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1.
Clin Appl Thromb Hemost ; 27: 1076029621989813, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523719

RESUMO

Brain-derived neurotrophic factor (BDNF) plays a functional role in vascular endothelium homeostasis and the alleviation of atherosclerosis. Matrix gla protein (MGP) and Nε-(1-carboxymethyl)-l-lysine (CML) are both confirmed to be VC predictors. This study investigated the association between BDNF, MGP, CML and coronary artery calcification (CAC). Plasma BDNF, MGP, and CML levels were measured in 274 patients who underwent computed tomography to determine the CAC score (Agatston score). It was found that patients with CAC exhibited lower BDNF and MGP and higher CML levels than those without CAC. Plasma BDNF levels in patients with diabetes or hypertension were lower compared with the control groups. In logistic regression analysis, age, hypertension, BDNF, and MGP were independent predictors of CAC. Plasma BDNF and MGP levels were both correlated with the Agatston score even after adjustment for age, total cholesterol level, triglycerides, low-density lipoprotein level, creatinine clearance rate, and the presence of hypertension and diabetes mellitus. In 167 patients with CAC, circulating BDNF level was inversely associated with CML level and positively related to MGP level. In the receiver operating characteristic analysis for CAC, the areas under the curves for BDNF, MGP, and CML were 0.757, 0.777 and 0.653, respectively. In summary, plasma BDNF levels are associated with the Agatston score, and BDNF further predicts the occurrence of CAC.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Doença da Artéria Coronariana/sangue , Calcificação Vascular/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteínas de Ligação ao Cálcio/sangue , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Proteínas da Matriz Extracelular/sangue , Feminino , Humanos , Lisina/análogos & derivados , Lisina/sangue , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Calcificação Vascular/diagnóstico por imagem
2.
Nutr Metab Cardiovasc Dis ; 31(4): 1035-1043, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33573921

RESUMO

BACKGROUND AND AIMS: The present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults. METHODS AND RESULTS: The analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013-2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1-L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64-0.84) and (women OR = 0.58, CI95%, 0.47-0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women. CONCLUSION: Lower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.


Assuntos
Aorta Abdominal , Doenças da Aorta/epidemiologia , Força da Mão , Sarcopenia/epidemiologia , Calcificação Vascular/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Inquéritos Nutricionais , Fenótipo , Exame Físico/instrumentação , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Sarcopenia/diagnóstico , Sarcopenia/fisiopatologia , Estados Unidos/epidemiologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia
3.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495188

RESUMO

Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm2 and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm2 and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.


Assuntos
Angioplastia Coronária com Balão/métodos , Estenose Coronária/cirurgia , Stents Farmacológicos , Tomografia de Coerência Óptica , Calcificação Vascular/cirurgia , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Desenho de Prótese , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Terapia Trombolítica , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem
4.
Br J Radiol ; 94(1117): 20200894, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33053316

RESUMO

Incidental coronary and cardiac calcification are frequent findings on non-gated thoracic CT. We recommend that the heart is reviewed on all CT scans where it is visualised. Coronary artery calcification is a marker of coronary artery disease and it is associated with an adverse prognosis on dedicated cardiac imaging and on non-gated thoracic CT performed for non-cardiac indications, both with and without contrast. We recommend that coronary artery calcification is reported on all non-gated thoracic CT using a simple patient-based score (none, mild, moderate, severe). Furthermore, we recommend that reports include recommendations for subsequent management, namely the assessment of modifiable cardiovascular risk factors and, if the patient has chest pain, assessment as per standard guidelines. In most cases, this will not necessitate additional investigations. Incidental aortic valve calcification may also be identified on non-gated thoracic CT and should be reported, along with ancillary findings such as aortic root dilation. Calcification may occur in other parts of the heart including mitral valve/annulus, pericardium and myocardium, but in many cases these are an incidental finding without clinical significance.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Achados Incidentais , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Consenso , Coração , Humanos , Sociedades Médicas , Reino Unido
5.
PLoS One ; 15(12): e0244639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378347

RESUMO

INTRODUCTION: Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients. METHODS: We measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (≥4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (ΔCAC SQRV) using linear mixed models. Reference category was conventional hemodialysis. RESULTS: The mean age of the study population was 53 ±13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12-56) months. Median CAC score at enrollment was 171 (IQR 10-647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models. CONCLUSIONS: Nocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk.


