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1.
J Appl Oral Sci ; 27: e20180596, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31508793

RESUMO

Bone development and healing processes involve a complex cascade of biological events requiring well-orchestrated synergism with bone cells, growth factors, and other trophic signaling molecules and cellular structures. Beyond health processes, MMPs play several key roles in the installation of heart and blood vessel related diseases and cancer, ranging from accelerating metastatic cells to ectopic vascular mineralization by smooth muscle cells in complementary manner. The tissue inhibitors of MMPs (TIMPs) have an important role in controlling proteolysis. Paired with the post-transcriptional efficiency of specific miRNAs, they modulate MMP performance. If druggable, these molecules are suggested to be a platform for development of "smart" medications and further clinical trials. Thus, considering the pleiotropic effect of MMPs on mammals, the purpose of this review is to update the role of those multifaceted proteases in mineralized tissues in health, such as bone, and pathophysiological disorders, such as ectopic vascular calcification and cancer.


Assuntos
Remodelação Óssea/fisiologia , Matriz Extracelular/fisiologia , Metaloproteinases da Matriz/fisiologia , Doenças Ósseas/metabolismo , Doenças Ósseas/fisiopatologia , Progressão da Doença , Humanos , Inibidores de Metaloproteinases de Matriz/uso terapêutico , Neoplasias/metabolismo , Neoplasias/fisiopatologia , Osteoblastos/fisiologia , Inibidores Teciduais de Metaloproteinases/fisiologia , Calcificação Vascular/metabolismo , Calcificação Vascular/fisiopatologia
2.
Medicine (Baltimore) ; 98(33): e16802, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415390

RESUMO

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ±â€Š10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (ß = 0.37, P < .001), hypertension (ß = 0.19, P = .003), diabetes mellitus (ß = 0.12, P = .045), smoking (ß = 0.17, P = .016), and estimated glomerular filtration rate (ß = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (ß = 0.34, P < .001), body mass index (ß = -0.19, P = .018), and diabetes mellitus (ß = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.


Assuntos
Aorta/patologia , Artérias/anormalidades , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Calcificação Vascular/fisiopatologia , Malformações Vasculares/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Aorta/fisiopatologia , Artérias/patologia , Artérias/fisiopatologia , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Dermatopatias Genéticas/patologia , Calcificação Vascular/patologia , Malformações Vasculares/patologia
3.
Cardiology ; 142(3): 141-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170719

RESUMO

Current guidelines do not recommend coronary computed tomography angiography (CCTA) in patients with high levels of coronary calcium, as severe calcification leads to difficulties in estimating stenosis severity due to blooming artifacts obscuring the vessel lumen. Whether the CCTA-derived fractional flow reserve (FFRCT) improves the diagnostic performance of CCTA in patients with high levels of coronary calcification has not been sufficiently evaluated. We hypothesize that a noninvasive diagnostic strategy using FFRCT will perform comparably to an invasive diagnostic strategy in the detection of hemodynamically significant coronary artery disease (CAD) in clinical stable chest pain patients with high levels of coronary calcium. In this prospective, blinded, multicenter study, patients with suspected stable CAD referred for CCTA and demonstrating an Agatston score >399 will be included. Patients accepting inclusion will, in addition to CCTA, undergo invasive coronary angiography (ICA) and invasive FFR measurement. FFRCT analyses are performed by an external core laboratory blinded to any patient data, and the FFRCT results are blinded to all participating study sites. The primary objective is to evaluate whether FFRCT can identify patients with and without hemodynamically significant CAD, when ICA with FFR is the reference standard. A negative study result would question the clinical usefulness of FFRCT in patients with high levels of coronary calcium. A positive study result, however, would imply a reduction in the number of patients referred for coronary catheterization and, at the same time, increase the proportion of patients with hemodynamically significant CAD at the subsequent invasive examination.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Calcificação Vascular/diagnóstico por imagem , Cálcio/sangue , Cateterismo Cardíaco , Dor no Peito/etiologia , Doença da Artéria Coronariana/fisiopatologia , Dinamarca , Hemodinâmica , Humanos , Estudos Multicêntricos como Assunto , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Calcificação Vascular/fisiopatologia
4.
J Cardiovasc Surg (Torino) ; 60(5): 572-581, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31241269

RESUMO

Despite the continuous evolution of endovascular therapy, severe calcification remains a major issue for the minimally invasive treatment of superficial femoral artery (SFA) disease. The presence of calcium might negatively affect both the crossing of peripheral lesions and outcomes of all available treatment modalities and is therefore associated with unfavorable acute and long-term results. This manuscript summarizes the challenges raised from severe calcified atherosclerotic lesions and presents the outcomes of the various endovascular modalities in the treatment of calcified SFA disease.


