Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function.

Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular (LV) function. Methods CAC score was measured by computed tomography at CARDIA study (Coronary Artery Risk Development in Young Adults) year-15 examination and at year-25 examination (Y25) in 3043 and 3189 participants, respectively. CAC score was assessed as a continuous variable and log-transformed to account for nonlinearity. Change in CAC from year-15 examination to Y25 was evaluated as the absolute difference of log-transformed CAC from year-15 examination to Y25. LV structure and function were evaluated by echocardiography at Y25. Results At Y25, mean age was 50.1±3.6 years, 56.6% women, 52.4% black. In the multivariable analysis at Y25, higher CAC was related to higher LV mass (ß=1.218; adjusted P=0.007), higher LV end-diastolic volume (ß=0.811; adjusted P=0.007), higher LV end-systolic volume (ß=0.350; adjusted P=0.048), higher left atrial volume (ß=0.214; adjusted P=0.009), and higher E/e' ratio (ß=0.059; adjusted P=0.014). CAC was measured at both year-15 examination and Y25 in 2449 individuals. Higher change in CAC score during follow-up was independently related to higher LV mass index in blacks (ß=4.789; adjusted P<0.001), but not in whites (ß=1.051; adjusted P=0.283). Conclusions Higher CAC in middle age is associated with higher LV mass and volumes and worse LV diastolic function. Being free of CAC from young adulthood to middle age correlates to better LV function at middle age. Higher change in CAC score during follow-up is independently related to higher LV mass index in blacks.

Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study.

Aims: To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study. Methods and results: We conducted a prospective post hoc analysis of individuals enrolled at the Coronary Artery Risk Development in Young Adults, which is a multi-centre bi-racial cohort with 30 years of follow-up. Cumulative systolic and diastolic BP levels were defined by summing the product of average millimetres of mercury and the years between each two consecutive clinic visits over 30 years of follow-up. Multivariable linear regression analyses were used to assess the relationship between cumulative systolic and diastolic BP with 3DE LA structure and function, adjusting for demographics and traditional cardiovascular risk factors. A total of 1033 participants were included, mean age was 55.4 ± 3.5 years, 55.2% women, 43.9% blacks. Cumulative systolic BP had stronger correlations than cumulative diastolic BP. Higher cumulative systolic BP was independently associated with higher 3D LA volumes: maximum (ß = 1.74, P = 0.004), pre-atrial contraction (ß = 1.87, P < 0.001), minimum (ß = 0.76, P = 0.04), total emptying (ß = 0.98, P = 0.006), active emptying (ß = 1.12, P < 0.001), and lower magnitude 3D LA early diastolic strain rate (ß = 0.05, P = 0.02). Higher cumulative diastolic BP was independently associated with higher 3D LA active emptying volume (ß = 0.66, P = 0.002), lower magnitude 3D LA early diastolic strain rate (ß = 0.05, P = 0.004), and higher magnitude 3D LA late diastolic strain rate (ß = -0.04, P = 0.05). Conclusion: Higher cumulative BP from early adulthood throughout middle age was associated with adverse LA remodelling evaluated by 3D echocardiography.

Influência do escore de cálcio na gravidade de lesões coronárias moderadas avaliadas pelo ultrassom intracoronário / Influence of calcium score on the severity of moderate coronary lesions evaluated by intravascular ultrasound

INTRODUÇÃO: A área luminal mínima (ALM), obtida pelo ultrassom intracoronário (USIC), é preditora de eventos em pacientes com lesões de moderada gravidade, identificadas à angiografia coronária. Por outro lado, a presença de cálcio é preditora de estabilidade das lesões. O objetivo deste estudo é avaliar qual a influência da quantidade total de cálcio coronário, obtido pela tomografia computadorizada cardíaca (TCC), na gravidade de lesões moderadas, avaliadas por meio de USIC. MÉTODOS: Realizamos USIC de 27 lesões moderadas, em uma série consecutiva de 22 pacientes com indicação para o procedimento, e que tinham TCC prévia. Foram obtidas medidas da ALM, carga de placa e porcentual de área de estenose. RESULTADOS: Os pacientes eram, em sua maioria, do sexo masculino (85%), com idade de 60 ± 9 anos e 41% eram diabéticos. Observamos correlação significativa entre ALM e escore de cálcio total (r = 0,67; P = 0,002), mas não houve correlação entre escore de cálcio total e carga de placa (r = 0,02; P = 0,93) ou porcentual de área de estenose (r = 0,3; P = 0,32). Os preditores independentes da ALM na análise multivariada foram idade (P = 0,02), índice de massa corporal (P = 0,01), diabetes (P = 0,02), dislipidemia (P = 0,02), proteína C-reativa ultrassensível (P = 0,02), glicemia (P = 0,02), HDL-colesterol (P = 0,02), triglicerídeos (P = 0,02), fração de ejeção do ventrículo esquerdo < 50% (P = 0,02) e escore de cálcio total (P = 0,03). CONCLUSÕES: O escore de cálcio total apresenta correlação positiva com a ALM em artérias coronárias, sugerindo que maior quantidade de cálcio na árvore coronária implica lesões ateroscleróticas moderadas com maiores áreas luminais ao USIC.

BACKGROUND: The minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) is a predictor of cardiovascular events in patients with angiographically moderate lesions. On the other hand, the presence of calcium is a predictor of lesion stability. The objective of this study is to evaluate the influence of the total amount of coronary calcium, obtained by multislice CT scanner (MDCT), on the severity of moderate lesions as assessed by IVUS. METHODS: IVUS was performed in 27 moderate lesions in a consecutive series of 22 patients with indication for the procedure who had a previous MDCT. Measurements of the minimal luminal area (MLA), plaque burden and percentage area stenosis were obtained. RESULTS: Most patients were male (85%), with mean age of 60 ± 9 years and 41% were diabetic. A significant correlation was observed between the MLA and total calcium score (r = 0.67; P = 0.002), but there was no correlation between the total calcium score and plaque burden (r = 0.02; P = 0.93) or percentage area stenosis (r = 0.3; P = 0.32). Independent predictors of MLA in the multivariate analysis were age (P = 0.02), body mass index (P = 0.01), diabetes (P = 0.02), dyslipidemia (P = 0.02), high-sensitive Creactive protein (P = 0.02), glucose (P = 0.02), HDL-cholesterol (P = 0.02), triglycerides (P = 0.02), left ventricular ejection fraction < 50% (P = 0.02) and total calcium score (P = 0.03). CONCLUSIONS: The total calcium score correlates positively with MLA in coronary arteries, suggesting that a large calcium burden in the coronary tree is related to angiographically moderate lesions with larger luminal areas at IVUS.