer-aided system for automatic detection and quantification of aortic calcifications in low-dose noncontrast-enhanced chest CT. Methods: The system was trained and tested on scans from participants of a lung cancer screening trial. A total of 433 low-dose, non-ECG-synchronized, noncontrast-enhanced 16 detector row examinations of the chest was randomly divided into 340 training and 93 test data sets. A first observer manually identified aortic calcifications on training and test scans. A second observer did the same on the test scans only. First, a multiatlas-based segmentation method was developed to delineate the aorta. Segmented volume was thresholded and potential calcifications (candidate objects) were extracted by three-dimensional connected component labeling. Due to image resolution and noise, in rare cases extracted candidate objects were connected to the spine. They were separated into a part outside and parts inside the aorta, and only the latter was further analyzed. All candidate objects were represented by 63 features describing their size, position, and texture. Subsequently, a two-stage classification with a selection of features and k-nearest neighbor classifiers was performed. Based on the detected aortic calcifications, total calcium volume score was determined for each subject. Results: The computer system correctly detected, on the average, 945 mm 3 out of 965 mm 3 (97.9%) calcified plaque volume in the aorta with an average of 64 mm 3 of false positive volume per scan. Spearman rank correlation coefficient was ρ=0.960 between the system and the

Association between Dietary Intake and Coronary Artery Calcification in Non-Dialysis Chronic Kidney Disease: The PROGREDIR Study

Directory of Open Access Journals (Sweden)

Alisson Diego Machado

2018-03-01

Full Text Available Coronary artery calcification (CAC is a widespread condition in chronic kidney disease (CKD. Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirm these findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.

Breakfast consumption by African-American and white adolescent girls correlates positively with calcium and fiber intake and negatively with body mass index

NARCIS (Netherlands)

Affenito, SG; Thompson, DR; Barton, BA; Franko, DL; Daniels, [No Value; Obarzanek, E; Schreiber, GB; Striegel-Moore, RH

Objective To describe age- and race-related differences in breakfast consumption and to examine the association of breakfast intake with dietary calcium and fiber and body mass index (BMI). Design Data from the National Heart, Lung, and Blood Institute Growth and Health Study, a 9-year, longitudinal

The minimum coronary artery diameter in which coronary spasm can be identified by synchrotron radiation coronary angiography

International Nuclear Information System (INIS)

Matsushita, Shonosuke; Hyodo, Kazuyuki; Imazuru, Tomohiro; Tokunaga, Chiho; Sato, Fujio; Enomoto, Yoshiharu; Hiramatsu, Yuji; Sakakibara, Yuzuru

2008-01-01

Background: Coronary vasospasm is defined as a temporary, intense narrowing of the coronary conduit artery. It brings about ischemic chest pain and becomes one of the causes of myocardial infarction. Coronary spasms are divided into two categories. One is the coronary spasm of the conduit artery and the other is the coronary microvascular spasm. Although coronary spasms are diagnosed with the images of coronary angiography, microvascular spasms cannot be diagnosed because of the limitations of conventional angiographic systems. However, synchrotron radiation coronary angiography (SRCA) can identify coronary arteries down to 100 μm in diameter in the beating heart and 50 μm in arrested heart. Aim: The purpose of this study was to confirm whether microvascular spasms could be identified or not using SRCA, and then down that size identification was possible. Methods: The Langendorff perfusion system with isolated rat hearts was employed. Krebs-Henseleit solution (KH solution) was used as a perfusate. 10 mM of 4-aminopyridine (4-AP: a voltage-gated potassium channel blocker; spasm inducer) was added to the KH solution and maintained for 5 min. SRCA was performed at pre-, during and 10 min after cessation of the KH solution with 4-AP. Coronary spasms were defined as a temporal 75% reduction of coronary arterial diameter. Results and conclusion: Multiple sizes of coronary arteries showed coronary spasms. The minimum stenosed coronary artery size was 100 μm. Since coronary microvascular spasms are seen in the arterioles (50-400 μm), coronary microvascular spasms may be diagnosed with the use of synchrotron radiation coronary angiography

The Value of Calcium-scoring CT for Ischemic Cardiovascular Disease Screening

International Nuclear Information System (INIS)

Oh, Jung Hoan; An, Sung Min

2009-01-01

The cardiovascular disease has been known as a common cause of death for a long time in the west. The eating habits of Asia, including Korea, have changed recently, so that this disease is also a problem in Asia now. Annual Report on the Cause of Death Statistics from 1996 to 2006 reported that the cardiovascular disease would become the number one cause of death in the next years. Therefore we realize that more accurate examination is required. The aim of this study was to investigate the accuracy of Calcium-scoring CT and the relationship between risk factor and quantitative scores of Calcium-scoring CT. Through this study we expect that the national public health will be improved. Seventy patients with chest pain were chosen at random. The patients were undergone both coronary CT antigraphy and Calcium - scoring CT at G hospital in Incheon from February 1 to June 30, 2008. The result of the Calcium-scoring CT showed its usefulness for Ischemic cardiovascular disease, with an accuracy similar to that of exercise/pharmacologic stress or ECG when it is difficult for a patient to exercise due to joint problems, aging or for other reasons.

Calcium signals in planetary embryos

Science.gov (United States)

Morbidelli, Alessandro

2018-03-01

The calcium-isotope composition of planetary bodies in the inner Solar System correlates with the masses of such objects. This finding could have implications for our understanding of how the Solar System formed.

Coronary ligation reduces maximum sustained swimming speed in Chinook salmon, Oncorhynchus tshawytscha

DEFF Research Database (Denmark)

Farrell, A P; Steffensen, J F

1987-01-01

The maximum aerobic swimming speed of Chinook salmon (Oncorhynchus tshawytscha) was measured before and after ligation of the coronary artery. Coronary artery ligation prevented blood flow to the compact layer of the ventricular myocardium, which represents 30% of the ventricular mass, and produced...... a statistically significant 35.5% reduction in maximum swimming speed. We conclude that the coronary circulation is important for maximum aerobic swimming and implicit in this conclusion is that maximum cardiac performance is probably necessary for maximum aerobic swimming performance....

Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

Energy Technology Data Exchange (ETDEWEB)

Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

2014-07-01

Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

The role of nitrates, beta blockers, and calcium antagonists in stable angina pectoris.

Science.gov (United States)

Chan, P K; Heo, J Y; Garibian, G; Askenase, A; Segal, B L; Iskandrian, A S

1988-09-01

Numerous controlled studies have shown that nitrates, beta blockers, and calcium antagonists are effective in the treatment of stable angina pectoris. The pharmacokinetics, pharmacodynamics, and hemodynamic effects of these agents are different, and thus combination therapy offers additive improvement and also counterbalancing of the undesirable side effects of each drug. The choice of therapy depends on the severity of symptoms, associated diseases, compliance, side effects, and status of left ventricular function. The main mechanism of improvement is a decrease in myocardial oxygen consumption, though an increase in coronary blood flow is another potential reason for the use of calcium blockers. This review considers the properties of these drugs, their mechanism of action, and the results of randomized studies.

Feasibility of spectral shaping for detection and quantification of coronary calcifications in ultra-low dose CT

Energy Technology Data Exchange (ETDEWEB)

Vonder, Marleen; Pelgrim, Gert Jan; Vliegenthart, Rozemarijn [University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen (Netherlands); Huijsse, Sevrin E.M.; Greuter, Marcel J.W. [University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); Meyer, Mathias; Henzler, Thomas [Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg (Germany); Flohr, Thomas G. [Siemens Healthcare GmbH, Computed Tomography, Forchheim (Germany); Oudkerk, Matthijs [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen (Netherlands)

2017-05-15

To evaluate detectability and quantification of coronary calcifications for CT with a tin filter for spectral shaping. Phantom inserts with 100 small and 9 large calcifications, and a moving artificial artery with 3 calcifications (speed 0-30 mm/s) were placed in a thorax phantom simulating different patient sizes. The phantom was scanned in high-pitch spiral mode at 100 kVp with tin filter (Sn100 kVp), and at a reference of 120 kVp, with electrocardiographic (ECG) gating. Detectability and quantification of calcifications were analyzed for standard (130 HU) and adapted thresholds. Sn100 kVp yielded lower detectability of calcifications (9 % versus 12 %, p = 0.027) and lower Agatston scores (p < 0.008), irrespective of calcification, patient size and speed. Volume scores of the moving calcifications for Sn100 kVp at speed 10-30 mm/s were lower (p < 0.001), while mass scores were similar (p = 0.131). For Sn100 kVp with adapted threshold of 117 HU, detectability (p = 1.000) and Agatston score (p > 0.206) were similar to 120 kVp. Spectral shaping resulted in median dose reduction of 62.3 % (range 59.0-73.4 %). Coronary calcium scanning with spectral shaping yields lower detectability of calcifications and lower Agatston scores compared to 120 kVp scanning, for which a HU threshold correction should be developed. (orig.)

Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall).

Science.gov (United States)

Lehmann, Nils; Erbel, Raimund; Mahabadi, Amir A; Rauwolf, Michael; Möhlenkamp, Stefan; Moebus, Susanne; Kälsch, Hagen; Budde, Thomas; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl-Heinz

2018-02-13

Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events. In 3281 participants (45-74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed. We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1-Q3, 23-360] versus 8 [0-83], P value of baseline CT and risk assessment in terms of C-statistic or integrated discrimination index, especially for total cardiovascular events. However, CAC progression did not improve models including CAC 5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CAC b =CAC 5y =0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CAC b progressed from 1 to 399 to CAC 5y ≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC 5y =400. Participants with CAC b ≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively). CAC progression is associated with

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

NARCIS (Netherlands)

P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

2009-01-01

textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

Relation of body mass index to risk of stent thrombosis after percutaneous coronary intervention

DEFF Research Database (Denmark)

Schmiegelow, Michelle; Torp-Pedersen, Christian; Gislason, Gunnar H

2012-01-01

Stent thrombosis is a devastating complication after percutaneous coronary intervention (PCI), but the influence of obesity on risk of stent thrombosis is unclear, and it is unknown if this relation is dependent on stent type. The objective of this study was to examine the relation between body...... mass index (BMI) and stent thrombosis after PCI with bare-metal stent (BMS) or drug-eluting stent (DES). We followed 5,515 patients who underwent PCI with implantation of ≥1 BMS or DES at a high-volume tertiary invasive cardiology center from 2000 through 2006. Only patients with a single type of stent...... (BMS or DES) implanted at the index PCI were included. Median follow-up period was 26 months (interquartile range 12 to 44) and definite stent thrombosis occurred in 78 patients. Hazard ratio of definite stent thrombosis adjusted for number of stents at the index PCI was 0.92 (95% confidence interval...

Effects of Hyperthyroidism on Coronary Artery Disease: A Computed Tomography Angiography Study.

Science.gov (United States)

Beyer, Christoph; Plank, Fabian; Friedrich, Guy; Wildauer, Matthias; Feuchtner, Gudrun

2017-10-01

Changes in thyroid hormone concentration can negatively affect the cardiovascular system. Subclinical hyperthyroidism has been linked to an increase of cardiovascular heart disease, however, clinical effects and significance are still uncertain. Therefore, we analyzed coronary computed tomography angiographies of patients with overt and subclinical hyperthyroidism for quantitative parameters and plaque morphology. Seven hundred forty-four (47.1% female) patients who underwent coronary computed tomography angiography were stratified into 3 groups: 51 patients with overt, 74 patients with subclinical hyperthyroidism, and 619 patients with euthyroidism. Analysis included grades of stenosis (no stenosis = 0, mild 70%) and plaque types (noncalcified, mixed, and calcified), segment involvement score (SIS), noncalcified SIS, and high-risk plaque features (napkin ring sign, low attenuation plaque, spotty calcifications, positive remodelling). Patients with overt and subclinical hyperthyroidism had more high-grade stenoses (39.2% vs 37.8% vs 24.2%; P = 0.007) and a higher coronary calcium score (456.5 vs 199.5 vs 155.9; P hyperthyroidism, followed by those with subclinical hyperthyroidism, had the most high-risk plaque features: napkin ring (21.6% vs 9.5% vs 6.0%, P hyperthyroid patients. Patients with subclinical and overt hyperthyroidism showed more high-grade coronary stenoses, plaque burden, and high-risk plaque features than patients with euthyroidism, which indicates that an increase of thyroid hormones might lead to coronary vascular degeneration and plaque instability. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

CT coronary angiography vs. invasive coronary angiography in CHD

Directory of Open Access Journals (Sweden)

Anja Hagen

2012-04-01

Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

Non-obstructive low attenuation coronary plaque predicts three-year acute coronary syndrome events in patients with hypertension. Multidetector computed tomographic study

International Nuclear Information System (INIS)

Nakanishi, Koki; Shimada, Kenei; Fukuda, Shota

2012-01-01

Arterial hypertension is an established risk factor for acute coronary syndrome (ACS). Multidetector computed tomography (MDCT) is an accurate and less invasive technique for assessment of the degree of coronary artery luminal narrowing and characterization of coronary atherosclerosis. We therefore aimed to investigate the predictive power of MDCT for future ACS events and compared with traditional parameters in patients with hypertension. One hundred and thirty-four patients (93 men, mean age 70±11 years) with hypertension underwent MDCT for evaluation of coronary artery disease. MDCT analysis focused on the presence of plaques, the degree of stenosis, and the plaque characteristics. Traditional parameters included Framingham risk score, carotid intima-media thickness, and left ventricular mass index. During a mean follow-up of 39±10 months, ACS events occurred in 10 patients, including myocardial infarction (n=3) and unstable angina (n=7). Multivariate analysis identified total number of low attenuation plaques as an independent predictor of ACS events (p<0.001). We demonstrated that non-obstructive low attenuation coronary plaques on MDCT predicted more accurately future ACS events in patients with hypertension than traditional parameters. (author)

[Association between dietary calcium/dairy intakes and overweight/obesity].