Assuntos
Vasos Coronários/patologia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Vasos Coronários/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Diálise Renal/efeitos adversos , Calcificação Vascular/patologia
6.
PLoS One ; 15(12): e0244707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378410

RESUMO

BACKGROUND: Since the outbreak of the COVID-19 pandemic, a number of risk factors for a poor outcome have been identified. Thereby, cardiovascular comorbidity has a major impact on mortality. We investigated whether coronary calcification as a marker for coronary artery disease (CAD) is appropriate for risk prediction in COVID-19. METHODS: Hospitalized patients with COVID-19 (n = 109) were analyzed regarding clinical outcome after native computed tomography (CT) imaging for COVID-19 screening. CAC (coronary calcium score) and clinical outcome (need for intensive care treatment or death) data were calculated following a standardized protocol. We defined three endpoints: critical COVID-19 and transfer to ICU, fatal COVID-19 and death, composite endpoint critical and fatal COVID-19, a composite of ICU treatment and death. We evaluated the association of clinical outcome with the CAC. Patients were dichotomized by the median of CAC. Hazard ratios and odds ratios were calculated for the events death or ICU or a composite of death and ICU. RESULTS: We observed significantly more events for patients with CAC above the group's median of 31 for critical outcome (HR: 1.97[1.09,3.57], p = 0.026), for fatal outcome (HR: 4.95[1.07,22.9], p = 0.041) and the composite endpoint (HR: 2.31[1.28,4.17], p = 0.0056. Also, odds ratio was significantly increased for critical outcome (OR: 3.01 [1.37, 6.61], p = 0.01) and for fatal outcome (OR: 5.3 [1.09, 25.8], p = 0.02). CONCLUSION: The results indicate a significant association between CAC and clinical outcome in COVID-19. Our data therefore suggest that CAC might be useful in risk prediction in patients with COVID-19.


Assuntos
/patologia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/diagnóstico , Idoso , /terapia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/patologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Calcificação Vascular/patologia
7.
Medicine (Baltimore) ; 99(42): e22813, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080758

RESUMO

RATIONALE: Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic colitis. It is more common in the Asian population people with Asian ancestry. Disease pathogenesis and etiology are not fully elucidated but may be associated with the long-term intake of toxins and other substances, including Chinese herbs. The disease has typical radiological and endoscopic features. Radiologic examination combined with endoscopy can lead to a conclusive diagnosis. PATIENT CONCERNS: We present 2 cases of IMP: in male patients aged 66 and 79 years. The first patient presented with diarrhea and abdominal pain, and the second patient presented with numbness of limbs and abdominal discomfort. These patients had a history of long-term use of Chinese herbal medicine (CHM). DIAGNOSIS: Both patients were diagnosed with IMP by endoscopy and radiology, and the diagnosis confirmed by biopsy in the first patient. INTERVENTIONS: The first patient was advised to stop using CHM. Both patients were given conservative treatment and were followed up regularly. OUTCOMES: Symptoms improved after conservative treatment. The patients had no obvious discomfort during the follow-up period. CONCLUSION: We suspect that the disease is induced by the long-term use of CHM, and dosage and duration of use may determine disease severity.


Assuntos
Colite Isquêmica/induzido quimicamente , Medicamentos de Ervas Chinesas/efeitos adversos , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Calcificação Vascular/induzido quimicamente , Idoso , Colite Isquêmica/diagnóstico por imagem , Colite Isquêmica/patologia , Humanos , Mucosa Intestinal/patologia , Masculino , Esclerose , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
8.
Radiol Med ; 125(11): 1135-1147, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33047297

RESUMO

In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Coração/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Doenças Assintomáticas , Doença da Artéria Coronariana/mortalidade , Humanos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Radiol Med ; 125(11): 1186-1199, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32946002

RESUMO

Artificial intelligence (AI) is entering the clinical arena, and in the early stage, its implementation will be focused on the automatization tasks, improving diagnostic accuracy and reducing reading time. Many studies investigate the potential role of AI to support cardiac radiologist in their day-to-day tasks, assisting in segmentation, quantification, and reporting tasks. In addition, AI algorithms can be also utilized to optimize image reconstruction and image quality. Since these algorithms will play an important role in the field of cardiac radiology, it is increasingly important for radiologists to be familiar with the potential applications of AI. The main focus of this article is to provide an overview of cardiac-related AI applications for CT and MRI studies, as well as non-imaging-based applications for reporting and image optimization.


