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Background:
The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina.
Methods:
A total of 2018 stable angina patients who underw...
Context in source publication
Context 1
... were resolved by discussion with the senior author. The extent of AoAC in each chest X-ray assessed is shown in Figure 1. The AoAC was graded semi-quantitatively on a 4-point scale using a modified method based on previous reports: grade 0, no visible calcification; grade 1, < 50% calcification in the arch; grade 2, > 50% calcification; grade 3, circumferential calcification. ...
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Lung cancer, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD) are expected to cause most deaths by 2050. State-of-the-art computed tomography (CT) allows early detection of lung cancer and simultaneous evaluation of imaging biomarkers for the early stages of COPD, based on pulmonary density and bronchial wall thicknes...
Objective:
To determine if high fasting blood glucose (FBG) level is an independent predictor of serious coronary lesions in patients with coronary artery disease (CAD).
Methods:
We enrolled 64 patients who had symptoms of chest discomfort and who underwent coronary angiography. FBG was determined from blood samples and the extent of coronary ar...
Citations
... The association of vascular and valve calcifications with the clinical outcomes of AMI has been the subject of several studies [2,5,[15][16][17]. However, no previous study had explored the relationship between the cumulative calcification score (including CAC, TAC, and AVC) and the prognosis of STEMI. ...
Background
To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients.
Methods
This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score.
Results
The overall population’s calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4–5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01–5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61–0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75–0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027).
Conclusion
The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.
... Atherosclerosis is a diffuse progressive disease characterized by vascular calcification, which is associated with disease progression [20][21][22]. Chest radiography can assess the condition of the aortic arch based on the presence or absence of aortic arch calcification (AoAC) [22]. Given that AoAC on chest radiographs is associated with an unfavorable aortic arch type, it can also provide information regarding tortuous vascular conditions [20,23]. ...
... Atherosclerosis is a diffuse progressive disease characterized by vascular calcification, which is associated with disease progression [20][21][22]. Chest radiography can assess the condition of the aortic arch based on the presence or absence of aortic arch calcification (AoAC) [22]. Given that AoAC on chest radiographs is associated with an unfavorable aortic arch type, it can also provide information regarding tortuous vascular conditions [20,23]. ...
Background:
Vascular conditions can affect the recanalization rates after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Chest radiography can assess the conditions of the aortic arch based on the presence or absence of aortic arch calcification (AoAC). The aim of this study was to investigate the relationship between AoAC on chest radiography and first-pass successful recanalization (modified thrombolysis in cerebral infarction 2b/3 after the first-pass).
Methods:
We compared the rate of first-pass successful recanalization between patients with and without AoAC. A total of 193 patients with anterior circulation occlusion who underwent EVT between January 2017 and December 2021 were included.
Results:
AoAC was observed in 80 (41.5%) patients. Patients with AoAC were older (74.5 ± 7.78 vs. 63.9 ± 12.4 years, p < 0.001), had more EVT attempts (3.04 ± 1.95 vs. 2.01 ± 1.34 times, p < 0.001), and a longer procedural time (71.7 ± 31.2 vs. 48.7 ± 23.1 min, p < 0.001) than those without AoAC. Moreover, Patients with AoAC showed a lower incidence of first-pass successful recanalization (18.8% vs. 47.8%, p < 0.001) and a higher incidence of postprocedural hemorrhage (45.0% vs. 27.7%, p = 0.015) than those without AoAC. On multivariate analysis, AoAC was independently associated with first-pass successful recanalization (odds ratio: 0.239 [0.121-0.475], p < 0.001).
Conclusions:
AoAC on chest radiography can be used as a preoperative predictor of successful first-pass recanalization in patients undergoing EVT for AIS.
... Also, serum calcium levels were significantly higher in patients with high-grade vs. low-grade ACC, but there was no significant difference comparing the serum levels of phosphorus and albumin between the two groups (21). In another study, the AAC grade increased with age, was higher in males, and was significantly associated with a history of hypertension, diabetes, and chronic kidney disease (22). ...
