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1.
J Cardiovasc Surg (Torino) ; 61(1): 84-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32079379

RESUMO

BACKGROUND: The aim of this study was to evaluate the safety and performance of the sinus-SuperFlex-635 self-expandable nitinol stent (Optimed GmbH) for the treatment of steno-occlusive lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA). METHODS: The prospective, multicenter, observational HERO study recruited 117 eligible patients (83 men; mean age 69.4±9.7y) from 7 centers in Belgium. RESULTS: A total of 129 stents were successfully deployed in 121 lesions in 117 patients (100%). The patients presented with symptomatic ≥50% stenosis or chronic total occlusion (CTO) (30.6%). Mean lesion length was 71.4±56.3 mm. Moderate to severe calcification was present in 82.6% of the lesions. Acute lesion success (<30% residual stenosis) was achieved in 96.0%. There were no in-hospital serious adverse events. Duplex ultrasound-driven primary patency at 12 months was recorded in 84 of 107 (78.5%) lesions. The overall target lesion revascularization (TLR) rate was 8.4% at 12 months; the target extremity revascularization (TER) rate was 4.7%. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford class, without the need for TLR (i.e. primary sustained clinical improvement) in 83.9% of patients and with the need for TLR in 90.6% of patients (i.e. secondary sustained clinical improvement). CONCLUSIONS: Based on the high primary patency, low stent fracture rate and significant clinical improvement, combined with refined stent design and long stent availability, the sinus-SuperFlex-635 self-expandable nitinol stent proves its value in the treatment of complex femoropopliteal lesions.


Assuntos
Procedimentos Endovasculares/instrumentação , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents Metálicos Autoexpansíveis , Calcificação Vascular/terapia , Idoso , Idoso de 80 Anos ou mais , Ligas , Bélgica , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular
2.
Angiology ; 71(4): 333-339, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31955606

RESUMO

This study aims to explore the association between serum cotinine and severe abdominal aortic calcification (AAC) in the US adults. We examined 2840 participants with a weighted mean age of 57.4 years from the National Health and Nutrition Examination Survey 2013-2014. Serum cotinine was analyzed as the main exposure both continuously and categorically (tertiles). Abdominal aortic calcification detected with dual-energy X-ray absorptiometry was quantified using the Kauppila score system. Severe AAC was detected in 252 (8.9%) participants. The multivariable-adjusted odds ratios and 95% confidence intervals (CIs) of the middle and top cotinine categories were 1.14 (0.79-1.64) and 1.80 (1.21-2.68), respectively, P for trend = .004. Per unit increase in log-transformed serum cotinine was associated with 10% (95% CI: 6%-15%) higher odds of severe AAC when serum cotinine was analyzed as a continuous variable. The association was consistent across sex and ethnic groups. In conclusion, elevated serum cotinine level was associated with higher odds for severe AAC in a representative sample of US adults.


Assuntos
Aorta Abdominal , Doenças da Aorta/sangue , Cotinina/sangue , Calcificação Vascular/sangue , Absorciometria de Fóton , Doenças da Aorta/diagnóstico por imagem , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/diagnóstico por imagem
3.
Eur J Endocrinol ; 182(3): 343-350, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31958313

RESUMO

Background: To investigate the association between fasting serum insulin and glucose levels with atherosclerotic plaque composition in the carotid artery. Impaired insulin and glucose levels are implicated in the etiology of cardiovascular disease; however, their influence on the formation and composition of atherosclerotic plaque remains unclear. Methods: In 1740 participants (mean age 72.9 years, 46% women, 14.4% diabetes mellitus) from the population-based Rotterdam Study, we performed carotid MRI to evaluate the presence of calcification, lipid core, and intraplaque hemorrhage in carotid atherosclerosis. All participants also underwent blood sampling to obtain information on serum insulin and glucose levels. Using logistic regression models, we assessed the association of serum insulin and glucose levels (per s.d. and in tertiles) with the different plaque components, while adjusting for sex, age, intima-media thickness, and cardiovascular risk factors. Results: Serum insulin levels were associated with the presence of intraplaque hemorrhage (adjusted odds ratio (OR): 1.42 (95% CI: 1.12-1.7)) We found no association with the presence of calcification or lipid core. Sensitivity analyses restricted to individuals without diabetes mellitus yielded similar results. No associations were found between serum glucose levels and any of the plaque components. Conclusions: Serum insulin levels are associated with the presence of vulnerable components of carotid plaque, specifically with intraplaque hemorrhage. These findings suggest a complex role for serum insulin in the pathophysiology of carotid atherosclerosis and in plaque vulnerability.