Assuntos
Algoritmos , Inteligência Artificial , Coração/diagnóstico por imagem , Radiologia/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Prognóstico , Calcificação Vascular/diagnóstico por imagem , Fluxo de Trabalho
10.
Radiol Med ; 125(11): 1200-1207, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32970273

RESUMO

Cardiovascular diseases are still among the first causes of death worldwide with a huge impact on healthcare systems. Within these conditions, the correct diagnosis of coronary artery disease with the most appropriate imaging-based evaluations is of utmost importance. The sustainability of the healthcare systems, considering the high economic burden of modern cardiac imaging equipments, makes cost-effective analysis an important tool, currently used for weighing different costs and health outcomes, when policy makers have to allocate funds and to prioritize interventions, getting the most out of their financial resources. This review aims at evaluating cost-effective analysis in the more recent literature, focused on the role of Calcium Score, coronary computed tomography angiography and cardiac magnetic resonance.


Assuntos
Técnicas de Imagem Cardíaca/economia , Angiografia por Tomografia Computadorizada/economia , Angiografia Coronária/economia , Doença da Artéria Coronariana/diagnóstico por imagem , Imagem por Ressonância Magnética/economia , Calcificação Vascular/diagnóstico por imagem , Análise Custo-Benefício , Humanos , Substituição da Valva Aórtica Transcateter/métodos
11.
Am J Cardiol ; 134: 48-54, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892992

RESUMO

Statin therapy reduces low-density lipoprotein cholesterol (LDL-C), inflammation, and atherosclerotic cardiovascular disease. We investigated the association between LDL-C and statin therapy on the prevalence of plaque rupture (PR). Patients with acute coronary syndromes who underwent optical coherence tomography imaging of the culprit lesion were divided into 4 groups based on LDL-C level and statin use (Group 1: LDL-C ≤ 100 without statin; Group 2; LDL-C ≤ 100 with statin; Group 3: LDL-C > 100 with statin; Group 4: LDL-C > 100 without statin), and the prevalence of PR was compared between the groups. Among 896 patients, PR was diagnosed in 444 (49.6%) patients. The prevalence of PR was significantly different among the 4 groups (p = 0.007): it was highest in the high LDL-C without statin group and lowest in the low LDL-C without statin group (53.9% and 39.2%, respectively). Compared with the high LDL-C without statin group, the low LDL-C without statin and low LDL-C with statin groups had a significantly lower prevalence of PR (p = 0.001, p = 0.040, respectively), and the low LDL-C with statin group had a significantly higher prevalence of calcification (p = 0.037). The patients with naturally low LDL-C have the lowest risk of PR. The patients with low LDL-C achieved by statin therapy had a higher prevalence of calcification. When LDL-C level is elevated, early and aggressive treatment with statin may help to prevent PR by stabilizing plaques through calcification.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Placa Aterosclerótica/diagnóstico por imagem , Síndrome Coronariana Aguda/sangue , Idoso , Doença da Artéria Coronariana/sangue , Feminino , Humanos , Hipercolesterolemia/sangue , Modelos Logísticos , Macrófagos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Ruptura Espontânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Tomografia de Coerência Óptica , Calcificação Vascular/diagnóstico por imagem
12.
J Stroke Cerebrovasc Dis ; 29(10): 105135, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912521

RESUMO

BACKGROUND: Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry. METHODS: The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living in rural Ecuadorian villages. ICAD was identified by means of CT determinations of carotid siphon calcifications (CSC) or MRA findings of significant stenosis of intracranial arteries. Fully-adjusted logistic regression models were fitted with biomarkers of ICAD as the dependent variables. RESULTS: A total of 205 (35%) of 581 participants had ICAD, including 185 with high calcium content in the carotid siphons and 40 with significant stenosis of at least one intracranial artery (20 subjects had both biomarkers). Increasing age, high fasting blood glucose, >10 enlarged basal ganglia-perivascular spaces and non-lacunar strokes were associated with high calcium content in the carotid siphons. In contrast, male gender, moderate-to-severe white matter hyperintensities, lacunar and non-lacunar strokes were associated with significant stenosis of intracranial arteries. Stroke was more common among subjects with any biomarker of ICAD than in those with no biomarkers (29% versus 9%, p < 0.001). Significant stenosis of intracranial arteries was more often associated with stroke than high calcium content in the carotid siphons, suggesting that CSC are more likely an ICAD biomarker than causally related to stroke. CONCLUSIONS: ICAD prevalence in Amerindians is high, and is significantly associated with stroke. CSC and significant stenosis of intracranial arteries may represent different phenotypes of ICAD.


