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Li Y, Zhang Y, Xiao K, Si J, Zhang H, Sun L, Miao Z, Zhao T, Sun J, Sun X, Liu Z, Gao J, Zhao J, Chu X, Li J. The incidence of subclinical atherosclerosis in subjects with low and moderate cardiovascular risk. Clin Cardiol 2023; 46:1260-1267. [PMID: 37522647 PMCID: PMC10577528 DOI: 10.1002/clc.24087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The cardiovascular risk models and subclinical atherosclerotic indicators are both recommended for cardiovascular risk stratification. The accordance between the incidence of subclinical atherosclerosis and subjects with low and moderate cardiovascular risk is unclear. HYPOTHESIS Subjects with low and moderate cardiovascular risk have a lower incidence of subclinical atherosclerosis compared with subjects with high risk. METHODS Brachial-ankle pulse wave velocity (BaPWV) and brachial flow-mediated dilation (BFMD) were measured in 421 subjects without a history of atherosclerotic cardiovascular disease (ASCVD) from October 2016 to January 2020. All subjects were classified into low, moderate, and high risk based on Framingham and China-par risk models respectively. RESULTS Mean age was 57.05 ± 9.35 years and 248 (58.9%) were male. In subjects with low, moderate, and high risk assessed by Framingham and China-par risk models, the percentage of abnormal BaPWV ( > 1400 cm/s) was 42.9%, 70.1%, 85.7%, and 40.4%, 71.4%, 89.7%, respectively. Meanwhile, the percentage of abnormal BFMD ( ≤ 7%) was 43.8%, 68.5%, 77.3%, and 44.9%,72.1%, and 76.6%. According to Framingham-based high-risk categories, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for BaPWV abnormality were 85.7%, 39.4%, 36.1%, and 87.5%, respectively. For BFMD abnormality, the values were 77.3%, 40.1%, 34.1%, and 81.8%, respectively. According to China-par high-risk categories, the values for BaPWV abnormality were 89.7%, 43.8%, 45.6%, and 89.0%, respectively. For BFMD abnormality, the values were 76.6%, 41.3%, 40.7%, and 77%, respectively. In multivariate analysis, age and blood pressure were the independent predictors for subclinical atherosclerosis in subjects with low-moderate risk. CONCLUSIONS More than one-half of subjects with low and moderate risk already have detectable subclinical atherosclerosis, indicating higher cardiovascular risk beyond the traditional stratification.
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Affiliation(s)
- Yan Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Yinghua Zhang
- Department of CardiologyChui Yang Liu Hospital affiliated to Tsinghua UniversityBeijingChina
| | - Keling Xiao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Jin Si
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Haoyu Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Lijie Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Zupei Miao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Ting Zhao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Jinghao Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Xipeng Sun
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Zhi Liu
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jing Gao
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jing Zhao
- Health Management Center, Xuanwu hospitalCapital Medical UniversityBeijingChina
| | - Xi Chu
- Health Management Center, Xuanwu hospitalCapital Medical UniversityBeijingChina
| | - Jing Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
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Martins AMA, Paiva MUB, Paiva DVN, de Oliveira RM, Machado HL, Alves LJSR, Picossi CRC, Faccio AT, Tavares MFM, Barbas C, Giraldez VZR, Santos RD, Monte GU, Atik FA. Innovative Approaches to Assess Intermediate Cardiovascular Risk Subjects: A Review From Clinical to Metabolomics Strategies. Front Cardiovasc Med 2021; 8:788062. [PMID: 35004898 PMCID: PMC8727773 DOI: 10.3389/fcvm.2021.788062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022] Open
Abstract
Current risk stratification strategies for coronary artery disease (CAD) have low predictive value in asymptomatic subjects classified as intermediate cardiovascular risk. This is relevant because not all coronary events occur in individuals with traditional multiple risk factors. Most importantly, the first manifestation of the disease may be either sudden cardiac death or acute coronary syndrome, after rupture and thrombosis of an unstable non-obstructive atherosclerotic plaque, which was previously silent. The inaccurate stratification using the current models may ultimately subject the individual to excessive or insufficient preventive therapies. A breakthrough in the comprehension of the molecular mechanisms governing the atherosclerosis pathology has driven many researches toward the necessity for a better risk stratification. In this Review, we discuss how metabolomics screening integrated with traditional risk assessments becomes a powerful approach to improve non-invasive CAD subclinical diagnostics. In addition, this Review highlights the findings of metabolomics studies performed by two relevant analytical platforms in current use-mass spectrometry (MS) hyphenated to separation techniques and nuclear magnetic resonance spectroscopy (NMR) -and evaluates critically the challenges for further clinical implementation of metabolomics data. We also discuss the modern understanding of the pathophysiology of atherosclerosis and the limitations of traditional analytical methods. Our aim is to show how discriminant metabolites originated from metabolomics approaches may become promising candidate molecules to aid intermediate risk patient stratification for cardiovascular events and how these tools could successfully meet the demands to translate cardiovascular metabolic biomarkers into clinical settings.