Assuntos
Procedimentos Endovasculares , Artéria Femoral , Doença Arterial Periférica/terapia , Calcificação Vascular/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular
5.
Life Sci ; 232: 116582, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220525

RESUMO

AIMS: Vascular calcification/aging can cause different kind of serious diabetic vascular complications. High glucose could induce vascular smooth muscle cells (VSMCs) calcification/aging and then lead to diabetes-related vascular calcification/aging. In this study, we investigated how information in the blood is transmitted to VSMCs and the mechanisms of VSMCs calcification/aging under hyperglycaemic conditions. MATERIALS AND METHODS: Transmission electron microscopy and molecular size analysis were used to assess the morphology and size of exosomes. Alizarin Red S staining and senescence-associated ß galactosidase (SA-ß-gal) staining were carried out to detect calcification and senescence in VSMCs, respectively. Proteomics analysis was carried out to detect the different expression of exosomal proteins. Protein levels were measured by western blot analysis. KEY FINDINGS: The results show that exosomes isolated from high glucose stimulated human umbilical vein endothelial cell (HG-HUVEC-Exo) exhibited a bilayer structure morphology with a mean diameter of 63.63 ±â€¯2.96 nm. The presence of exosome markers including CD9, CD63 and TSG101 were also detected in HG-HUVEC-Exo. High glucose could induce VSMCs calcification/aging by increasing the expression of osteocalcin (OC) and p21 as well as the formation of mineralised nodules and SA-ß-gal positive cells. Fluorescence microscopy verified that the exosomes were taken up by VSMCs and Notch3 protein was enriched in HG-HUVEC-Exo. Most importantly, mTOR signalling was closely related to Notch3 protein and was involved in regulating HG-HUVEC-Exo-induced VSMCs calcification/aging. SIGNIFICANCE: The data demonstrate that Notch3 is required for HG-HUVEC-Exo promoted VSMCs calcification/aging and regulates VSMCs calcification/aging through the mTOR signalling pathway.


Assuntos
Músculo Liso Vascular/metabolismo , Receptor Notch3/fisiologia , Calcificação Vascular/metabolismo , Calcificação Fisiológica/efeitos dos fármacos , Cálcio/metabolismo , Células Cultivadas , Senescência Celular/fisiologia , Complicações do Diabetes/metabolismo , Complicações do Diabetes/fisiopatologia , Células Endoteliais/metabolismo , Células Endoteliais/fisiologia , Exossomos/metabolismo , Glucose/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Hiperglicemia/metabolismo , Músculo Liso Vascular/fisiologia , Miócitos de Músculo Liso/metabolismo , Osteocalcina/metabolismo , Receptor Notch3/metabolismo , Transdução de Sinais/efeitos dos fármacos , Calcificação Vascular/fisiopatologia
6.
Arterioscler Thromb Vasc Biol ; 39(6): 1088-1099, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31070451