Assuntos
Vida Independente , Índios Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Saúde da População Rural/etnologia , Acidente Vascular Cerebral/etnologia , Calcificação Vascular/etnologia , Fatores Etários , Idoso , Envelhecimento/etnologia , Comorbidade , Equador/epidemiologia , Feminino , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem
13.
Br J Radiol ; 93(1113): 20200349, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783626

RESUMO

The aim of this review is to provide an overview of different functional cardiac CT techniques which can be used to supplement assessment of the coronary arteries to establish the significance of coronary artery stenoses. We focus on cine-CT, CT-FFR, CT-myocardial perfusion and how developments in machine learning can supplement these techniques.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Aprendizado de Máquina , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Ensaios Clínicos como Assunto , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico , Humanos , Volume Sistólico , Calcificação Vascular/diagnóstico por imagem , Função Ventricular Esquerda
14.
Rev Cardiovasc Med ; 21(2): 157-162, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706205

RESUMO

Cardiovascular disease, and in particular coronary artery disease (CAD), remains an important contributor of morbidity and mortality among patients with chronic kidney disease (CKD). Classic symptomatology of CAD and effectiveness of established therapeutic measures is less frequent in patients with CKD. This suggests unique characteristics of CAD among patients with CKD. Two important features of CAD in CKD include increased calcific density of atherosclerotic plaques and of the vessels themselves (coronary artery calcification -- CAC), as well as a decrease in microcirculatory function -- or coronary microcirculatory dysfunction. A multitude of pathophysiologic pathways have been identified that contribute to CAC in CKD; less is known about the pathophysiology of microcirculatory dysfunction. It is not well established if these two processes are directly related to each other, but the combination results in a greater severity of effect on overall myocardial function and may in part explain the greater preponderance of silent myocardial infarction. Further investigation is needed to better understand these unique aspects of CAD in CKD as well as the role they play in overall CVD in this group, and ultimately therapeutics that may lessen the burden of disease.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Rim/fisiopatologia , Microcirculação , Insuficiência Renal Crônica/fisiopatologia , Calcificação Vascular/fisiopatologia , Animais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Progressão da Doença , Taxa de Filtração Glomerular , Hemodinâmica , Humanos , Placa Aterosclerótica , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Calcificação Vascular/terapia
17.
J Comput Assist Tomogr ; 44(4): 490-500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697520

RESUMO

PURPOSE: To evaluate the agreement and correlation between attenuation values and vascular calcification volume for intra-abdominal structures from true noncontrast (TNC) images and those from virtual noncontrast (VNC) images obtained by dual-source dual-energy computed tomography (CT) using a quadriphasic dynamic protocol. METHODS: Seventy-six patients who underwent quadriphasic abdominal CT were retrospectively reviewed. An arterial, portal venous, and 5-minute delayed phase postcontrast series was obtained using dual-source dual-energy CT. Virtual noncontrast images were processed from the arterial, portal venous, and 5-minute delayed phase series. Attenuation values for the liver, pancreas, kidneys, muscle, fat, vertebra, gallbladder, aorta, inferior vena cava, portal vein, and aortic calcification volumes were recorded. Attenuation values for the liver, pancreas, vertebra, and muscle obtained from VNC were adjusted using linear regression. RESULTS: Repeated-measures analysis of variance and Bonferroni multiple-comparison post hoc correction revealed significant differences between TNC and VNC attenuation values for the organs. There was an excellent correlation between the TNC and VNC attenuation values for the liver, pancreas, muscle, vertebra, and fat. The calcification volume was significantly smaller on VNC than on TNC. The adjusted attenuation values estimated by regression equations afforded better approximation. CONCLUSIONS: Abdominal VNC images obtained with third-generation dual-source dual-energy CT cannot replace TNC images without adjustment of the attenuation values.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Fígado/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/patologia , Meios de Contraste , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Estudos Retrospectivos , Sensibilidade e Especificidade
18.
J Stroke Cerebrovasc Dis ; 29(8): 104862, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689638