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Affiliation(s)
- Aline M. A. Martins
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
- School of Medicine, University of Brasilia, Brasilia, Brazil
- School of Medicine, University Center of Brasilia (UniCeub), Brasilia, Brazil
| | | | | | | | - Henrique L. Machado
- School of Medicine, University Center of Brasilia (UniCeub), Brasilia, Brazil
| | | | - Carolina R. C. Picossi
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Andréa T. Faccio
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Marina F. M. Tavares
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Coral Barbas
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
| | - Viviane Z. R. Giraldez
- Lipid Clinic, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Raul D. Santos
- Lipid Clinic, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Guilherme U. Monte
- Department of Heart Transplant, Federal District Institute of Cardiology (ICDF), Brasilia, Brazil
| | - Fernando A. Atik
- School of Medicine, University of Brasilia, Brasilia, Brazil
- Department of Heart Transplant, Federal District Institute of Cardiology (ICDF), Brasilia, Brazil
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Mitu O, Crisan A, Redwood S, Cazacu-Davidescu IE, Mitu I, Costache II, Onofrei V, Miftode RS, Costache AD, Haba CMS, Mitu F. The Relationship between Cardiovascular Risk Scores and Several Markers of Subclinical Atherosclerosis in an Asymptomatic Population. J Clin Med 2021; 10:955. [PMID: 33804436 PMCID: PMC7957548 DOI: 10.3390/jcm10050955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The current cardiovascular disease (CVD) primary prevention guidelines prioritize risk stratification by using clinical risk scores. However, subclinical atherosclerosis may rest long term undetected. This study aimed to evaluate multiple subclinical atherosclerosis parameters in relation to several CV risk scores in asymptomatic individuals. METHODS A cross-sectional, single-center study included 120 asymptomatic CVD subjects. Four CVD risk scores were computed: SCORE, Framingham, QRISK, and PROCAM. Subclinical atherosclerosis has been determined by carotid intima-media thickness (cIMT), pulse wave velocity (PWV), aortic and brachial augmentation indexes (AIXAo, respectively AIXbr), aortic systolic blood pressure (SBPao), and ankle-brachial index (ABI). RESULTS The mean age was 52.01 ± 10.73 years. For cIMT-SCORE was more sensitive; for PWV-Framingham score was more sensitive; for AIXbr-QRISK and PROCAM were more sensitive while for AIXao-QRISK presented better results. As for SBPao-SCORE presented more sensitive results. However, ABI did not correlate with any CVD risk score. CONCLUSIONS All four CV risk scores are associated with markers of subclinical atherosclerosis in asymptomatic population, except for ABI, with specific particularities for each CVD risk score. Moreover, we propose specific cut-off values of CV risk scores that may indicate the need for subclinical atherosclerosis assessment.
