64层双源螺旋CT与血管内超声对冠状动脉粥样硬化斑块性质的对比研究

目的对比冠状动脉血管内超声(IVUS)与64层双源螺旋CT(64-sCT)检查对冠状动脉粥样硬化斑块特征判定的准确性。方法选择35例不稳定性心绞痛患者行64-sCT与IVUS检查,分别测定同一病变同一位置的血管横截面积、管腔横截面积、斑块负荷;采用IVUS判定斑块性质,64-sCT测定其CT值。结果 45支血管(左前降支23支;左回旋支15支;右冠状动脉7支)的72个不同截面行IVUS与64-sCT检查,在可用于评估的68个截面中,64-sCT对51个存在斑块的截面,正确显示49个存在斑块(敏感性96%),对提示17个无斑块的截面,正确显示16个无斑块存在(特异性94%)。脂质斑块(25±14)HU、纤维斑块(90±20)HU、钙化斑块(530±185)HU;混合斑块中,钙化-脂质斑块(540±175)HU、钙化-纤维斑块(540±195)HU、纤维-脂质斑块(91±22)HU。纤维-脂质斑块与纤维斑块差异无统计学意义;钙化-脂质斑块、钙化-纤维斑块与钙化斑块差异无统计学意义。靶血管外弹力膜截面积、管腔截面积、斑块负荷、狭窄程度之间差异无统计学意义。结论对比IVUS与64-sCT检查能够定性及定量分析冠状动脉粥样硬化斑块,但其精确度仍有一定的限制。     

Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events.Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated.Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100.Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.     

Characterization and morphology of atherosclerotic plaque of coronary arteries: utility of electron-beam tomography to detect non-calcified plaque: a comparison with conventional coronary angiography and intravascular ultrasound

BackgroundElectron-beam tomography (EBT) may provide useful information about characterization and morphology of atherosclerotic plaque of coronary arteries.Materials and methodsTwenty-six subjects (20 male, 6 female) with suspected coronary heart disease had two routine (r) and one enhanced (e) EBT scans to detect non-calcified plaque (NCP) in the coronary arterial lumen, and were compared with conventional coronary angiograms (CAG) and intravascular ultrasound (IVUS).ResultsThree had the sites, which did not have high CT values suggesting calcification in rEBT, nor which was not enhanced by contrast material in eEBT. One had the site with positive CT values that were supposed to be the proliferation intima or organized thrombus and at the corresponding site mixed plaque was observed in the IVUS image. The other two had the site with negative CT values that were supposed to be fat tissue with significant stenosis in CAG. We also made the cross-sectional images of the vessel and the morphology of the NCP, which projected into the lumen, could be evaluated.ConclusionsWe could detect the NCP, differentiate fat tissue from soft tissue and evaluate the morphology of the plaque in EBT.     

急性冠脉综合征血管内超声斑块显像与血清淀粉样蛋白A、妊娠相关蛋白A表达的相关性研究

目的：探讨急性冠脉综合征（ACS）患者血管内超声（IVUS）显像与血清淀粉样蛋白A（SAA）、妊娠相关血浆蛋白A（PAPP-A）浓度的相关性。方法：按照1979年WHO缺血性心脏病诊断标准选择80例住院冠心病患者,分为稳定型心绞痛（SAP）组（20例）和ACS组（60例）,所有患者均行IVUS、冠脉造影检查,术前至少1h分别检测患者血清SAA、血浆PAPP-A的浓度,并与IVUS检查所得出的斑块纤维帽厚度、偏心指数、重构指数比较,分析其相关性。结果：与SAP组患者相比,ACS组患者纤维帽厚度明显变薄[（1.0±0.2）mm∶（0.7±0.1）mm],偏心指数[（0.4±0.1）∶（0.9±0.2）]、重构指数明显提高[（0.8±0.1）∶（1.3±0.2）],SAA[（13.75±9.65）MIU/L∶（36.4±12.32）MIU/L]、PAPP-A[（10.36±8.25）mg/L∶（32.68±12.5）mg/L]浓度明显升高（P均〈0.001）。SAA、PAPP-A水平与纤维帽厚度均呈负相关（r=-0.68,-0.68,P均〈0.05）,与偏心指数（r=0.75,0.81）、重构指数（r=0.71,0.78）呈正相关（P均〈0.05）。结论：急性冠脉综合征患者易损斑块的纤维帽厚度、偏心指数、重构指数（斑块稳定性）与血清淀粉样蛋白A、妊娠相关蛋白A存在相关关系,血清淀粉样蛋白A、妊娠相关蛋白A可作为预测易损斑块稳定性的重要指标。     

