RESUMEN
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT. METHODS: A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores. RESULTS: Participants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores. CONCLUSION: Our study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.
Asunto(s)
Enfermedad de la Arteria Coronaria , Calcificación Vascular , Humanos , Masculino , Femenino , Anciano , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico , Pronóstico , Persona de Mediana Edad , Medición de Riesgo/métodos , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Aorta Torácica/diagnóstico por imagen , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/diagnóstico , Curva ROC , Vasos Coronarios/diagnóstico por imagen , Técnicas de Imagen Sincronizada Cardíacas , Estados Unidos/epidemiología , Electrocardiografía , Incidencia , Angiografía Coronaria/métodos , Tomografía Computarizada por Rayos X , Aterosclerosis/epidemiología , Aterosclerosis/diagnósticoRESUMEN
BACKGROUND: Patients with homozygous and heterozygous familial hypercholesterolemia (HeFH) develop severe aortic calcifications in an age- and gene dosage-dependent manner. The purpose of this study was to determine the rate of progression of aortic calcification in patients with HeFH. METHODS: We performed thoracoabdominal computed tomography scans and quantified aortic calcium (AoCa) score in 16 HeFH patients, all with the null low-density lipoprotein (LDL) receptor DEL15Kb mutation. Patients (12 men, 4 women) were rescanned an average of 8.2 ± 0.8 years after the first scan. RESULTS: Mean LDL cholesterol (LDL-C) during treatment was 2.53 mmol/L; all patients were receiving high-dose statin/ezetimibe; 5 of 16 were receiving evolocumab. Baseline LDL-C was 7.6 ± 1.3 mmol/L. Aortic calcifications increased in all patients in an exponential fashion with respect to age. Age was the strongest correlate of AoCa score. Cholesterol, LDL-C, or age × cholesterol did not correlate with AoCa score or its progression. Control patients (n = 31; 8 male, 23 female; mean age 61 ± 11 years) who underwent virtual colonoscopy were rescanned over the same period and showed an abdominal AoCa score of 1472 ± 2489 compared with 7916 ± 7060 Agatston U (P < 0.001) in patients with HeFH during treatment (mean age, 60 ± 14 years). The rate of progression was 159 vs 312 Agatston U/y in control participants vs those with HeFH. CONCLUSIONS: HeFH patients exhibit accelerated aortic calcification that increases exponentially with age. LDL-C at baseline or during treatment seems to have little effect on the rate of progression of AoCa score. Strategies to prevent aortic calcifications with statins have not met with clinical success and novel approaches are required; statins might also contribute to the process of arterial calcification.
Asunto(s)
Aorta , Enfermedades de la Aorta , Ezetimiba , Hiperlipoproteinemia Tipo II , Receptores de LDL/genética , Calcificación Vascular , Anciano , Anticolesterolemiantes/administración & dosificación , Anticolesterolemiantes/efectos adversos , Aorta/diagnóstico por imagen , Aorta/patología , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/prevención & control , Calcio/análisis , LDL-Colesterol/análisis , Ezetimiba/administración & dosificación , Ezetimiba/efectos adversos , Femenino , Heterocigoto , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hiperlipoproteinemia Tipo II/genética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Calcificación Vascular/diagnóstico , Calcificación Vascular/etiología , Calcificación Vascular/prevención & controlRESUMEN
BACKGROUND: The aim of this study was to investigate the effect of vitamin E on homocysteine and cholesterol-induced damage of rat aorta. METHODS: Wistar rats (all fed with a vitamin E poor diet) were divided into five groups. Control group was fed with the diet only, the second group received 1 mg kg(-1) day(-1) L-methionine in drinking water, the third group was fed with 2% cholesterol containing diet, the fourth group received L-methionine and cholesterol together, and the fifth group was fed with L-methionine and cholesterol and received intramuscular injections of vitamin E. After 4 weeks serum homocysteine, cholesterol and vitamin E levels were measured; aortas were removed; collagen and elastin and the major extracellular matrix components were evaluated microscopically as indicators of aortic degeneration. Aortic collagen content was measured by a colorimetric hydroxyproline assay. RESULTS: Four-week diet supplementation with methionine and cholesterol caused a twofold increase in serum homocysteine and 22% increase in serum cholesterol levels; endothelial damage and degenerative alterations in the aortic media were observed, as indicated by the dissociation of elastic fibers and accumulation of collagen. Vitamin E completely prevented the accumulation of collagen and largely prevented aorta damage as shown by the morphological data. CONCLUSION: The results indicate that, even moderate increases in homocysteine and cholesterol levels are sufficient to induce vascular degeneration that may be prevented by vitamin E supplementation.