RESUMO

INTRODUCTION: Internal carotid artery (ICA) stenosis could be treated with stent placement. It was hypothesized that calcium amount could be predictive of vessel stenosis after stent placement. We utilised computed tomography (CT) angiography to quantify volume of calcium material in bulbar ICA. MATERIALS AND METHODS: 28 patients with 31 treated ICA stenosis were collected and analysed using CT angiography-based calcium volume measurement. The Casper stent system (CSS) was used exclusively. Prospective data on emergent carotid stenosis were collected using serial ultrasound controls over a 12-month period. RESULTS: Median age was 76 years (interquartile range (IQR) 67.5-77.8) and the majority were men (71.4%). Plaque median calcium volume was 0.142 cm3 (IQR 0.030 - 0.227) and median average Hounsfield Units (HU) were 561.0 (414.5-675.0). We detected positive linear relationship between average HU and ICA calcium volume. Furthermore, weak positive correlation was observed between calcium volume and residual stenosis as seen on post-interventional angiography, (correlation coefficient R = 0.38, p=0.035). Stronger positive correlation emerged between plaques' average HU and residual stenosis (R = 0.42, p=0.018). Angiographic stenosis showed univariate association with late stenosis as detected 12 months after CAS. CONCLUSION: Calcium burden could be associated with residual stenosis after CSS placement. Larger studies are needed to confirm our preliminary data.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/terapia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Placa Aterosclerótica , Stents , Ultrassonografia Doppler em Cores , Calcificação Vascular/terapia , Idoso , Estenose das Carótidas/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem
19.
J Endovasc Ther ; 27(4): 641-646, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32571134

RESUMO

Purpose: To investigate the prognostic impact of infrapopliteal (IP) artery anatomic severity according to the Global Limb Anatomic Staging System (GLASS) on delayed wound healing in patients with chronic limb-threatening ischemia (CLTI). Materials and Methods: This study retrospectively analyzed 639 limbs with tissue loss in 484 CLTI patients (mean age 74±10 years; 300 men) presenting IP lesions treated with endovascular therapy between April 2010 and December 2015. Two-thirds of patients had diabetes (323, 67%) and over half were on hemodialysis (255, 53%). More than a third of the limbs (251, 39%) were classified as clinical stage 4 according to the Wound, Ischemia, and foot Infection (WIfI) system. IP anatomic severity was classified based on preprocedural angiography according to the GLASS. Severity of arterial calcification was assessed using high-intensity fluoroscopy and classified into 3 groups: none (grade 0), unilateral (grade 1), and bilateral (grade 2). Poor below-the-ankle (BTA) runoff was defined as the lack of a pedal arch with 0 to 1-vessel runoff within the dorsal pedis artery and the lateral and medial plantar arteries. The outcome measure was 1-year wound healing. The association of anatomic characteristics with delayed wound healing was evaluated using Cox proportional hazards regression analysis. Outcomes are presented as the adjusted hazard ratio (HR) with 95% confidence interval (CI). Results: During a mean follow-up of 22±19 months, the 1-year cumulative wound healing rate was estimated to be 59.0% (95% CI 54.5% to 63.5%). Multivariable analysis demonstrated independent associations between delayed wound healing and IP calcification grade (HR 1.24, 95% CI 1.02 to 1.50, p=0.027) and poor BTA runoff (HR 1.39, 95% CI 1.04 to 1.85, p=0.025) but not the GLASS IP grade (HR 0.92, 95% CI 0.82 to 1.14, p=0.21). Conclusion: The current study revealed that IP arterial calcification and poor BTA runoff were significantly associated with delayed wound healing, whereas the GLASS was not predictive of wound healing.


Assuntos
Regras de Decisão Clínica , Procedimentos Endovasculares , Isquemia/terapia , Doença Arterial Periférica/terapia , Artéria Poplítea , Calcificação Vascular/terapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Stents , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem
20.
Angiology ; 71(8): 677-688, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32567327

RESUMO

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.


Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/terapia , Litotripsia , Calcificação Vascular/terapia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Cateteres Cardíacos , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem
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