Assuntos
Glicemia/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Insulina/sangue , Placa Aterosclerótica/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/metabolismo , Espessura Intima-Media Carotídea , Feminino , Hemorragia/sangue , Hemorragia/diagnóstico por imagem , Hemorragia/metabolismo , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Países Baixos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/metabolismo , Calcificação Vascular/sangue , Calcificação Vascular/metabolismo
4.
Am J Forensic Med Pathol ; 41(1): 56-59, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31929321

RESUMO

Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.


Assuntos
Fogo , Hérnia Inguinal/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Autopsia/métodos , Queimaduras/patologia , Impressões Digitais de DNA , Medicina Legal/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
J Stroke Cerebrovasc Dis ; 29(1): 104493, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31734123

RESUMO

OBJECTIVE: The aim of this study was to investigate the value of extracranial carotid artery calcium score in predicting severity of carotid arterial stenosis. MATERIAL AND METHODS: 200 patients who had indication of contrast neck multi detector computed tomography were included. Calcium volume score of each calcified plaque (density more than 130 HU) was determined by multiplying area of calcified plaque in slice increment and presented as cubic centimeter (cc). Calcium score of each side (right or left) and each patient were determined. Severity of carotid stenosis in axial images was estimated and categorized. Statistical analysis was performed. RESULTS: 87 cases were female with mean age of 58.90 ± 10.67 and 113 cases were male with mean age of 59.61 ± 11.89 years old. The mean of volume score for all evaluated 800 vessels was .079 ± .046 cc. There was no significant difference between calcium score of right and left side (P value = .16). The mean "patient score" was .080 ± .049 cc (range: 0-.15 cc).Nine patients had volume score of 0 and all of them had no evidence of luminal stenosis. Significant increase in severity of stenosis was seen with increase in "patient score".(P value < .001, r = .875).According to receiver operating characteristic analysis, "patient score" of .09 cc with sensitivity of 97% and "patient score" of .12 cc with sensitivity of 95% can predict 50% and 70% stenosis, respectively. CONCLUSIONS: Promising role of calcium score for predicting severity of carotid stenosis could be considered.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Tomografia Computadorizada Multidetectores , Calcificação Vascular/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
6.
Eur Radiol ; 30(1): 432-441, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31428828

RESUMO

BACKGROUND: Kawasaki disease (KD) is a vasculitis with formation of coronary artery aneurysms (CAAs) that can lead to myocardial ischemia. Echocardiography is the primary imaging modality for the coronary arteries despite limited visualization. Coronary angiography (CAG) is the gold standard yet invasive with high-radiation exposure. To date however, state-of-the-art CT scanners enable high-quality low-dose coronary computed tomographic angiography (cCTA) imaging. The aim of our study in KD is to report (i) the diagnostic yield of cCTA compared to echocardiography, and (ii) the radiation dose. METHODS AND RESULTS: We collected data of KD patients who underwent cCTA. cCTA findings were compared with echocardiography results. In 70 KD patients (median age 15.1 years [0.5-59.5 years]; 78% male; 38% giant CAA), the cCTA identified 61 CAAs, of which 34 (56%, with a Z score > 3, in 22 patients) were not detected by echocardiography. In addition, the left circumflex (aneurysmatic in 6 patients) was always visible upon cCTA and not detected upon echocardiography. Calcifications, plaques, and/or thrombi were visualized by cCTA in 25 coronary arteries (15 patients). Calcifications were seen as early as 2.7 years after onset of disease. In 5 patients, the cCTA findings resulted in an immediate change of treatment. The median effective dose (ED) in millisievert differed significantly (p < 0.01) between third-generation dual-source and other CT scanners (1.5 [0.3-9.4] (n = 56) vs 3.8 [1.7-20.0] (n = 14)). CONCLUSIONS: The diagnostic yield of third-generation dual-source cCTA combined with reduced radiation exposure makes cCTA a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for KD. KEY POINTS: • cCTA is a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for Kawasaki disease. • Kawasaki disease patients with proven coronary artery involvement on echocardiography require additional imaging.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/etiologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Linfonodos Mucocutâneos/complicações , Doses de Radiação , Exposição à Radiação/análise , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 29(2): 104579, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31852598