Thoracic aortic calcification measured by X-ray computed tomography vs age and risk factors of arteriosclerosis

The purpose of this study was to examine possible correlations among age, arteriosclerotic risk factors, and specific sites of calcification in the thoracic aorta as detected by X-ray computed tomography (CT). A total of 80 patients (mean age 59±9 years, 50 M/30 Fe) included 34 patients with ischemic heart disease, 32 with chest pain syndrome, 5 with valvular heart disease, and 9 with other diseases. The thoracic aortic calcification score, based on X-ray CT images, is the sum of the length (cm) of calcification detected in 1-cm-interval horizontal cross-sections. Differences in calcification were compared for patients with and without hypertension, diabetes, and hyperlipemia. Calcification occurred more often in the external left arch wall (52 cases), followed by the lower arch wall (50 cases). Calcification in the ascending aorta was detected in only 18 cases. Aortic calcification score ranged from 0 to 103.3 points with a mean of 8.8±14.9 points, showing a significant correlation (r=0.48,p<0.01) with patient age. However, there was no significant difference in ascending and descending aorta between sites of cross-sections. Calcification score was higher in patients with hypertension or diabetes. This difference, though significant, was very small. Moreover, patient age did have some correlation with calcification score, but the presence of ischemic heart disease and gender had no effect.A working version of this report was presented at the 36th Annual World Congress, International College of Angiology, New York, New York, July 1994     

血管内超声诊断冠状动脉钙化斑块优势

目的比较冠状动脉造影（ＣＡＧ）和冠状动脉内超声（ＩＶＵＳ）对冠状动脉钙化斑块检出率。方法１００例临床疑冠心病患者行ＣＡＧ和ＣＵＳ检查。结果ＣＡＧ对冠状动脉钙化斑块的检出率虽然较低（２８％）,但特异性高达９７％。ＩＶＵＳ不但检出率高（６４％）,而且能显示冠状动脉的结构,钙经斑块特点,对介入治疗有很好的指导作用。结论对冠状动脉钙化斑块的检出优势ＩＶＵＳ明显强于ＣＡＧ。     

The impact of coronary artery disease risk factors on intravascular ultrasound-derived morphologic indices of human coronaries

OBJECTIVE: The relationship of intravascular ultrasound (IVUS)-derived measurements of atherosclerotic plaque to various coronary artery disease (CAD) risk factors is not well known. The purpose of this study was to examine the relationship of percent coronary luminal stenosis by IVUS to other IVUS measures of CAD, as well as the relationship of common IVUS measures of CAD to traditional CAD risk factors. We hypothesized that one or more IVUS measures of CAD might relate more strongly to CAD risk factors than does percent luminal coronary stenosis. METHODS: The records of 897 consecutive patients (57% men, mean age 62 years) who underwent IVUS investigation of their coronary arteries from 1996 through 2001 were retrospectively reviewed. IVUS was performed using a 20-MHz probe (Jomed, Rancho Cordoba, CA) and a manual pull-back technique to image the coronary arteries. Coronary artery remodeling ratio-i.e., the ratio of coronary lesion external elastic membrane cross-sectional area (EEM CSA) to proximal reference artery EEM CSA; plaque burden-i.e., plaque plus media CSA divided by EEM CSA; calcium arc; and percent stenosis of luminal cross-sectional area were measured by a single reader. RESULTS: Percent area stenosis, the most commonly used IVUS parameter, did not correlate with the other three IVUS-derived parameters, nor was it related to any of the CAD risk factors considered. In contrast, remodeling ratio was directly correlated with plaque burden (r=0.22, P<0.001), but inversely related to calcium arc (r=-0.13, P=0.01). IVUS plaque burden was significantly correlated with male gender (P<0.0001) and diabetes mellitus (DM) (P=0.003). In multivariate analyses including age, gender, and CAD risk factors, plaque burden was significantly associated with age, male gender, and DM, but not with chronic renal failure, hypertension, or hypercholesterolemia. The multivariate model also revealed that the calcium arc was significantly associated with male gender and age. These IVUS findings provide anatomic documentation that the traditional CAD risk factors relate more strongly to plaque burden than to percent coronary arterial luminal narrowing.     