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Affiliation(s)
- Ovidiu Mitu
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Adrian Crisan
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Simon Redwood
- Department of Cardiology, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | | | - Ivona Mitu
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Irina-Iuliana Costache
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Viviana Onofrei
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Radu-Stefan Miftode
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Alexandru-Dan Costache
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Hospital of Rehabilitation, 700661 Iasi, Romania
| | - Cristian Mihai Stefan Haba
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiology, Clinical Emergency Hospital “Sf. Spiridon”, 700111 Iasi, Romania
| | - Florin Mitu
- 1st Medical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.M.); (I.-I.C.); (V.O.); (R.-S.M.); (A.-D.C.); (C.M.S.H.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Hospital of Rehabilitation, 700661 Iasi, Romania
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González-López MA, Lacalle M, Mata C, López-Escobar M, Corrales A, López-Mejías R, Rueda J, González-Vela MC, González-Gay MA, Blanco R, Hernández JL. Carotid ultrasound is useful for the cardiovascular risk stratification in patients with hidradenitis suppurativa. PLoS One 2018; 13:e0190568. [PMID: 29300768 PMCID: PMC5754122 DOI: 10.1371/journal.pone.0190568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/18/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease which has been associated with an increased risk of adverse cardiovascular (CV) outcomes. Adequate stratification of the CV risk is an issue of major importance in patients with HS. To analyze the usefulness of carotid ultrasound (US) assessment for the CV disease risk stratification compared with a traditional score, the Framingham risk score (FRS), in a series of patients with HS. Methods Cross-sectional study of 60 patients with HS without history of CV events, diabetes mellitus or chronic kidney disease. Information on CV risk factors was collected and the FRS was calculated. Thus, the patients were classified into low, intermediate and high-CV disease risk categories based on FRS. Carotid US was performed in all participants, and the presence of atherosclerotic plaques was considered as a marker of high CV risk. Results HS patients had a mean age of 45.1±10.2 years, and 55% were female. The median FRS was 5.7 (IQR: 3.1–14.7). Twenty-four (40%) of the patients were classified into the low risk group, 28 (46.7%) in the intermediate risk group, and 8 (13.3%) into the FRS-high risk category. Noteworthy, carotid US revealed that about one-third of the patients (17/52; 32.6%) in the FRS-based low and intermediate risk categories had carotid plaques, and, therefore, they were reclassified into a high-risk category. Conclusion CV risk in HS patients may be underestimated by using the FRS. Carotid US may be useful to improve the CV risk stratification of patients with HS.
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Affiliation(s)
- Marcos A. González-López
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
- * E-mail:
| | - Marina Lacalle
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Cristina Mata
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | - María López-Escobar
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Raquel López-Mejías
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Javier Rueda
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - M. Carmen González-Vela
- Division of Pathology Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Miguel A. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - José L. Hernández
- Division of Internal Medicine. Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
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Relationship between Framingham risk score and subclinical atherosclerosis in carotid plaques: an in vivo study using multi-contrast MRI. SCIENCE CHINA-LIFE SCIENCES 2017; 60:23-27. [PMID: 28078510 DOI: 10.1007/s11427-016-0385-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/09/2016] [Indexed: 02/04/2023]
Abstract
The assessment and management of early-stage atherosclerosis are important for the prevention of cardiovascular disease (CVD). In this study, we used multi-contrast magnetic resonance imaging (MRI) to investigate the carotid plaque feature in asymptomatic, at-risk subjects; we also evaluated the correlation between MRI findings and Framingham risk score (FRS). One hundred sixty-six asymptomatic individuals with risk factors for CVD underwent multi-contrast MRI. After the arterial morphology and plaque components were outlined, the differences in carotid plaque burden among the various risk categories were analyzed. The FRS analysis showed that high-risk individuals had thicker vessel wall and higher plaque lipid content than did low risk participants. A substantial proportion of advanced carotid plaques occurred in low and intermediate-risk groups. Multi-contrast MRI may provide incremental value to the FRS in managing asymptomatic at-risk population.
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Fiz F, Morbelli S, Bauckneht M, Piccardo A, Ferrarazzo G, Nieri A, Artom N, Cabria M, Marini C, Canepa M, Sambuceti G. Correlation between thoracic aorta 18F-natrium fluoride uptake and cardiovascular risk. World J Radiol 2016; 8:82-89. [PMID: 26834946 PMCID: PMC4731351 DOI: 10.4329/wjr.v8.i1.82] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride (18F-NaF) uptake, as a marker of ongoing calcification and cardiovascular risk factors.
METHODS: Seventy-eight patients (44 females, mean age 63, range 44-83) underwent whole body 18F-NaF positron emission tomography/computed tomography. Cardiovascular risk (CVR) was used to divide these patients in three categories: Low (LR), medium (MR) and high risk (HR). 18F-NaF uptake was measured by manually drawing volumes of interest on the ascending aorta, on the aortic arch, on the descending aorta and on the myocardium; average standardized uptake value was normalized for blood-pool, to obtain target-to-background ratio (TBR). Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.