RESUMO

OBJECTIVE: Vulnerable carotid plaque is associated with cerebrovascular events. Cholesterol crystals are often seen in the atherosclerotic plaques. However, the potential role of cholesterol crystals in carotid plaques destabilization is unknown. We aimed to identify the association between cholesterol crystals and carotid plaque vulnerability. METHODS: Optical coherence tomography assessment of carotid plaque was performed in 95 patients. Clinical characteristics and plaque morphology were examined. The differences in plaque characteristics (thrombus, calcification, neovascularization, and macrophage accumulations) and clinical parameters (age, symptom, coronary heart disease, total cholesterol, triglycerides, and C-reactive protein) between patients with or without cholesterol crystals were analyzed with multivariate logistic regression. RESULTS: Among 66 patients with acceptable carotid atherosclerotic optical coherence tomography images, 16 were with and 50 were without cholesterol crystals. 56.3% patients (9 of 16) with cholesterol crystals had cerebrovascular ischemic symptom related to ipsilateral internal carotid artery, whereas only 26.0% patients (13 of 50) without cholesterol crystals had symptom (OR, 3.66; 95% CI, 1.13-11.82; P = .025). 75.0% of the plaques with cholesterol crystals had concomitant macrophage accumulation (OR, 4.14; 95% CI, 1.17-14.65; P = .04). In segments with cholesterol crystals, a higher presence of calcification could be demonstrated compared to those without cholesterol crystals (62.5% versus 32.0%, P = .03). 70.0% plaques with cholesterol crystals and calcification were classified as symptomatic plaques (OR, 6.38; 95% CI, 1.46-27.91; P = .01). No association between plaque rupture and cholesterol crystals was identified. Multivariate logistic regression showed that age and macrophage accumulation were independently associated with cholesterol crystals. CONCLUSIONS: Carotid atherosclerotic plaques with cholesterol crystals were more likely to have concomitant macrophage and calcification accumulations. Patients with cholesterol crystals plaque experienced more cerebrovascular symptoms. Thus, cholesterol crystals, especially together with macrophage and calcification, may serve as an important component of venerable carotid plaques.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Colesterol/análise , Placa Aterosclerótica , Tomografia de Coerência Óptica , Idoso , Isquemia Encefálica/etiologia , Artéria Carótida Interna/química , Estenose das Carótidas/complicações , Estenose das Carótidas/metabolismo , Cristalização , Feminino , Humanos , Macrófagos/química , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença , Calcificação Vascular/diagnóstico por imagem
8.
J Stroke Cerebrovasc Dis ; 29(2): 104448, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31852597