Background: Aortic arch calcification (AAC) is very common in hemodialysis patients and is associated with cardiovascular events and the incidence of arteriovenous fistula (AVF) failure. In order to predict the prognosis of patients, a study was conducted to determine the annual failure rate of AVF and its related factors. Methods: This cross-sectional study was performed on 145 patients with end-stage renal disease (ESRD) who were AVF candidates, visiting a referral center in Golestan province of Iran. After the insertion of intravenous arterial fistulas, posterior-anterior chest x-rays were captured, and the grafts were classified by a radiologist. Patients were followed for one year, and the rates of fistula failure (FF) and cardiovascular mortality were recorded. Finally, the data were entered into SPSS 19 software and analyzed by the Chi-square test. Results: Of 112 patients followed up for one year, 56.2% were men. During the one-year follow-up period, 5.3% of the patients developed arteriovenous FF, and this event was more common in men, but the difference was not statistically significant. The majority of the AVF candidates had a history of diabetes and hypertension, but no association was found between the one-year FF rate and these two diseases. Nearly 7.7% of the patients had grade III calcification, but no significant relationship was observed between the AAC grade and AVF failure rate. Conclusions: The rate of one-year FF was higher among ESRD patients with a history of chronic kidney diseases. Our results also demonstrated that the mortality rate is higher in patients with a high degree of AAC and patients with medical history (cardiovascular disease and diabetes).
... Briefly, each plain chest radiography was divided into 16 sections according to the aortic arch and assigned a calcification index present as a percentage in our study. The aortic calcification indices were graded on a scale from 0 to 3, as in previous studies (15,16). ...
... Using an aortic calcification indices from chest X-rays is believed to be one most available and effective methods to predict cardiovascular events (19). To describe the severity of aortic calcification degree, AoAC score was used to predict the cardiovascular risks (15). Although calcification evaluation from chest X-ray might not be as accurate as from CT (20), long-term APD treatment for schizophrenia patients tend to suffer more from financial burdens (21), and it is quite hard for patients or caregivers to arrange such examinations. ...
Aims: This study concentrates on the relationship between antipsychotic drugs (APDs) and aortic calcification.
Methods: All 56 patients with schizophrenia were divided into two groups according to aortic calcification index. APD equivalent dose was calculated via defined daily doses method.
Results: In schizophrenia patients with higher aortic calcification index scores, APD equivalent doses were lower. APD equivalent dose was negatively related to aortic calcification index. Although equivalent APD dose in patients without olanzapine treatment was negatively related to aortic calcification index, it seems that equivalent APD dose did not associate with aortic calcification.
Conclusion: Aortic calcification is negatively associated with APD dose in schizophrenia patients. Olanzapine seems to be vital to the relationship between aortic calcification and APD treatment.
... In the field of neurointervention, including an MT for an AIS, procedural thromboembolism can be caused by atherosclerotic embolization from the aortic arch and adjacent large arteries, as the guiding catheters advance through the vessels [9][10][11][12]. Atherosclerosis of the aortic arch can be a source of procedural thromboembolism [5,12,13], and it can be assessed using a chest X-ray before the procedure [14]. We hypothesized that the aortic arch calcification (AoAC) on a chest X-ray could be related to procedural thromboembolism after an MT for an AIS. ...