RESULTS: A significant difference in whole thoracic aorta TBR was detected between HR and LR (1.84 ± 0.76 vs 1.07 ± 0.3, P < 0.001), but also between MR and HR-LR (1.4 ± 0.4, P < 0.02 and P < 0.01, respectively). Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta (P < 0.01). Myocardial uptake provided an effective CVR classes stratification (P < 0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered (R = 0.67), but it peaked when correlating the descending thoracic segment (R = 0.75), in comparison with the aortic arch and the ascending segment (R = 0.55 and 0.53, respectively).
CONCLUSION: Fluoride uptake within the thoracic aorta wall effectively depicts patients’ risk class and correlates with cardiovascular risk. Descending aorta is the most effective in CVR determination.
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Fiz F, Morbelli S, Piccardo A, Bauckneht M, Ferrarazzo G, Pestarino E, Cabria M, Democrito A, Riondato M, Villavecchia G, Marini C, Sambuceti G. ¹⁸F-NaF Uptake by Atherosclerotic Plaque on PET/CT Imaging: Inverse Correlation Between Calcification Density and Mineral Metabolic Activity. J Nucl Med 2015; 56:1019-23. [PMID: 25952737 DOI: 10.2967/jnumed.115.154229] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/25/2015] [Indexed: 01/13/2023] Open
Abstract
UNLABELLED Several studies have highlighted the role of vascular (18)F-NaF uptake as a marker of ongoing calcium deposition. However, accumulation of (18)F-NaF is often inconsistent with localization of arterial plaque. Calcification activity and thus (18)F-NaF uptake might prevail in the earlier plaque stages. To test this hypothesis, we evaluated (18)F-NaF uptake in plaque of 3 different densities, using density as a marker of calcification progression. We also tested whether attenuation-weighted image reconstruction affects (18)F-NaF uptake in the different plaque stages. METHODS Sixty-four oncologic patients (14 men and 50 women; mean age, 65.3 ± 8.2 y; range, 26-81 y) underwent (18)F-NaF PET/CT. A volume of interest was drawn on each plaque within the infrarenal aorta to assess mean standardized uptake value and attenuation (in Hounsfield units [HU]). Plaque was then categorized as light (<210 HU), medium (211-510 HU), or heavy (>510 HU). Standardized uptake value was normalized for blood (18)F-NaF activity to obtain the plaque target-to-background ratio (TBR). During this process, several focal, noncalcified areas of (18)F-NaF were identified (hot spots). The TBR of the hot spots was computed after isocontour thresholding. The TBR of a noncalcified control region was also calculated. In 35 patients, the TBR of non-attenuation-corrected images was calculated. RESULTS The average TBR was highest in light plaque (2.21 ± 0.88), significantly lower in medium plaque (1.59 ± 0.63, P < 0.001), and lower still in heavy plaque (1.14 ± 0.37, P < 0.0001 with respect to both light and medium plaque). The TBR of the control region was not significantly different from that of heavy plaque but was significantly lower than that of light and medium plaque (P < 0.01). Hot spots had the highest absolute TBR (3.89 ± 1.87, P < 0.0001 vs. light plaque). TBRs originating from non-attenuation-corrected images did not significantly differ from those originating from attenuation-corrected images. CONCLUSION Our results support the concept that (18)F-NaF is a feasible option in imaging molecular calcium deposition in the early stages of plaque formation, when active uptake mechanisms are the main determinants of calcium presence, but that retention of (18)F-NaF progressively decreases with increasing calcium deposition in the arterial wall. Our data suggest that non-attenuation-corrected reconstruction does not significantly affect evaluation of plaque of any thickness.