RESUMO

OBJECTIVES: To investigate the differences in characteristics of carotid plaques between patients Xining at high altitude and Jinan at sea level using magnetic resonance (MR) imaging. METHODS: Subjects were recruited from a cross-sectional, observational, multicenter imaging study of CARE-II study. Forty-nine (mean age 63.3 ± 12.0 years, 33 males) and 51 (mean age 64.5 ± 12.0 years, 34 males) patients were recruited from a site located in a high altitude region and a site located near sea level, respectively. All patients underwent multicontrast MR vessel wall imaging for carotid arteries on 3.0 T MR scanner. The carotid plaques features were compared between 2 patient groups. RESULTS: Compared with patients at sea level, those at high altitude had significantly greater lumen area (58.5 ± 17.8 mm2 versus 50.0 ± 19.6 mm2, P = .008), smaller maximum normalized wall index (48.6% ± 14.2% versus 57.8% ± 16.3%, P = .002), and smaller percentage volume of calcium (0.9% versus 5.6%, P < .001) in the symptomatic carotid artery. After adjustment for clinical risk factors including age, sex, systolic blood pressure, LDL-C, and statin use, these differences in plaque morphology and composition remained statistically significant. After further adjustment for normalized wall index as a measure of plaque burden, percentage volume of calcification was still significantly smaller in patients at high altitude area than that in patients at sea level area (P = .047). CONCLUSION: Symptomatic subjects from a high altitude area have lower plaque burden and less calcification in the carotid artery compared to those from an area near sea level.


Assuntos
Altitude , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Calcificação Vascular/diagnóstico por imagem , Idoso , Doenças das Artérias Carótidas/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/epidemiologia
9.
Prog Cardiovasc Dis ; 62(5): 423-430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31715194

RESUMO

The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called "risk-enhancing factors" in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Prevenção Primária/normas , Calcificação Vascular/tratamento farmacológico , Fatores Etários , Tomada de Decisão Clínica , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia
10.
Eur J Radiol ; 119: 108636, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493727

RESUMO

PURPOSE: To highlight the importance of quantitative breast arterial calcifications (BAC) assessment for an effective stratification of cardiovascular (CV) risk in women, for whom current preventive strategies are inadequate. BAC, easily detectable on mammograms, are associated with CV disease and represent a potential imaging biomarker for CV disease prevention in women. METHOD: We summarized the available evidence on this topic. RESULTS: Age, parity, diabetes, and hyperlipidemia were found to positively correlate with BAC. Women with BAC have a higher CV risk than those without BAC: the relative risk was reported to be 1.4 for transient ischemic attack/stroke, 1.5 for thrombosis, 1.8 for myocardial infarction; the reported hazard ratio was 1.32 for coronary artery disease (CAD), 1.52 for heart failure, 1.29 for CV death, 1.44 for death from CAD. However, BAC do not alarm radiologists; when reported, they are commonly mentioned as "present", not impacting on CV decision-making. Of 18 published studies, 9 reported only presence/absence of BAC, 4 used a semi-quantitative scale, and 5 a continuous scale (with manual, automatic or semiautomatic segmentation). Various appearance, topological complexity, and vessels overlap make BAC quantification difficult to standardize. Nevertheless, machine learning approaches showed promising results in BAC quantification on mammograms. CONCLUSIONS: There is a strong rationale for mammography to become a dual test for breast cancer screening and CV disease prevention. However, robust and automated quantification methods are needed for a deeper insight on the association between BAC and CV disease, to stratifying CV risk and define personalized preventive actions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Mama/diagnóstico por imagem , Doenças Mamárias/complicações , Doença da Artéria Coronariana/complicações , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Gravidez , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
11.
Saudi J Kidney Dis Transpl ; 30(4): 755-763, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464230