Coronary risk factors influence plaque morphology in patients with unstable angina.

BACKGROUND: The risk of plaque disruption and subsequent thrombosis in patients with unstable angina depends on the plaque type and size. DESIGN: Intravascular ultrasound (IVUS) was employed to illustrate the correlation between risk factors and plaque morphology in patients with unstable angina. METHODS: In a prospective study of 60 of 95 patients consecutively admitted with unstable angina [41 men, aged 61.2 +/- 8.1 years (mean +/- SD)], qualitative (soft and hard plaque, thrombus, calcification, eccentricity, adaptive and constrictive remodeling) and quantitative [lumen, external elastic membrane (EEM) and plaque cross-sectional area (CSA) and plaque burden] IVUS data relating to the target lesion, and proximal and distal reference segments were analyzed and correlated with risk factors. Univariate and multivariate nominal logistic regression analyses and analyses of variance were used to determine the independent predictors for IVUS morphology. RESULTS: For plaque composition univariate analysis showed a younger age (< 60 years) to be a predictor for adaptive remodeling (P = 0.019), and an older age to be a predictor for constrictive remodeling (P = 0.021). Hypercholesterolemia, smoking and sex were associated with a higher frequency of thrombus (P = 0.044, 0.038 and 0.043, respectively). Multivariate analyses revealed that only younger and older ages were independent predictors for adaptive and constrictive remodeling (P = 0.039 and P = 0.045). For plaque size, univariate and multivariate analyses demonstrated that diabetes mellitus and hypercholesterolemia were independent predictors for greater plaque (13.5 +/- 5.72 versus 10.17 +/- 4.6 mm2, P = 0.015, for diabetic versus non-diabetic patients; 12.0 +/- 5.35 versus 9.03 +/- 3.76 mm2, P = 0.010, for hypercholesterolemic versus normocholesterolemic patients) and EEM CSA (17.16 +/- 5.81 versus 14.3 +/- 5.1 mm2, P = 0.033, for diabetic versus non-diabetic patients; 16.57 +/- 5.49 versus 12.25 +/- 3.8 mm2, P = 0.001, for hypercholesterolemic versus normocholesterolemic patients) at the target lesion. Hypercholesterolemia was associated with significantly greater plaque and EEM CSA in both proximal and distal reference segments. CONCLUSIONS: Multivariate analyses indicated that age, diabetes and hypercholesterolemia are independent predictors for plaque morphology in patients with unstable angina.     

Aortic calcification detected in a mass chest screening program using a mobile helical computed tomography unit. Relationship to risk factors and coronary artery disease.

BACKGROUND: There is a significant relationship between calcification of the aortic arch (Arch) detected by chest X-ray examination and coronary artery disease (CAD), but the relationship between risk factors, CAD and aortic calcification detected during a mass screening program using a mobile helical computed tomography (CT) unit remains unknown. METHODS AND RESULTS: In total 2,623 subjects (1,347 men, and 1,276 women; mean age, 52.9+/-13.8) underwent an examination for lung cancer and tuberculosis using a mobile helical CT unit. The frequency of calcification was 19.6% in the Arch, 2.7% in the ascending aorta, and 10.1% in the descending aorta, values that were positively associated with age in both genders. Hypertension and smoking were significantly related to calcification of the thoracic aorta. There was a significant relationship between CAD and aortic calcification. The odds ratio of aortic calcification for patients with CAD increased as the number of calcified segments increased. CONCLUSIONS: These results suggest that detection of calcification in the thoracic aorta during a mass chest screening using a mobile helical CT unit can be used to evaluate the risk of CAD.     