Science.gov (United States)

Chen, Yanrong; Liu, Yan; Xue, Hongmei; Bao, Yuxin; Luo, Jiao; Tian, Guo; Cheng, Guo

2016-05-01

To investigate the intakes of dietary calcium/dairy and the current prevalence of overweight and obesity among children and adolescents aged 7-15 in Longquanyi District, Chengdu, and to explore the association of dietary calcium and dairy intake with overweight/obesity. 1738 children and adolescents were recruited in the cross-sectional study using cluster random sampling method. Information on dietary calcium and dairy intakes was collected using 24-hour dietary recall and food frequency questionnaire (FFQ). Height, weight and waist circumference were measured to calculate body mass index (BMI)/waist-to-height ratio (WHtR) and body mass index standard deviation (BMI SDS). Overweight/obesity was defined based on the criteria of Working Group on Obesity in China (WGOC). Participants were grouped into 3 categories indicating lower, moderate and higher intakes of dietary calcium and dairy, respectively. The association of dietary calcium and dairy consumption with (BMI SDS) /WHtR and the prevalence of overweight/obesity was analyzed after being stratified by gender and age. The prevalence of overweight/obesity in boys and girls were 11.92%/7.04% and 8.04%/6.30%, respectively. The intake of dietary calcium and dairy in girls were much higher than that in boys (P obesity in boys, however the associations were inconsistent among different age groups. Associations between consumption of calcium, dairy and overweight/obesity were not found among girls.

The Role of Calcium in Osteoporosis

Science.gov (United States)

Arnaud, C. D.; Sanchez, S. D.

1991-01-01

Calcium requirements may vary throughout the lifespan. During the growth years and up to age 25 to 30, it is important to maximize dietary intake of calcium to maintain positive calcium balance and achieve peak bone mass, thereby possibly decreasing the risk of fracture when bone is subsequently lost. Calcium intake need not be greater than 800 mg/day during the relatively short period of time between the end of bone building and the onset of bone loss (30 to 40 years). Starting at age 40 to 50, both men and women lose bone slowly, but women lose bone more rapidly around the menopause and for about 10 years after. Intestinal calcium absorption and the ability to adapt to low calcium diets are impaired in many postmenopausal women and elderly persons owing to a suspected functional or absolute decrease in the ability of the kidney to produce 1,25(OH)2D2. The bones then become more and more a source of calcium to maintain critical extracellular fluid calcium levels. Excessive dietary intake of protein and fiber may induce significant negative calcium balance and thus increase dietary calcium requirements. Generally, the strongest risk factors for osteoporosis are uncontrollable (e.g., sex, age, and race) or less controllable (e.g., disease and medications). However, several factors such as diet, physical activity, cigarette smoking, and alcohol use are lifestyle related and can be modified to help reduce the risk of osteoporosis.

Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

International Nuclear Information System (INIS)

Iyengar, S.S.; Morgan-Hughes, G.; Ukoumunne, O.; Clayton, B.; Davies, E.J.; Nikolaou, V.; Hyde, C.J.; Shore, A.C.; Roobottom, C.A.

2016-01-01

Aim: To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD). Materials and methods: Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥50%) stenosis and secondarily as the presence of severe (≥70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard. Results: No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis. Conclusion: The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role. - Highlights: • Diagnostic accuracy of High-Definition CT Angiography (HD-CTCA) has been assessed. • Invasive Coronary angiography (ICA) is the reference standard. • Diagnostic accuracy of HD-CTCA is comparable to ICA. • Diagnostic accuracy is not affected by coronary calcium or stents. • HD-CTCA provides a non-invasive alternative in high-risk patients.

Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

International Nuclear Information System (INIS)

Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

2013-01-01

Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events.

Science.gov (United States)

Thomas, Isac C; McClelland, Robyn L; Michos, Erin D; Allison, Matthew A; Forbang, Nketi I; Longstreth, W T; Post, Wendy S; Wong, Nathan D; Budoff, Matthew J; Criqui, Michael H

2017-10-01

The volume and density of coronary artery calcium (CAC) both independently predict cardiovascular disease (CVD) beyond standard risk factors, with CAC density inversely associated with incident CVD after accounting for CAC volume. We tested the hypothesis that ascending thoracic aorta calcium (ATAC) volume and density predict incident CVD events independently of CAC. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of participants without clinical CVD at baseline. ATAC and CAC were measured from baseline cardiac computed tomography (CT). Cox regression models were used to estimate the associations of ATAC volume and density with incident coronary heart disease (CHD) events and CVD events, after adjustment for standard CVD risk factors and CAC volume and density. Among 6811 participants, 234 (3.4%) had prevalent ATAC and 3395 (49.8%) had prevalent CAC. Over 10.3 years, 355 CHD and 562 CVD events occurred. One-standard deviation higher ATAC density was associated with a lower risk of CHD (HR 0.48 [95% CI 0.29-0.79], pdensity was inversely associated with incident CHD and CVD after adjustment for CVD risk factors and CAC volume and density. Copyright © 2017 Elsevier B.V. All rights reserved.

Prediction of coronary artery calcium progression by FDG uptake of large arteries in asymptomatic individuals

Energy Technology Data Exchange (ETDEWEB)

Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Song, Ho-Chun [Chonnam National University Hospital, Department of Nuclear Medicine, Gwang-ju (Korea, Republic of); Kang, Sae-Ryung; Kwon, Seong Young; Jabin, Zeenat; Kim, Young Jae; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung [Chonnam National University Hwasun Hospital, Department of Nuclear Medicine, Hwasun-gun, Jeollanam-do (Korea, Republic of); Seon, Hyun Ju [Chonnam National University Hwasun Hospital, Department of Radiology, Hwasun-gun, Jeollanam-do (Korea, Republic of)

2017-01-15

The purpose of this study is to evaluate whether fluorodeoxyglucose (FDG) uptake of the large arteries can predict coronary artery calcium (CAC) progression in asymptomatic individuals. Ninety-six asymptomatic individuals who underwent FDG positron emission tomography (PET) and CAC scoring on the same day for health screening and follow-up CAC scoring ≥1 year after baseline studies (mean 4.3 years) were included. Vascular FDG uptake was measured and corrected for blood pool activity to obtain peak and average target-to-blood pool ratios (TBRpeak and TBRavg, respectively) for the carotid arteries, and ascending and abdominal aorta. CAC scores at baseline and follow-up of each individual were measured and absolute CAC change (ΔCAC), annual CAC change (ΔCAC/year), and annual CAC change rate (ΔCAC%/year) were calculated. CAC progression was defined as ΔCAC >0 for individuals with negative baseline CAC; ΔCAC/year ≥10 for those with baseline CAC of 0

Subclinical coronary atherosclerosis by multi-scan axial tomography and its association with hyperglycemia

International Nuclear Information System (INIS)

Buchaca Faxas, Emilio F; Bencomo Rodriguez, Llimia; Bermudez Rojas, Sergio

2010-01-01

A study was conducted to assess the usefulness of multi-scan axial tomography techniques to detect, in a subclinical stage, the coronary damage in patients presenting with diabetes mellitus (DM) to describe the frequency of asymptomatic atherosclerotic affection and its potential association with the fasting and postprandial hyperglycemia. In study were included 59 patients with type 2 diabetes to compare the results of coronary calcium determination with the findings of angiography by multi-scan axial computed tomography (CAT-M). There was a concordance of a 44.1% between both studies, as well as a predominance of soft plaques in the 55.9 % of patients. The 42.4 % showed a narrowing of arterial lumen, which was significant in the 16.5 % of total. A high figure of patients with hyperglycemia had coronary damage compared to those ills with a good glycemia control (p = 0.024). This relation was more evident with the postprandial hyperglycemia (= 0.016). Hyperglycemia had a high opportunity (5.99 times) to detect coronary lesions by TAC-C compared to other major atherosclerosis risk factors like the high blood pressure, smoking, dyslipemias expressed in a significant way (p 0.045). We conclude that Angio TAC-C and Calcio Score techniques are useful to detect lesions of coronary arteries in patients with type 2 diabetes mellitus without symptoms of myocardial ischemia, which was associated to presence of a hyperglycemia, fundamentally postprandial

Young Adults' Perceptions of Calcium Intake and Health: A Qualitative Study

Science.gov (United States)

Marcinow, Michelle L.; Randall Simpson, Janis A.; Whiting, Susan J.; Jung, Mary E.; Buchholz, Andrea C.

2017-01-01

Many young Canadian adults are not meeting dietary calcium recommendations. This is concerning as adequate calcium is important throughout young adulthood to maximize peak bone mass for osteoporosis prevention. There are limited studies that have explored young adults' perceptions toward calcium and health. Our objectives were to determine young…

Kaempferol enhances endothelium-dependent relaxation in the porcine coronary artery through activation of large-conductance Ca(2+) -activated K(+) channels.

Science.gov (United States)

Xu, Y C; Leung, S W S; Leung, G P H; Man, R Y K

2015-06-01

Kaempferol, a plant flavonoid present in normal human diet, can modulate vasomotor tone. The present study aimed to elucidate the signalling pathway through which this flavonoid enhanced relaxation of vascular smooth muscle. The effect of kaempferol on the relaxation of porcine coronary arteries to endothelium-dependent (bradykinin) and -independent (sodium nitroprusside) relaxing agents was studied in an in vitro organ chamber setup. The whole-cell patch-clamp technique was used to determine the effect of kaempferol on potassium channels in porcine coronary artery smooth muscle cells (PCASMCs). At a concentration without direct effect on vascular tone, kaempferol (3 × 10(-6) M) enhanced relaxations produced by bradykinin and sodium nitroprusside. The potentiation by kaempferol of the bradykinin-induced relaxation was not affected by N(ω)-nitro-L-arginine methyl ester, an inhibitor of NO synthase (10(-4) M) or TRAM-34 plus UCL 1684, inhibitors of intermediate- and small-conductance calcium-activated potassium channels, respectively (10(-6) M each), but was abolished by tetraethylammonium chloride, a non-selective inhibitor of calcium-activated potassium channels (10(-3) M), and iberiotoxin, a selective inhibitor of large-conductance calcium-activated potassium channel (KCa 1.1; 10(-7) M). Iberiotoxin also inhibited the potentiation by kaempferol of sodium nitroprusside-induced relaxations. Kaempferol stimulated an outward-rectifying current in PCASMCs, which was abolished by iberiotoxin. The present results suggest that, in smooth muscle cells of the porcine coronary artery, kaempferol enhanced relaxations caused by endothelium-derived and exogenous NO as well as those due to endothelium-dependent hyperpolarization. This vascular effect of kaempferol involved the activation of KCa 1.1 channels. © 2015 The British Pharmacological Society.

Cardiac PET/CT for the diagnosis and prognostic evaluation of coronary artery disease

International Nuclear Information System (INIS)

Geronazzo, R.J.; Romero, R.L.; Campisi, R.

2014-01-01

Coronary artery disease is considered by de World Health Organization (WHO) to be pandemic. Eighty percent of the deaths occurs secondary to coronary artery disease, stroke and diabetes, thus they can be prevented. All of them are related to the same risk factors. Ischemic heart disease is the mayor cause of death in Argentina in the elderly population. Primary prevention strategies are essential in the health system. Hence, image complementary methods are very important to accomplish risk stratification, secondary prevention and pre-surgical evaluation. Nuclear cardiology has occupied this place through myocardial perfusion studies with radiopharmaceuticals, using SPECT (Single photon emission computed tomography) that have improved the level of sensitivity and specificity with ECG gated. Furthermore, positron emission tomography (PET) can evaluate relative myocardial perfusion, quantify absolute myocardial blood flow and coronary flow reserve. With its capacity to quantify rest-peak stress left ventricular systolic function we can underscore for example “balance ischemia”. By using hybrid PET/CT, also we can get information of coronary artery calcium scoring and coronary angiography. Currently, with the available softwares, we can acquire images in List mode. It means, from a single acquisition, it allows multiple image reconstructions, along with the associated electrocardiographic phase. PET/CT uses radiopharmaceuticals with short physical half life, and in conjunction with the possibility of acquiring in 3D mode, the perfusion studies can be done in a short time and offers lower radiation exposure to the patient. The new softwares for routine correction of misalignments between transmission and emission images have helped to reduce the frequency of artifacts and improve diagnostic accuracy. Hybrid PET/CT technology allows functional evaluation of myocardial perfusion combined with anatomic characterization of the epicardial coronary arteries, thereby

Discrete-State Stochastic Models of Calcium-Regulated Calcium Influx and Subspace Dynamics Are Not Well-Approximated by ODEs That Neglect Concentration Fluctuations

Science.gov (United States)

Weinberg, Seth H.; Smith, Gregory D.

2012-01-01

Cardiac myocyte calcium signaling is often modeled using deterministic ordinary differential equations (ODEs) and mass-action kinetics. However, spatially restricted “domains” associated with calcium influx are small enough (e.g., 10−17 liters) that local signaling may involve 1–100 calcium ions. Is it appropriate to model the dynamics of subspace calcium using deterministic ODEs or, alternatively, do we require stochastic descriptions that account for the fundamentally discrete nature of these local calcium signals? To address this question, we constructed a minimal Markov model of a calcium-regulated calcium channel and associated subspace. We compared the expected value of fluctuating subspace calcium concentration (a result that accounts for the small subspace volume) with the corresponding deterministic model (an approximation that assumes large system size). When subspace calcium did not regulate calcium influx, the deterministic and stochastic descriptions agreed. However, when calcium binding altered channel activity in the model, the continuous deterministic description often deviated significantly from the discrete stochastic model, unless the subspace volume is unrealistically large and/or the kinetics of the calcium binding are sufficiently fast. This principle was also demonstrated using a physiologically realistic model of calmodulin regulation of L-type calcium channels introduced by Yue and coworkers. PMID:23509597

Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

NARCIS (Netherlands)

Muinck, Ebo Derk de

1994-01-01

In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

Observations on total-body calcium in humans with bone disease

International Nuclear Information System (INIS)

Spinks, T.J.; Bewley, D.K.; Ranicar, A.S.O.; Joplin, G.F.; Evans, I.M.A.; Vlotides, J.; Paolillo, M.

