1
|
Lee SY, Chao CT, Han DS, Chiang CK, Hung KY. A combined circulating microRNA panel predicts the risk of vascular calcification in community-dwelling older adults with age strata differences. Arch Gerontol Geriatr 2024; 120:105333. [PMID: 38262252 DOI: 10.1016/j.archger.2024.105333] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Older adults have a higher risk of developing vascular calcification (VC). Circulating miRNAs can be potential risk indicators. However, prior studies used single miRNA mostly, whereas miRNA panels were rarely evaluated. We aimed to examine whether a miRNA panel outperformed each miRNA alone, and analyzed whether advanced age affected VC risk predictive performance offered by the miRNA panel. METHODS We prospectively enrolled older adults (age ≥65 years) during their annual health checkup in 2017, and examined their VC severity followed by analyzing sera for VC regulatory miRNAs (miR-125b-5p, miR-125b-3p, and miR-378a-3p). We used multiple regression analyses to determine associations between each miRNA or a 3-combind panel and VC risk, followed by area under the receiver-operating-characteristics curve (AUROC) analysis. Participants were further divided to those of 65-75 and ≥75 years for comparison. RESULTS From 199 older adults screened, 169 (median age, 73.3 years) with available calcification assessment were analyzed, among whom 74.6 % having VC. Those with VC had significantly lower circulating miR-125b-5p, miR-125b-3p, and miR-378a-3p levels than those without. Regression analyses showed that the 3-combined miRNA panel exhibited significant associations with VC risk, with significantly higher AUROC than those of models based on individual miRNA. Importantly, in those ≥75 years, the miRNA-predicted risk of VC was more prominent than that in the 65-75 years group. CONCLUSION A miRNA panel for VC risk prediction might outperform individual miRNA alone in older adults, and advanced age modified the association between circulating miRNAs and the risk of VC.
Collapse
Affiliation(s)
- Szu-Ying Lee
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan.
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Kang Chiang
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Integrative diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| |
Collapse
|
2
|
Imaoka K, Ohira M, Shimomura M, Hattori M, Bekki T, Sato K, Imaoka Y, Akabane S, Nakano R, Yano T, Sakai H, Hirata F, Kuroda S, Tahara H, Ide K, Ishiyama K, Kobayashi T, Tanaka Y, Ohdan H. Effect of Abdominal Aortic Calcification on Recurrence Following Initial Hepatectomy for Colorectal Liver Metastases. Anticancer Res 2024; 44:649-658. [PMID: 38307553 DOI: 10.21873/anticanres.16854] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM The aim of the study was to analyze the association between abdominal aortic calcification (AAC) and patient prognosis following resection of colorectal liver metastases (CRLM). AAC potentially reflects intrahepatic immunity and is involved in tumor development and progression. However, the clinical effects of AAC on colorectal cancer (CRC) prognosis after curative-intent liver resection for CRLM remain unclear. PATIENTS AND METHODS We evaluated the effect of AAC on the clinical prognosis and metastatic patterns in 99 patients who underwent hepatectomy for CRLM between 2010 and 2019. RESULTS The high-AAC group had significantly worse overall survival (OS) and remnant liver recurrence rate (RR) after propensity score matching to adjust for differences in baseline characteristics of patients and tumors. In multivariate Cox regression analyses, high AAC volume was an independent risk factor for poor OS and liver RR, but not poor lung RR. The expression of tumor necrosis factor-related apoptosis-inducing ligand, known as an anti-tumor marker, in liver natural killer (NK) cells was lower in the high-AAC group than in the low-AAC group. CONCLUSION High AAC volume showed a strong relationship with remnant liver RR after curative resection of CRLM. High AAC volume may be responsible for the suppression of anti-tumor activity of liver NK cells, which results in an increased risk of liver recurrence and poor prognosis.
