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Sardà H, Colom C, Benitez S, Carreras G, Amigó J, Miñambres I, Viladés D, Blanco-Vaca F, Sanchez-Quesada JL, Pérez A. PCSK9 plasma concentration is associated with epicardial adipose tissue volume and metabolic control in patients with type 1 diabetes. Sci Rep 2024; 14:7195. [PMID: 38532033 DOI: 10.1038/s41598-024-57708-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Patients with type 1 diabetes (T1D) have a greater risk of cardiovascular disease. Proconvertase subtilisin-kexin 9 (PCSK9) is involved in the atherosclerosis process. This study aimed to determine the relationship between PCSK9 levels and epicardial adipose tissue (EAT) volume and cardiometabolic variables in patients with T1D. This was an observational cross-sectional study including 73 patients with T1D. Clinical, biochemical and imaging data were collected. We divided the patients into two groups according to their glycemic control and the EAT index (iEAT) percentile. We performed a correlation analysis between the collected variables and PCSK9 levels; subsequently, we performed a multiple regression analysis with the significant parameters. The mean age was 47.6 ± 8.5 years, 58.9% were men, and the BMI was 26.9 ± 4.6 kg/m2. A total of 31.5%, 49.3% and 34.2% of patients had hypertension, dyslipidemia and smoking habit, respectively. The PCSK9 concentration was 0.37 ± 0.12 mg/L, which was greater in patients with worse glycemic control (HbA1c > 7.5%), dyslipidemia and high EAT volume (iEAT > 75th percentile). The PCSK9 concentration was positively correlated with age (r = 0.259; p = 0.027), HbA1c (r = 0.300; p = 0.011), insulin dose (r = 0.275; p = 0.020), VLDL-C level (r = 0.331; p = 0.004), TG level (r = 0.328; p = 0.005), and iEAT (r = 0.438; p < 0.001). Multiple regression analysis revealed that 25% of the PCSK9 variability was explained by iEAT and HbA1c (p < 0.05). The PCSK9 concentration is associated with metabolic syndrome parameters, poor glycemic control and increased EAT volume in patients with T1D.
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Affiliation(s)
- Helena Sardà
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau - Hospital Dos de Maig, Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Cristina Colom
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau - Hospital Dos de Maig, Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Sonia Benitez
- Cardiovascular Biochemistry Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí, 77-79, 08041, Barcelona, Spain
- CIBER en Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Gemma Carreras
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Judit Amigó
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Inka Miñambres
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau - Hospital Dos de Maig, Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER en Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - David Viladés
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación en red de enfermedades cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco Blanco-Vaca
- CIBER en Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jose Luís Sanchez-Quesada
- Cardiovascular Biochemistry Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí, 77-79, 08041, Barcelona, Spain.
- CIBER en Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain.
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau - Hospital Dos de Maig, Antoni Maria Claret, 167, 08025, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- CIBER en Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain.
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Sendra-Balcells C, Campello VM, Martín-Isla C, Viladés D, Descalzo ML, Guala A, Rodríguez-Palomares JF, Lekadir K. Domain generalization in deep learning for contrast-enhanced imaging. Comput Biol Med 2022; 149:106052. [DOI: 10.1016/j.compbiomed.2022.106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
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Bos L, Agudelo V, Viladés D. <i>Stent</i> bioabsorbible Magmaris: seguimiento por cardio-TC. RECIC 2022. [DOI: 10.24875/recic.m20000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ruiz-López A, Li CHP, Valdovinos P, Rodríguez Á, Bonet A, Tauron M, Ligero C, Millan X, Alegret JM, Viladés D, Arzamendi D. Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device. JACC Case Rep 2022; 4:727-731. [PMID: 35734523 PMCID: PMC9207944 DOI: 10.1016/j.jaccas.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
An 80-year-old woman with mitral valve repair failure was admitted with hemolytic anemia secondary to the impact of a regurgitant jet on the annuloplasty ring. Transcatheter repair to treat both mitral regurgitation and hemolysis was favored because of surgical risk. Transcatheter edge-to-edge repair represents an alternative for treating hemolysis associated with mitral regurgitation. (Level of Difficulty: Advanced.)
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Altisent OAJ, Goncalves-Ramírez LR, Fernández L, Viladés D, Gutiérrez E, Mitomo S, Latib A, Córdoba-Soriano JG, Adeliño R, Amat-Santos I, Muñoz JF, Elízaga J, Bezzera H, Pereira GTR, de Prado AP, Carrillo X, Fernández-Nofrerias E, Vilalta V, Rodríguez-Leor O, Llibre C, Fadeuilhe E, Trujillo A, Mauri J, de la Torre Hernández JM, Bayes-Genís A, Puri R. Long-Term Intracoronary Structural and Vasomotor Assessment of the ABSORB Bioresorbable Vascular Scaffold. Am J Cardiol 2022; 168:55-63. [PMID: 35058053 DOI: 10.1016/j.amjcard.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.