Low variation and high reproducibility in plaque volume with intravascular ultrasound

BACKGROUND: Intravascular ultrasound (IVUS) has several advantages compared to angiography when evaluating coronary atherosclerosis in the vessel wall. METHODS: The accuracy, reproducibility, and short-time spontaneous variation in volume of vessel, plaque and lumen were studied by electrocardiographic-gated three-dimensional (3D) IVUS in 20 male patients with ischaemic heart disease (IHD). RESULTS: The study lesions were angiographically insignificant, with a length of the analysed segment on 11.4+/-5.9 mm. At baseline the mean minimal lumen diameter was 2.41+/-0.59 mm, minimal lumen area 4.82+/-2.38 mm2, and maximal plaque burden 65.61+/-9.57%. Mean reference diameter was 3.1+/-0.6 mm. No significant changes were observed in volumes of total vessel, lumen or plaque. The coefficient of variation (CV) for two volume measurements at baseline was: vessel 0.8%, plaque 1.3%, and lumen 1.4%. For measurements recorded at baseline and after 12.6+/-1.5 weeks, CV was respectively 3.5%, 3.3% and 6.6%. Reproducibility and interobserver and intraobserver variation showed very high correlations. A linear correlation was present in percent changes over 12.6+/-1.5 weeks between vessel volume and lumen volume (r=0.804; p<0.001) and between percent changes in plaque volume and vessel volume (r=0.581; p=0.007). No correlation was found between changes in plaque volume and lumen volume (r=0.015; p=0.950). CONCLUSION: ECG-gated 3D IVUS is a highly reproducible method when applied on coronary artery atherosclerosis. CV for lumen volume over 12.6+/-1.5 weeks is twice that of plaque volume indicating the superiority of the 3D IVUS compared to coronary angiography (CAG).     

应用血管内超声显像技术评价冠状动脉病变与颈动脉病变相关性

目的 通过研究血管内超声、冠状动脉造影检查结果与体表颈动脉超声检测的颈动脉病变的相关性,分析颈动脉粥样硬化与冠心病的关系,进一步探讨颈动脉粥样硬化对冠心病发病的预测价值.方法 38例拟诊为冠心病的患者行冠状动脉造影、血管内超声和体表颈动脉超声检查,其中8例患者经冠状动脉造影和血管内超声检查未发现冠状动脉有明显狭窄病变为对照组;30例经冠状动脉造影和血管内超声检查发现冠状动脉有明显狭窄病变为冠心病组,其中不稳定型心绞痛18例,稳定型心绞痛12例.将血管内超声及冠状动脉造影检查结果与颈动脉超声指标进行分析比较.结果 30例冠心痛患者冠状动脉造影平均直径狭窄率71.21%±9.81%,血管内超声示有不同类型的动脉粥样硬化斑块,平均面积狭窄率80.88%±7.77%;8例对照组无动脉粥样硬化斑块.冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间差异有显著性(P<0.01);冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间有显著相关性(r=0.663,P<0.01).根据冠状动脉造影平均直径狭窄率计算的Gensini积分分别与颈动脉粥样硬化的等级积分、Crouse积分和斑块数三项指标间均有相关性(P<0.01).颈动脉斑块对冠心痛的阳性预测值为70%(21/30),阴性预测值为75%(6/8).结论 应用血管内超声显像技术能准确诊断冠状动脉斑块的性质并测量冠状动脉狭窄率;与冠状动脉造影相比,血管内超声对评价冠状动脉病变更准确.颈动脉粥样硬化严重程度与冠状动脉血管内超声检查结果有很好的相关性;颈动脉超声检测对冠心病的诊断有一定的预测价值.     

Involvement of Lipoprotein(a) in calcification of coronary arteries and thoracic aorta as detected by X-ray computed tomography