Collapse
Affiliation(s)
- Kouki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Bekki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koki Sato
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Akabane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Nakano
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuya Yano
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Sakai
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumihiro Hirata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Renal Transplant Surgery, Aichi Medical School Medicine, Nagoya, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuka Tanaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
3
|
Craiem D, Guilenea F, de Freminville JB, Azizi M, Casciaro ME, Gencer U, Jannot AS, Amar L, Soulat G, Mousseaux E. Abdominal aortic calcium and geometry in patients with essential hypertension. Diagn Interv Imaging 2023:S2211-5684(23)00241-3. [PMID: 38148259 DOI: 10.1016/j.diii.2023.12.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Abdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. MATERIALS AND METHODS Patients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. RESULTS Among 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). CONCLUSION In patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.
Collapse
Affiliation(s)
- Damian Craiem
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Federico Guilenea
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Jean-Batiste de Freminville
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Michel Azizi
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Mariano E Casciaro
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Umit Gencer
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Anne-Sophie Jannot
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Laurence Amar
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Gilles Soulat
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Elie Mousseaux
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| |
Collapse
|
4
|
Atteia HH. Co-supplementation of Vitamin K2 and Selenium Synergistically Improves Metabolic Status and Reduces Cardiovascular Risk Markers in Dyslipidemic Rabbits. Biol Trace Elem Res 2023; 201:4758-4768. [PMID: 36696048 DOI: 10.1007/s12011-023-03569-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
This work investigated the impact of vitamin K2 and selenium co-supplementation on metabolic profile and indicators of cardiovascular health in dyslipidemic rabbits. Fifty adult male rabbits were equally allocated into 5 groups: Control group, Dyslipidemic group: received 0.5% cholesterol in diet for 12 weeks, groups 3, 4 and 5 dyslipidemic rabbits daily treated with vitamin K2 (10 mg/kg bw) or/and selenium (1 mg/kg bw) for 8 weeks. Co-supplementation of vitamin K2 and selenium significantly decreased body weight gain and blood pressure elevation in dyslipidemic rabbits compared to un-treated ones. Consuming vitamin K2 plus selenium also markedly lowered serum lipids encompassing cholesterol, triglycerides and LDL and elevated HDL relative to placebo. Additionally, such co-supplementation reduced fasting glucose and insulin, enhancing insulin sensitivity with respect to placebo. Regarding cardiovascular risk markers, dyslipidemic rabbits received vitamin K2 concurrently with selenium displayed lower levels of atherogenic index (LDL/HDL), serum C-reactive protein, heart fatty acid-binding protein and asymmetric dimethylarginine as well as aortic ox-LDL, lipid peroxidation and calcium but higher levels of serum nitric oxide and aortic total antioxidants than un-treated ones. Concomitant administration of vitamin K2 and selenium improved metabolic profile, markers of cardiovascular health and atherosclerosis in dyslipidemic rabbits.
Collapse
Affiliation(s)
- Hebatallah Husseini Atteia
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk, Kingdom of Saudi Arabia.
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Sharkia, Egypt.
| |
Collapse
|
5
|
Liu XR, Liu F, Zhang W, Peng D. The aortic calcification is a risk factor for colorectal anastomotic leakage. Updates Surg 2023; 75:1857-1865. [PMID: 37594659 DOI: 10.1007/s13304-023-01630-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/12/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The current pooling up analysis aimed to evaluate whether aortic calcification (AC) was a potential risk factor for anastomotic leakage (AL) after colorectal surgery. METHODS In this study, we searched studies in three databases including PubMed, Embase, and the Cochrane Library on April 20, 2022. In order to investigate the association between AC and AL, the hazard ratios (HRs) and 95% confidence intervals (CIs) of AC were pooled up. Our study was performed with RevMan 5.3 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS We finally enrolled eight studies involving 1955 patients for statistical analysis. As for all patients, we found that AC could significantly increase the risk of AL after surgery (HR = 2.31, I2 = 0%, 95%CI = 1.58 to 3.38, P < 0.01). In five studies including patients undergoing colorectal surgery (benign diseases and cancers), AC was also a risk factor for AL (HR = 3.30, I2 = 2%; 95%CI = 1.83 to 5.95, P < 0.01). In terms of the other three studies that only included CRC patients, there was still a correction between AC and AL (HR = 1.80, I2 = 0%, 95%CI = 1.10 to 2.96, P = 0.02). CONCLUSION Patients with AC were more likely to develop AL after colorectal surgery. Moreover, subgroup analysis suggested that AC was a predictor for AL after CRC surgery.