1979-01-01

Total-body calcium was measured in-vivo by neutron activation in a number of patients suffering from metabolic abnormalities which affect the skeleton. In general, less than 2% of total calcium resides in tissue other than bone allowing calcium mass to be directly related to skeletal mass. The conditions studied were (i) Paget's disease, treated with synthetic human calcitonin, (ii) osteoporosis, treated variously with calcium and phosphate supplements and 1,25 hydroxycholecalciferol, and (iii) Cushing's disease treated by pituitary implant of 198 Au or 90 Y seeds. The neutron beam used in these studies was produced by bombarding a beryllium target with deuterons accelerated in a cyclotron. The mean neutron energy was 7.5 MeV and patients received a total dose of 1 rem in about 30 s, a bilateral irradiation being employed. Measurements were made at approximately yearly intervals, the maximum period of study being about four and a half years. The precision of the method was estimated to be +-3% (SE) and a correction was applied for changes in body weight. In most patients, total calcium remained stable. However, in the Paget's patients, there was an indication of a slow upward trend while the osteoporotics (both treated and untreated) showed on average no change. Most of the patients with Cushing's disease showed no recovery of skeletal mass. Absolute calibration indicated that mean total body calcium in the Paget's patients was close to a predicted normal while that for the osteoporotic and Cushing's patients was 20-25% below this. (author)

NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

DEFF Research Database (Denmark)

Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

2011-01-01

for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score=400, carotid intima...

Diagnostic pathway of integrated SPECT/CT for coronary artery disease

International Nuclear Information System (INIS)

Slart, Riemer H.J.A.; Tio, Rene A.; Zijlstra, Felix; Dierckx, Rudi A.

2009-01-01

Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The integration of anatomic and functional information may provide additional information for the clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography (CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower- and higher-risk categories based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography

Gender and age effects on risk factor-based prediction of coronary artery calcium in symptomatic patients

DEFF Research Database (Denmark)

Nicoll, R; Wiklund, U; Zhao, Y

2016-01-01

BACKGROUND AND AIMS: The influence of gender and age on risk factor prediction of coronary artery calcification (CAC) in symptomatic patients is unclear. METHODS: From the European Calcific Coronary Artery Disease (EURO-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62......, diabetes and smoking were independently predictive of CAC presence in both genders. In addition to a progressive increase in CAC with age, the most important predictors of CAC presence were dyslipidaemia and diabetes (β = 0.64 and 0.63, respectively) in males and diabetes (β = 1.08) followed by smoking (β...... = 0.68) in females; these same risk factors were also important in predicting increasing CAC scores. There was no difference in the predictive ability of diabetes, hypertension and dyslipidaemia in either gender for CAC presence in patients aged 70, only...

[Coronary heart disease: epidemiologic-genetic aspects].

Science.gov (United States)

Epstein, F H

1985-01-01

Coronary heart disease and the risk factors which predispose to it aggregate in families. How much of this clustering of disease is "explained" by the familial resemblance in predisposing factors? The published reports which bear on this question fall into six distinct study designs: prospective studies, persons at high or low risk or persons with and without a positive family history as points of departure, case-control studies, studies of patients who had a coronary angiogram and studies in different ethnic groups. The findings of the 16 investigations reviewed suggest that there are as yet unidentified factors - genetic, environmental or both - which are responsible for familial clustering of coronary heart disease, apart from the three main risk factors (serum lipids, blood pressure, smoking) and diabetes. Future research must put greater emphasis on studies of families rather than individuals and on closer collaboration between epidemiologists and geneticists, in order to fill these gaps in knowledge. It is likely that the individual predisposition to coronary heart disease is due in part to genetic influences which remain to be discovered in the course of such studies. They would help in identifying susceptible person in the population with greater precision than is now possible. The "high-risk strategy" of coronary heart disease prevention will become more efficient as more specific and sensitive tests of disease prediction are developed. In the meantime, preventive programmes must be put into action on the basis of what is already known, on the level of both the high-risk and the community-wide mass strategy.

Herpes simplex virus type 2 (HSV-2) as a coronary atherosclerosis risk factor in HIV-infected men: multicenter AIDS cohort study.

Science.gov (United States)

Hechter, Rulin C; Budoff, Matthew; Hodis, Howard N; Rinaldo, Charles R; Jenkins, Frank J; Jacobson, Lisa P; Kingsley, Lawrence A; Taiwo, Babafemi; Post, Wendy S; Margolick, Joseph B; Detels, Roger

2012-08-01

We assessed associations of herpes simplex virus types 1 and 2 (HSV-1 and -2), cytomegalovirus (CMV), and human herpesvirus 8 (HHV-8) infection with subclinical coronary atherosclerosis in 291 HIV-infected men in the Multicenter AIDS Cohort Study. Coronary artery calcium (CAC) was measured by non-contrast coronary CT imaging. Markers for herpesviruses infection were measured in frozen specimens collected 10-12 years prior to case identification. Multivariable logistic regression models and ordinal logistic regression models were performed. HSV-2 seropositivity was associated with coronary atherosclerosis (adjusted odds ratio [AOR]=4.12, 95% confidence interval [CI]=1.58-10.85) after adjustment for age, race/ethnicity, cardiovascular risk factors, and HIV infection related factors. Infection with a greater number of herpesviruses was associated with elevated CAC levels (AOR=1.58, 95% CI=1.06-2.36). Our findings suggest HSV-2 may be a risk factor for subclinical coronary atherosclerosis in HIV-infected men. Infection with multiple herpesviruses may contribute to the increased burden of atherosclerosis. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

Directory of Open Access Journals (Sweden)

Vijayamma K. N

2018-01-01

Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

Science.gov (United States)

Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

2013-04-01

Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

Tibolone and its metabolites acutely relax rabbit coronary arteries in vitro

DEFF Research Database (Denmark)

Lund, Claus Otto; Nilas, Lisbeth; Pedersen, Susan Helene

2004-01-01

under curve (AUC). RESULTS: Tibolone and its metabolites induced a concentration-dependent vasodilatation comparable to that of 17 beta-estradiol with the rank of potency: 3 beta-OH-tibolone approximately = to tibolone>3 alpha-OH-tibolone>Delta 4-isomer (ANOVA). l-NAME partly inhibited the relaxation.......05, ANOVA). CONCLUSIONS: Our data indicate that the acute relaxation induced by tibolone and its metabolites in coronary arteries in vitro are probably mediated by endothelium independent inhibition of calcium channels but may also involve an endothelium-dependent mechanism via nitric oxide. The effect...

Radiation and contrast agent doses reductions by using 80-kV tube voltage in coronary computed tomographic angiography: A comparative study

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Cao, Jian-xin [Department of Radiology, Wuhan 161th Hospital, Wuhan (China); Wang, Yi-min, E-mail: wym6669@yahoo.com.cn [Department of Radiology, Wuhan 161th Hospital, Wuhan (China); Lu, Jin-guo [Department of Cardiology, Asia Heart Hospital, Wuhan (China); Zhang, Yu; Wang, Peng; Yang, Cheng [Department of Radiology, Wuhan 161th Hospital, Wuhan (China)

2014-02-15

Objective: To investigate the effects of 80-kilovoltage (kV) tube voltage coronary computed tomographic angiography (CCTA) with a reduced amount of contrast agent on qualitative and quantitative image quality parameters and on radiation dose in patients with a body mass index (BMI) <23.0 kg/m{sup 2}. Methods: One hundred and twenty consecutive patients with a BMI <23.0 kg/m{sup 2} and a low calcium load undergoing retrospective electrocardiogram (ECG)-gated dual-source CCTA were randomized into two groups [standard-tube voltage (120-kV) vs. low-tube voltage (80-kV)]. The injection flow rate of contrast agent (350 mg I/mL) was adjusted to body weight of each patient (4.5–5.5 mL/s in the 120-kV group and 2.8–3.8 mL/s in the 80-kV group). Radiation and contrast agent doses were evaluated. Quantitative image quality parameters and figure of merit (FOM) of coronary artery were evaluated. Each coronary segment was evaluated for image quality on a 4-point scale. Results: Compared with the 120-kV group, effective dose and amount of contrast agent in the 80-kV group were decreased by 57.8% and 30.5% (effective dose:2.7 ± 0.5vs. 6.4 ± 1.3 mSv; amount of contrast agent:57.1 ± 3.2 vs. 82.1 ± 6.1 mL; both p < 0.0001), respectively. Image noise was 22.7 ± 2.1 HU for 120-kV images and 33.2 ± 5.2 HU for 80-kV images (p < 0.0001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal right coronary artery (RCA) and left main coronary artery (LMA) were all lower in 80-kV than 120-kV images (SNR in the proximal RCA: 16.5 ± 1.8 vs. 19.4 ± 2.8; SNR in the LMA: 16.3 ± 2.0 vs.19.6 ± 2.7; CNR in the proximal RCA: 19.4 ± 2.3 vs.22.9 ± 3.0; CNR in the LMA: 18.8 ± 2.4 vs. 22.7 ± 2.9; all p < 0.0001). FOM were all significantly higher in 80-kV than 120-kV images (proximal RCA: 146.7 ± 45.1 vs. 93.4 ± 32.0; LMA: 139.1 ± 47.2 vs. 91.6 ± 31.1; all p < 0.0001). There was no significant difference in image quality score between the two groups (3.3 ± 0

Radiation and contrast agent doses reductions by using 80-kV tube voltage in coronary computed tomographic angiography: A comparative study

International Nuclear Information System (INIS)

Cao, Jian-xin; Wang, Yi-min; Lu, Jin-guo; Zhang, Yu; Wang, Peng; Yang, Cheng

2014-01-01

Objective: To investigate the effects of 80-kilovoltage (kV) tube voltage coronary computed tomographic angiography (CCTA) with a reduced amount of contrast agent on qualitative and quantitative image quality parameters and on radiation dose in patients with a body mass index (BMI) <23.0 kg/m 2 . Methods: One hundred and twenty consecutive patients with a BMI <23.0 kg/m 2 and a low calcium load undergoing retrospective electrocardiogram (ECG)-gated dual-source CCTA were randomized into two groups [standard-tube voltage (120-kV) vs. low-tube voltage (80-kV)]. The injection flow rate of contrast agent (350 mg I/mL) was adjusted to body weight of each patient (4.5–5.5 mL/s in the 120-kV group and 2.8–3.8 mL/s in the 80-kV group). Radiation and contrast agent doses were evaluated. Quantitative image quality parameters and figure of merit (FOM) of coronary artery were evaluated. Each coronary segment was evaluated for image quality on a 4-point scale. Results: Compared with the 120-kV group, effective dose and amount of contrast agent in the 80-kV group were decreased by 57.8% and 30.5% (effective dose:2.7 ± 0.5vs. 6.4 ± 1.3 mSv; amount of contrast agent:57.1 ± 3.2 vs. 82.1 ± 6.1 mL; both p < 0.0001), respectively. Image noise was 22.7 ± 2.1 HU for 120-kV images and 33.2 ± 5.2 HU for 80-kV images (p < 0.0001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal right coronary artery (RCA) and left main coronary artery (LMA) were all lower in 80-kV than 120-kV images (SNR in the proximal RCA: 16.5 ± 1.8 vs. 19.4 ± 2.8; SNR in the LMA: 16.3 ± 2.0 vs.19.6 ± 2.7; CNR in the proximal RCA: 19.4 ± 2.3 vs.22.9 ± 3.0; CNR in the LMA: 18.8 ± 2.4 vs. 22.7 ± 2.9; all p < 0.0001). FOM were all significantly higher in 80-kV than 120-kV images (proximal RCA: 146.7 ± 45.1 vs. 93.4 ± 32.0; LMA: 139.1 ± 47.2 vs. 91.6 ± 31.1; all p < 0.0001). There was no significant difference in image quality score between the two groups (3.3 ± 0.8 vs. 3

Coronary blood flow and coronary stenosis correlations in ischemic heart patients

International Nuclear Information System (INIS)

Manukov, I.

2003-01-01

The aim of the study is the assessment of the methodology for the C-TIMI frame count by Gibson for easy and fast determination of the coronary blood flow during a selective coronary angiography. 75 patient have been studied with one-branch affection of the coronary arteries. The criteria for exclusion are: myocardial hypertrophy, valve lesions, myocardial infarction and dyslipidemia. Depending of the characteristics of the coronary stenotic changes, the patients have been divided into two groups: 1) Patients with 'ordinary' stenosis of the coronary artery and 2) Patients with 'complex' stenosis. The severity of the stenotic changes in percents is the same for the two groups - 78%±13% vs 81±12%, respectively. In the first group a pronounced correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. The 'threshold' stenotic level is 89%. In the second group the lowest value of the coronary stenosis is 73% (p>0.01 vs group 1). No correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. A conclusion is made that the Gibson method for the assessment of the blood flow is convenient for the daily practice not only for the assessment of the significance of the coronary changes, but also for fast analysis of the achieved reconstruction of the coronary arteries after angioplasty. Additional studies of the significance of the different signs of 'complexity' of the coronary stenosis for the slowing of the blood flow are necessary

Immunologic burden links periodontitis to acute coronary syndrome.

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Liljestrand, John M; Paju, Susanna; Pietiäinen, Milla; Buhlin, Kåre; Persson, G Rutger; Nieminen, Markku S; Sinisalo, Juha; Mäntylä, Päivi; Pussinen, Pirkko J

2018-01-01

Periodontitis, a common polymicrobial inflammatory disease in the tooth supporting tissues, is a risk factor for coronary artery disease. One of the proposed underlying mechanisms is the systemic immune response to periodontal infection. We studied how serum antibodies against seven periodontal pathogens and their subgingival levels associate with each other, periodontitis, and coronary artery disease. The Parogene cohort included 505 Finnish patients (mean age 63 y) who underwent coronary angiography, and clinical and radiographic oral examinations. Coronary diagnosis was defined as no significant coronary artery disease (disease (≥50% stenosis, n = 184) and acute coronary syndrome (n = 169). Levels of subgingival Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Tannerella forsythia, Campylobacter rectus, and Fusobacterium nucleatum were determined by checkerboard DNA-DNA hybridization. Serum antibody (IgA/IgG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). Aggregate IgA/IgG burdens were calculated by summing and standardizing the serum antibody levels. Patients with active periodontitis were characterized by higher levels of subgingival bacteria and corresponding IgA/IgG response. Quartiles 2-4 of serum IgA/IgG burden indicated higher risk for acute coronary syndrome (OR 1.84, 95%CI 1.01-3.35 for IgA; OR 1.87, 95%CI 1.01-3.46 for IgG) independently of established cardiovascular risk factors, body mass index, number of teeth, subgingival bacterial levels and periodontal diagnosis. Our findings support the hypothesis that the association between periodontitis and cardiovascular diseases is partly mediated by the immunologic response for periodontal pathogens. Copyright © 2017 Elsevier B.V. All rights reserved.

Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants

NARCIS (Netherlands)

Kromhout, D.; Soedamah-Muthu, S.S.; Groot, de C.P.G.M.; Hollander, de E.L.; Geleijnse, J.M.; Feskens, E.J.M.

2014-01-01

Background - Body-mass index (BMI) and diabetes have increased worldwide, whereas global average blood pressure and cholesterol have decreased or remained unchanged in the past three decades. We quantified how much of the effects of BMI on coronary heart disease and stroke are mediated through blood

The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome

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Hatav Ghasemi Tehrani

2014-01-01

Full Text Available Background: Poly cystic ovary syndrome (PCOS is considered one of the most common endocrine disorders of women in reproductive age. The aim of this study was evaluating the efficacy of calcium and Vitamin D supplementation on the regularity of menstrual cycles, body mass index (BMI and hyper androgenism state of women with PCOS. Materials and Methods: In this clinical trial, 80 women with PCOS were evaluated. They randomly located in four groups receiving metformin (group 1, metformin plus calcium and Vitamin D (group 2, calcium and Vitamin D (group 3 and placebo (group 4 for 4 months. BMI, regularity of menstrual cycles, hyperandrogenism (hirsutism and acne and serum calcium and Vitamin D levels were compared in four studying groups at baseline and 4 months after the trial. Results: All studied subjects were similar at baseline (P > 0.05. After trial, the frequency of hirsutism and acne were not different among groups. Frequency regular menstrual cycle and dominant follicle were significantly higher in group 1 and 2 than others (P < 0.05. After trial, there was no significant difference with respect to BMI among groups. Conclusion: Vitamin D and calcium supplementation in addition to metformin therapy in women with PCOS could result in a better outcome in a variety of PCOS symptoms including menstrual regularity, and ovulation.

Coronary wave energy: a novel predictor of functional recovery after myocardial infarction.

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De Silva, Kalpa; Foster, Paul; Guilcher, Antoine; Bandara, Asela; Jogiya, Roy; Lockie, Tim; Chowiencyzk, Phil; Nagel, Eike; Marber, Michael; Redwood, Simon; Plein, Sven; Perera, Divaka

2013-04-01

Revascularization after acute coronary syndromes provides prognostic benefit, provided that the subtended myocardium is viable. The microcirculation and contractility of the subtended myocardium affect propagation of coronary flow, which can be characterized by wave intensity analysis. The study objective was to determine in acute coronary syndromes whether early wave intensity analysis-derived microcirculatory (backward) expansion wave energy predicts late viability, defined by functional recovery. Thirty-one patients (58±11 years) were enrolled after non-ST elevation myocardial infarction. Regional left ventricular function and late-gadolinium enhancement were assessed by cardiac magnetic resonance imaging, before and 3 months after revascularization. The backward-traveling (microcirculatory) expansion wave was derived from wave intensity analysis of phasic coronary pressure and velocity in the infarct-related artery, whereas mean values were used to calculate hyperemic microvascular resistance. Twelve-hour troponin T, left ventricular ejection fraction, and percentage late-gadolinium enhancement mass were 1.35±1.21 µg/L, 56±11%, and 8.4±6.0%, respectively. The infarct-related artery backward-traveling (microcirculatory) expansion wave was inversely correlated with late-gadolinium enhancement infarct mass (r=-0.81; Pwave threshold of 2.8 W m(-2) s(-2)×10(5) predicted functional recovery with sensitivity and specificity of 0.91 and 0.82 (AUC 0.88). Hyperemic microvascular resistance correlated with late-gadolinium enhancement mass (r=0.48; P=0.03) but not left ventricular recovery (r=-0.34; P=0.07). The microcirculation-derived backward expansion wave is a new index that correlates with the magnitude and location of infarction, which may allow for the prediction of functional myocardial recovery. Coronary wave intensity analysis may facilitate myocardial viability assessment during cardiac catheterization.

[Developments in percutaneous coronary intervention and coronary stents].

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Simsek, C; Daemen, J; Zijlstra, F

2014-01-01

In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

Coronary dual source multi detector computed tomography in patients suspected of coronary artery disease: Prevalence of incidental extra-cardiac findings

International Nuclear Information System (INIS)

Bendix, K.; Jensen, J.M.; Poulsen, S.; Mygind, N.; Norgaard, B.L.

2011-01-01

Objectives: (1) To establish the prevalence of incidental extra-cardiac findings (ECFs) in coronary multi detector computed tomography (CCT) performed in a large, homogeneous cohort of patients suspected of coronary artery disease (CAD). (2) To examine whether any association can be established between ECFs and pretest risk as determined by conventional risk factors for CAD, the Diamond-Forrester risk model or coronary artery calcium scores. (3) To assess cost related to extra-cardiac examinations. Design: Retrospective study of consecutive patients who had CCT performed. A large field of view was recreated from the non-enhanced CT scan and evaluated by a radiologist for incidental ECFs. Subjects: Patients with chest pain referred to CTA by a cardiologist. Results: In 1383 patients a total of 481 ECFs were indentified, 378 minor (meaning no follow-up was needed) and 103 major ECFs (ECF followed up clinically and/or with additional imaging), in a total of 393 (28%) patients. 85 (6%) patients had one major ECF and 9 (0.7%) patients had two major ECFs. In 19 (4 cases of malignancy) patients the major ECF had therapeutic consequences. Significant positive associations were found between age and smoking, respectively and the presence of ECFs. The cost estimate of saving one life from malignant disease based on ECF examinations is 40,190 Euro . Conclusion: Incidental extra-cardiac findings are common, sometimes revealing serious, even malignant disease. Diagnostic follow-up of major ECFs seems to be cost-effective in a Danish clinical setting. We recommend investigating a large field of view for incidental ECFs following CCT.

Kaempferol enhances endothelium-dependent relaxation in the porcine coronary artery through activation of large-conductance a2+-activated K+ channels

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Xu, Y C; Leung, S W S; Leung, G P H; Man, R Y K

2015-01-01

Background and Purpose Kaempferol, a plant flavonoid present in normal human diet, can modulate vasomotor tone. The present study aimed to elucidate the signalling pathway through which this flavonoid enhanced relaxation of vascular smooth muscle. Experimental Approach The effect of kaempferol on the relaxation of porcine coronary arteries to endothelium-dependent (bradykinin) and -independent (sodium nitroprusside) relaxing agents was studied in an in vitro organ chamber setup. The whole-cell patch-clamp technique was used to determine the effect of kaempferol on potassium channels in porcine coronary artery smooth muscle cells (PCASMCs). Key Results At a concentration without direct effect on vascular tone, kaempferol (3 × 10−6 M) enhanced relaxations produced by bradykinin and sodium nitroprusside. The potentiation by kaempferol of the bradykinin-induced relaxation was not affected by Nω-nitro-L-arginine methyl ester, an inhibitor of NO synthase (10−4 M) or TRAM-34 plus UCL 1684, inhibitors of intermediate- and small-conductance calcium-activated potassium channels, respectively (10−6 M each), but was abolished by tetraethylammonium chloride, a non-selective inhibitor of calcium-activated potassium channels (10−3 M), and iberiotoxin, a selective inhibitor of large-conductance calcium-activated potassium channel (KCa1.1; 10−7 M). Iberiotoxin also inhibited the potentiation by kaempferol of sodium nitroprusside-induced relaxations. Kaempferol stimulated an outward-rectifying current in PCASMCs, which was abolished by iberiotoxin. Conclusions and Implications The present results suggest that, in smooth muscle cells of the porcine coronary artery, kaempferol enhanced relaxations caused by endothelium-derived and exogenous NO as well as those due to endothelium-dependent hyperpolarization. This vascular effect of kaempferol involved the activation of KCa1.1 channels. PMID:25652142

Calcium scoring with prospectively ECG-triggered CT: Using overlapping datasets generated with MPR decreases inter-scan variability

International Nuclear Information System (INIS)

Rutten, A.; Isgum, I.; Prokop, M.

2011-01-01

Objective: To examine the feasibility of reducing the inter-scan variability of prospectively ECG-triggered calcium-scoring scans by using overlapping 3-mm datasets generated from multiplanar reformation (MPR) instead of non-overlapping 3-mm or 1.5-mm datasets. Patients and methods: Seventy-five women (59-79 years old) underwent two sequential prospectively ECG-triggered calcium-scoring scans with 16 mm x 1.5 mm collimation in one session. Between the two scans patients got off and on the table. We performed calcium scoring (Agatston and mass scores) on the following datasets: contiguous 3-mm sections reconstructed from the raw data (A), contiguous 3-mm sections from MPR (B), overlapping 3-mm sections from MPR (C) and contiguous 1.5-mm sections from the raw data (D). To determine the feasibility of the MPR approach, we compared MPR (B) with direct raw data reconstruction (A). Inter-scan variability was calculated for each type of dataset (A-D). Results: Calcium scores ranged from 0 to 1455 (Agatston) and 0 to 279 mg (mass) for overlapping 3-mm sections (C). Calcium scores (both Agatston and mass) were nearly identical for MPR (B) and raw data approaches (A), with inter-quartile ranges of 0-1% for inter-scan variability. Median inter-scan variability with contiguous 3-mm sections (B) was 13% (Agatston) and 11% (mass). Median variability was reduced to 10% (Agatston and mass) with contiguous 1.5-mm sections (D) and to 8% (Agatston) and 7% (mass) with overlapping 3-mm MPR (A). Conclusion: Calcium scoring on MPR yields nearly identical results to calcium scoring on images directly reconstructed from raw data. Overlapping MPR from prospectively ECG-triggered scans improve inter-scan variability of calcium scoring without increasing patient radiation dose.

Anomalous origin of right coronary artery from left coronary sinus.

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Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

2008-08-01

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

Influence of synthetic calcium silicates on the strength properties of fine-grained concrete

Science.gov (United States)

Yarusova, S. B.; Gordienko, P. S.; Kozin, A. V.; Zhevtun, I. G.; Perfilev, A. V.

2018-04-01

The effect of additives based on acicular calcium hydrosilicates (xonotlite and tobermorite) and wollastonite, obtained from boric acid production waste in autoclave synthesis at a temperature of 220 °C, on the strength of fine-grained concrete, has been studied in this paper. It was shown that when the calcium hydrosilicates and wollastonite are introduced, an increase in the strength characteristics of concrete is observed. After heat and moisture treatment, the maximum increase in strength is observed with the addition of 4% of mass content of calcium hydrosilicates and 6% of mass content of wollastonite. After 28 days of hardening under normal conditions, the maximum increase in strength of concrete is observed with the addition of 4% of mass content of both types of additives. It was shown that the water absorption of concrete decreases with a maximum when 4% of mass content is added, as in the case of the introduction of calcium hydrosilicates, and wollastonite. With a further increase in the number of additives, the amount of water absorption increases, but these values remain below the values for the control sample without additives.

Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method.

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Lee, Kyung Eun; Kwon, Soon-Sung; Ji, Yoon Cheol; Shin, Eun-Seok; Choi, Jin-Ho; Kim, Sung Joon; Shim, Eun Bo

2016-08-01

Flow resistances exerted in the coronary arteries are the key parameters for the image-based computer simulation of coronary hemodynamics. The resistances depend on the anatomical characteristics of the coronary system. A simple and reliable estimation of the resistances is a compulsory procedure to compute the fractional flow reserve (FFR) of stenosed coronary arteries, an important clinical index of coronary artery disease. The cardiac muscle volume reconstructed from computed tomography (CT) images has been used to assess the resistance of the feeding coronary artery (muscle volume-based method). In this study, we estimate the flow resistances exerted in coronary arteries by using a novel method. Based on a physiological observation that longer coronary arteries have more daughter branches feeding a larger mass of cardiac muscle, the method measures the vessel lengths from coronary angiogram or CT images (vessel length-based method) and predicts the coronary flow resistances. The underlying equations are derived from the physiological relation among flow rate, resistance, and vessel length. To validate the present estimation method, we calculate the coronary flow division over coronary major arteries for 50 patients using the vessel length-based method as well as the muscle volume-based one. These results are compared with the direct measurements in a clinical study. Further proving the usefulness of the present method, we compute the coronary FFR from the images of optical coherence tomography.

Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

International Nuclear Information System (INIS)

Arisaka, Hiraku

2000-01-01

Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

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Zhonghua Sun

2014-01-01

Full Text Available Coronary computed tomography angiography (CCTA has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

Detection of coronary calcification in ultrafast CT compared to coronary angiography

International Nuclear Information System (INIS)

Koesling, S.; Hoffmann, U.; Rother, T.; Lieberenz, S.; Heywang-Koebrunner, S.H.; Schulz, H.G.

1994-01-01

The angiographical findings of 24 patients with coronary artery disease were compared with qualitative and quantitative detection of coronary calcification by ultrafast CT. Doubts concerning the capabilities of the ultrafast CT for a screening of coronary artery disease arise when the results of one third false positive and fase negative findings are considered. Variations in the quantification of coronary calcification were too great to allow a realistic assessment of the degree of stenosis of the coronary arteries. (orig.) [de

Calcium paradox and calcium entry blockers

NARCIS (Netherlands)

Ruigrok, T.J.C.; Slade, A.M.; Nayler, W.G.; Meijler, F.L.

1984-01-01

Reperfusion of isolated hearts with calcium-containing solution after a short period of calcium-free perfusion results in irreversible cell damage (calcium paradox). This phenomenon is characterized by an excessive influx of calcium into the cells, the rapid onset of myocardial contracture,

Simulating antler growth and energy, nitrogen, calcium and phosphorus metabolism in caribou

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Ron Moen

1998-03-01

Full Text Available We added antler growth and mineral metabolism modules to a previously developed energetics model for ruminants to simulate energy and mineral balance of male and female caribou throughout an annual cycle. Body watet, fat, protein, and ash are monitored on a daily time step, and energy costs associated with reproduction and body mass changes are simulated. In order to simulate antler growth, we had to predict calcium and phosphorus metabolism as it is affected by antler growth, gestation, and lactation. We used data on dietary digestibility, protein, calcium and phosphorus content, and seasonal patterns in body mass to predict the energy, nitrogen, calcium, and phosphorus balances of a "generic" male and female caribou. Antler growth in males increased energy requirements during antler growth by 8 to 16%, depending on the efficiency with which energy was used for antler growth. Female energy requirements for antler growth were proportionately much smaller because of the smaller size of female antlers. Protein requirements for antler growth in both males and females were met by forage intake. Calcium and phosphorus must be resorbed from bone during peak antler growth in males, when > 25 g/day of calcium and > 12 g/day of phosphorus are being deposited in antlers. Females are capable of meeting calcium needs during antler growth without bone resorption, but phosphorus was resorbed from bone during the final stages of antler mineralization. After energy, phosphorus was most likely to limit growth of antlers for both males and females in our simulations. Input parameters can be easily changed to represent caribou from specific geographic regions in which dietary nutrient content or body mass patterns differ from those in our "generic" caribou. The model can be used to quantitatively analyze the evolutionary basis for development of antlers in female caribou, and the relationship between body mass and antler size in the Cervidae.