Asunto(s)
Aorta/efectos de los fármacos , Enfermedades de la Aorta/prevención & control , Aterosclerosis/prevención & control , Colesterol en la Dieta/sangre , Suplementos Dietéticos , Homocisteína/sangre , Deficiencia de Vitamina E/tratamiento farmacológico , Vitamina E/farmacología , Animales , Aorta/metabolismo , Aorta/patología , Enfermedades de la Aorta/sangre , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/patología , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Aterosclerosis/etiología , Aterosclerosis/patología , Colágeno/metabolismo , Citoprotección , Modelos Animales de Enfermedad , Tejido Elástico/efectos de los fármacos , Tejido Elástico/metabolismo , Tejido Elástico/patología , Masculino , Metionina/administración & dosificación , Metionina/metabolismo , Ratas , Ratas Wistar , Factores de Tiempo , Vitamina E/sangre , Deficiencia de Vitamina E/sangre , Deficiencia de Vitamina E/complicaciones , Deficiencia de Vitamina E/patologíaRESUMEN
Acute aortic syndromes are a life-threatening set of conditions that require rapid triage and intervention to obtain satisfactory outcomes. The Methodist Hospital is the first institution to establish an Acute Aortic Treatment Center (AATC) based on a clinical care pathway that expedites the care of acute aortic syndromes. This pathway has resulted in a 64% reduction in time to definitive therapy and a reduction in intensive care unit (ICU) length of stay. Establishment of a multidisciplinary pathway to treat acute aortic syndromes improves efficiency and enhances outcomes.
Asunto(s)
Enfermedades de la Aorta/terapia , Vías Clínicas/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Hospitales , Grupo de Atención al Paciente/organización & administración , Enfermedad Aguda , Enfermedades de la Aorta/diagnóstico , Conducta Cooperativa , Eficiencia Organizacional , Humanos , Comunicación Interdisciplinaria , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Síndrome , Resultado del TratamientoRESUMEN
El uso de la ecocardiografía transesofágica (ETE) durante la inserción de una endoprótesis aórtica torácica percutánea puede ser de gran utilidad. Esto es porque se trata de una técnica de monitorización escasamente invasiva con la que se obtienen imágenes de la aorta en tiempo real y de alta calidad, sin interferir en el campo quirúrgico. Se presenta el caso clínico de un paciente de alto riesgo portador de una disección de aorta torácica tipo B al que se le instaló con éxito una endoprótesis bajo visión angiográfica y ecocardiográfica. La ETE fue muy útil durante este procedimiento, pues permitió una excelente visión anatómica de la aorta. Además, con el uso de Doppler color fue posible evaluar la ausencia de endofugas paraprotésicas durante el procedimiento. En conclusión, la ETE puede ser una técnica de imágenes útil y complementaria de la angiografía durante la instalación de una endoprótesis de aorta torácica.
Transesophageal echocardiography (TEE) can be very useful during endovascular treatment of the thoracic aorta. TEE is a minimally invasive monitoring technique that provides high qua lit y images of the aorta without interfering the surgical field. A successful endovascular repair of a thoracic aortic dissection monitored by angiography and TEE is reported. The excellent images of the aorta provided by TEE and color Doppler were very useful for its anatomical evaluation and for demonstrating the absence of paraprosthetic endoleaks. In conclusion, during the implantation of a stent-graft in the aorta, TEE must be installed because it provides additional in formation to angiography.