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Affiliation(s)
- Francesco Fiz
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Matteo Bauckneht
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Giulia Ferrarazzo
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Manlio Cabria
- Nuclear Medicine Unit, Galliera Hospital, Genoa, Italy
| | - Alessia Democrito
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Mattia Riondato
- Nuclear Medicine Unit, S. Andrea Hospital, La Spezia, Italy; and
| | | | - Cecilia Marini
- Institute of Molecular Bioimaging and Physiology, CNR, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
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Corrales A, Dessein PH, Tsang L, Pina T, Blanco R, Gonzalez-Juanatey C, Llorca J, Gonzalez-Gay MA. Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study. Arthritis Res Ther 2015; 17:55. [PMID: 25888724 PMCID: PMC4376096 DOI: 10.1186/s13075-015-0576-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/20/2015] [Indexed: 11/13/2022] Open
Abstract
Introduction We previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and a concurrent low CVD risk according to the SCORE. Methods A cohort of 144 women with an evaluated low risk of CVD (SCORE value of zero) was assembled amongst 550 consecutive patients with RA that underwent CVD risk factor recording and carotid artery ultrasound. Participants had no established CVD, moderate or severe chronic kidney disease, or diabetes. We assessed carotid plaque(s) presence and its associated patient characteristics. Results Carotid artery plaque was present in 35 (24.3%) of women with RA. Age, the number of synthetic disease-modifying agents (DMARDs) and total cholesterol concentrations were independently associated with plaque in multivariable stepwise backward regression analysis (odds ratio (95% confidence interval) = 1.15 (1.07 to 1.24), P <0.0001, 1.51 (1.05 to 2.17), P = 0.03 and 1.66 (1.00 to 2.73) P = 0.04), respectively). The area under the curve (AUC) of the receiver operating curve (ROC) for the association with plaque was 0.807 (P <0.0001), 0.679 (P = 0.001) and 0.599 (P = 0.08) for age, total cholesterol concentrations and number of synthetic DMARDs used, respectively. The optimal cutoff value in predicting plaque presence for age was 49.5 years with a sensitivity and specificity of 74% and 75%, respectively, and for total cholesterol concentration, it was 5.4 mmol/l with a sensitivity and specificity of 63% and 70%, respectively. The plaque prevalence was 37.5% in patients (n = 80; 55.6%) with age >49.5 years or/and total cholesterol concentration of >5.4 mmol/l, respectively, compared to only 7.8% in those (n = 64; 44.4%) with age ≤49.5 years or/and total cholesterol concentration of ≤5.4 mmol/l, respectively. Conclusions Approximately one-third of women with RA who experience a low SCORE value and are aged >49.5 years or/and have a total cholesterol concentration of >5.4 mmol/l, experience high-risk atherosclerosis, which requires intensive CVD risk management. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0576-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. .,School of Physiology, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
| | - Linda Tsang
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
| | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | | | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain.
| | - Miguel A Gonzalez-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. .,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
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9
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Durhan G, Hazırolan T, Sunman H, Karakaya J, Karçaaltıncaba M, Aytemir K, Karaağaoğlu E, Akata D. Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without? Correlation with computed tomography coronary angiography. Eur Radiol 2014; 25:776-84. [PMID: 25465710 DOI: 10.1007/s00330-014-3477-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) in adult patients for significant coronary artery stenosis by using computed tomography coronary angiography (CTCA) as reference standard. METHODS Two thousand twenty-one patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA. Patients were examined with dual-source CT and were grouped according to their age, gender, CACS, and estimated SCORE risk. Coronary plaque existence and degree of stenosis were assessed with CTCA. Sensitivity, specificity, and ROC curves were analyzed. RESULTS CACS was the single independent variable in estimating relative risk of critical stenosis and had superior outcome when compared with SCORE risk in logistic regression and ROC curve. Area under the ROC curve was greatest in the interval between 50-59 years. When SCORE was combined with CACS in patients with zero CACS, percentage of significant stenosis increased from 1.4% to 7.0% in patients with high or very high SCORE risk, and decreased to 0.9 % in patients with low or moderate SCORE risk. CONCLUSIONS CACS combination with SCORE risk predicts coronary artery stenosis. When CACS is zero, CTCA can be performed in patients with high or very high SCORE risk.