The authors compared the severity of coronary calcification and thoracic aortic calcification as detected by x-ray computed tomography (X-ray CT) with Lipoprotein(a) [Lp(a)], and investigated whether Lp(a) is more important than total cholesterol (TC) or HDL-cholesterol (HDLC) as a risk factor for arteriosclerosis. Subjects were 64 patients (47 males, mean age 57.1±8.4 years) comprising 43 cases of ischemic heart disease, 9 cases of chest pain syndrome, 7 of valvular heart disease, and 5 of dilated cardiomyopathy. Fasted blood samples were collected early in the morning and values before medication were used. Lp(a) was measured by ELISA. Evaluation of coronary calcification by X-ray CT was performed in accordance with the procedure described in the authors' previous reports. Coronary calcification was assessed in all slices (slice thickness: 1 cm; scoring system: no coronary calcification, 0 points; coronary calcification less than 1 cm in length, 1 point; 1–2 cm, 2 points; over 2 cm, 3 points). The total score was used as coronary calcification score. For the aortic calcification score, the total number of aorta (slice thickness: 1 cm) with calcification from the superior margin of the aortic arch to the inferior cardiac margin was used. Mean scores of coronary and aortic calcification were 6.1±7.9 and 4.5±5.2 points, and Lp(a), TC, and HDLC, 23.7±23.3, 213±37, and 49.9±15.1 mg/dl, respectively. No correlation was seen between the scores of both coronary calcification and aortic calcification and any of the three lipid parameters, but for cases without coronary calcification, Lp(a) (10.6±8.5 mg/dl) was significantly lower (p<0.1) than that for cases with coronary calcification (1 vessel, 29.4±24.4; 2 vessels, 26.5±16.7; 3 vessels, 32.6±31.0 mg/dl).No significant difference was observed, however, for TC and HDLC between patients with and without coronary calcification/aortic calcification. It is suggested that Lp(a) may be a risk factor for coronary calcification. There is no correlation, however, between Lp(a) and the severity of coronary calcification. Aortic calcification is not related to the serum Lp(a) level.Presented at the 35th Annual Congress of the International College of Angiology in Copenhagen, Denmark, July 1993     

Relationship between aortic calcification and atherosclerotic disease in patients with abdominal aortic aneurysm.

BACKGROUND: Calcification of the aortic wall has been used as an index of the degree of complicated atherosclerotic plaque formation. Atherosclerosis in the abdominal aorta in patients with abdominal aortic aneurysm (AAA) was studied by measuring aortic calcification via computerised tomography. METHODS: Design: retrospective study. Patients: preoperative computer tomography (CT) in 129 male patients with a mean age of 68.6 years (range: 42 to 82) undergoing elective aneurysmectomy. Measurements: a conventional CT scanner was used. Aortic calcification was assessed at four levels: (A) the origin of the coeliac artery, (B) the left renal vein, (C) the maximum diameter of the aneurysm, and (D) the aortic bifurcation. Calcification was graded as: (0) no calcification, (1) calcification less than 40% of the aortic circumference, or (2) calcification more than 40% of the aortic circumference. The relationships between aortic calcification at each level and various factors related to atherosclerosis were analysed. RESULTS: Maximum calcification was seen at level D, followed by levels C, B and A, in that order. Calcification was less common in patients younger than 50 years old. Hypertension, coronary artery disease, and peripheral vascular occlusive disease correlated with the incidence of aortic calcification. CONCLUSIONS: A correlation between aortic calcification and atherosclerotic disease was demonstrated in patients with abdominal aortic aneurysm.     

CT Emphysema Predicts Thoracic Aortic Calcification in Smokers with and Without COPD

ABSTRACT

COPD patients are at increased risk for cardiovascular morbidity and mortality independent of smoking habits. Recent studies suggest CT emphysema is an independent predictor of cardiovascular risk as evidenced by its association with arterial stiffness and impaired endothelial function. We examined the relationship between demographics, lung function, CT emphysema and airway wall thickness and thoracic aortic calcification, another marker of cardiovascular risk, in the National Lung Screening Trial. We hypothesized that CT emphysema would be independently associated with thoracic aortic calcification. Two hundred forty current and former smokers were enrolled. After CT examination, we recorded subjects’ demographics and they performed spirometry. Subjects were classified into COPD and non-COPD subgroups. CT emphysema was quantified as a percentage of lung volume and measurements of the right upper lobe airway were performed using standard methods and expressed as wall area (%). Total calcification scores for the thoracic aorta were computed using TeraRecon image analysis. Univariate and multivariate analyses were performed to determine the associations between calcium score and subject characteristics. Subjects with COPD were older, more often male, heavier smokers and had more CT emphysema and greater aortic calcification than those without COPD. Calcium score was associated with age, pack-years, CT emphysema, wall area%, and lung function on univariate testing but only with age and CT emphysema on multivariate analysis. We conclude that CT emphysema is independently associated with thoracic calcification and thus may be used to assess cardiovascular risk in smokers with and without COPD.     

Assessment of Angiographic Coronary Calcification and Plaque Composition in Virtual Histology Intravascular Ultrasound

Objectives

We assessed the relation between coronary plaque composition and angiographic calcification by using virtual histology intravascular ultrasound (VH‐IVUS).

Background

The plaque vulnerability according to angiographic calcification is unclear.