The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics.

Science.gov (United States)

Won, Ki-Bum; Kim, Yun Seok; Lee, Byoung Kwon; Heo, Ran; Han, Donghee; Lee, Ji Hyun; Lee, Sang-Eun; Sung, Ji Min; Cho, Iksung; Park, Hyung-Bok; Cho, In-Jeong; Chang, Hyuk-Jae

2018-05-01

The triglyceride glucose (TyG) index is a useful surrogate marker for insulin resistance, which is an important risk factor for coronary artery disease (CAD). However, data on the relationship of the TyG index and coronary plaque characteristics are limited.This study included 2840 participants with near-normal renal function who underwent coronary computed tomography angiography. CAD was defined as the presence of any plaques, and obstructive CAD was defined as the presence of plaques with ≥50% stenosis. The relationship between the TyG index and noncalcified plaque (NCP), calcified or mixed plaque (CMP), and coronary artery calcium score (CACS) was evaluated.All participants were stratified into 4 groups based on the quartiles of the TyG index. The prevalence of CAD and obstructive CAD significantly increased with increasing quartiles. The risk for NCP and obstructive NCP was not different among all groups. However, compared with group I (lowest quartile), the risk for CMP was higher in groups III (odds ratio [OR]: 1.438) and IV (highest quartile) (OR: 1.895) (P index was associated with an increased risk for CAD (OR: 1.700), obstructive CAD (OR: 1.692), and CACS >400 (OR: 1.448) (P index was independently associated with the presence and severity of CAD due to an increased risk for CMP.

Uncontrolled hypertension is associated with coronary artery calcification and electrocardiographic left ventricular hypertrophy

DEFF Research Database (Denmark)

Nielsen, Mette Lundgren; Pareek, Manan; Gerke, O

2015-01-01

We conducted a 1:2 matched case-control study in order to evaluate whether the prevalence of coronary artery calcium (CAC) and electrocardiographic left ventricular hypertrophy (LVH) or strain was higher in patients with uncontrolled hypertension than in subjects from the general population......, and evaluate the association between CAC and LVH in patients with uncontrolled hypertension. Cases were patients with uncontrolled hypertension, whereas the controls were random individuals from the general population without cardiovascular disease. CAC score was assessed using a non-contrast computed...

Current role of MDCT in the diagnosis of coronary artery disease (2011). A clinical guideline of the Austrian Societies of Cardiology and Radiology; Aktueller Stellenwert der MSCTA in der Koronargefaessdiagnostik (2011). Klinischer Leitfaden der Oesterreichischen Gesellschaften fuer Kardiologie und Radiologie

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Hergan, K. [Salzburger Landeskliniken, Paracelsus Medizinische Privatuniv. (Austria). Universitaetsinst. fuer Radiologie; Globits, S. [Landesklinikum St. Poelten (Austria). 3. Medizinische Abt./Kardiologie; Loewe, C. [Medizinische Univ. Wien (AT). Universitaetsklinik fuer Radiodiagnostik] (and others)

2011-10-15

The clinical guideline of the Austrian Societies for Cardiology and Radiology on the actual role of MDCT in the diagnosis of coronary artery diseases includes the following issues: CT calcium scoring; CT angiography (CTA) of the coronaries; actually recommended application of MDCR; generally inappropriate use of the technique for specific patients; radiation exposure; structural and organizational framework.

Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

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Sorin Giusca

2017-01-01

Full Text Available Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

A Left Atrial Myxoma Case with a History of Stroke on whom a Coronary Bypass Surgery was Performed

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Cihangir Kaymaz

2009-12-01

Full Text Available Cardiac myxomas are the most frequently encountered benign cardiac tumors in adult groups. Patients with myxoma may suffer from variety of clinical features. A patient who had suffered from stroke a yearago came to our hospital with a chest pain complaint. In the echocardiography of the patient suffering from acute coronary syndrome, left ventricular disfunction and left atrial mass was determined. In the coronary angiography, LAD and Cx critical stenosis, and an abnormal feeding artery which roots from Cxperformed was observed. LIMA-AD, Ao-RCA bypass and mass exision withleft atriotomy was made. Cardiac tumor embolism which makes up a rare cause of cerebral embolies should be considered especiallyin patients with sinus rhythm. In the coronary angiography the feeding artery of the myxoma was shown. A patient who has underwent coronary bypass operation and left atrial myxoma exision has beenpresented as a case.

High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep.

Science.gov (United States)

Simon, M J K; Beil, F T; Rüther, W; Busse, B; Koehne, T; Steiner, M; Pogoda, P; Ignatius, A; Amling, M; Oheim, R

2014-07-01

Chronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass. Understanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures. Dorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy. The fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure. Our data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone

Epicardial adipose tissue radiodensity is independently related to coronary atherosclerosis. A multidetector computed tomography study

International Nuclear Information System (INIS)

Pracon, R.; Kruk, M.; Kepka, C.

2011-01-01

Preliminary research indicates that epicardial adipose tissue (EAT) may display both anti- and proatherosclerotic properties. Because the varying radiodensities of selected human tissues assessed by multidetector computed tomography (MDCT) has been shown to reflect differences in biological characteristics, the present study investigated the hypothesis that the proatherosclerotic properties of EAT may be linked to its radiodensity. The study included 164 consecutive patients (82 females, mean age 58.8±11.1 years) with suspected coronary artery disease (CAD) undergoing MDCT coronary angiography. Coronary atherosclerosis was defined as: CAD (id est (ie), presence of at least 1 coronary stenosis ≥50%) and coronary artery calcium (CAC) determined by Agatston score. EAT radiodensity was assessed by MDCT and averaged -81.00±4.64 HU (Hounsfield unit (HU) scale). Mean CAC score was 96.0±220.0. Patients with CAD (n=36) showed higher EAT radiodensity than patients without CAD (-78.99±4.12 vs. -81.57±4.64 HU, P<0.01). In the multivariable model, only EAT radiodensity and age were independently associated with CAD (odds ratio (OR) 1.15, 95%confidence interval (CI) 1.04-1.28; OR 1.08, 95%CI 1.04-1.12; respectively). EAT radiodensity also correlated with CAC score (r=0.23, P<0.01). EAT radiodensity (P<0.001), age (P<0.001), sex (P=0.03), and past smoking (P<0.01) were independent correlates of CAC in the multivariable linear regression model. Increased EAT radiodensity is independently associated with coronary atherosclerosis, which may reflect the unfavorable, proatherosclerotic metabolic properties of more radiodense epicardial fat. (author)

Obesity, health status, and 7-year mortality in percutaneous coronary intervention

DEFF Research Database (Denmark)

Younge, John O; Damen, Nikki L; van Domburg, Ron T

2013-01-01

Obesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the "obesity paradox". As there is no clear...... understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox....

Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography

Science.gov (United States)

Oliveira, Joselina Luzia Menezes; Hirata, Mario Hiroyuki; Sousa, Amanda Guerra de Moraes Rego; Gabriel, Fabíola Santos; Hirata, Thiago Dominguez Crespo; Tavares, Irlaneide da Silva; Melo, Luiza Dantas; Dória, Fabiana de Santana; Sousa, Antônio Carlos Sobral; Pinto, Ibraim Masciarelli Francisco

2015-01-01

Background Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. Objective To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. Methods Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. Results HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). Conclusion Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques. PMID:25861034

Inversion prepared coronary MR angiography: direct visualization of coronary blood flow

International Nuclear Information System (INIS)

Katoh, M.; Spuentrup, E.; Buecker, A.; Guenther, R.W.; Stuber, M.; Manning, W.J.; Botnar, R.M.

2005-01-01

Purpose: visualization of coronary blood flow by means of a slice-selective inversion pre-pulse in concert with bright-blood coronary MRA. Materials and methods: coronary magnetic resonance angiography (MRA) of the right coronary artery (RCA) was performed in eight healthy adult subjects on a 1.5 Tesla MR system (Gyroscan ACS-NT, Philips Medical Systems, Best, NL) using a free-breathing navigator-gated and cardiac-triggered 3D steady-state free-precession (SSFP) sequence with radial k-space sampling. Imaging was performed with and without a slice-selective inversion pre-pulse, which was positioned along the main axis of the coronary artery but perpendicular to the imaging volume. Objective image quality parameters such as SNR, CNR, maximal visible vessel length, and vessel border definition were analyzed. Results: in contrast to conventional bright-blood 3D coronary MRA, the selective inversion pre-pulse provided a direct measure of coronary blood flow. In addition, CNR between the RCA and right ventricular blood pool was increased and the vessels had a tendency towards better delineation. Blood SNR and CNR between right coronary blood and epicardial fat were comparable in both sequences. (orig.)

Clinical validation of dual-source dual-energy computed tomography (DECT) for coronary and valve imaging in patients undergoing trans-catheter aortic valve implantation (TAVI).

Science.gov (United States)

Mahoney, R; Pavitt, C W; Gordon, D; Park, B; Rubens, M B; Nicol, E D; Padley, S P

2014-08-01

To assess the validity of virtual non-contrast (VNC) reconstructions for coronary artery calcium (CACS) and aortic valve calcium scoring (AVCS) in patients undergoing trans-catheter aortic valve implantation (TAVI). Twenty-three consecutive TAVI patients underwent a three-step computed tomography (CCT) acquisition: (1) traditional CACS; (2) dual-energy (DE) CT coronary angiogram (CTCA); and (3) DE whole-body angiogram. Linear regression was used to model calcium scores generated from VNC images with traditional scores to derive a conversion factor [2.2 (95% CI: 1.97-2.58)]. The effective radiation dose for the TAVI protocol was compared to a standard control group. Bland-Altman analysis and weighted k-statistic were used to assess inter-method agreement for absolute score and risk centiles. CACS and AVCS from VNC reconstructions correlated well with traditional scores (r = 0.94 and r = 0.86; both p VNC and non-contrast coronary calcium scores [mean difference -71.8 (95% limits of agreement -588.7 to 445.1)], with excellent risk stratification into risk centiles (k = 0.99). However, the agreement was weaker for the aortic valve [mean difference -210.6 (95% limits of agreement -1233.2 to 812)]. Interobserver variability was excellent for VNC CACS [mean difference of 6 (95% limits of agreement 134.1-122.1)], and AVCS [mean difference of -16.4 (95% limits of agreement 576 to -608.7)]. The effective doses for the DE TAVI protocol was 16.4% higher than standard TAVI protocol (22.7 versus 19.5 mSv, respectively) accounted for by the DE CTCA dose being 47.8% higher than that for a standard CTCA [9.9 (5.6-14.35) versus 6.7 (1.17-13.72) mSv; p VNC reconstructions. However, the dose from DE CTCA is significantly greater than the standard single-energy CTCA precluding the use of this technology in routine clinical practice. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

A study of calcium intake and sources of calcium in adolescent boys and girls from two socioeconomic strata, in Pune, India.

Science.gov (United States)

Sanwalka, Neha J; Khadilkar, Anuradha V; Mughal, M Zulf; Sayyad, Mehmood G; Khadilkar, Vaman V; Shirole, Shilpa C; Divate, Uma P; Bhandari, Dhanshari R

2010-01-01

Adequate intake of calcium is important for skeletal growth. Low calcium intake during childhood and adolescence may lead to decreased bone mass accrual thereby increasing the risk of osteoporotic fractures. Our aim was to study dietary calcium intake and sources of calcium in adolescents from lower and upper economic strata in Pune, India. We hypothesized that children from lower economic strata would have lower intakes of calcium, which would predominantly be derived from non-dairy sources. Two hundred male and female adolescents, from lower and upper economic stratum were studied. Semiquantitative food frequency questionnaire was used to evaluate intakes of calcium, phosphorus, oxalic acid, phytin, energy and protein. The median calcium intake was significantly different in all four groups, with maximum intake in the upper economic strata boys (893 mg, 689-1295) and lowest intake in lower economic strata girls (506 mg, 380-674). The median calcium intake in lower economic strata boys was 767 mg (585-1043) and that in upper economic strata girls was 764 mg (541-959). The main source of calcium was dairy products in upper economic strata adolescents while it was dark green leafy vegetables in lower economic strata adolescents. The median calcium intake was much lower in lower economic strata than in the upper economic strata both in boys and girls. Girls from both groups had less access to dairy products as compared to boys. Measures need to be taken to rectify low calcium intake in lower economic strata adolescents and to address gender inequality in distribution of dairy products in India.

Interaction of bovine gallbladder mucin and calcium-binding protein: effects on calcium phosphate precipitation.

Science.gov (United States)

Afdhal, N H; Ostrow, J D; Koehler, R; Niu, N; Groen, A K; Veis, A; Nunes, D P; Offner, G D

1995-11-01

Gallstones consist of calcium salts and cholesterol crystals, arrayed on a matrix of gallbladder mucin (GBM), and regulatory proteins like calcium-binding protein (CBP). To determine if interactions between CBP and GBM follow a biomineralization scheme, their mutual binding and effects on CaHPO4 precipitation were studied. Binding of CBP to GBM was assessed by inhibition of the fluorescence of the complex of GBM with bis-1,8-anilinonaphthalene sulfonic acid (bis-ANS). The effects of the proteins on precipitation of CaHPO4 were assessed by nephelometry and gravimetry. Precipitates were analyzed for calcium, phosphate, and protein. CBP and bis-ANS competitively displaced each other from 30 binding sites on mucin, with a 1:1 stoichiometry and similar affinity. The rate of precipitation of CaHPO4 was retarded by mucin and CBP. Precipitate mass was unaffected by GBM alone but decreased with the addition of CBP. Complexing CBP with GBM abolished or moderated this latter effect, altered precipitate morphology, and changed the stoichiometric ratios of Ca to PO4 in the precipitates from 1:1 to 3:2. Mucin and CBP were incorporated into the precipitates. These studies suggest that the formation of calcium-containing gallstones is a biomineralization process regulated by both GBM and CBP.