RESUMO

The aim of this study was to determine the relationship between the presence of carotid artery calcification (CAC) and pulp stone (PS). A total of 60 chronic hemodialysis (HD) patients (30 CAC positive, 30 CAC negative) participated in this study. The mean age of patients was 54.7 ± 16.4 years, and 32 (53%) of them were male. CAC was defined as the presence of heterogeneous nodular opacities in the soft tissue in C3-C4 intervertebral area. Panoramic radiographs of the patients were evaluated for CAC and PS by two oral and maxillofacial radiologists. PS was evaluated in all healthy, decayed, and restored teeth except the third molar teeth, in the coronal, sagittal, and axial planes. The Statistical Package for the Social Sciences (version 20.0; SPSS, Inc., an IBM Company, Chicago, IL, USA) was used. A probability P <0.05 was considered statistically significant. The prevalence of PS in this study was 30% (18 patients) all group. A total of 1324 teeth were analyzed and PS was detected in 237 teeth (17.9%). The occurrence of PS in teeth in CAC-positive group (10 patients, 17.2% of 654 teeth) was similar to that in CAC-negative group (8 patient, 18.3% of 670 teeth). There was no statistical correlation between CAC and PS in chronic HD patients (P = 0.08). In the subgroup analysis, the presence of diabetes (P = 0.003), parathormone level (P = 0.02), calcium × phosphorus product (P = 0.04), and C-reactive protein levels (P = 0.002) were higher, and duration of HD (P = 0.03) was significantly longer in patients with CAC-positive and PS. In chronic HD patients, the presence of PS was not a strong predictor for the presence of CAC.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Calcificações da Polpa Dentária/epidemiologia , Diálise Renal , Insuficiência Renal Crônica/terapia , Calcificação Vascular/epidemiologia , Adulto , Idoso , Biomarcadores/sangue , Cálcio/sangue , Doenças das Artérias Carótidas/diagnóstico por imagem , Calcificações da Polpa Dentária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Prevalência , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologia , Calcificação Vascular/diagnóstico por imagem
12.
Saudi J Kidney Dis Transpl ; 30(4): 819-824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464238

RESUMO

Vascular calcification (VC) is a well-known complication in patients with chronic kidney disease (CKD). Keeping in mind, the end goal to assess the genuine effect of mineral bone disease in the pathogenesis of blood vessel calcification during the pre-dialysis course of CKD, we assessed the prevalence and extent of abdominal aortic calcification (AAC) in nondiabetic CKD patients recently starting hemodialysis (HD). Eighty-one patients with end-stage renal disease beginning HD over a one-month period were selected. They underwent a detailed clinical examination and laboratory evaluation, including serum calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF-23), and alkaline phosphatase were measured, and spiral computed tomography was performed to evaluate AAC score. AAC was present in 64 patients (79%). There was a significant correlation between the AAC score and age (r = 0.609, P <0.001) and FGF-23 (r = 0.800, P <0.001). This study suggests that the prevalence and extent of AAC are critical in incident HD patients. Serum FGF-23 level is the sole statistically significant correlate of AAC in these patients.


Assuntos
Aorta Abdominal , Doenças da Aorta/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal , Calcificação Vascular/epidemiologia , Adulto , Idoso , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/sangue , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Egito/epidemiologia , Feminino , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Prevalência , Diálise Renal/efeitos adversos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada Espiral , Resultado do Tratamento , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Adulto Jovem
13.
J Obstet Gynaecol ; 39(7): 959-964, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274364

