Pulmonary Artery Dilatation Is a Common Finding in a Coronary Artery CT Angiography Population

BACKGROUND/AIM

Dilatation of the main pulmonary artery (mPA) is a common incidental finding in chest imaging and often leads to consultation. The aim of this study was to determine the prevalence of mPA dilatation in a coronary artery CT angiography (CCTA) population.

PATIENTS AND METHODS

The study investigated 985 consecutive patients scheduled for diagnostic CCTA. The transverse axial diameter of the mPA was measured. The prevalence of mPA dilatation was estimated using different reference values (Framingham Heart Study: 28.9 mm for males and 26.9 mm for females, Bozlar: 29.5 mm for both genders and Karazincir: 32.6 mm for males and 31.9 mm for females).

RESULTS

The patient mean age was 53.0±9.7 years (66.5% were women). Body surface area (BSA) correlated moderately with the mPA diameter (r=0.423, p<0.001). The prevalence of mPA dilatation varied from 5.9% (Karazincir) to 33.7% (Framingham Heart Study) in the overall study population.

CONCLUSION

The prevalence of mPA dilatation is high in a CCTA patient population when using a cut-off value from the Framingham Heart Study.

A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress

OBJECTIVES

The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied.

METHODS

HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed.

RESULTS

The mean age of patients undergoing CCTA was 52.9 ± 9.8 years; 66.5% were women. Their median HAA was 128.7° and interquartile range 123.3-134.1°. HAA was significantly smaller in patients with dilated AA (median 126.7° [121.3-130.8°]) compared with the patients with normal AA (median 129.5° [124.3-135.3°], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9° [124.3-134.3°]) compared with patients with normal AA (median 131.9° [127.6-136.9°], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = - 0.510, p = 0.006).

CONCLUSION

A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA.

KEY POINTS

• A smaller angle between the long axis of the heart and ascending aorta midline associated with ascending aortic dilatation. • A smaller heart-aorta-angle correlated with increased total wall shear stress in the outer curvature of the proximal ascending aorta.

P2786Current ESC guidelines for normal ascending aortic diameter: prevalence of aortic dilatation increases to 20% in a consecutive coronary CTA population

Introduction

Epidemiological studies on the prevalence of ascending aortic (AA) dilatation are scanty.

Purpose

To clarify prevalence of AA dilatation according to ESC 2014 guidelines and to study its risk factors.

Methods

This retrospective study included 1000 consecutive patients scheduled for diagnostic coronary artery computer tomography angiography (CCTA) with low to moderate pretest probability for coronary artery disease (CAD). AA diameter was measured at 3 planes; sinus valsalva, sinotubular junction and tubular part. Threshold for AA dilatation was set to >40 mm (ESC 2014). Traditional risk factors for AA dilatation were collected from medical records.

Aortic size index (ASI) was used as a comparative measurement. ASI is defined as the ratio between aortic diameter and body surface area (BSA). The threshold for AA dilatation was set to upper limit of normal distribution exceeding two standard deviations (95%).

Heart-aorta angle (HAA, Figure) was measured as one suggestive risk factor.

Results

Patients' mean age was 52.9±9.8 years, 66.5% were women. The prevalence of AA dilatation in the whole study population was 20.4% according to ESC 2014 guidelines. When patients with hypertension (n=445) or coronary calcifications or stenosis in CCTA (n=375) were excluded, the prevalence of AA dilatation was 14.5% in the population of normotensive patients without CAD (n=380).

According to the normal-distributed ASI values the threshold for normal dimension of sinus valsalva was defined as 23.5 mm/m2 and for tubular part 22.7 mm/m2 for normotensive patients without CAD. Using these thresholds, the prevalence of AA dilatation was 7.8% in the whole population and 7.1% in normotensive patients without CAD.

Smaller HAA was associated to AA dilatation. Median HAA was 125.6° (range: 119.2–131.5°) in patients with dilated AA and 130.1° (123.7–136.4°) in patients with non-dilated AA (p<0.001).

Higher BSA was associated to larger AA dimensions. Risk factors for AA dilatation (according to ESC criteria) were male gender, BAV, hypertension and smoking (p<0.01).

Figure 1

Conclusions

The prevalence of AA dilatation proved to be relatively high in this consecutive CCTA population when using ESC 2014 guidelines. Body size is associated to AA dimensions; thus, it seems reasonable to include BSA in the definition of AA dilatation.

Acknowledgement/Funding

Oiva Vaittinen will grant, Aarne Koskelo Foundation

High prevalence of ascending aortic dilatation in a consecutive coronary CT angiography patient population

Objectives

To clarify the prevalence and risk factors of ascending aortic (AA) dilatation according to ESC 2014 guidelines.