RESUMO

Objective- Vascular calcification is associated with high risk of cardiovascular events and mortality. Osteochondrogenic differentiation of vascular smooth muscle cells (VSMCs) is the major cellular mechanism underlying vascular calcification. Because tissue hypoxia is a common denominator in vascular calcification, we investigated whether hypoxia per se triggers osteochondrogenic differentiation of VSMCs. Approach and Results- We studied osteochondrogenic differentiation of human aorta VSMCs cultured under normoxic (21% O2) and hypoxic (5% O2) conditions. Hypoxia increased protein expression of HIF (hypoxia-inducible factor)-1α and its target genes GLUT1 (glucose transporter 1) and VEGFA (vascular endothelial growth factor A) and induced mRNA and protein expressions of osteochondrogenic markers, that is, RUNX2 (runt-related transcription factor 2), SOX9 (Sry-related HMG box-9), OCN (osteocalcin) and ALP (alkaline phosphatase), and induced a time-dependent calcification of the extracellular matrix of VSMCs. HIF-1 inhibition by chetomin abrogated the effect of hypoxia on osteochondrogenic markers and abolished extracellular matrix calcification. Hypoxia triggered the production of reactive oxygen species, which was inhibited by chetomin. Scavenging reactive oxygen species by N-acetyl cysteine attenuated hypoxia-mediated upregulation of HIF-1α, RUNX2, and OCN protein expressions and inhibited extracellular matrix calcification, which effect was mimicked by a specific hydrogen peroxide scavenger sodium pyruvate and a mitochondrial reactive oxygen species inhibitor rotenone. Ex vivo culture of mice aorta under hypoxic conditions triggered calcification which was inhibited by chetomin and N-acetyl cysteine. In vivo hypoxia exposure (10% O2) increased RUNX2 mRNA levels in mice lung and the aorta. Conclusions- Hypoxia contributes to vascular calcification through the induction of osteochondrogenic differentiation of VSMCs in an HIF-1-dependent and mitochondria-derived reactive oxygen species-dependent manner.


Assuntos
Subunidade alfa 1 de Fator de Ligação ao Core/genética , Fator 1 Induzível por Hipóxia/genética , Hipóxia/complicações , Espécies Reativas de Oxigênio/metabolismo , Calcificação Vascular/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Modelos Animais de Doenças , Dissulfetos/farmacologia , Feminino , Regulação da Expressão Gênica , Humanos , Alcaloides Indólicos/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Músculo Liso Vascular/citologia , Miócitos de Músculo Liso/metabolismo , RNA Mensageiro/genética , Distribuição Aleatória , Valores de Referência , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Calcificação Vascular/fisiopatologia
7.
BMJ Case Rep ; 12(5)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31076494

RESUMO

Coral reef aorta (CRA) is a rare condition, characterised by rock-hard calcification of the juxta-renal and supra-renal aorta with luminal encroachment causing significant stenosis of the aorta and its branches. It usually presents as resistant hypertension, renal dysfunction, mesenteric ischaemia, limb claudication or embolic manifestations. Although surgical thrombo-endarterectomy along with bypass graft to the affected visceral arteries remains the cornerstone of treatment, it is associated with considerable mortality and morbidity, especially in patients with pre-existing comorbidities. Here we report an elderly female of resistant hypertension, who had successful endovascular aortic stenting using a non-graft self-expanding stent. Her blood pressure dramatically improved following endovascular management. In comparison to the conventional surgical approach, endovascular stenting can be an alternative, less invasive approach in selected CRA patients.


Assuntos
Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Angiopatias Diabéticas/cirurgia , Hipertensão/cirurgia , Stents , Calcificação Vascular/cirurgia , Idoso , Ligas , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/etiologia , Hipertensão/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia
9.
Int J Cardiovasc Imaging ; 35(6): 1133-1139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30874979

RESUMO

Computed tomography coronary angiography (CTCA) has a higher negative predictive value (NPV) for coronary artery disease (CAD) than stress echocardiography (SE). CT calcium scoring (CTCS) allows detection and quantification of coronary artery calcification (CAC). The NPV of combined SE and CTCS for CAD is not well defined. Consecutive patients from the executive screening program who underwent exercise SE and concomitant CTCA were retrospectively identified between January 2010 and December 2014. Patients with normal SE and CAC score of zero were determined, and the presence or absence of any CAD (obstructive or non-obstructive plaques) on CTCA was confirmed. The NPV of combined SE and CTCS was then re-tested using a validation cohort of subsequent consecutive patients enrolled between January 2015 and July 2018. The initial cohort consisted of 173 patients (19% age > 65 years, 19% diabetic); 40% had normal CTCA, 48% with non-obstructive CTCA (77 with CAC score > 0), and 12% with obstructive CTCA (all with CAC score > 0). There were 16 (9.2%) patients with inducible ischemia on SE. A normal SE had a 93% NPV to exclude obstructive CAD but only 42% NPV to exclude any CAD. A combined normal SE and CTCS had a 100% NPV for obstructive CAD, and 92% for any CAD. In a validation cohort of 111 patients, a normal SE and CAC score of zero had NPV of 100% for obstructive CAD and 92% for any CAD. The combined cohort consisted of predominately low Framingham risk patients; more than 40% (70/181) had CAC score > 0 and 5/70 had obstructive CAD, with the remaining non-obstructive. A concomitant normal SE and CAC score of zero excluded obstructive CAD (NPV 100%) and any CAD in 92% of the testing and validation cohorts. CTCS seems to add incremental risk stratification, particularly for patients with low Framingham score.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Doença da Artéria Coronariana/fisiopatologia , Bases de Dados Factuais , Teste de Esforço , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Calcificação Vascular/fisiopatologia
10.
Surg Technol Int ; 34: 351-358, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30825317