RESUMO

Atherosclerosis is a systematic disease affecting all arteries and is the most common cause of mortality. Our aim was to evaluate the predictive value of the presence of uterine arcuate artery calcification (AAC) for coronary heart disease (CHD) in women. Seventy women presenting with angina pectoris or a finding suggestive of cardiac ischaemia in non-invasive tests, scheduled for angiography between June 2014 and July 2015 were recruited in the study. One day before the coroner artery angiography, all of the patients were examined about the presence of AAC by transvaginal ultrasonography and were classified in the presence of CHD. CHD is classified as obstructive (obstruction >70%) or as non-obstructive (obstruction <70%) according to the severity of stenosis. The association of AAC is evaluated with the presence and severity of CHD that's diagnosed by angiography. CHD was present in 87.2% of women with positive for AAC and in 4.3% of who were negative for AAC (p = .001). AAC positive women were more likely to develop obstructive CHD than non-obstructive CHD (66.6% versus 30.9%, p = .001), respectively. Sensitivity and specificity of AAC for CHD were 97.6% and 78.5%, respectively. AAC detected by transvaginal ultrasound seems to have a strong association with both presences of CHD and the severity of disease. Impact statement What is already known on this subject? Atherosclerosis affecting all arteries is the primary cause of mortality and morbidity of coronary heart disease (CHD) (Lim et al. 2011). Uterine artery calcification and its association with atherosclerosis were first reported by Camiel et al. (1967). Ozdemir et al. (2016) found a correlation between carotid artery intima thickness and the presence of uterine arcuate artery calcification (AAC). What do the results of this study add? Very few studies have been performed in this area investigating the relationship of AAC and non-invasive predictors of atherosclerosis or the relationship between arterial calcifications and cardiovascular or systemic disease. Our study is the first to evaluate the correlation between AAC and CHD confirmed using coronary artery angiography at a high sensitivity rate (97.6%). What are the implications of these findings for clinical practice and/or further research? Our study presents an alternative, easy and non-invasive method for the prediction of subclinical CHD in clinical practice. From the view of a gynaecologist, cardiology consultation of patients with AAC detected by transvaginal ultrasonography during the routine gynaecologic examination may be useful and protective against serious cardiac problems. Thus, this study is of great importance in terms of predicting when the majority of CHD patients are asymptomatic or in the subclinical phase.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ultrassonografia , Artéria Uterina/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Angiografia Coronária , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Am J Cardiol ; 124(4): 534-538, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31262497

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is considered a potential independent risk factor for cardiovascular disease (CVD). The Multi-Ethnic Study of Atherosclerosis cohort enrolled 6,814 adults without previous CVD. We excluded 2,692 participants who had missing variables, were heavy drinkers, or history of steroid use and/or chronic liver disease. NAFLD was defined using noncontrast cardiac CT and a liver/spleen Hounsfield Unit attenuation ratio <1. Ultrasound-measured carotid arterial compliance and stiffness, was expressed as distensibility coefficient and Young's modulus. Common and internal carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) >0 were used as markers of subclinical CVD. A multivariate robust linear regression and logistic regression analysis were done to evaluate the association of NAFLD and this subclinical CVD markers. Our analysis of 4,123 participants showed 55% were female with a mean age of 63 (±10) years, 39% white, 10% Chinese, 28% black, and 23% were Hispanic. The prevalence of NAFLD was 17% (n = 729). Patients with NAFLD had higher distensibility coefficient and higher CIMT. Multivariate linear regression analysis showed the presence of NAFLD was associated with both the common carotid and internal carotid IMT and logCAC. Logistic analysis showed an independent association with CAC > 0 (odds ratio [OR] 1.44 95% confidence interval [CI] 1.18, 1.75) and CIMT > 1 mm (OR 1.30 95% 1.08, 1.56). When stratified by race the association with CIMT > 1 mm was significant in whites (OR 1.37 95% 1.00, 1.90) and Hispanic (OR 1.53 95% 1.08, 2. 17) and CAC > 0 was significant in Hispanics (OR 1.52 95% 1.06, 2.19). In conclusion, NAFLD is modestly associated with carotid IMT and coronary artery calcification in a multiethnic population.


Assuntos
Aterosclerose/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Calcificação Vascular/epidemiologia , Rigidez Vascular , Afro-Americanos/estatística & dados numéricos , Idoso , Doenças Assintomáticas , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Módulo de Elasticidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Calcificação Vascular/diagnóstico por imagem
15.
Lipids Health Dis ; 18(1): 149, 2019 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-31279347

