Epicardial and intra-thoracic adipose tissue and cardiovascular calcifications in type 1 diabetes (T1D) in epidemiology of diabetes Interventions and Complications (EDIC): A pilot study.

Objective: Coronary artery, aortic valve, and descending aorta calcification (CAC, AVC, DAC) are manifestations of atherosclerosis, and cardiac epicardial adipose tissue (EAT) indicates heart adiposity. This study explored the association between cardiac adipose tissue and cardiovascular calcification in participants with long-standing T1D. Methods: EAT and intra-thoracic adipose tissue (IAT) were measured in 100 T1D subjects with cardiac computed tomography (CT) scans in the EDIC study. Volume analysis software was used to measure fat volumes. Spearman correlations were calculated between CAC, AVC, DAC with EAT, and IAT. Associations were evaluated using multiple linear and logistic regression models. Results: Participants ranged in age from 32 to 57. Mean EAT, and IAT were 38.5 and 50.8 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6 %, 4.7 %, and 26.8 %, respectively. CAC was positively correlated with age (p-value = 0.0001) and EAT (p-value = 0.0149) but not with AVC and DAC; IAT was not associated with calcified lesions. In models adjusted for age and sex, higher levels of EAT and IAT were associated with higher CAC (p-value < 0.0001 for both) and higher AVC (p-values of 0.0111 and 0.0053, respectively), but not with DAC. The associations with CAC remained significant (p-value < 0.0001) after further adjustment for smoking, systolic blood pressure, BMI, and LDL, while the associations with AVC did not remain significant. Conclusion: In participants with T1D, higher EAT and IAT levels are correlated with higher CAC scores. EAT and IAT were not independently correlated with DAC or AVC.

Coronary artery-positive remodeling in current smokers.

BACKGROUND: This study aims to evaluate the association of the coronary artery-positive remodeling (CAPR) observed on cardiac computed tomography angiography (CCTA) with cigarette smoking. PATIENTS AND METHODS: This retrospective case-control study enrolled 178 consecutive patients with CAPR plaque (case group) and 180 consecutive patients with coronary artery plaque, but no positive remodeling (control group). CAPR was evaluated in CCTA images and defined as at least 10% larger vessel diameter at the plaque site compared with a normal reference segment. RESULTS: The average age of this population was 61.8±11.5 years (30.4% women). In the case group, the prevalences of current smokers, former smokers, and nonsmokers were 15.7, 26.4, and 57.9%, respectively. In the control group, the prevalences were 6.1, 20.6, and 73.3%, respectively, which were significantly different from the control group (P=0.002 for all). In a subanalysis of the CAPR location in the CAPR group, CAPR was more prevalent in the proximal than the distal segments of the major coronary arteries. Most of the patients in the case group had only one segment involvement with CAPR (71.35%). Logistic regression analyses showed that a history of current smoking has a significant correlation with CAPR in both unadjusted and adjusted models after controlling for risk factors. Current smokers have a 3.5-fold higher risk of having CAPR compared with nonsmokers (P<0.01). CONCLUSION: There is a significant independent association between a history of cigarette smoking and CAPR evaluated by CCTA. Current cigarette smokers have a 3.5 times higher risk of having CAPR.

The relationship between cardio-ankle vascular index and subclinical atherosclerosis evaluated by cardiac computed tomographic angiography.

BACKGROUND: The cardio-ankle vascular index (CAVI) is a new noninvasive index to evaluate arterial stiffness. We investigated whether CAVI can predict severity, extent, and burden of coronary artery disease by comparing results with cardiac computed tomographic angiography (CCTA). HYPOTHESIS: CAVI may predict the presence of subclinical atherosclerosis. METHODS: We prospectively enrolled 95 patients (66% male; mean age, 50 ± 16 years) who underwent both CCTA and CAVI consecutively. We evaluated if CAVI correlated with (1) severe stenosis (≥50%); (2) plaque extent, determined by a segment-involvement score (SIS), defined by the total number of coronary artery segments containing any plaque; and (3) plaque burden, determined by a segment-stenosis score (SSS), defined by the extent of obstruction of coronary luminal diameter in individual coronary artery segments. RESULTS: Bivariate analysis showed a statistically significant relationship not only between CAVI and SIS, but also between CAVI and SSS (r2 = 0.4, P < 0.0001 for SIS; r2 = 0.36, P < 0.0001 for SSS). Multivariable logistic analysis demonstrated that CAVI is significantly associated with SSS >5 (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.1-7.8, P = 0.03) and SIS >5 (OR: 2.3, 95% CI: 1.1-5.8, P = 0.02), but not severe stenosis (OR: 1.7, 95% CI: 0.9-4.3, P = 0.13), after adjusting for age, sex, chest pain, hypertension, dyslipidemia, family history, diabetes, and current smoking. CONCLUSIONS: We demonstrated that CAVI had a significant relationship with subclinical coronary atherosclerosis evaluated by CCTA, especially in relation to plaque burden and plaque extent, but not severe stenosis. Thus, CAVI may reflect coronary atherosclerosis burden more than severity.

Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study.

INTRODUCTION: Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC). METHODS: We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). The associations between HIV infection and the presence of each type of ECC (score > 0) were evaluated by multivariable logistic regression. We also evaluated the association of ECC with inflammatory biomarker levels and coronary plaque morphology. RESULTS: Among HIV+ and HIV- men, the age-standardized prevalences were 15% for TAC (HIV+ 14%/HIV- 16%), 10% for AVC (HIV+ 11%/HIV- 8%), 24% for AVRC (HIV+ 23% HIV- 24%), and 5% for MAC (HIV+ 7%/HIV- 3%). After adjustment, HIV+ men had 3-fold greater odds of MAC compared to HIV- men (OR = 3.2, 95% CI: 1.5-6.7), and almost twice the odds of AVC (1.8, 1.1-2.9). HIV serostatus was not associated with TAC or AVRC. AVRC was associated with higher Il-6 and sCD163 levels. TAC was associated with higher ICAM-1, TNF-α RII, and Il-6 levels. AVC and AVRC calcification were associated with presence of non-calcified plaque in HIV+ but not HIV- men. CONCLUSION: HIV infection is an independent predictor of MAC and AVC. Whether these calcifications predict mortality in HIV+ patients deserves further investigation.

Recent improvement in coronary computed tomography angiography diagnostic accuracy.

Although invasive coronary angiography has been the gold standard for evaluating coronary artery disease (CAD), it should not be routinely performed as an initial test to assess CAD in subjects with suspected CAD by the recent guidelines, due to cost, invasiveness, and measurable risk. Coronary computed tomography angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of CAD becomes of great promise with high diagnostic accuracy. Although artifact issues have created some challenges for CCTA, recent advances-including the introduction of more detectors, leading to broader coverage, and faster and higher-definition scanners-allow improved precision and fewer uninterpretable studies. This review article summarizes the current key literature regarding the diagnostic accuracy of CCTA in native coronary arteries, stents, coronary artery bypass grafts, lesions with high calcification, and the functional assessment of CAD.