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Salido M, Soriano M, Fernández-Peregrina E, Arzamendi D, Maestro A, Sans-Roselló J, Vidal M, Bos L, Viladés D, Sionis A. Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration. JACC Case Rep 2021; 3:888-892. [PMID: 34317648 PMCID: PMC8311284 DOI: 10.1016/j.jaccas.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
A patient underwent left atrial appendage occlusion due to recurrent stroke despite new oral anticoagulant therapy. The patient later presented with severe acute mitral regurgitation secondary to occluder device migration, which was retrieved percutaneously from the descending aorta via the femoral artery. Mitral surgical repair was required and successfully performed. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Mario Salido
- Cardiology Residency, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Address for correspondence: Dr. Mario Salido Iniesta, Calle Torrente, number 19, 2º Cerdanyola del Vallès, Barcelona 08290, Spain. @MSalido2
| | - Marc Soriano
- Cardiology Residency, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Maestro
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Sans-Roselló
- Coronary Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Vidal
- Coronary Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lidia Bos
- Cardiac imaging department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Viladés
- Cardiac imaging department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alessandro Sionis
- Coronary Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Colom C, Viladés D, Pérez-Cuellar M, Leta R, Rivas-Urbina A, Carreras G, Ordóñez-Llanos J, Pérez A, Sánchez-Quesada JL. Associations between epicardial adipose tissue, subclinical atherosclerosis and high-density lipoprotein composition in type 1 diabetes. Cardiovasc Diabetol 2018; 17:156. [PMID: 30526614 PMCID: PMC6284304 DOI: 10.1186/s12933-018-0794-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/23/2018] [Indexed: 12/23/2022] Open
Abstract
Background The pathophysiology of cardiovascular complications in people with type 1 diabetes (T1DM) remains unclear. An increase in epicardial adipose tissue (EAT) and alterations in the composition of high-density lipoprotein (HDL) are associated with coronary artery disease, but information on its relationship in T1DM is very limited. Our aim was to determine the association between EAT volume, subclinical atherosclerosis, and HDL composition in type 1 diabetes. Methods Seventy-two long-term patients with T1DM without clinical atherosclerosis were analyzed. EAT volume and subclinical atherosclerosis were measured using cardiac computed tomography angiography. EAT was adjusted according to body surface to obtain an EAT index (iEAT). HDL composition was determined. Results The mean iEAT was 40.47 ± 22.18 cc/m2. The bivariate analysis showed positive associations of the iEAT with gender, age, hypertension, dyslipidemia, smoking, body mass index, waist circumference, insulin dose, and triglyceride (P < 0.05). The iEAT correlated positively with small HDL, increased content of apolipoprotein (apo)A-II and apoC-III, and decreased content of apoE and free cholesterol. Multiple linear regression showed that age, apoA-II content in HDL, and waist circumference were independently associated with the iEAT. Fifty percent of the patients presented subclinical atherosclerotic lesions. These patients had a higher iEAT, and their HDL contained less cholesterol and more apoA-II and lipoprotein-associated phospholipase A2 than patients without subclinical atherosclerosis. Conclusion Alterations in the composition of HDL in TIDM are associated with increased iEAT and the presence of subclinical atherosclerosis. We propose that these abnormalities of HDL composition could be useful to identify T1DM patients at highest cardiovascular risk. Electronic supplementary material The online version of this article (10.1186/s12933-018-0794-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Colom
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Viladés
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montserrat Pérez-Cuellar
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Rubén Leta
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andrea Rivas-Urbina
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Carreras
- Pediatrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Ordóñez-Llanos
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Pérez
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain. .,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jose Luis Sánchez-Quesada
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain. .,CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain.