RESUMO

BACKGROUND: Coronary artery calcium (CAC) is known as a reliable tool for estimating risk of myocardial infarction, coronary death, all-cause mortality and is even used to evaluate suitable asymptomatic patients. We therefore aimed to evaluate whether CAC scoring can be applied in the algorithm for clinical examination of patients with severe hypercholesterolemia (SH). METHODS: During the period of 2016-2017 a total of 213 asymptomatic adults, underwent computed tomography angiography to evaluate their CAC scoring. The sample consisted of 110 patients with SH and 103 age and sex matched controls without dyslipidemia and established cardiovascular disease. RESULTS: In total there were 79 (37.2%) subjects with elevated (≥25th) CAC percentiles. Out of them 47 (59.5%) had SH and 32 (40.5%) did not. CAC score did not differ between groups (SH (+) 140.30 ± 185.72 vs SH (-) 87.84 ± 140.65, p = 0.146), however there was a comparable difference in how the participants of these groups distributed among different percentile groups (p = 0.044). Gender, blood pressure, tabaco use, physical activity, family history of coronary artery disease and diabetes mellitus were not associated with CAC score (p > 0.05). There were no significant correlations between biochemical parameters and CAC percentiles except for increase in lipoprotein(a) (p = 0.038). Achilles tendon pathology, visceral obesity, body mass index and increased waist-hip ratio were not associated with CAC percentiles either (p > 0.05). CONCLUSIONS: CAC score is not associated with presence of SH. CAC score is not an appropriate diagnostic tool in the algorithm for clinical examination of patients with SH. Further larger studies are needed to support our findings.


Assuntos
Cálcio , Vasos Coronários/diagnóstico por imagem , Hipercolesterolemia/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Tendão do Calcâneo/patologia , Adolescente , Adulto , Composição Corporal , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Feminino , Humanos , Hipercolesterolemia/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Int J Med Sci ; 16(7): 939-948, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31341407

RESUMO

Introduction: There is general interest in finding clinical markers for left ventricular diastolic dysfunction (LVDD), a major cause of cardiorenal syndrome leading to heart failure in chronic kidney disease (CKD) patients. The aim was to assess the utility of computed tomography (CT)-based abdominal aortic calcification (AAC) for the prediction of LVDD and prognosis of asymptomatic pre-dialysis CKD patients. Materials and methods: We prospectively evaluated 218 pre-dialysis CKD patients [median estimated glomerular filtration rate (eGFR); 40.9 mL/min/1.73m²]. Non-contrast CT scan and echocardiography were performed to determine the aortic calcification index (ACI) as a semi-quantitative measure of AAC. Results: The median ACI was 11.4. AAC and LVDD were diagnosed in 193 patients (89%) and 75 patients (34%), respectively. Using receiver operating characteristic curve analysis for the estimation of LVDD, ACI of 20 showed optimal sensitivity (52.0%) and specificity (62.8 %) (AUC = 0.664, p < .001). High ACI group included more patients with LVDD-related factors, such as old age, hypertension, diabetes, and more severe CKD. LVDD was significantly more common in patients with high ACI group [39 (50%) and 36 (26%), respectively, p<0.001]. Multivariate analysis showed that ACI correlated significantly with E/A (ß=-0.993, p=0.003), E/e' (ß=0.077, p<0.001), and cardio-ankle vascular index (ß=0.209, p=0.001). Correspondingly, E/e' correlated with logBNP and log(ACI+1), and increased proportionately and significantly with the quartiles of ACI values. Cox proportional hazard models showed that ACI was an independent predictor of CV outcome (hazard ratio 1.03, 95% confidence interval 1.00-1.06, p=0.029). Conclusion: The results would suggest the usefulness of AAC assessment by CT to predict latent LVDD and future CV risk in asymptomatic pre-dialysis CKD patients.


Assuntos
Insuficiência Renal Crônica/complicações , Calcificação Vascular/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Estudos Transversais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Fatores de Risco , Tomografia Computadorizada por Raios X , Calcificação Vascular/etiologia , Calcificação Vascular/patologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
18.
J Cardiovasc Comput Tomogr ; 13(4): 190-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239172