Background and Objective: Procedural thromboembolism after a mechanical thrombectomy (MT) for an acute ischemic stroke (AIS) has rarely been studied. It may occur from the artery-to-artery embolization of atherosclerotic plaque in the aortic arch. We investigated the relationship between aortic arch calcification (AoAC) on a chest X-ray and procedural thromboembolism on diffusion-weighted imaging (DWI) after an MT. Materials and Methods: From January 2017 to December 2020, 131 patients underwent DWI within two days following an MT for an AIS. Procedural thromboembolism was defined as new DWI-positive lesions in other territories from the occluded artery on DWI within two days after MT. Results: Procedural thromboembolism was observed in 30 (22.9%) patients. Procedural thromboembolism was associated with old age (72.3 ± 9.44 vs. 65.7 ± 12.8 years, p = 0.003), a longer procedural time (77.6 ± 37.6 vs. 60.1 ± 29.7 min, p = 0.024), and AoAC (calcification (73.3%) vs. no calcification (29.7%), p < 0.001). Multivariable logistic regression analysis showed that procedural thromboembolism was independently associated with AoAC (adjusted odds ratio (OR): 6.107, adjusted 95% confidence interval (CI): 2.374-15.705, p < 0.001) and a longer procedural time (adjusted OR: 1.015, adjusted 95% CI: 1.001-1.030, p = 0.031). Conclusions: Procedural thromboembolism after an MT for an AIS was related to AoAC on a chest X-ray and a longer procedural time. Our results suggest that although rapid recanalization is the most crucial goal of an MT for an AIS, the importance of the careful advance of the guiding catheter through the aortic arch should not be underestimated to reduce the risk of procedural thromboembolism, especially in patients with AoAC on a chest X-ray.
... A study led by Iijima et al. suggested that the grading of aortic calcifications based on chest X-rays could be valuable in the management and follow-up of aortic atherosclerosis because the detected aortic arch calcifications on a plain radiograph were prominent independent risk factors for cardiovascular events [9]. In a recent study, Woo et al. found that the aortic arch calcification seen on a conventional chest X-ray combined with coronary artery calcium score were beneficial in the detection and the prediction of outcome in patients suffering from angina [10]. ...
Background and Objectives: Aortic arch calcification (AoAC) is associated with a variety of cardiovascular complications. The measurement and grading of AoAC using posteroanterior (PA) chest X-rays are well established. The cardiothoracic ratio (CTR) can be simultaneously measured with PA chest X-rays and used as an index of cardiomegaly. The genetic and environmental contributions to the degree of the AoAC and CTR are not well understood. The purpose of this study was to investigate the effect of genetics and environmental factors on the AoAC and CTR. Materials and Methods: A total of 684 twins from the South Korean twin registry (261 monozygotic, MZ and 81 dizygotic, DZ pairs; mean age 38.6 ± 7.9 years, male/female = 264/420) underwent PA chest X-rays. Cardiovascular risk factors and anthropometric data were also collected. The AoAC and CTR were measured and graded using a standardized method. A structural equation method was used to calculate the proportion of variance explained by genetic and environmental factors behind AoAC and CTR. Results: The within-pair differences were low regarding the grade of AoAC, with only a few twin pairs showing large intra-pair differences. We found that the thoracic width showed high heritability (0.67, 95% CI: 0.59–0.73, p = 1). Moderate heritability was detected regarding cardiac width (0.54, 95% CI: 0.45–0.62, p = 0.572) and CTR (0.54, 95% CI: 0.44–0.62, p = 0.701). Conclusions: The heritable component was significant regarding thoracic width, cardiac width, and the CTR.
... [10] In fact, AAC that is detected by chest x-ray has been demonstrated to be an independent risk factor for CV morbidity and mortality in the general population and several patient groups. [3,9,[11][12][13][14][15] In light of these available data, we hypothesize that AAC detected by chest x-ray might be a good candidate for risk stratification for ACS patients undergoing PCI. However, there are insufficient studies regarding the association between AAC and clinical outcomes among ACS patients undergoing PCI. ...
... AAC is associated with CV morbidity and mortality in the general population and several patient cohorts. [3,9,[11][12][13][14][15] Iribarren et al [3] evaluated risk factors for AAC and long-term (median follow-up, 28 years) association between AAC and CV diseases in a large population-based cohort study. Among the 116,309 participants, AAC was present in 2.3% of all participants and was independently associated with older age, current smoking, hypertension, and elevated serum cholesterol level. ...