Collapse
Affiliation(s)
- Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
6
|
Chao CT, Liao MT, Wu CK. Left Ventricular Hypertrophy Geometry and Vascular Calcification Co-Modify the Risk of Cardiovascular Mortality in Patients with End-Stage Kidney Disease: A Retrospective Cohort Study. J Atheroscler Thromb 2023; 30:1242-1254. [PMID: 36567124 PMCID: PMC10499460 DOI: 10.5551/jat.63870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 12/25/2022] Open
Abstract
AIM Patients with end-stage kidney disease (ESKD) have an unparalleled risk of left ventricular hypertrophy (LVH) and vascular calcification (VC), both of which introduce excessive cardiovascular risk. However, it remains unclear whether LVH geometry co-modulates cardiovascular outcomes with VC in this population. METHODS A retrospective cohort study was conducted. Patients with ESKD requiring chronic hemodialysis were identified from Shin Kong Wu Ho-Su Memorial Hospital between October and December 2018, with echocardiographic LVH geometry and aortic arch calcification (AoAC) determined. They were divided into four groups according to AoAC severity and eccentric or concentric LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyze their cardiovascular and all-cause mortality after multivariate adjustment. RESULTS Overall, 223 patients with ESKD with LVH were analyzed, among whom 29.1%, 23.3%, 25.1%, and 22.4% had non-to-mild AoAC with eccentric and concentric LVH and moderate-to-severe AoAC with eccentric and concentric LVH, respectively. After 3.5 years of follow-up, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher risk of cardiovascular mortality than those with non-to-mild AoAC and eccentric LVH (hazard ratio 3.35, p=0.002). However, those with moderate-to-severe AoAC but eccentric LVH did not have higher cardiovascular mortality. Similarly, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher all-cause mortality than those with non-to-mild AoAC and eccentric LVH, whereas the other two groups did not have higher risk. CONCLUSION LVH geometry could help stratify the risk of patients with ESKD when they had severe VC, and co-existing severe VC and concentric LVH aggravated cardiovascular risk.
Collapse
Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
7
|
Bulut FD, Kor D, Kılavuz S, Şeker Yılmaz B, Kaplan İ, Ekinci F, Burgaç E, Varol İ, Köşeci B, Tuğ Bozdoğan S, Kara E, Demir F, Deniz A, Temiz F, Önenli Mungan N. Expanding the phenotypic landscape of Gaucher disease type 3c with a novel entity - Transient neonatal cholestasis. Eur J Med Genet 2023; 66:104764. [PMID: 37061027 DOI: 10.1016/j.ejmg.2023.104764] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 04/17/2023]
Abstract
Gaucher disease (GD) is the most frequent lysosomal storage disorder due to biallelic pathogenic variants in GBA gene. Only homozygous D409H variant has been associated with the cardiovascular phenotype which is also known as Gaucher disease type 3c. In this descriptive study, we presented phenotypic heterogeneity and a novel clinical finding among 13 patients with GD type 3c. Patients presented with varying degrees of cardiac valve and/or aortic calcifications (84,6%) and corneal opacities (76,9%) in addition to visceral (100%), hematological (92,3%), neurological (92,3%), and skeletal (30%) manifestations. Also, cervical dystonia (38,4%) and psychiatric disorders (46,1%) were not infrequent entities with respect to neurological involvement in GD type 3c. In this report, we highlight transient neonatal cholestasis (38,4%) as a novel finding in GD type 3c. Neonatal cholestasis is a finding associated with Gaucher type 2, but transient neonatal cholestasis has not been reported in GD patients, so far. The clinical features of GD type 3c are highly heterogeneous, from disease severity or age of onset to disease progression. Also, we concluded that phenotypic spectrum may be associated with age at onset of clinical symptoms. As, patients presenting in infancy or childhood had mainly visceral and hematological involvement and patients presenting in adolescence and adulthood had mainly cardiac, neurological involvement, and psychiatric behavioral disorders. Identifying the heterogeneous clinical course of these patients in this fatal disease, may lead a sufficient understanding of the pathophysiology which will enable targeted therapeutic interventions.