RESUMO

BACKGROUND: Aortic valve calcification (AVC) is an active process that involves inflammation, disorganization of matrix disposition, lipid accumulation and lamellar bone formation. AVC without hemodynamic changes has been associated with cardiovascular (CV) risk factors and increased risk of coronary and CV events. Nowadays, echocardiography is the standard imaging technique to evaluate aortic valve pathologies. However, cardiac computed tomography (CT) allows high accuracy and reproducible measurement of AVC, without exposing the patients to excessive radiation or contrast administration. AIMS: To better understand if AVC assessment may improve CV risk-prediction, we performed a systematic search and meta-analysis of literature studies, evaluating the relationship among AVC, coronary artery disease (CAD), and overall mortality. METHODS AND RESULTS: A detailed search, according to PRISMA guidelines, was performed to identify all available studies investigating AVC, measured by CT scan, and CV events. Thirteen studies on 3,782 AVC patients and 32,890 controls were included in the final analysis. Patients with AVC have a higher risk of CAD (OR 1.7, 95%CI: 1.04-2.87; p = 0.04) when compared to controls. We also found an association between AVC and coronary artery calcification (OR 3.8; 95%CI: 2.4-6.0; p < 0.001.) Finally, AVC had 93.2% specificity for overall mortality (95%CI: 92.8-93.6) with a negative predictive value of 98.8% (95%CI: 98.7-98.8). CONCLUSION: AVC is associated with coronary artery calcification and overall mortality. The present data cannot support the use of cardiac CT over echocardiography for AVC assessment in all patients, but when cardiac CT is performed for suspected CAD, AVC evaluation may contribute to risk stratification and patient management. Ad hoc designed studies should address this issue in the next future.


Assuntos
Estenose da Valva Aórtica/mortalidade , Valva Aórtica/patologia , Calcinose/mortalidade , Doença da Artéria Coronariana/mortalidade , Calcificação Vascular/mortalidade , Idoso , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Causas de Morte , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagem
19.
Vasc Endovascular Surg ; 53(6): 464-469, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31213146

RESUMO

INTRODUCTION: During endovascular aneurysm repair, the iliac artery typically serves as a conduit for device delivery. The degree of tortuosity and calcification in the iliac artery ultimately determines whether the device can successfully traverse the vessel. These 2 parameters can be assessed using qualitative approaches or calculated using quantitative methods based on the Society for Vascular Surgery (SVS) reporting standards. The objective of this study was to determine whether qualitative methods are sufficient to accurately assess iliac artery tortuosity and calcification by calculating interobserver variability and comparing them to the SVS Reporting Standards. METHODS: Three vascular surgeons reviewed preoperative computed tomography scans for 50 patients who underwent fenestrated endovascular aneurysm repair and qualitatively assessed left and right iliac artery tortuosity and calcification. Iliac artery geometries were segmented from these image sets. Tortuosity index and calcification length ratio were calculated and categorized based on the SVS Reporting Standards. RESULTS: Interobserver variability was calculated for the qualitative assessments using interclass correlation coefficients. For tortuosity index, among the 3 observers, good agreement was found for the left iliac artery and fair agreement was found for the right. For calcification length ratio, excellent agreement was found for both iliac arteries. When compared to the quantitative assessment, the qualitative assessments underpredicted tortuosity in 2.3% of cases, matched the quantitative values in 16.7% of cases, and overpredicted tortuosity in 81.0% of cases. The qualitative assessments underpredicted calcification in 46.3% of cases, matched the quantitative values in 49.3% of cases, and overpredicted calcification in 4.3% of cases. CONCLUSION: Qualitative assessment of iliac artery tortuosity showed fair-to-good interobserver agreement and poor agreement to SVS Reporting Standards. Qualitative assessment of iliac artery calcification showed excellent interobserver agreement and fair agreement to SVS Reporting Standards. These trends should be considered when qualitative reporting methodologies are used.


Assuntos
Angiografia por Tomografia Computadorizada , Artéria Ilíaca/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Rev Col Bras Cir ; 46(3): e20192170, 2019 Jun 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31241686

RESUMO

OBJECTIVE: to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity. METHODS: prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS). RESULTS: the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression. CONCLUSION: bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.


Assuntos
Cirurgia Bariátrica , Doença da Artéria Coronariana/etiologia , Obesidade/cirurgia , Calcificação Vascular/etiologia , Adolescente , Adulto , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Medição de Risco , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem , Adulto Jovem
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