Methods

Subjects were 140 consecutive patients (145 lesions) undergoing VH‐IVUS before percutaneous coronary intervention. Subjects were divided into 4 groups: no calcification group (n = 27), spotty group (n = 65) that had calcium deposits under 90° in grayscale IVUS, intermediate group (n = 37) had calcium deposits with 90° or more and under 180°, and extensive group (n = 16) had calcium deposits with 180° or more.

Results

The number of VH thin‐cap fibroatheromas in spotty group was significantly larger than no calcification group, intermediate group, and extensive group (0.66 ± 0.71 vs 0.22 ± 0.42 [P < 0.01], 0.32 ± 0.48 [P < 0.05], 0.13 ± 0.34 [P < 0.01], respectively). Spotty group without angiographic calcification had significantly larger %necrotic core than with angiographic calcification (24.5 ± 6.7% vs 19.9 ± 7.2%, P < 0.05). Intermediate group without angiographic calcification had significantly larger necrotic core area than with angiographic calcification (2.5 ± 0.9 mm² vs 1.7 ± 0.9 mm², P < 0.05). Extensive group with angiographic calcification had significantly larger %dense calcium than without angiographic calcification (18.3 ± 4.0% vs 13.4 ± 4.4%, P < 0.05).

Conclusions

Lesions with spotty calcification was highly vulnerable in VH‐IVUS. Spotty or intermediate plaque calcification without angiographic calcification was more vulnerable than those with angiographic calcification. Extensive plaque calcification with angiographic calcification had more dense calcium than those without angiographic calcification.

     

Pulmonary function is associated with distal aortic calcium, not proximal aortic distensibility. MESA lung study

Forced expiratory volume in one second strongly predicts mortality from cardiovascular disease. FEV(1) has been associated with aortic stiffness a strong independent predictor of cardiovascular mortality. However, the anatomical site and possible mechanisms linking aortic stiffness and lung function are unknown. We therefore examined if FEV(1) and CT percent emphysema were associated with calcification of the abdominal aorta or reduced distensibility of the proximal thoracic aorta.The Multi-Ethnic Study of Atherosclerosis (MESA) measured aortic calcification on cardiac and abdominal CT scans and proximal aortic distensibility using magnetic resonance among participants aged 45-84 years without clinical cardiovascular disease. Spirometry was measured following ATS/ERS guidelines and percent emphysema was measured in the lung fields of cardiac CT scans. Multivariate analyses adjusted for age, sex, race/ethnicity and cardiovascular risk factors. Of 1,917 participants with aortic distensibility measures, 13% were current and 38% were former smokers. Eighteen percent had airflow limitation without asthma. FEV(1) was associated with the extent of distal aortic calcification (0.76; 95%CI 0.60-0.97, p = 0.02) but not proximal aortic calcification or proximal aortic distensibility (-0.04 mmHg(-1); 95%CI -0.16-0.09 mmHg(-1), p = 0.60). Percent emphysema was associated with neither measure. FEV(1) was associated with severity of distal aortic calcification where it was present independently of smoking and other cardiovascular risk factors but not with distensibility or calcification of the proximal aorta.     

CT emphysema predicts thoracic aortic calcification in smokers with and without COPD

COPD patients are at increased risk for cardiovascular morbidity and mortality independent of smoking habits. Recent studies suggest CT emphysema is an independent predictor of cardiovascular risk as evidenced by its association with arterial stiffness and impaired endothelial function. We examined the relationship between demographics, lung function, CT emphysema and airway wall thickness and thoracic aortic calcification, another marker of cardiovascular risk, in the National Lung Screening Trial. We hypothesized that CT emphysema would be independently associated with thoracic aortic calcification. Two hundred forty current and former smokers were enrolled. After CT examination, we recorded subjects' demographics and they performed spirometry. Subjects were classified into COPD and non-COPD subgroups. CT emphysema was quantified as a percentage of lung volume and measurements of the right upper lobe airway were performed using standard methods and expressed as wall area (%). Total calcification scores for the thoracic aorta were computed using TeraRecon image analysis. Univariate and multivariate analyses were performed to determine the associations between calcium score and subject characteristics. Subjects with COPD were older, more often male, heavier smokers and had more CT emphysema and greater aortic calcification than those without COPD. Calcium score was associated with age, pack-years, CT emphysema, wall area%, and lung function on univariate testing but only with age and CT emphysema on multivariate analysis. We conclude that CT emphysema is independently associated with thoracic calcification and thus may be used to assess cardiovascular risk in smokers with and without COPD.     