Collapse
Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Berna Şeker Yılmaz
- University College London, Genetics and Genomics Medicine, Institute of Child Health London, UK
| | - İrem Kaplan
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Faruk Ekinci
- Çukurova University, Pediatric Intensive Care Department, Adana, Turkey
| | - Ezgi Burgaç
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - İlknur Varol
- İnönü University, Pediatric Gastroenterology and Hepatology Department, Malatya, Turkey
| | - Burcu Köşeci
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | | | - Esra Kara
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Fadli Demir
- Çukurova University, Pediatric Cardiology Department, Adana, Turkey
| | - Ali Deniz
- Çukurova University, Pediatric Gastroenterology and Hepatology Department, Adana, Turkey
| | - Fatih Temiz
- Sütçü İmam University, Pediatric Endocrinology Department, Kahramanmaraş, Turkey
| | | |
Collapse
|
8
|
Imaoka K, Shimomura M, Shimizu W, Akabane S, Ohira M, Imaoka Y, Yoshinaka H, Ono K, Mochizuki T, Matsubara K, Bekki T, Hattori M, Ohdan H. Effect of abdominal aortic calcification on the prognosis and recurrence of colorectal cancer stages II-III: A retrospective cohort study. Int J Colorectal Dis 2023; 38:21. [PMID: 36680603 DOI: 10.1007/s00384-023-04321-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Abdominal aortic calcification (AAC) is a well-known risk marker for cardiovascular disease. However, its clinical effect on patients who underwent radical surgery for colorectal cancer (CRC) stages II-III is unclear. This study aimed to analyze the associations between AAC and prognosis of patients with stage II-III CRC. METHODS To evaluate the effect of AAC on clinical outcomes, prognosis, and metastatic patterns of CRC, we analyzed 362 patients who underwent radical surgery for stage II-III CRC between 2010 and 2018. RESULTS The high AAC group had significantly worse overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) after propensity score matching to adjust for differences in baseline characteristics of patients and tumors. In the multivariate Cox regression analyses, a high AAC was an independent risk factor for poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.23-4.59; p = 0.01), poor CSS (HR, 5.22; 95% CI, 1.74-15.6; p < 0.01), and poor RFS (HR, 1.83; 95% CI, 1.19-2.83; p < 0.01). A high AAC was not associated with a risk of lung metastasis or local or peritoneal recurrence, but a risk for liver metastasis of CRC. CONCLUSION A high AAC showed a strong relationship with poor OS, CSS, and RFS after curative resection for stage II-III CRC. A high AAC was also associated with a risk for liver metastasis, which may worsen the prognosis in stage II-III CRC. AAC could be a new clinical tool for predicting the prognosis for patients in stage II-III CRC.