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Aulinas A, Crespo I, Viladés D, Leta R, Urgell E, Biagetti B, Webb SM, Valassi E. Cystatin-C and epicardial adipose tissue as noninvasive predictors of cardiovascular risk in acromegaly. Clin Endocrinol (Oxf) 2017; 86:214-222. [PMID: 27910111 DOI: 10.1111/cen.13273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/13/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acromegaly (ACRO) is associated with elevated cardiovascular risk, although the prevalence of coronary artery disease (CAD) is unclear. Increased epicardial adipose tissue (EAT) and elevated cystatin-C (Cys-C) levels are cardiovascular risk factors, also related to the progression of CAD in several populations. AIMS To measure the severity and extent of CAD in patients with ACRO and to determine whether either EAT or Cys-C reflect higher cardiovascular risk in patients with ACRO than in healthy controls. SUBJECTS AND METHODS Case-control study, of 35 patients with ACRO (19 males, 17 with active disease) and 35 age-, gender- and body mass index (BMI)-matched healthy controls; mean age was 48·1 ± 8·1 years and mean BMI was 27·6 ± 4·8 kg/m2 . Cys-C was measured by an immunoturbidimetric assay. The 10-year risk of developing a coronary event was calculated using the Framingham Risk Score (FRS). EAT index (volume indexed to body surface area), and severity and extent of CAD were measured using a 256-slice multidetector computed tomography scanner (iCT-256 Philips Healthcare, Amsterdam). RESULTS Coronary artery disease lesions, EAT index and severity/extent of CAD were similar between patients with ACRO and controls. Forty-four per cent of patients with ACRO had mild coronary lesions associated with greater EAT index (ß = 0·022, P = 0·036). Cys-C levels correlated with both EAT index (ρ = 0·386, P = 0·031) and FRS (ρ = 0·477, P = 0·004) in patients with ACRO only, despite similar prevalence of traditional cardiovascular risk factors. In a multiple linear regression model, both Cys-C levels (ß = 0·369, P = 0·007) and EAT index (ß = 0·29, P = 0·025) predicted FRS (R2 = 0·613). CONCLUSIONS In patients with ACRO, both Cys-C and EAT index might be used as noninvasive predictors of cardiovascular risk.
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Affiliation(s)
- Anna Aulinas
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Hospital Universitari de Vic, Barcelona, Spain
| | - Iris Crespo
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - David Viladés
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Ruben Leta
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Eulàlia Urgell
- Biochemistry Department, Hospital Sant Pau, Barcelona, Spain
| | - Betina Biagetti
- Endocrinology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Barahona MJ, Resmini E, Viladés D, Fernández-Real JM, Ricart W, Moreno-Navarrete JM, Pons-Lladó G, Leta R, Webb SM. Soluble TNFα-receptor 1 as a predictor of coronary calcifications in patients after long-term cure of Cushing's syndrome. Pituitary 2015; 18:135-41. [PMID: 24728972 DOI: 10.1007/s11102-014-0566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Increased cardiovascular (CV) risk persists in Cushing's syndrome (CS), despite remission of hypercortisolism. The aim of this study was to evaluate prevalence of coronary artery disease in CS patients and its correlation with classical CV risk factors and inflammatory markers. METHODS Cardiac multidetector computed tomography (MDCT) was performed in 41 patients (7 men, 31 of pituitary origin, 29 cured, mean age: 48.6 ± 13 years), using 64-slice Toshiba Aquilion systems. Coronary atherosclerotic plaques were detected and coronary calcifications quantified by the Agatston score (AS). Clinical and biochemical parameters were correlated with the AS to identify possible surrogate markers of coronary disease. Normal values for clinical and biochemical parameters were obtained from a gender- and age-matched normal reference population (n = 82). RESULTS CS patients with calcifications (AS > 0) (N = 13, 32%) had higher levels of sTNF-R1, homocysteine, triglycerides, blood pressure and body mass index than patients without calcifications (AS = 0) and those of normal reference population. Both groups of CS patients (AS > 0 and AS = 0) had elevated trunk fat mass and IL-6 compared to reference values. Patients with AS > 0 had less adiponectin and higher insulin, HOMA and fibrinogen than those found in normal reference population. sTNF-R1 correlated positively with AS and remained significant after adjusting for confounding factors. The same result was observed when we considered only cured CS patients. CONCLUSION In our cohort of CS patients sTNF-R1 was a predictor of coronary calcifications. Since MDCT is an expensive technique not readily available in daily clinical practice, increased sTNF-R1 could be a marker of CV risk even in cured CS.