RESUMO

Endovascular treatment of arterial diseases has become first-line in most cases due to improved technology. However, until recently, excessive atherosclerotic calcification has been a major limiting factor in the endovascular management of peripheral arterial disease, as well as vascular access for endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR). The Peripheral Intravascular Lithotripsy (IVL) System (Shockwave Medical, Inc., Fremont California) applies pulsatile mechanical energy under fluoroscopic guidance to disrupt calcified lesions. The purpose of this paper is to introduce IVL in the treatment of calcific access vessels in preparation for EVAR and TAVR, as well as peripheral arterial disease applications to enhance luminal gain. Using the IVL System, angioplasty can be performed with lower pressures, which may minimize arterial dissection. Further, the lithotripsy effect on calcium will enhance vessel compliance. We describe several cases where IVL was applied successfully and present additional cases that may have benefitted from the use of this technology.


Assuntos
Aneurisma/cirurgia , Procedimentos Endovasculares/instrumentação , Doenças das Valvas Cardíacas/terapia , Substituição da Valva Aórtica Transcateter/instrumentação , Calcificação Vascular/cirurgia , Aneurisma/epidemiologia , Aneurisma/fisiopatologia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento , Calcificação Vascular/epidemiologia , Calcificação Vascular/fisiopatologia
11.
High Blood Press Cardiovasc Prev ; 26(2): 127-134, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30779026

RESUMO

INTRODUCTION: Cognitive impairment and dementia represent an emerging health problem. Cardiovascular (CV) risk factors contribute to cognitive impairment. AIM: To investigate the effect of vascular calcification on cognitive impairment and dementia, independently of plaque and traditional CV risk factors. METHODS: Four hundred and sixty-nine patients (age of 78.6 ± 6.1 years, 74.4% women) were studied. Traditional CV risk factors levels, cognitive function (MMSE), brain CT scan, and other vascular parameters were measured. Common Carotid Artery (CCA) plaque and calcification were evaluated by ultrasound. RESULTS: CCA calcification was associated with a lower MMSE score than in subjects with no CCA calcification (23.7 ± 0.3 versus 25.5 ± 0.8; p = 0.015), after controlling for age, sex, education, blood pressure levels, diabetes, creatinine, lipid lowering therapy, neuroimaging alteration, and CCA plaque. Similarly, CCA calcification was associated with higher odds of dementia regardless of the presence of CCA plaque (OR 1.70, 95% CI 1.01-2.94, p < 0.05). This trend was not observed when stratifying patients according to the presence of CCA plaque. CONCLUSION: CCA calcification is associated with cognitive impairment and dementia, independently of established CV risk factors and CCA plaque. The impact of arterial calcification on cognition seems largely independent of arterial stiffness.