Collapse
Affiliation(s)
- Kouki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan.
| | - Wataru Shimizu
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Shintaro Akabane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Hisaaki Yoshinaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Kosuke Ono
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Tetsuya Mochizuki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Keiso Matsubara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Tomoaki Bekki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan
| |
Collapse
|
9
|
Sayanthan S, Allison MA, Budoff MJ, Rye KA, Ong KL. Relationship of fibroblast growth factor 21 with the prevalence and progression of vascular and valvular calcification: Multi-ethnic study of atherosclerosis. Int J Cardiol 2023; 370:388-395. [PMID: 36306948 DOI: 10.1016/j.ijcard.2022.10.145] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Elevated circulating levels of fibroblast growth factor 21 (FGF21) are associated with cardiovascular disease (CVD). Therefore, we investigated the relationship of plasma FGF21 with calcification at different vascular and valvular sites. METHODS A total of 5786 participants, free of clinically apparent CVD at baseline and with valid data on plasma FGF21 and calcification (Agatston score, volume and density) at coronary arteries, thoracic arteries, mitral and aortic valves, and aortic valve ring, were included in the analysis. Vascular calcification was measured at 2-3 follow-up visits. RESULTS At baseline, higher FGF21 levels were associated with prevalent descending thoracic aortic calcification (DTAC) (prevalence ratio = 1.06 [95% CI 1.01-1.11] per SD increase in log-transformed unit, P = 0.016). Among participants without prevalent calcification, higher FGF21 levels were associated with incident DTAC (relative risk [RR] = 1.13 [95% CI 1.04-1.22], P = 0.002). Among all participants, higher FGF21 levels were also associated with the progression of DTAC score and volume (RR = 1.07 [95% CI 1.03-1.12] and 1.08 [95% CI 1.03-1.12] respectively, both P < 0.01). No significant association of FGF21 was found for prevalence (prevalence ratio = 0.89-1.05), incidence (RR = 0.97-1.16) and progression of calcification (RR = 0.94-1.14) at the other sites. CONCLUSION Higher FGF21 levels were associated with the presence, incidence and progression of DTAC. However, the magnitude of this association was similar to those of the non-significant associations of FGF21 levels with calcifications at other sites. Further research is needed to assess the potential of FGF21 as a biomarker for vascular calcification.
Collapse
Affiliation(s)
- Shoban Sayanthan
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, United States
| | - Kerry-Anne Rye
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kwok Leung Ong
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
10
|
Siepmann R, Bruners P, Lang SA, Bednarsch J, Amygdalos I, Joechle K, Pedersoli F, Keil S, Isfort P, Ulmer TF, Kuhl C, Neumann UP, Meister FA, Czigany Z. Calcification of the visceral aorta and celiac trunk is associated with renal and allograft outcomes after deceased donor liver transplantation. Abdom Radiol (NY) 2023; 48:608-20. [PMID: 36441198 DOI: 10.1007/s00261-022-03629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Atherosclerosis affects clinical outcomes in the setting of major surgery. Here we aimed to investigate the prognostic role of visceral aortic (VAC), extended visceral aortic (VAC+), and celiac artery calcification (CAC) in the assessment of short- and long-term outcomes following deceased donor orthotopic liver transplantation (OLT) in a western European cohort. METHODS We retrospectively analyzed the data of 281 consecutive recipients who underwent OLT at a German university medical center (05/2010-03/2020). The parameters VAC, VAC+, or CAC were evaluated by preoperative computed tomography-based calcium quantification according to the Agatston score. RESULTS Significant VAC or CAC were associated with impaired postoperative renal function (p = 0.0016; p = 0.0211). Patients with VAC suffered more frequently from early allograft dysfunction (EAD) (38 vs 26%, p = 0.031), while CAC was associated with higher estimated procedural costs (p = 0.049). In the multivariate logistic regression analysis, VAC was identified as an independent predictor of EAD (2.387 OR, 1.290-4.418 CI, p = 0.006). Concerning long-term graft and patient survival, no significant difference was found, even though patients with calcification showed a tendency towards lower 5-year survival compared to those without (VAC: 65 vs 73%, p = 0.217; CAC: 52 vs 72%, p = 0.105). VAC+ failed to provide an additional prognostic value compared to VAC. CONCLUSION This is the first clinical report to show the prognostic role of VAC/CAC in the setting of deceased donor OLT with a particular value in the perioperative phase. Further studies are warranted to validate these findings. CT computed tomography, OLT orthotopic liver transplantation.