O uso da ecocardiografia transesofágica (ETE) durante a colocação de uma endoprótese aórtica torácica percutanea pode ser de grande utilidade, por tratar-se de uma técnica de monitoramento minimamente invasiva que gera imagens da aorta de alta qualidade em tempo real e sem interferir no campo cirúrgico. É apresentado o caso clínico de um paciente de alto risco, portador de uma dissecção de aorta torácica tipo B, ao qual se colocou com exito uma endoprótese sob visão angiográfica e ecocardiográfica. A ETE foi de grande utilidade durante este procedimento, pois permitiu uma excelente visão anatómica da aorta. Além disso, o uso do Doppler em cores possibilitou avaliar a ausencia de endofugas paraprotéticas durante o procedimento. Em conclusão, a ETE pode ser uma técnica de imagens útil e complementar da angiografia durante a colocação de uma endoprótese de aorta torácica.
Asunto(s)
Humanos , Masculino , Adulto , Anestesia General/métodos , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico , Ecocardiografía Transesofágica/métodos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Anestesia Local , Anestésicos Intravenosos/uso terapéutico , Disección Aórtica/diagnóstico , Disección Aórtica , Angiografía/métodos , Aorta Torácica/lesiones , Aorta Torácica , Arteria Renal/lesiones , Arteria Renal , Drenaje , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
El síndrome aórtico agudo es un proceso agudo de la pared aórtica que afecta a la capa media; incluye la disección aórtica, el hematoma intramural y la úlcera penetrante. En los últimos años, las técnicas de imagen han ayudado a conocer la historia natural de estas entidades y a comprender mejor el importante dinamismo de esta enfermedad. A pesar de los importantes avances en el diagnóstico y el tratamiento quirúrgico, la mortalidad en la fase aguda sigue siendo alta. La sospecha clínica precoz y la mejoría de la experiencia quirúrgica parecen ser las únicas variables que podrían facilitar la reducción de la mortalidad. Una vez superada la fase aguda, en la mayoría de los pacientes permanece una afectación de la aorta descendente y un 30% presenta complicaciones a los 3-5 años. En esta fase es necesario instaurar un tratamiento médico óptimo y un seguimiento próximo con técnicas de imagen. La incorporación del tratamiento intravascular ha abierto nuevas perspectivas en el tratamiento de esta enfermedad y podría mejorar el pronóstico a largo plazo. En este artículo se revisan los avances en el diagnóstico y el tratamiento de este síndrome (AU)
Acute aortic syndrome is an acute lesion of the aortic wall involving the aortic media. The term covers aortic dissection, intramural hematoma, and penetrating ulcer. In the last few years, imaging techniques have increased our understanding of the natural history of these disease entities and of the dynamics of the disease processes. Despite significant advances in diagnosis and surgical treatment, the mortality rate in the acute phase remains high. Early clinical suspicion and greater surgical expertise appear to be the only factors that are able reduce mortality. Once the acute phase is past, the descending aorta continues to be involved in most patients, 30% of whom develop complications within 3-5 years. During this later phase, it is essential to optimize medical treatment and to use imaging techniques to follow-up the patient closely. The availability of endovascular treatment has provided new approaches to the management of the condition and could improve long-term prognosis. The aim of this article was to review recent progress in the diagnosis and therapeutic management of this syndrome (AU)
Asunto(s)
Humanos , Enfermedades de la Aorta/cirugía , Úlcera Péptica/cirugía , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico , Disección/métodos , Evolución Clínica , Biomarcadores , Úlcera Péptica/complicaciones , Úlcera Péptica/diagnósticoRESUMEN
BACKGROUND: A 32-year-old man presented at hospital with persistent pain, hypothermia and paraesthesia in his right leg, caused by embolic occlusion of all three large arteries as a result of massive thrombi in the abdominal aorta. Previously, the patient had been diagnosed with pulmonary embolism and admitted at least a 6-month history of alcohol abuse. Laboratory assessment of the patient's lipid levels, platelet function and coagulation factors yielded normal results. Duplex ultrasound revealed substantial media thickening of the carotid and femoral arteries, without evidence of calcification. Further laboratory tests revealed elevated plasma levels of homocysteine, asymmetric dimethylarginine, symmetric dimethylarginine and 8-isoprostaglandin F2alpha. INVESTIGATIONS: Physical examination, laboratory analyses, bronchoscopy, duplex ultrasonography, CT scan and CT angiography. DIAGNOSIS: Severe hyperhomocysteinemia associated with acute aortic thrombi and peripheral emboli. MANAGEMENT: Diet supplementation with folic acid, vitamin B6 and vitamin B12, low-molecular-weight heparin and L-arginine.