Methods

This study included 1000 consecutive patients scheduled for diagnostic coronary artery computed tomographic angiography. AA diameter was retrospectively measured in 3 planes: sinus valsalva, sinotubular junction, and tubular part. The threshold for AA dilatation was set to > 40 mm which has been suggested as an upper normal limit for AA diameter in ESC 2014 guidelines on aortic diseases. Aortic size index (ASI) using the ratio between aortic diameter and body surface area (BSA) was applied as a comparative measurement. The threshold for AA dilatation was set to the upper limit of normal distribution exceeding two standard deviations (95%). Risk factors for AA dilatation were collected from medical records.

Results

The patients’ mean age was 52.9 ± 9.8 years (66.5% women). The prevalence of AA dilatation was 23.0% in the overall study population (52.5% males) and 15.1% in the subgroup of patients with no coronary artery disease or bicuspid (BAV)/mechanical aortic valve (n = 365). According to the normal-distributed ASI values, the threshold for sinus valsalva was defined as 23.2 mm/m² and for tubular part 22.2 mm/m² in the subgroup. Higher BSA was associated with larger AA dimensions (r = 0.407, p < 0.001). Male gender (p < 0.001), BAV (p < 0.001), hypertension (p = 0.009) in males, and smoking (p < 0.001) appeared as risk factors for AA dilatation.

Conclusions

The prevalence of AA dilatation is high with current ESC guidelines for normal AA dimension, especially in males. Body size is strongly associated with AA dimensions; it would be more reliable to use BSA-adjusted AA diameters for the definition of AA dilatation.

Key Points

• The prevalence of AA dilatation is high in patients who are candidates for coronary CT angiography.

• Body size is strongly associated with AA dimensions.

X-Ray Nanotomography of Individual Pulp Fibre Bonds Reveals the Effect of Wall Thickness on Contact Area

Fibre bonds play an essential role in various properties of paper. Much research has focused on their strength, but the determination of the actual contact area also provides a challenge. Many of the research methods rely on optical tools, which are restricted by the wavelength of light that is utilised. Novel X-ray computed tomography devices utilise X-rays in studying the inner structure of materials, and surpass the optical methods in terms of resolution, allowing detection of even smaller details and variations in distance between the fibres in the bond intersection area. X-ray nanotomography was used to image 26 individual cellulose fibre bonds made of springwood and summerwood fibres of refined bleached softwood kraft pulp. Various dimensional properties of the bonds were measured, most importantly the relative contact area (apparent contact area/intersection area), whose values showed wide variation from 6.4 to 85% with an average of 57.7%. Although the summerwood bonds had a somewhat smaller intersection and contact area than springwood bonds, there were no significant differences in the relative contact area between the bond types. This suggests that the effect of relative and absolute contact area on the strength differences between bond types seems to be minor.

Imaging connected porosity of crystalline rock by contrast agent-aided X-ray microtomography and scanning electron microscopy

We set out to study connected porosity of crystalline rock using X-ray microtomography and scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS) with caesium chloride as a contrast agent. Caesium is an important radionuclide regarding the final deposition of nuclear waste and also forms dense phases that can be readily distinguished by X-ray microtomography and SEM-EDS. Six samples from two sites, Olkiluoto (Finland) and Grimsel (Switzerland), where transport properties of crystalline rock are being studied in situ, were investigated using X-ray microtomography and SEM-EDS. The samples were imaged with X-ray microtomography, immersed in a saturated caesium chloride (CsCl) solution for 141, 249 and 365 days and imaged again with X-ray microtomography. CsCl inside the samples was successfully detected with X-ray microtomography and it had completely penetrated all six samples. SEM-EDS elemental mapping was used to study the location of caesium in the samples in detail with quantitative mineral information. Precipitated CsCl was found in the connected pore space in Olkiluoto veined gneiss and in lesser amounts in Grimsel granodiorite. Only a very small amount of precipitated CsCl was observed in the Grimsel granodiorite samples. In Olkiluoto veined gneiss caesium was found in pinitised areas of cordierite grains. In the pinitised areas caesium was found in notable excess compared to chloride, possibly due to the combination of small pore size and negatively charged surfaces. In addition, elevated concentrations of caesium were found in kaolinite and sphalerite phases. The findings concerning the location of CsCl were congruent with X-ray microtomography.

Interventions to mitigate the effects of poverty and inequality on mental health

PURPOSE

To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health.

METHODS

Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions.

RESULTS

Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted.

CONCLUSIONS

The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.

Promotion of mental health in the core of public health work

Positive trends achieved in health in Finland are not equally reflected mental health, hence mental health promotion deserves a central position. Mental health promotion refers to strengthening of psychological resources, and has been linked to increased well-being and life satisfaction. Health care has an important role in supporting a solid foundation of mental health and in preventing intergenerational transmission of problems. Mental health promotion requires strong involvement of non-health sectors. There are means for strengthening mental health skills also on the individual level. The gap between existing evidence on effectiveness and cost-effectiveness of mental health promotion and the lack of large scale implementation needs to addressed by future health and social policies.