老年主动脉瓣膜钙化患者与冠心病关系的探讨

目的通过超声心动图及冠状动脉造影的检查,探讨老年主动脉瓣膜钙化患者与冠心病的关系。方法选择我院拟诊为冠心病的老年住院患者(年龄≥60岁)308例,均经过超声心动图及冠状动脉造影术检查。根据超声心动图对主动脉瓣膜钙化情况的检查,将其分成主动脉瓣膜钙化组(166例)及主动脉瓣膜无钙化组(142例)。结果主动脉瓣膜钙化组与主动脉瓣膜无钙化组在年龄、高血压史、糖尿病史、吸烟史比较无统计学差异(P>0.05);血脂指标:主动脉瓣膜钙化组与主动脉瓣膜无钙化组比较,TG、TC、HDL-C及LDL-C有统计学差异(P<0.05);冠状动脉造影检查:主动脉瓣膜钙化组与主动脉瓣膜无钙化组比较有统计学差异(P<0.05)。结论老年主动脉瓣膜钙化患者与冠心病有一定的相关性,通过对老年主动脉瓣膜钙化患者行心脏超声心动图的无创检查,结合病史及实验室检查,对高危患者有一定的筛查作用。     

Relation of thoracic aorta calcification on computed tomography and coronary risk factors to obstructive coronary artery disease on angiography

The aim of this study was to investigate whether thoracic aorta calcification (TAC) on computed tomography (CT) and coronary risk factors had any correlation with obstructive coronary artery disease (CAD) on angiography. A total of 225 consecutive Japanese patients underwent both thoracic conventional helical CT and coronary angiography. The thoracic aorta was divided into 4 locations according to the aortic anatomy (inner curve of the aortic arch, aortic arch but not on the inner curve, ascending aorta, and thoracic descending aorta). The classified TAC and coronary risk factors were evaluated for the presence or absence of obstructive CAD. TAC was detected in 185 patients; 141 of 225 patients had significant obstructive CAD. All of the 13 patients with no TAC and no coronary risk factors had no CAD. The obstructive CAD rate with 1 thoracic calcified location and with no, 1, or 2 coronary risk factors was 10%, 58%, and 90%, respectively, and each showed a significant difference (p < 0.0001). The combinations of TAC and coronary risk factors with obstructive CAD were 1 or 2 thoracic calcified locations with 3 coronary risk factors, and 3 thoracic calcified locations with more than 2 coronary risk factors. Increasing thoracic calcified locations and increasing coronary risk factors indicated a higher likelihood of CAD.     

Pulmonary Function is Associated with Distal Aortic Calcium,Not Proximal Aortic Distensibility. MESA Lung Study

Forced expiratory volume in one second strongly predicts mortality from cardiovascular disease. FEV₁ has been associated with aortic stiffness a strong independent predictor of cardiovascular mortality. However, the anatomical site and possible mechanisms linking aortic stiffness and lung function are unknown. We therefore examined if FEV₁ and CT percent emphysema were associated with calcification of the abdominal aorta or reduced distensibility of the proximal thoracic aorta.The Multi-Ethnic Study of Atherosclerosis (MESA) measured aortic calcification on cardiac and abdominal CT scans and proximal aortic distensibility using magnetic resonance among participants aged 45–84 years without clinical cardiovascular disease. Spirometry was measured following ATS/ERS guidelines and percent emphysema was measured in the lung fields of cardiac CT scans. Multivariate analyses adjusted for age, sex, race/ethnicity and cardiovascular risk factors. Of 1,917 participants with aortic distensibility measures, 13% were current and 38% were former smokers. Eighteen percent had airflow limitation without asthma. FEV₁ was associated with the extent of distal aortic calcification (0.76; 95%CI 0.60–0.97, p = 0.02) but not proximal aortic calcification or proximal aortic distensibility (?0.04 mmHg^?1; 95%CI ?0.16–0.09 mmHg^?1, p = 0.60). Percent emphysema was associated with neither measure. FEV₁ was associated with severity of distal aortic calcification where it was present independently of smoking and other cardiovascular risk factors but not with distensibility or calcification of the proximal aorta.