Periodontal disease, tooth loss and coronary heart disease assessed by coronary angiography: a cross-sectional observational study.

Science.gov (United States)

Zanella, S M; Pereira, S S; Barbisan, J N; Vieira, L; Saba-Chujfi, E; Haas, A N; Rösing, C K

2016-04-01

To evaluate the association between periodontal disease, tooth loss and coronary heart disease (CHD). There is still controversy about the relationship between periodontal disease and tooth loss with vessel obstruction assessed using coronary angiography. This cross-sectional study included 195 patients that underwent coronary angiography and presented with at least six teeth. Patients were classified into three categories of coronary obstruction severity: absence; one or more vessels with ≤ 50% obstruction; and one or more vessels with ≥ 50% obstruction. The extent of coronary obstruction was dichotomized into 0 and ≥ 1 affected vessels. A periodontist blinded to patient CHD status conducted a full mouth examination to determine mean clinical attachment loss, mean periodontal probing depth and tooth loss. Multiple logistic regression models were applied adjusting for age, gender, hypertension, smoking, body mass index, low-density lipoprotein cholesterol and C-reactive protein. Most patients were males (62.1%) older than 60 years (50.8%), and 61% of them had CHD. Mean periodontal probing depth, clinical attachment loss and tooth loss were 2.64 ± 0.72 mm, 4.40 ± 1.31 mm and 12.50 ± 6.98 teeth respectively. In the multivariable models, tooth loss was significantly associated with a higher chance of having at least one obstructed vessel (odds ratio = 1.04; 95% confidence interval 1.01-1.09) and with vessel obstruction ≥ 50% (odds ratio = 1.06; 95% confidence interval 1.01-1.11). No significant associations were found between periodontal variables and vessel obstruction. Tooth loss was found to be a risk indicator for CHD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Coronary Artery Anomalies in Animals

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Brian A. Scansen

2017-04-01

Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

Calcium Absorption in Infants and Small Children: Methods of Determination and Recent Findings

Directory of Open Access Journals (Sweden)

Steven A. Abrams

2010-04-01

Full Text Available Determining calcium bioavailability is important in establishing dietary calcium requirements. In infants and small children, previously conducted mass balance studies have largely been replaced by stable isotope-based studies. The ability to assess calcium absorption using a relatively short 24-hour urine collection without the need for multiple blood samples or fecal collections is a major advantage to this technique. The results of these studies have demonstrated relatively small differences in calcium absorption efficiency between human milk and currently available cow milk-based infant formulas. In older children with a calcium intake typical of Western diets, calcium absorption is adequate to meet bone mineral accretion requirements.

Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI.

Science.gov (United States)

Ghoshhajra, Brian B; Takx, Richard A P; Stone, Luke L; Girard, Erin E; Brilakis, Emmanouil S; Lombardi, William L; Yeh, Robert W; Jaffer, Farouc A

2017-06-01

The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. • Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI. • CTA fusion data can be toggled on/off as desired during CTO PCI • Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

Calcium response to vitamin D supplementation

Directory of Open Access Journals (Sweden)

Francisco R. Spivacow

2018-01-01

Full Text Available Several studies show the importance of serum vitamin D sufficient levels to prevent multiple chronic diseases. However, vitamin D supplementation and its effects on urine calcium excretion remain controversial. The objective of this prospective and interventional study was to evaluate urine calcium excretion in women with normal calciuria or hypercalciuria, once serum vitamin D sufficiency was achieved. We studied 63 women with idiopathic hypercalciuria, (9 with renal lithiasis and 50 normocalciuric women. Both groups had serum vitamin D levels low (deficiency or insufficiency. Baseline urine calcium excretion was measured before being supplemented with vitamin D2 or D3 weekly or vitamin D3 100.000 IU monthly. Once serum vitamin D levels were corrected achieving at least 30 ng/ml, a second urine calcium excretion was obtained. Although in the whole sample we did not observe significant changes in urine calcium excretion according to the way of supplementation, some of those with weekly supplementation had significant higher urine calcium excretion, 19% (n = 12 of hypercalciuric women and 12% (n = 6 of the normocalciuric group. Monthly doses, also showed higher urine calcium excretion in 40% of hypercalciuric women (n = 4/10 and in 44% (n = 4/9 of the renal lithiasis hypercalciuric patients. In conclusion, different ways of vitamin D supplementation and adequate serum levels are safe in most patients, although it should be taken into account a subgroup, mainly with monthly loading doses, that could increase the calciuria significantly eventually rising renal lithiasis risk or bone mass loss, if genetically predisposed.

A model of propagating calcium-induced calcium release mediated by calcium diffusion

NARCIS (Netherlands)

Backx, P. H.; de Tombe, P. P.; van Deen, J. H.; Mulder, B. J.; ter Keurs, H. E.

1989-01-01

The effect of sudden local fluctuations of the free sarcoplasmic [Ca++]i in cardiac cells on calcium release and calcium uptake by the sarcoplasmic reticulum (SR) was calculated with the aid of a simplified model of SR calcium handling. The model was used to evaluate whether propagation of calcium

The relationship of socioeconomic status with coronary artery calcification and pericardial fat.

Science.gov (United States)

Nafakhi, Hussein; Almosawi, Abdulameer; Alnafakh, Hasan; Mousa, Widad

2017-01-01

Little data currently exist supporting the correlation of socioeconomic status (SES) to markers of subclinical coronary atherosclerosis. The main aim was to investigate the relationship of SES measured by economic status and educational level with coronary artery calcification (CAC) and pericardial fat volume (PFV) assessed by multi-detector computed tomography (MDCT). A total of 220 consecutive patients with suspected coronary artery disease, who underwent 64-slice MDCT angiography for assessment of coronary atherosclerosis, were recruited between January 2014 and March 2015. Of these, 186 patients were enrolled in this cross sectional study. Low economic status patients showed higher PFV values; median (inter-quartile range [IQR] was 94 [50-140] cm3, p = 0.00001 and r = 0.37, compared to patients with high economic status, and this association persisted even after multiple logistic regression to conventional cardiac risk factors (p = 0.004, CI 7.3-30.4), while patients with low economic status reported a higher calcium score (but statistically non significant) (p = 0.12) compared to high economic status patients. Pa-tients with no formal education showed higher PFV (median [IQR] was 93 [48-140] cm3, p = 0.01) compared to patients with bachelor's degree (median [IQR] was 56 [28-92] cm3), but this association was attenuated after further adjustment for conventional cardiac risk factors (p = 0.1, CI -9.52-10.88), while CAC showed no significant correlation with educational level (p = 0.2, r = 0.117). Socioeconomic status, particularly economic status measure, reported a significant inverse relationship with PFV independent of conventional cardiac risk factors.

Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

Energy Technology Data Exchange (ETDEWEB)

Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R. [University Hospital Zurich, Cardiac Imaging, Department of Nuclear Medicine, Zurich (Switzerland)

2017-11-15

To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

International Nuclear Information System (INIS)

Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R.

2017-01-01

To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

Diagnosing coronary artery disease after a positive coronary computed tomography angiography

DEFF Research Database (Denmark)

Nissen, L; Winther, S; Westra, J

2018-01-01

Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim...

Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

DEFF Research Database (Denmark)

Nielsen, L.; Bøtker, H. E.; Sorensen, H.

2015-01-01

Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

Model of Inclusion Evolution During Calcium Treatment in the Ladle Furnace

Science.gov (United States)

Tabatabaei, Yousef; Coley, Kenneth S.; Irons, Gordon A.; Sun, Stanley

2018-04-01

Calcium treatment of steel is typically employed to modify alumina inclusions to liquid calcium aluminates. However, injected calcium also reacts with the dissolved sulfur to form calcium sulfide. The current work aims to develop a kinetic model for the evolution of oxide and sulfide inclusions in Al-killed alloyed steel during Ca treatment in the ladle refining process. The model considers dissolution of the calcium from the calcium bubbles into the steel and reduction of calcium oxide in the slag to dissolved calcium. A steel-inclusion kinetic model is used for mass transfer to the inclusion interface and diffusion within the calcium aluminate phases formed on the inclusion. The inclusion-steel kinetic model is then coupled with a previously developed steel-slag kinetic model. The coupled inclusion-steel-slag kinetic model is applied to the chemical composition changes in molten steel, slag, and evolution of inclusions in the ladle. The result of calculations is found to agree well with an industrial heat for species in the steel as well as inclusions during Ca treatment.

Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients.

Science.gov (United States)

Jarrah, Mohamad; Hammoudeh, Ayman J; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Okkeh, Osama; Alhaddad, Imad A; Tawalbeh, Loai Issa; Hweidi, Issa M

2018-04-01

Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight. Obese patients were more likely to be female and to have a higher prevalence of diabetes, hypertension, hypercholesterolemia, or previous percutaneous coronary intervention. Acute coronary syndrome was the indication for percutaneous coronary intervention in 77.0% of obese, 76.4% of overweight, and 77.4% of normal/underweight patients. No significant differences in the prevalence of multi-vessel coronary artery disease or multi-vessel percutaneous coronary intervention were found among the three groups. Additionally, no significant differences were found in stent thrombosis, readmission bleeding rates, or cardiac mortality among the three groups during hospitalization, at 1 month, and at 1 year. Conclusion The major adverse cardiovascular event rate was the same among the three groups throughout the study period. Accordingly, body mass index is considered a weak risk factor for cardiovascular comorbidities in Arab Jordanian patients.

Coronary hemodynamics in vasospastic angina

International Nuclear Information System (INIS)

Matsumura, Kentaro; Kubota, Shinobu; Serizawa, Takashi; Nakase, Emiko; Kawai, Ichiro; Saito, Takayuki

1991-01-01

To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77±0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65±0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca ++ -antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T 1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion. (author)

Calcium status in premenopausal and post menopausal women

International Nuclear Information System (INIS)

Qureshi, H.J.; Hussain, G.; Bashir, M.U.; Latif, N.; Riaz, Z.

2010-01-01

Background: In postmenopausal women, the two major causes of bone loss are oestrogen deficiency after menopause and age related processes. Bone turnover increases to high levels and oestrogen deficiency may induce calcium loss by indirect effects on extra skeletal calcium homeostasis. Objective of this study was to evaluate calcium status in pre-menopausal and postmenopausal women. Methods: This cross sectional study was carried out in 34 premenopausal women and 33 postmenopausal women, in Department of Physiology, Services Institute of Medical Sciences, Lahore. Height and weight of each woman were taken to find out the body mass index (BMI). Serum calcium, parathyroid hormone and calcitonin levels of each subject were determined. Results: Premenopausal women were obese (BMI>30 Kg/m/sup 2/) while postmenopausal women were overweight (BMI>25 Kg/m/sup 2/). Serum calcium levels were significantly lower in postmenopausal women than in pre-menopausal women, while serum parathyroid hormone levels were significantly higher in postmenopausal woman. Serum calcitonin level was not significantly different in the two groups. Conclusion: Postmenopausal women are calcium deficient and have increased bone turnover as indicated by increased serum parathyroid hormone levels. (author)

Lifetime physical activity and calcium intake related to bone density in young women.

Science.gov (United States)

Wallace, Lorraine Silver; Ballard, Joyce E

2002-05-01

Osteoporosis is a significant public health problem associated with increased mortality and morbidity. Our aim in this cross-sectional study was to investigate the relationship between lifetime physical activity and calcium intake and bone mineral density (BMD) and BMC (bone mineral content) in 42 regularly menstruating Caucasian women (age 21.26+/-1.91 years, BMI 23.83+/-5.85). BMD and BMC at the lumbar spine (L2-L4), hip (femoral neck, trochanter, total), and total body were assessed by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity and calcium intake was obtained by a structured interview using valid and reliable instruments. Measures of both lifetime physical activity and calcium intake were highly correlated. In stepwise multiple regression analyses, lean mass was the most important and consistent factor for predicting BMD and BMC at all skeletal sites (attributable r2 = 28.8%-78.7%). Lifetime physical activity contributed to 3.0% of the variation in total body BMD, and life-time weight-bearing physical activity explained 15.1% of variance in lumbar spine BMC. Current calcium intake predicted 6% of the variance in BMD at the femoral neck and trochanter. We found lean mass to be a powerful predictor of BMD and BMC in young women. Because lean mass can be modified to some extent by physical activity, public health efforts must be directed at increasing physical activity throughout the lifespan. Furthermore, our results suggest that adequate calcium intake may help to enhance bone mass, thus decreasing the risk of osteoporotic fracture later in life.

Mammary-Specific Ablation of the Calcium-Sensing Receptor During Lactation Alters Maternal Calcium Metabolism, Milk Calcium Transport, and Neonatal Calcium Accrual

Science.gov (United States)

Mamillapalli, Ramanaiah; VanHouten, Joshua; Dann, Pamela; Bikle, Daniel; Chang, Wenhan; Brown, Edward

2013-01-01

To meet the demands for milk calcium, the lactating mother adjusts systemic calcium and bone metabolism by increasing dietary calcium intake, increasing bone resorption, and reducing renal calcium excretion. As part of this adaptation, the lactating mammary gland secretes PTHrP into the maternal circulation to increase bone turnover and mobilize skeletal calcium stores. Previous data have suggested that, during lactation, the breast relies on the calcium-sensing receptor (CaSR) to coordinate PTHrP secretion and milk calcium transport with calcium availability. To test this idea genetically, we bred BLG-Cre mice with CaSR-floxed mice to ablate the CaSR specifically from mammary epithelial cells only at the onset of lactation (CaSR-cKO mice). Loss of the CaSR in the lactating mammary gland did not disrupt alveolar differentiation or milk production. However, it did increase the secretion of PTHrP into milk and decreased the transport of calcium from the circulation into milk. CaSR-cKO mice did not show accelerated bone resorption, but they did have a decrease in bone formation. Loss of the mammary gland CaSR resulted in hypercalcemia, decreased PTH secretion, and increased renal calcium excretion in lactating mothers. Finally, loss of the mammary gland CaSR resulted in decreased calcium accrual by suckling neonates, likely due to the combination of increased milk PTHrP and decreased milk calcium. These results demonstrate that the mammary gland CaSR coordinates maternal bone and calcium metabolism, calcium transport into milk, and neonatal calcium accrual during lactation. PMID:23782944

Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

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Toischer Karl

2009-09-01

Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

Analysis and differentiation of mineral dust by single particle laser mass spectrometry

International Nuclear Information System (INIS)

Gallavardin, S. J.; Lohmann, U.; Cziczo, Daniel J.