Assuntos
Doenças das Artérias Carótidas/complicações , Artéria Carótida Primitiva , Transtornos Cognitivos/etiologia , Cognição , Envelhecimento Cognitivo , Demência/etiologia , Calcificação Vascular/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Demência/diagnóstico , Demência/psicologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Placa Aterosclerótica , Análise de Onda de Pulso , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Rigidez Vascular
12.
Ann Vasc Surg ; 57: 276.e1-276.e4, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30731232

RESUMO

BACKGROUND: Radiation therapy may accelerate atherosclerosis with progressive stenosis and occlusions of supra-aortic trunks. METHODS AND RESULTS: We report the case of a 44-year-old woman with radiation-induced occlusion of the supra-aortic trunks presenting with recurrent cerebrovascular insufficiency after an unusual surgical revascularization technique (retrograde femoral-axillary bypass) performed for late failure of previous endovascular treatment. CONCLUSIONS: Customized surgical procedure can be considered as a bailout to improve cerebral blood inflow in selected cases.


Assuntos
Arteriopatias Oclusivas/etiologia , Transtornos Cerebrovasculares/etiologia , Lesões por Radiação/etiologia , Calcificação Vascular/etiologia , Adulto , Angioplastia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Circulação Cerebrovascular , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Endarterectomia , Feminino , Humanos , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/fisiopatologia , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Recuperação de Função Fisiológica , Recidiva , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Calcificação Vascular/cirurgia , Grau de Desobstrução Vascular
13.
J Biol Regul Homeost Agents ; 33(1): 29-38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30734547

RESUMO

Since vascular calcification is considered a process regulated similar to that of bone tissue mineralization, we investigated the participation of bone formation proteins. We analyzed the correlation of serum circulating bone markers, osteoprotegerin (OPG) and receptor activator of nuclear factor ĸB ligand (RANKL) in chronic kidney disease (CKD) patients, to coronary artery calcification score. We also considered the effect of inorganic phosphate on pro- and anti-calcifying tissue factors. We confirmed that circulating OPG is an independent calcium score predictor with its high serum concentration favoring high coronary artery calcification. In tissue samples of non-diseased human renal arteries, the expression of OPG and receptor activator of nuclear factor ĸB (RANK) was positive, while expression of RANKL was absent. In atherosclerotic specimens and arteries with medial calcification, the most upregulated was expression of bone morphogenetic proteins, BMP-2 and BMP-7, as well as expression of RANK and RANKL. In the diseased arteries, OPG expression was present only in areas where bone structures were formed. In atherosclerotic and medial calcification arteries, loss of alpha-smooth muscle actin (α-SMA) expression was observed. These data suggest a possible regulatory role of the examined proteins, especially OPG and RANKL, in vascular calcification, as well as their possible clinical significance as circulating predictors of vascular calcification.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Osteoprotegerina/sangue , Ligante RANK/sangue , Calcificação Vascular/fisiopatologia , Proteína Morfogenética Óssea 2/metabolismo , Proteína Morfogenética Óssea 7/metabolismo , Osso e Ossos , Humanos
14.
Int J Cardiovasc Imaging ; 35(5): 897-905, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30805755

RESUMO

Coronary flow velocity reserve (CFVR) can be noninvasively measured by phase-contrast cine magnetic resonance imaging (PC-MRI). Heavy coronary calcification degrades the diagnostic accuracy for the detection of coronary arterial stenosis on computed tomography (CT). The aim of this study was to evaluate the value of CFVR measurement with PC-MRI for detecting significant coronary stenoses in patients with heavy coronary calcification. Sixteen patients (71 ± 8 years) with coronary calcium score above 400 who had suspected moderate coronary stenosis (50-69% diameter stenosis) on CT angiography were prospectively studied. The CFVR values, calculated as the ratio of peak flow velocity during hyperemia to the peak flow velocity at rest, were measured using breath-hold PC-MRI with 3 T system, and were compared with the results of quantitative coronary angiography (QCA). The mean coronary calcium score was 985 ± 378. CFVR was successfully determined with PC-MRI in 17/18 (94%) vessels. Using a threshold of 1.4 for CFVR, the sensitivity, specificity, and positive and negative predictive value for detecting ≥ 50% stenosis on QCA was 88% (7/8), 89% (8/9), 88% (7/8), 89% (8/9), respectively. When MRI CFVR measurements was added to CT angiography for the evaluation of coronary stenosis, the positive predictive value was 88% (7/8), while the positive predictive value of CT angiography alone was 44% (8/18). PC-MRI can provide noninvasive detection of altered CFVR caused by significant stenosis in patient. CFVR measurement by PC-MRI is useful for diagnosing physiologically significant coronary stenosis in patients with high calcium score on CT.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética , Calcificação Vascular/diagnóstico por imagem , Idoso , Velocidade do Fluxo Sanguíneo , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Calcificação Vascular/fisiopatologia
15.
Ann Vasc Surg ; 59: 1-4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802575