... Recently, the prognostic value of AAC extent for future CV outcomes in patients with stable angina was studied in a large, respective cohort study. [14] Among 2018 patients, 620 had a significant CAD that required coronary revascularization, whereas 191 developed adverse CV events comprising death from all causes, MI, repeated coronary revascularizations, or stroke over a mean follow-up period of 3.8 ± 0.7 years (range 0.7-5.1 years). There were higher rates of significant CAD (Grade 0 vs Grade 1/2 vs Grade 3: 25.9% vs 42.4% vs 54.5%, P < .001) ...
Currently, little is known regarding the predictive utility of aortic arch calcification (AAC) for clinical outcomes in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). The present study was designed to investigate the predictive performance of AAC as detected by chest x-ray for clinical outcomes among ACS patients undergoing PCI.
A total of 912 patients who were diagnosed as ACS and treated with PCI were included in this prospective, cohort study. All study participants received chest x-rays on admission, and a semiquantitative 4-point scale was used to assess the extent of AAC. The primary end point was defined as a composite of major adverse cardiovascular events (MACE) comprising death, nonfatal stroke, nonfatal myocardial infarction, and unplanned repeat revascularization. The key secondary end point was the composite of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction. The prognostic values of AAC were assessed in multivariate Cox-proportional hazards regression analyses adjusted for major confounders.
The mean follow-up duration was 917 days and, during the follow-up period, MACE occurred in 168 (18.4%) patients. Kaplan-Meier analyses revealed significantly higher incidences of the primary and key secondary end points in patients with higher AAC grades (log-rank test; all P < .001). Multivariate Cox-proportional hazards regression analyses showed that, in comparison to AAC grade 0, the hazard ratios of AAC grades 1, 2, and 3 for predicting MACE were 1.63 (95% confidence interval [CI] 0.99–2.67), 2.15 (95% CI 1.27–3.62), and 2.88 (95% CI 1.41–5.86), respectively. The C-index of the variables, including peripheral arterial disease and serum levels of triglyceride for predicting MACE, was 0.644 (95% CI 0.600–0.687) versus 0.677 (95% CI 0.635–0.719) when AAC grades were also included; the continuous net reclassification improvement was 16.5% (8.7%–23.4%; P < .001).
The extent of AAC as detected by chest x-ray is an independent predictor of MACE among ACS patients undergoing PCI. Further research is warranted to evaluate whether specific treatment strategies that are established based on AAC extent are needed for optimal risk reduction in relevant patient populations.
Galectin-3 levels have been studied as a potential biomarker for predicting cardiovascular (CV) risk and mortality in hemodialysis (HD) patients. Recently, a close relationship between galectin-3 and vascular calcification (VC) has been reported. Here, we investigated the role of VC as a mediating factor in the association between galectin-3 and mortality. Serum galectin-3 and baseline aortic arch calcification (AoAC) score were measured in 477 incident HD patients. Mortality data were obtained at a median follow-up of 40 months. Causal mediation analysis was performed to examine the effect of vascular risk factors on galectin-3-related mortality. The prevalence of AoAC in HD patients was 57% (n = 272), and elevated galectin-3 levels were associated with a significantly increased risk of AoAC. When the galectin-3 level was divided by the median level of 37 ng/mL, a higher galectin group increased the risk of all-cause mortality by 1.71-fold (95% CI 1.02–2.92, p = 0.048), even after adjustment for multiple CV risk factors. Mediation analysis showed that both the direct effect of the galectin-3 on mortality (β = 0.0368, bootstrapped 95% CI [0.0113–0.0622]) and the indirect effects were significant. AoAC score and high-sensitivity CRP levels significantly mediated the association between galectin-3 and mortality (total indirect effects: β = 0.0188, bootstrapped 95% CI [0.0066–0.0352]). This study suggests that the association between high galectin-3 and mortality may be partially mediated by higher VC and inflammatory state in HD patients.