Collapse
|
11
|
Abdalbary M, Elrggal ME, El-Husseini A. Does aortic calcification have really no impact on lumbar spine BMD? Bone 2022; 165:116568. [PMID: 36162747 DOI: 10.1016/j.bone.2022.116568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, United States.
| |
Collapse
|
12
|
Zhang X, Fujiyoshi A, Ahuja V, Vishnu A, Barinas-Mitchell E, Kadota A, Miura K, Edmundowicz D, Ueshima H, Sekikawa A. Association of equol producing status with aortic calcification in middle-aged Japanese men: The ERA JUMP study. Int J Cardiol 2022; 352:158-164. [PMID: 35122909 PMCID: PMC8915951 DOI: 10.1016/j.ijcard.2022.01.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/15/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Equol, an isoflavone (ISF)-derived metabolite by the gut microbiome in certain individuals termed as equol-producers, might be the key anti-atherogenic component of ISFs. Our objective was to determine the association between equol-producing status and aortic atherosclerosis assessed as aortic calcification (AC). METHODS This population-based study of 302 Japanese men aged 40-49, free of cardiovascular disease, examined serum levels of equol and ISFs, AC in the entire aorta by electron-beam computed tomography with Agatston method, and cardiovascular risk factors. We defined equol-producers as individuals with serum levels of equol ≥20 nM and prevalent AC as an AC score ≥ 10. We analyzed the association between equol-producing status and AC using Tobit and logistic regressions. We performed age-stratified analyses since age was a significant effect-modifier. RESULTS The 60th to 90th percentile AC scores were 4 to 243 in equol-producers and 15 to 444 in non-producers, respectively. Overall, equol-producers (41% of the sample) had lower AC scores (-209, [95% confidence interval (CI): -455, 36]) and odds of AC (odds ratio (OR): 0.7 [95% CI: 0.4, 1.3]), although not statistically significant, compared to non-producers after controlling for cardiovascular risk factors. Among men aged 46-49, equol-producers had significantly lower AC scores (-428 [95% CI: -827, -29]). Furthermore, there were null associations between serum levels of ISFs and both AC score and the odds of AC. CONCLUSION In middle-aged Japanese men, equol-producers had a non-significantly lower burden of aortic atherosclerosis than non-producers whereas ISFs had a null association. Studies with larger sample sizes in both sexes are warranted.
Collapse
Affiliation(s)
- Xiao Zhang
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Vasudha Ahuja
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abhishek Vishnu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Daniel Edmundowicz
- Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
13
|
Horbal SR, Brown E, Derstine BA, Zhang P, Bidulescu A, Sullivan JA, Ross BE, Su GL, Holcombe SA, Wang SC. A correction score to compare aortic calcification in contrast enhanced and non-contrast measurements from computed tomography scans. Clin Imaging 2021; 83:51-55. [PMID: 34954502 DOI: 10.1016/j.clinimag.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Aortic wall calcification shows strong promise as a cardiovascular risk factor. While useful for visual enhancement of vascular tissue, enhancement creates heterogeneity between scans with and without contrast. We evaluated the relationship between aortic calcification in routine abdominal computed tomography scans (CT) with and without contrast. METHODS Inclusion was limited to those with abdominal CT-scans with and without contrast enhancement within 120 days. Analytic Morphomics, a semi-automated computational image processing system, was used to provide standardized, granular, anatomically indexed measurements of aortic wall calcification from abdominal CT-scans. Aortic calcification area (ACA) and aortic wall calcification percent (ACP) and were the outcomes of interest. Multiple linear regression was used to evaluate the relationship of aortic measurements. Models were further controlled for age and sex. Stratification of measurements by vertebral level was also performed. RESULTS A positive association was observed for non-contrast calcification in ACP β 0.74 (95% CI 0.72, 0.76) and ACA β 0.44 (95% 0.43, 0.45). Stratified results demonstrated the highest coefficient of determination at L2 for percent and L3 for area models [R2 0.91 (ACP) 0.74 (ACA)]. Adjusted lumber-level associations between non-contrast and contrast measurements ranged from (β 0.69-0.82) in ACP and (β 0.37-0.54) in ACA. CONCLUSION A straightforward correction score for comparison of abdominal aortic calcification measurements in contrast-enhanced and non-contrast scans is discussed. Correction of aortic calcification from CT scans can reduce scan heterogeneity and will be instrumental in creating larger cardiovascular cohorts as well as cardiovascular risk surveillance programs.