RESUMO

BACKGROUND: Duplex ultrasonography (DUS), although consolidated as the primary tool for the estimation of carotid stenosis, may be impaired by calcified plaques that promote acoustic shadow (AcS). AcS seems to hamper the quantification of the main parameter used in the determination of percentage stenosis, that is, the maximal peak systolic velocity (PSV) at the lesion site. The aim of our study was to compare the degrees of carotid artery stenosis in DUS/PSV and computed tomography angiography (CTA) in the presence of AcS. METHODS: During 36 months, 1,178 carotid DUS tests were performed. A total of 164 carotids in 139 patients showed AcS resulting from calcified plaques. Carotids with AcS were referred for a second imaging examination; thus, 62 carotids were analyzed by both DUS/PSV and CTA. CTA measured the area reduction at the lesion site to calculate the percent stenosis. PSV was measured immediately after the end of the AcS. According to velocities-based DUS criteria, stenoses were classified as mild (PSV < 125 cm/s), moderate (125 ≤ PSV ≤ 230 cm/s), and severe (PSV > 230). CTA and DUS/PSV measurements were compared to determine the accuracy of PSV in characterizing the severity of carotid stenosis with AcS. RESULTS: Of the 62 lesions, PSV characterized 10 as severe, 21 as moderate, and 31 as mild. According to the CTA study, there were 36 severe, 8 moderate, and 18 mild lesions. PSV underestimated in 27.79% the incidence of cases of severe carotid artery stenosis detected by the CTA. In addition, PSV overestimated the incidence of the cases of moderate and mild stenosis in 61.91% and 37.78%, respectively. The agreement ratio between the imaging examinations used in this study was 50%. DUS/PSV discretely correlated with CTA (r = 0.668, P < 0.0001, 95% confidence interval = 0.502-0.786). Using PSVs >125 and >230 as predictors of carotid lesions higher than 50% and 70%, respectively, the sensitivities were 63.3% and 27.8%, the specificities were 100%, the positive predictive values were 100%, and the negative predictive values were 71.9% and 50%. CONCLUSION: PSV alone is inadequate to quantify carotid stenosis in the presence of calcified plaques and AcS. Another image tool, such as CTA, could be recommendable for clinical decision-making.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Placa Aterosclerótica , Ultrassonografia Doppler Dupla , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/patologia , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/patologia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Calcificação Vascular/patologia , Calcificação Vascular/fisiopatologia , Calcificação Vascular/terapia
16.
Clin Calcium ; 29(2): 171-177, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30679397

RESUMO

Osteoporosis(OP)is associated with high risk for cardiovascular disease(CVD). Concomitant occurrence of both OP and CVD seems to result from common pathological mechanisms between bone system and vascular system. It is expected that therapeutic agent for OP may be effective not only in normalization of bone metabolism but also in reducing vascular calcification. I give an outline with the relationship between bone metabolism and vascular calcification including epidemiology, outbreak mechanism, and effect on vascular calcification of OP treatment.


Assuntos
Osso e Ossos/fisiologia , Doenças Cardiovasculares , Osteoporose , Calcificação Vascular , Humanos , Osteoporose/fisiopatologia , Fatores de Risco , Calcificação Vascular/metabolismo , Calcificação Vascular/fisiopatologia
17.
Clin Calcium ; 29(2): 193-198, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30679400

RESUMO

Abnormalities, such as hyperparathyroidism, vascular calcification, and osteoporosis, are devastating complications in patients with end-stage renal disease(ESRD). These abnormalities significantly affect the quality of life and prognosis. Therefore, controlling the abnormalities of chronic kidney disease-mineral and bone metabolism play an important role in these patients. Conventionally, calcium and phosphorus metabolism abnormalities have been mainly attributed to the development of vascular calcification, but preventing vascular calcification is still difficult even if calcium and phosphorus levels are controlled. Additionally, the mechanisms of the development and progression of vascular calcification in patients with ESRD are still unknown. Recently, advanced glycation end products(AGEs)have been known to be involved in the development and promotion of bone abnormality, such as bone embrittlement and vascular calcification. Therefore, blockade of AGEs and the receptor for AGE(RAGE)system may be a novel therapeutic strategy to improve the prognosis of patients with ESRD by inhibiting bone embrittlement and vascular calcification.


Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica , Falência Renal Crônica , Insuficiência Renal Crônica , Calcificação Vascular , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Humanos , Falência Renal Crônica/fisiopatologia , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Calcificação Vascular/metabolismo , Calcificação Vascular/fisiopatologia
18.
Clin Calcium ; 29(2): 199-205, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30679401

RESUMO

Acute coronary syndromes are caused by sudden luminal thrombosis due to plaque rupture, plaque erosion, or calcified nodule in coronary atherosclerotic lesions. Coronary calcification is a well-known marker of atherosclerotic plaque burden. Accurate evaluation of coronary calcification is critical for percutaneous coronary intervention(PCI)strategy. Optical coherence tomography(OCT)is a high-resolution(10~20 µm)intravascular imaging technique that uses near infrared light to create images. OCT allows us to identify the details of coronary calcification and assess the effect of cutting balloon angioplasty and rotational atherectomy. Then, OCT is a useful technique to guide PCI in the severe calcified lesions.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Placa Aterosclerótica , Tomografia de Coerência Óptica/métodos , Calcificação Vascular , Doença da Artéria Coronariana/fisiopatologia , Humanos , Placa Aterosclerótica/fisiopatologia , Calcificação Vascular/fisiopatologia
19.
Clin Calcium ; 29(2): 225-230, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30679404

RESUMO

It has been known that diabetes mellitus is known to have a high risk of cardiovascular diseases as well as osteoporosis. Prevention and treatment of vascular calcification in patients with diabeties mellitus by anti-osteoporosis agents is prospected bcause similar molecular mechanisms in bone tissue were found in calcified lesion in blood vessels. However, the anti-vascular calcification effect has not always been observed in clinical practice in contrast to basic research and animal experiments. More optimized clinical research desined for prevention of vascular calcification as primary outcome, such as applying elaborated method for detemination of calcified lesion, is needed.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Osteoporose , Calcificação Vascular , Animais , Osso e Ossos , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/metabolismo , Humanos , Osteoporose/fisiopatologia , Calcificação Vascular/metabolismo , Calcificação Vascular/fisiopatologia
20.
J Cardiovasc Surg (Torino) ; 60(2): 212-220, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30698373

RESUMO

The orbital atherectomy system is a novel form of atherectomy that uses orbital sanding and pulsatile forces, an effective method of treatment for peripheral atherosclerotic lesions with varying levels of occlusion. Although the devices only has a general indication from the FDA to treat atherosclerotic lesions, they are effective in treating all kinds of lesions, and can therefore mitigate effects of all severities of peripheral artery disease. This approach to endovascular therapy involves the use of differential sanding to preferentially ablate fibrous, fibrofatty and calcified lesions, while deflecting healthy intima away from the crown. The eccentrically mounted crown design allows the device to employ rhythmic pulsating forces that penetrate the medial layer, and cause cracking in the lesions in order to facilitate easier balloon inflation and intravascular drug elution. The combination of vessel modification and lumen enlargement through sanding can effectively restore blood flow to the extremities, and can eliminate risk of critical limb ischemia, as well as subsequent amputation. Extensive lab testing and clinical trials have confirmed the high success rates and low major adverse events associated with this form of treatment. The device is economically viable as well, since its cost is offset by the lower frequency of adjunctive therapy sessions when compared to other devices. Considering the results outlined in this manuscript, the Diamondback 360° is an effective form of atherectomy therapy for peripheral artery disease. In-depth understanding of the operation preparation, procedure, and best imaging techniques can help to optimize outcomes.


Assuntos
Aterectomia/métodos , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Calcificação Vascular/terapia , Aterectomia/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular
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