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Affiliation(s)
- María-José Barahona
- Department of Endocrinology, Hospital Universitari Mútua de Terrassa, Pl Dr Robert 5, 08221, Terrassa, Barcelona, Spain,
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Viladés D, Leta R, Moustafa AH, Alomar X, Carreras F, Pons-Lladó G. Correlación entre la puntuación de Agatston obtenida por tomografía computarizada cardiaca con y sin contraste en población asintomática. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Barahona MJ, Resmini E, Viladés D, Pons-Lladó G, Leta R, Puig T, Webb SM. Coronary artery disease detected by multislice computed tomography in patients after long-term cure of Cushing's syndrome. J Clin Endocrinol Metab 2013; 98:1093-9. [PMID: 23393183 DOI: 10.1210/jc.2012-3547] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Increased cardiovascular risk persists in Cushing's syndrome (CS), despite remission of hypercortisolism. The aim of this study was to evaluate the prevalence of coronary artery disease in patients after long-term cure of CS. METHODS Cardiac multidetector computed tomography was performed in 29 cured CS patients (5 men, 21 of pituitary origin, 50 ± 13 y, mean time of "cure" 11 ± 6 y), using 64-slice Toshiba Aquilion systems (Toshiba Medical Systems, Otawara, Japan). Noncontrast acquisitions were performed to detect coronary calcifications and, after injection of an iodinated contrast agent, for coronary angiography. Calcium was quantified by the Agatston score. Cured patients were compared with 48 gender-matched and age-matched healthy controls. RESULTS Cured CS patients had more hypertension and smoked less than controls (P < .05). The prevalence of coronary calcifications (31% vs 21%) and noncalcified plaques (20% vs 7.8%) tended to be higher in cured CS patients than controls. When only women were analyzed (24 CS and 34 controls), more abnormal multidetector computed tomography results were found (42% vs 18%; P < .05). When patients and controls in the youngest tertile (<45 y) were compared, cured CS patients had significantly more noncalcified plaques than controls (30% vs 0%, P = .01); this difference persisted when hypopituitary or dyslipidemic CS patients were excluded. CONCLUSION Despite long-term biochemical "cure" of CS, patients exhibit more coronary artery disease, especially in women and in those aged <45 years, in comparison to healthy matched controls.
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Affiliation(s)
- María-José Barahona
- Department of Endocrinology, Hospital Universitari Mútua de Terrassa, Plaça Doctor Robert 5, 08221 Terrassa, Barcelona, Spain.
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Catalán P, Leta R, Hidalgo A, Montiel J, Alomar X, Viladés D, Barros A, Pujadas S, Carreras F, Padró JM, Cinca J, Pons-Lladó G. Ruling out coronary artery disease with noninvasive coronary multidetector CT angiography before noncoronary cardiovascular surgery. Radiology 2010; 258:426-34. [PMID: 21079198 DOI: 10.1148/radiol.10100384] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the usefulness of preoperative coronary computed tomographic (CT) angiography in the detection of coronary artery disease (CAD) in nonselected patients scheduled to undergo noncoronary cardiovascular surgery to avoid unnecessary invasive coronary angiography (ICA). MATERIALS AND METHODS The institutional review board approved the study protocol; informed consent was given. This prospective study involved 161 consecutive patients who underwent coronary calcium scoring and coronary CT angiography before undergoing noncoronary cardiovascular surgery. Seven patients were excluded because of contraindications to CT angiography. The major indication of noncoronary cardiovascular surgery was valvular heart disease (121 patients). Follow-up was performed at a median of 20 months to define ischemic events described as acute coronary syndrome or death secondary to acute coronary syndrome, arrhythmias, or cardiac failure. Multivariate analysis was performed to determine predictors of nondiagnostic coronary CT angiography. Kaplan-Meier analysis was performed to evaluate outcome at follow-up. RESULTS Twenty-one patients did not undergo surgery, which left 133 patients as the study group. Atrial fibrillation was present in 45 of 133 patients. The interquartile range of the Agatston coronary calcium score was 0-471. Coronary CT angiography was diagnostic in 108 of 133 patients. Of these, 93 of 108 had no significant CAD (≤ 50% stenosis), and noncoronary cardiovascular surgery was performed in them without preoperative ICA. No patients in this group had postoperative ischemic events at follow-up. Coronary CT angiography was nondiagnostic in 25 of 133 patients who were referred for preoperative ICA. Multivariate analysis showed Agatston score to be the only independent predictor of nondiagnostic coronary CT angiography (odds ratio = 1.002; 95% confidence interval: 1.001, 1.003; P = .001). The best Agatston score cutoff for diagnostic coronary CT angiography was 579. CONCLUSION In nonselected patients scheduled to undergo noncoronary cardiovascular surgery, preoperative coronary CT angiography was diagnostic in 81% of cases. Preoperative ICA could be safely avoided in patients without significant CAD by using coronary CT angiography. The Agatston score, but not the presence of atrial fibrillation, was an independent predictor of nondiagnostic coronary CT angiography. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100384/-/DC1.
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Affiliation(s)
- Paz Catalán
- Cardiac Imaging Unit, Department of Cardiovascular Surgery and Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Clínica Creu Blanca, Reina Elisenda de Montcada 17, Barcelona 08034, Spain.
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