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Affiliation(s)
- Gamze Durhan
- Department of Radiology, Hacettepe University Medical School, Ankara, Turkey
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10
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Pal GK, Adithan C, Ananthanarayanan PH, Pal P, Nanda N, Durgadevi T, Lalitha V, Syamsunder AN, Dutta TK. Effects of gender on sympathovagal imbalance, prehypertension status, and cardiovascular risks in first-degree relatives of type 2 diabetics. Am J Hypertens 2014; 27:317-24. [PMID: 24286720 DOI: 10.1093/ajh/hpt219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although cardiovascular (CV) risks are reported in first-degree relatives (FDRs) of type 2 diabetics, effects of gender on sympathovagal imbalance (SVI) and CV risks in these subjects have not been investigated. METHODS Body mass index (BMI), blood pressure variability parameters including baroreflex sensitivity (BRS), spectral indices of heart rate variability, autonomic function tests, insulin resistance, lipid profile, inflammatory markers (interleukin 6, high-sensitivity C-reactive protein, tumor necrosis factor α) and oxidative stress (OS) marker were measured and analyzed in control group (without family history of diabetes; 65 women, 60 men) and study group (FDRs of type 2 diabetics; 52 women, 49 men) subjects. RESULTS BMI, heart rate, blood pressure, rate-pressure product, stroke volume, left-ventricular ejection time, cardiac output, total peripheral resistance, homeostatic model of insulin resistance, lipid profile, inflammatory and OS markers, and ratio of low-frequency to high-frequency power of heart rate variability (LF-HF ratio), a sensitive marker of SVI, were significantly increased, and BRS was significantly decreased in study group men compared with women. SVI was more intense in men and was due to concomitant sympathetic activation and vagal inhibition. There was no SVI in control subjects. Multiple regression analysis demonstrated independent contribution of BMI, homeostatic model of insulin resistance, atherogenic index, inflammatory and OS markers, and BRS to LF-HF ratio. Logistic regression analysis demonstrated significant prediction of prehypertension status and rate-pressure product (markers of CV risk) by LF-HF, which was more prominent in men. CONCLUSIONS SVI is more intense in male FDRs of type 2 diabetics, and SVI is associated with increased CV risk due to insulin resistance, dyslipidemia, inflammation, and oxidative stress in these subjects.
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Affiliation(s)
- Gopal K Pal
- Department of Physiology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
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11
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Canpolat U, Yorgun H, Aytemir K, Oto A. Risk estimation scores do not mean everything: what about plaque burden and prognosis? Am J Cardiol 2013; 111:1374-1375. [PMID: 23622103 DOI: 10.1016/j.amjcard.2013.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/19/2013] [Indexed: 11/22/2022]
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12
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Pen A, Yam Y, Chen L, Dennie C, McPherson R, Chow BJW. Discordance between Framingham Risk Score and atherosclerotic plaque burden. Eur Heart J 2013; 34:1075-82. [PMID: 23303659 DOI: 10.1093/eurheartj/ehs473] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM Clinical predictors are routinely used to identify individuals who may benefit from aggressive risk factor modification. However, clinical predictors cannot account for all genetic and environmental variables. The objective of this study is to investigate the association of Framingham Risk Score (FRS) with computed tomography angiography (CTA) measures of coronary atherosclerosis. METHODS AND RESULTS Consecutive patients who underwent CTA were prospectively enrolled and categorized according to clinical predictors such as FRS and pre-test probability for obstructive coronary artery disease (CAD). Atherosclerotic calcific and non-calcific plaques were assessed. Of the 1507 patients without a history of diabetes mellitus, myocardial infarction, and not on statin therapy, coronary atherosclerosis was present in 63.5% of the patients. Of the 1173 patients with low and intermediate FRS, atherosclerotic plaque was visually present in 47.6 and 72.7% of the patients, respectively. A higher proportion of low FRS patients had isolated non-calcific plaque (14.8%) compared with patients in the intermediate (10.1%) or high (7.2%) FRS groups, and 11.7% of high FRS patients had no visual evidence of plaque. The correlation between FRS and plaque was fair (r = 0.48; P < 0.001). CONCLUSION Although clinical variables are predictive of CAD events, CTA identified coronary atherosclerosis in a significant proportion of patients with low to intermediate FRS, and a small minority of patients with high FRS had no evidence of atherosclerosis. Prospective studies are required to determine the potential value of identifying coronary atherosclerosis using CTA and to assess whether modifying therapies based on these results are warranted.
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Affiliation(s)
- Ally Pen
- Department of Medicine Cardiology, The University of Ottawa Heart Institute, Ottawa, ON, Canada
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