2008-01-01

This study evaluates the potential of single particle laser desorption/ionization mass spectrometry for the analysis of atmospherically relevant mineral dusts. Samples of hematite, goethite, calcium carbonate, calcium sulfate, silica, quartz, montmorrillonite, kaolinite, illite, hectorite, wollastonite and nephelinsyenit were investigated in positive and negative ion mode with a monopolar time-of-flight mass spectrometer where the desorption/ionization step was performed with a 193 nm excimer laser (∼10 9 W/cm 2 ). Particle size ranged from 500 nm to 3 (micro)m. Positive mass spectra mainly provide elemental composition whereas negative ion spectra provide information on element speciation and of a structural nature. The iron oxide, calcium-rich and aluminosilicate nature of particles is established in positive ion mode. The differentiation of calcium materials strongly relies on the calcium counter-ions in negative mass spectra. Aluminosilicates can be differentiated in both positive and negative ion mode using the relative abundance of various aluminum and silicon ions

Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover.

Science.gov (United States)

Kruger, Marlena C; Kruger, Iolanthé M; Wentzel-Viljoen, Edelweiss; Kruger, Annamarie

2011-10-01

Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the North West Province of South Africa (Prospective Urban and Rural Epidemiology-South Africa project). Fasting blood samples were taken; and participants were interviewed to complete questionnaires on self-reported diseases, fractures, and dietary intakes. Bone health markers were assessed in a subgroup of 658 women older than 45 years. Specific lifestyle risk factors identified were inactivity, smoking, injectable progestin contraception use, and high alcohol consumption. Dietary risk factors identified were low calcium and high animal protein, phosphorous, and sodium intakes. The 25(OH)D3 and C-terminal telopeptide (CTX) levels were significantly higher in the rural vs the urban women older than 50 years. Parathyroid hormone (PTH) levels increased with age in both groups. The 25(OH)D levels were inversely correlated with CTX and PTH in rural women. In urban women, PTH and CTX were correlated while dietary calcium was inversely correlated with CTX and PTH with 25(OH)D3. The combination of low dietary calcium (<230 mg/d), marginally insufficient 25(OH)D3 status, and raised PTH may result in increased bone resorption. Further research is required to assess bone health and fracture risk in black African women. Copyright © 2011 Elsevier Inc. All rights reserved.

Morphological study on coronary ostial and clinicoangiographic analysis of isolated coronary ostial stenosis

International Nuclear Information System (INIS)

Kanoh, Tatsuji

2007-01-01

A morphological study of coronary ostia was performed in 70 autopsied human hearts, with particular attention being focused on the funnel-shaped structure, aging changes, and relation to atherosclerosis. The following results were obtained: The ostium is particularly well-defined and forms a funnel-shaped structure. The structure is predominantly a double circular shape on the right and comet-shaped on the left. The funnel-shaped structure of coronary ostia is characterized by a longitudinal smooth muscle arrangement in the inner layer and circular one in the outer layer. Including overhang formation, coronary sclerosis of the ostium appears mainly on the upper margin of the funnel-shaped structure of the right ostium and at the upper right margin of the left. In ischemic heart disease, along with changes in coronary arteries themselves, changes in the ostia of these arteries should be paid close attention. Ostial stenosis of the coronary artery in the absence of distal vessel obstructions, isolated ostial stenosis, is a rare form of coronary artery disease. In a previous review of the international literature, the incidence of coronary ostial stenosis varied between 0.13% and 2.7%. Among 7,500 patients undergoing selective coronary cineangiography at Juntendo University Hospital and Juntendo Urayasu Hospital from 1975 to 1990, five women (0.07%) were diagnosed as having ''isolated coronary ostial stenosis'', of which the cause is unknown. Atherosclerosis, particularly early premature atherome, congenital coronary anomaly, fibro-muscular dysplasia, Takayasu's aortitis, humoral factors, spasm, and iatrogenic events have been considered as its causes. In contrast to usual atherosclerotic coronary artery disease, patients with isolated coronary ostial stenosis of unknown etiology were characterized as being middle-aged, premenopausal, slender females having few coronary risk factors, experiencing severe angina pector is with marked ischemic electrocardiogram changes

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT.

Science.gov (United States)

Tang, Lijun; Zhu, Xiaomei; Xu, Yi; Yu, Tongfu; Xu, Hai; Tang, Jinhua; Dogra, Vikram; Wang, Dehang

2011-02-01

CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and

Separation of calcium isotopes by counter-current electromigration in molten salts (1962); Separation des isotopes du calcium par electro-migration a contre-courant en sels fondus (1962)

Energy Technology Data Exchange (ETDEWEB)

Menes, F; Dirian, G; Roth, E [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1962-07-01

The method of counter-current electromigration in molten salts has been applied to calcium bromide with an alkali metal bromide added to the cathode compartment. Enrichments on calcium-46 greater than a factor of two were obtained at the anode. The mass effect was found to be about 0.06. An estimation of the cost of energy for a process based on this method has been made. (authors) [French] La methode d'electro-migration a contre-courant en sels fondus a ete appliquee au bromure de calcium additionne dans le compartiment cathodique d'un bromure alcalin. On a pu ainsi obtenir avec surete des enrichissements anodiques superieurs a 2 sur l'isotope 46, determiner l'effet de masse (environ 0,06) et faire une estimation sommaire du cout energetique d'un procede base sur cette methode. (auteurs)

Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease

International Nuclear Information System (INIS)

Tsukamoto, Takahiro; Naya, Masanao; Tsutsui, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Inubushi, Masayuki; Kuge, Yuji; Tamaki, Nagara

2006-01-01

Myocardial flow reserve (MFR) measurement has an important role in assessing the functional severity of coronary artery stenosis. However, a discrepancy between the anatomical severity of coronary artery stenosis and MFR is often observed. Such a discrepancy may be explained by coronary risk factors. In this study, we aimed to investigate the influence of coronary artery stenosis severity and risk factors on MFR. Seventy-four patients suspected to have coronary artery disease and seven age-matched healthy volunteers were enrolled. Myocardial blood flow (MBF) and MFR were measured using 15 O-labelled water PET. Regional MFR was calculated in regions with significant coronary artery stenosis (stenotic regions) and in regions without significant stenosis (remote regions). The contributions of coronary artery stenosis severity and coronary risk factors were assessed using univariate and multivariate analyses. In stenotic regions, MFR correlated inversely with coronary artery stenosis severity (r=-0.50, p<0.01). Univariate analysis did not show any significant difference in MFR between the patients with and the patients without each risk factor. In remote regions, however, MFR was significantly decreased in the diabetes and smoking groups (each p<0.05). By multivariate analysis, diabetes and smoking were independent predictors of MFR (each p<0.05). In the group with more than one risk factor, MFR was significantly lower (2.78±0.79) than in the other group (3.40±1.22, p<0.05). MFR is influenced not only by coronary stenosis severity but also by coronary risk factors. In particular, the influence of risk factors should be considered in regions without severe coronary stenosis. (orig.)

Coronary artery aneurysms

Energy Technology Data Exchange (ETDEWEB)

Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

1982-04-01

Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change?

Science.gov (United States)

Johnson, Jennie E; Gulanick, Meg; Penckofer, Sue; Kouba, Joanne

2015-01-01

Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change. The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P behavior change were perceived barriers (β = -.41; P Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.

Severity of coronary artery disease in obese patients undergoing coronary angiography

International Nuclear Information System (INIS)

Javed, A.; Ali, J.; Kayani, A.M.

2012-01-01

Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

Directory of Open Access Journals (Sweden)

Jayanth Koneru

2011-01-01

Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Role of coronary physiology in the contemporary management of coronary artery disease

Science.gov (United States)

Ruparelia, Neil; Kharbanda, Rajesh K

2015-01-01

Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

Role of coronary physiology in the contemporary management of coronary artery disease.

Science.gov (United States)

Ruparelia, Neil; Kharbanda, Rajesh K

2015-02-16

Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

Strategies for Primary Prevention of Coronary Heart Disease Based on Risk Stratification by the ACC/AHA Lipid Guidelines, ATP III Guidelines, Coronary Calcium Scoring, and C-Reactive Protein, and a Global Treat-All Strategy: A Comparative--Effectiveness Modeling Study.

Directory of Open Access Journals (Sweden)

Benjamin Z Galper

Full Text Available Several approaches have been proposed for risk-stratification and primary prevention of coronary heart disease (CHD, but their comparative and cost-effectiveness is unknown.We constructed a state-transition microsimulation model to compare multiple approaches to the primary prevention of CHD in a simulated cohort of men aged 45-75 and women 55-75. Risk-stratification strategies included the 2013 American College of Cardiology/American Heart Association (ACC/AHA guidelines on the treatment of blood cholesterol, the Adult Treatment Panel (ATP III guidelines, and approaches based on coronary artery calcium (CAC scoring and C-reactive protein (CRP. Additionally we assessed a treat-all strategy in which all individuals were prescribed either moderate-dose or high-dose statins and all males received low-dose aspirin. Outcome measures included CHD events, costs, medication-related side effects, radiation-attributable cancers, and quality-adjusted-life-years (QALYs over a 30-year timeframe.Treat-all with high-dose statins dominated all other strategies for both men and women, gaining 15.7 million QALYs, preventing 7.3 million myocardial infarctions, and saving over $238 billion, compared to the status quo, far outweighing its associated adverse events including bleeding, hepatitis, myopathy, and new-onset diabetes. ACC/AHA guidelines were more cost-effective than ATP III guidelines for both men and women despite placing 8.7 million more people on statins. For women at low CHD risk, treat-all with high-dose statins was more likely to cause a statin-related adverse event than to prevent a CHD event.Despite leading to a greater proportion of the population placed on statin therapy, the ACC/AHA guidelines are more cost-effective than ATP III. Even so, at generic prices, treating all men and women with statins and all men with low-dose aspirin appears to be more cost-effective than all risk-stratification approaches for the primary prevention of CHD

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

DEFF Research Database (Denmark)

von Scholten, Bernt Johan; Reinhard, Henrik; Hansen, Tine Willum

2015-01-01

BACKGROUND: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diab...

Calcium scores in the risk assessment of an asymptomatic population: implications for airline pilots.

Science.gov (United States)

Wirawan, I Made Ady; Wu, Rodney; Abernethy, Malcolm; Aldington, Sarah; Larsen, Peter D

2014-08-01

This study evaluated whether coronary artery calcium score (CACS) improved cardiovascular disease risk prediction when compared to the New Zealand Cardiovascular Risk Charts (NZ-CRC), and describes the potential utilization of CACS in cardiovascular disease (CVD) risk assessment of pilots. A cross-sectional study was performed among asymptomatic patients who underwent coronary computed tomography angiography at Pacific Radiology Wellington, New Zealand, between August 2007 and July 2012 and had their CACS and CVD risk score calculated. Receiver-operating characteristics (ROC) analyses were used to measure the accuracy of the NZ-CRC and CACS. Reclassification analyses were performed to examine the net reclassification improvement (NRI) of CACS when compared to NZ-CRC. Over a 5-yr study period, 237 male asymptomatic patients with ages ranging from 30 to 69 yr with a mean (SD) of 53.24 (8.18) yr, were included. The area under the ROC curves (AUC) (95% CI) for CACS and NZ-CRC were 0.88 (0.83-0.93) and 0.66 (0.59-0.73), respectively. The NRI (95% CI) of the calcium scores was 0.39 (0.17-0.62). CACS should be assessed in pilots with 5-yr CVD risk scores of 5-10% and 10-15%. CACS has a better accuracy than the NZ-CRC and reclassified a considerable proportion of asymptomatic patients into correct cardiovascular risk categories. An approach on how the CACS should be employed in the cardiovascular risk assessment of airline pilots is noted in this paper.

Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

Directory of Open Access Journals (Sweden)

Beganu Elena

2017-09-01

Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

International Nuclear Information System (INIS)

Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

2011-01-01

Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

[Calcium suppletion for patients who use gastric acid inhibitors: calcium citrate or calcium carbonate?].

NARCIS (Netherlands)

Jonge, H.J. de; Gans, R.O.; Huls, G.A.

2012-01-01

Various calcium supplements are available for patients who have an indication for calcium suppletion. American guidelines and UpToDate recommend prescribing calcium citrate to patients who use antacids The rationale for this advice is that water-insoluble calcium carbonate needs acid for adequate

Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

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Bruno da Silva Matte

2018-01-01

Full Text Available We here report a case of ST-elevation myocardial infarction (STEMI due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel.

[Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures].

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Fantidis, P; Fernández Ruiz, M A; Madero Jarabo, R; Moreno Granados, F; Cordovilla Zurdo, G; Sanz Galeote, E

1990-11-01

In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

Calcium and vitamin D requirements for optimal bone mass during adolescence

Science.gov (United States)

There remains very strong interest in the calcium and vitamin D requirements of adolescents related to bone health. The Institute of Medicine (IOM) released new dietary guidelines in late 2010 for these nutrients. These guidelines were primarily based on literature published in 2009 and earlier and ...

Three-Dimensional Respiratory-Gated Coronary Mr Angiography with Reference to X-Ray Coronary Angiography

International Nuclear Information System (INIS)

Ikonen, A. E. J.; Manninen, H. I.; Vainio, P.; Vanninen, R. L.; Matsi, P. J.; Soimakallio, S.; Hirvonen, T.P.J.; Hartikainen, J.E.K.