Procedural thromboembolism after coil embolization of a cerebral aneurysm can occur because of fragmented atherosclerotic plaques in the aortic arch. The purpose of this study was to investigate the relationship between aortic arch calcification (AoAC) observed using preoperative chest X-ray and procedural thromboembolisms after coil embolization of cerebral aneurysms. Between January 2019 and December 2020, 66 patients underwent coil embolization for cerebral aneurysms at our hospital. AoAC was assessed based on the presence of calcification using a preoperative chest X-ray. A procedural thromboembolism was defined as a new positive lesion on diffusion-weighted imaging within 7 days post-procedure. A procedural thromboembolism occurred in 34 (51.5%) patients. The thromboembolism was associated with AoAC (calcification [52.9%] vs. no calcification [6.3%], p < 0.001), aneurysm type (aneurysm with incorporated branches [63.9%] vs. sidewall aneurysm [36.7%], p = 0.047), and a longer procedural time (100.2 ± 34.1 min vs. 79.7 ± 24.9 min, p = 0.007). Multivariable logistic regression analysis showed that AoAC (adjusted odds ratio [OR], 23.566; adjusted 95% confidence interval [CI], 3.921–141.654; p = 0.001) and aneurysm type (adjusted OR, 5.501; adjusted 95% CI, 1.455–20.799; p = 0.012) were independent risk factors for procedural thromboembolism. AoAC on preoperative chest X-ray was associated with a significant increase in the procedural thromboembolism rate. Our study suggests that a procedural thromboembolism after coil embolization of cerebral aneurysms might result primarily from fragmented atherosclerotic plaques in the aortic arch. Preoperative chest X-ray could be a useful tool to predict the risk of procedural thromboembolisms.
Cardiac coronary Ca score (CCS), and extra coronary Ca score (ECCS) estimation in asymptomatic systemic sclerosis (SSc) patients and their relation to different disease and patients’ variables. The CCS and ECCS were estimated in asymptomatic 20 SSc patients compared to 20 age and sex-matched healthy control using non-contrast cardiac computed tomography. All were applied for cardiac history taking, examination, echocardiography, body mass index (BMI), complete blood picture, erythrocyte sedimentation rate, and lipid profile estimation. The SSc patients were 11 females and 9 males with a mean age of (42.55 ± 9.145) and mean disease duration (12.9 ± 6.774). CCS was reported in 9 (45%) SSc cases and 2 (10%) of the control; (p = 0.013) and was significantly greater in SSc patients (58.4 ± 175.443) than in the control group (0.7 ± 2.25); (p = 0.01). The ECCS was significantly higher in SSc cases (194.45 ± 586.511) than control group (2.8 ± 7.8); (p = 0.001) and reported in 16 (80%) SSc cases and 3 (15%) of controls; (p = 0.000). Limited scleroderma cases had higher scores than diffuse type. Patients with total ca score (> 100) were older (p = 0.016), had longer disease duration (p = 0.001) and greater BMI (p = 0.002). Significant correlation was found between the log-transformed CCS and disease duration, age, BMI, left ventricular mass, and mass index. Systemic sclerosis patients are at increased risk of subclinical cardiovascular disease determined by cardiac Ca scoring as a noninvasive and reliable method. Extra coronary calcification may be an earlier indicator for this. Disease duration is a determinant risk factor for cardiac calcification in SSc.
Key Points
• Although the association between interleukin-6 (IL-6) promoter polymorphism and rheumatic arthritis (RA) has been discussed in the previous meta-analysis, their conclusions are inconsistent.
• Systemic sclerosis patients are at high risk of accelerated atherosclerosis and cardiovascular diseases. Coronary
atherosclerosis was previously estimated in SSc patients through coronary angiography. A novel method of
assessing coronary artery disease is the coronary calcium score, as determined by multidetector computed
tomography, it measures coronary artery calcification that occurs in atherosclerotic plaque. In this study, the cardiac
coronary and extra coronary Ca score were evaluated in relation to disease characteristics in asymptomatic SSC
patients for early detection of coronary artery disease.