2003-01-01

Purpose: To assess the clinical value of three-dimensional coronary MR angiography (CMRA) in the detection of significant coronary artery stenosis using conventional X-ray angiography as the standard reference. Material and Methods: Sixty-nine patients underwent X-ray coronary angiography and CMRA because of suspected or previously diagnosed coronary artery disease. MRI was performed with a 1.5-T whole body imaging system using ECG-triggered 3D gradient echo sequence with retrospective navigator echo respiratory gating and fat suppression. Results: A total of 276 coronary artery segments were analyzed. The X-ray coronary angiography was normal in 22 patients. Significant proximal stenoses (exceeding 50%) or occlusions were present in 102 coronary artery segments. In all, 120 stenoses or occlusions were identified in CMRA. Sixteen percent of the coronary artery segments had to be excluded because of poor image quality. The overall sensitivity and specificity for MRA for identification of significant stenosis were 75% and 62%, respectively. CMRA correctly detected 89% of patients with at least one vessel disease, but 6 patients with coronary artery disease would have been missed. Conclusions: Because of the high data exclusion and false-negative case rate, CMRA with retrospective navigator echo triggering is at present not suitable as a clinical screening method in coronary artery disease

Coronary artery anomalies in adults: imaging at dual source CT coronary angiography

International Nuclear Information System (INIS)

Laspas, Fotios; Roussakis, Arkadios; Mourmouris, Christos; Kritikos, Nikolaos; Efthimiadou, Roxani; Andreou, John

2013-01-01

Congenital abnormalities of the coronary arteries have an incidence of 1%, and most of these are benign. However, a small number are associated with myocardial ischaemia and sudden death. Various imaging modalities are available for coronary artery assessment. Recently, multi-detector CT has emerged as an accurate diagnostic tool for defining coronary artery anomalies. The purpose of this pictorial essay is to review the dual source CT appearance of congenital anomalies of the coronary arteries in adults.

A long-acting calcium antagonist over one year did not improve BMIPP myocardial scintigraphic imagings in patients with pure coronary spastic angina

International Nuclear Information System (INIS)

Sueda, Shozo; Oshita, Akira; Izoe, Yousuke; Kohno, Hiroaki; Fukuda, Hiroshi; Ochi, Takaaki; Uraoka, Tadao

2007-01-01

Calcium antagonists (Ca) have been effective in reducing angina attacks in patients with variant angina. However, there are no reports regarding the effectiveness of Ca on myocardial fatty acid metabolic images in patients with pure coronary spastic angina (CSA). This study sought to examine the correlation between myocardial fatty acid metabolic images and the medical treatment of Ca in patients with pure CSA. This study included 35 consecutive patients (28 men, mean age of 66±10 years) with angiographically confirmed coronary spasm and no fixed stenosis. Long-acting Ca was administered to all 35 patients. Isosorbide dinitrate/nicorandil/another Ca/beta-blocker were administered when chest pain was not controlled. Using an iodinated fatty acid analogue, 15-(p-[iodine-123]iodophenyl)-3-(R,S)methylpentadecanoic acid (BMIPP), myocardial scintigraphies with intravenous adenosine triphosphate infusion were performed before cardiac catheterization and 12 mo after medical therapy. According to the medical control states, these 35 patients were classified into 3 groups; response (disappearance of angina attacks, 12 pts, 60±11 years), partial response (angina attacks <4/mo, 12 pts, 67±10 years), and no response to therapy (angina attacks ≥4/mo, 11 pts, 71±6 years). Reduced BMIPP uptake was observed in 24 (69%) of 35 patients before the treatment. Reduced BMIPP uptake was also found in 18 patients (51%) after 12 mo. Normal BMIPP uptake after 12 mo therapy was observed in about half (response: 42%, partial response: 58%, no response: 45%) of patients among the 3 groups. There was no difference regarding the value of washout rate (WOR) (response; 10±7 (before), 14±8% (12 mo)), partial response; 11±7, 10±5%, no response; 13±9, 14±8%) among the 3 groups. The defect scores of BMIPP in the three groups were not different during at least one year medical therapy. No difference regarding the distribution of other medical therapies (angiotensin converting enzyme

A Prospective Trial of Ayurveda for Coronary Heart Disease: A Pilot Study.

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DuBroff, Robert; Lad, Vasant; Murray-Krezan, Cristina

2015-01-01

Coronary heart disease is the leading cause of death worldwide, and its incidence is rapidly accelerating in developing nations. Patients often search for therapies that are alternatives to traditional treatments, such as heart medicines, coronary bypass surgery, or coronary stenting. Ayurveda is an ancient, East Indian, holistic approach to health care, and its use has never been formally evaluated for patients with coronary heart disease. The study intended to examine the feasibility and effectiveness of comprehensive ayurvedic therapy-incorporating diet, meditation, breathing exercises, yoga, and herbs-for patients with established coronary heart disease. The study was a prospective, single-group, pilot study. The study took place at the University of New Mexico Cardiology Clinic and at the Ayurvedic Institute in Albuquerque, NM, USA. The participants were adults with a history of a prior heart attack, coronary bypass surgery, or a coronary intervention (ie, a coronary angioplasty and/or stent). All enrolled patients were evaluated by a single ayurvedic physician with >40 y of experience, and each received therapy consisting of a calorically unrestricted ayurvedic diet; instruction in yoga, meditation, and breathing; and use of ayurvedic herbs. The primary endpoint was arterial pulse wave velocity, a marker of arterial function and vascular health. Secondary endpoints included the following measurements: (1) body mass index (BMI); (2) blood pressure (BP) and amount of reduction in BP medications; and (3) levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. All parameters were measured at baseline and after 90 d of therapy. Twenty-two patients were enrolled in the study, and 19 patients completed it. The research team observed significant improvements in arterial pulse wave velocity (P = .015), and favorable reductions in BMI (P ayurveda on arterial function and multiple risk

Maternal nutrient restriction during pregnancy impairs an endothelium-derived hyperpolarizing factor-like pathway in sheep fetal coronary arteries.

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Shukla, Praveen; Ghatta, Srinivas; Dubey, Nidhi; Lemley, Caleb O; Johnson, Mary Lynn; Modgil, Amit; Vonnahme, Kimberly; Caton, Joel S; Reynolds, Lawrence P; Sun, Chengwen; O'Rourke, Stephen T

2014-07-15

The mechanisms underlying developmental programming are poorly understood but may be associated with adaptations by the fetus in response to changes in the maternal environment during pregnancy. We hypothesized that maternal nutrient restriction during pregnancy alters vasodilator responses in fetal coronary arteries. Pregnant ewes were fed a control [100% U.S. National Research Council (NRC)] or nutrient-restricted (60% NRC) diet from days 50 to 130 of gestation (term = 145 days); fetal tissues were collected at day 130. In coronary arteries isolated from control fetal lambs, relaxation to bradykinin was unaffected by nitro-l-arginine (NLA). Iberiotoxin or contraction with KCl abolished the NLA-resistant response to bradykinin. In fetal coronary arteries from nutrient-restricted ewes, relaxation to bradykinin was fully suppressed by NLA. Large-conductance, calcium-activated potassium channel (BKCa) currents did not differ in coronary smooth muscle cells from control and nutrient-restricted animals. The BKCa openers, BMS 191011 and NS1619, and 14,15-epoxyeicosatrienoic acid [a putative endothelium-derived hyperpolarizing factor (EDHF)] each caused fetal coronary artery relaxation and BKCa current activation that was unaffected by maternal nutrient restriction. Expression of BKCa-channel subunits did not differ in fetal coronary arteries from control or undernourished ewes. The results indicate that maternal undernutrition during pregnancy results in loss of the EDHF-like pathway in fetal coronary arteries in response to bradykinin, an effect that cannot be explained by a decreased number or activity of BKCa channels or by decreased sensitivity to mediators that activate BKCa channels in vascular smooth muscle cells. Under these conditions, bradykinin-induced relaxation is completely dependent on nitric oxide, which may represent an adaptive response to compensate for the absence of the EDHF-like pathway. Copyright © 2014 the American Physiological Society.

Referral to a Commercial Weight Management Program in Patients With Coronary Heart Disease: A PILOT STUDY IN THE NETHERLANDS

NARCIS (Netherlands)

Minneboo, Madelon; Peters, Ron J. G.; Miller-Kovach, Karen; Lemmens, Jeanine; Bucx, Jeroen J. J.

2015-01-01

To quantify the impact of a commercial weight management program on weight change in obese patients with coronary heart disease. An observational, single-center pilot study in the Netherlands. Forty-five patients diagnosed with a recent acute coronary syndrome and a body mass index of >30 kg/m2 were

Calcium antagonistic effects of Chinese crude drugs: Preliminary investigation and evaluation by 45Ca

International Nuclear Information System (INIS)

Liu Ning; Yang Yuanyou; Mo Shangwu; Liao Jiali; Jin Jiannan

2005-01-01

Coronary and other diseases in cardiac or brain blood vessels are considered to be due to the excessive influx of Ca 2+ into cytoplasm. If Ca 2+ channels in cell membrane are blocked by medicines or other substances with considerable calcium antagonistic effects, these diseases might be cured or controlled. The influence of some Chinese crude drugs, including Crocus sativus, Carthamus tinctorius, Ginkgo biloba and Bulbus allii macrostemi on Ca 2+ influx in isolated rat aortas was investigated by using 45 Ca as a radioactive tracer, and their calcium antagonistic effects were evaluated. It can be noted that Ca 2+ uptake in isolated rat aorta rings in normal physiological status was not markedly altered by these drugs, whereas the Ca 2+ influxes induced by norepinephrine of 1.2 μmol/L and KCl of 100 mmol/L were significantly inhibited by Crocus, Carthamus and Bulbus in a concentration-dependent manner, but not by Ginkgo. The results show that extracellular Ca 2+ influx through receptor-operated Ca 2+ channels and potential-dependent Ca 2+ channels can be blocked by Crocus, Carthamus and Bulbus. This implies that these Chinese crude drugs have obvious calcium antagonistic effects

Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease.

Science.gov (United States)

Harbaoui, Brahim; Courand, Pierre-Yves; Cividjian, Andrei; Lantelme, Pierre

2017-02-02

Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease. In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid-femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid-femoral PWV, did not differ significantly. CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Coronary MR angiography: current status

International Nuclear Information System (INIS)

Danias, P.G.; Manning, W.J.

2000-01-01

Since first described in the early 1990s, coronary magnetic resonance angiography (MRA) has evolved as a promising noninvasive modality for imaging of the coronary arteries and evaluation of coronary artery disease. Despite technical limitations, coronary MRA has established value for imaging of anomalous coronary arteries and assessment of bypass graft patency. Current research focuses on the development of optimal respiratory compensation strategies, improved spatial and temporal resolution and faster acquisition of image data. The accurate detection of stenoses and assessment of the severity of coronary atherosclerosis is presently being evaluated with large multi-center studies. With further technique enhancements and more clinical experience, coronary MRA is likely to become the dominant noninvasive modality in clinical cardiology. (orig.) [de

Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

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Xiangfei Wang

2014-01-01

Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

21 CFR 172.330 - Calcium pantothenate, calcium chloride double salt.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Calcium pantothenate, calcium chloride double salt... FOOD FOR HUMAN CONSUMPTION Special Dietary and Nutritional Additives § 172.330 Calcium pantothenate, calcium chloride double salt. The food additive calcium chloride double salt of calcium pantothenate may...

Congenital coronary artery fistula

International Nuclear Information System (INIS)

Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

1986-01-01

Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

Heart rate modulation in stable coronary artery disease without clinical heart failure: What we have already learned from SIGNIFY?

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Gian Piero Perna

2016-12-01

In conclusion, heart rate is a marker of risk but is not a risk factor and/or a target of therapy in patients with stable coronary artery disease and preserved ventricular systolic function. Standard doses of ivabradine are indicated for treatment of angina as an alternative or in addition to beta-blockers, but should not be administered in association with CYP3A4 inhibitors or heart rate-lowering calcium-channel blockers.

Dose reduction using prospective electrocardiograph-triggered axial coronary scan on the 64-slice spiral CT

International Nuclear Information System (INIS)

Wang Yanyan; Wu Guogeng; Zhou Cheng; Gao Jianhua; Jiao Sheng; Cao Huizhi

2008-01-01

Objective: To compare radiation dose and image quality between prospective electrocardiograph (ECG)-triggered axial scan and retrospective ECG-gated helical scan in coronary 64-slice CT angiography (CTA). Methods: Seventy-seven consecutive patients [group A. Average body mass index (BMI): 24.6, heart rate 0.05). Conclusion: Prospective ECG-triggered axial scan in 64-slice coronary CTA can significantly reduce radiation exposure and the image quality can fulfill clinical diagnostic needs. (authors)

Non-invasive assessment of coronary calcification

International Nuclear Information System (INIS)

Vliegenthart, Rozemarijn; Oei, Hok-Hay S.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jackqueline C. M.

2004-01-01

Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to cardiovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for non-invasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research

Young Adults' Perceptions of Calcium Intake and Health: A Qualitative Study.

Science.gov (United States)

Marcinow, Michelle L; Randall Simpson, Janis A; Whiting, Susan J; Jung, Mary E; Buchholz, Andrea C

2017-12-01

Many young Canadian adults are not meeting dietary calcium recommendations. This is concerning as adequate calcium is important throughout young adulthood to maximize peak bone mass for osteoporosis prevention. There are limited studies that have explored young adults' perceptions toward calcium and health. Our objectives were to determine young adults' (18-34 years) knowledge of calcium in relation to health, facilitators and barriers to adequate calcium intake, and to explore both their suggestions for individual strategies to increase calcium intake and ways to communicate calcium-related messaging to this population. Eight gender-specific focus groups (18 men; 35 women) were conducted using a semistructured interview guide, guided by social cognitive theory. Deductive thematic analysis was used to generate themes. Participants perceived adequate calcium intake to be important for children and older adults but were uncertain of the benefits for their own age group. Perceived positive outcomes (e.g., aesthetics such as strong nails) associated with adequate calcium intake were cited as a motivator to increase intake. Perceived barriers to achieving increased calcium intake included the high cost and inconvenience of milk products and negative practices of dairy farmers. Participants suggested planning healthy well-balanced meals and forming a habit of consuming calcium-rich foods as individual strategies to increase calcium intake. Strategies to convey calcium-related information to young adults included increasing awareness of the importance of calcium via credible sources of information and developing nutrition education curricula. Social media and advertising were perceived as ineffective. Our findings provide key information for nutrition education initiatives.