Collapse
Affiliation(s)
- Steven R Horbal
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Edward Brown
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian A Derstine
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Peng Zhang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | | | - June A Sullivan
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian E Ross
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Grace L Su
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Sven A Holcombe
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
14
|
Li B, Tang Y, Zhou L, Jin X, Liu Y, Li H, Huang Y, Wang K. Association between aortic calcification and the presence of kidney stones: calcium oxalate calculi in focus. Int Urol Nephrol 2021. [PMID: 34846621 DOI: 10.1007/s11255-021-03058-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/11/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The current research is aimed at analyzing the relationship between kidney stone (KS) and abdominal aortic calcification (AAC) and the relationship between KS components and AAC. METHODS This is a retrospective, case-control study. Kidney stone formers (KSFs) were treated at the Department of Urology, West China Hospital, Sichuan University for urological calculus disease from January 2014 to January 2020. Matched non-stone formers (non-SFs) were drawn from the same hospital for routine health examination from January 2018 to February 2019. Research-related information was collected and reviewed retrospectively from the hospital's computerized records. AAC were evaluated using available results of computed tomography imaging and abdominal vascular ultrasound. The relationships of AAC between KSFs and non-SFs were compared. The composition of renal calculi was analyzed by Fourier-transform infrared spectrophotometer. KSFs were divided into AAC groups and non-AAC based on AAC. The relationship of the composition of renal calculi between AAC and non-AAC were compared. The independent-sample t test, the chi-squared test and binary logistics regression were performed. RESULTS Altogether, 4516 people were included, with 1027 KSFs and 3489 non-SFs. There were no significant differences in the laboratory parameters between KSFs and non-SFs. The association between the presence of AAC and KS was significant in multivariable model 2 [adjusting hypertension, diabetes mellitus, fasting blood glucose, uric acid, serum triglyceride (TG), serum calcium, and urine pH] (OR 5.756, 95% CI 4.616-7.177, p < 0.001). The result of KSFs showed that calcium oxalate calculi (CaOx) was significantly associated with AAC in multivariable model 3 (adjusting age, hypertension, diabetes mellitus, drinking history, smoking history, and TG) (OR 1.351, 95% CI 1.002-1.822, p = 0.048). CONCLUSIONS The current study pioneered the revelation of the relationship between CaOx and AAC. Through an elimination of the confounding factors, the study demonstrated that KS and AAC were connected.
Collapse
|
15
|
Planek MIC, Ruge M, Du Fay de Lavallaz JM, Kyung SB, Gomez JMD, Suboc TM, Williams KA, Volgman AS, Simmons JA, Rao AK. Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes. Am Heart J Plus 2021; 11:100052. [PMID: 34667971 PMCID: PMC8511552 DOI: 10.1016/j.ahjo.2021.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients. SETTING/PARTICIPANTS 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. DESIGN Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians. INTERVENTIONS/MAIN OUTCOME MEASURES These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO. RESULTS Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11-3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality (p = 0.005). CONCLUSION Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.
Collapse
Key Words
- Ao, aorta
- Aortic calcification
- CAC, coronary artery calcification
- CAD, coronary artery disease
- CI, confidence intervals
- COVID-19
- CT, computed tomography
- CVD, cardiovascular disease
- Chest computed tomography
- Coronary artery calcification
- ECMO, extracorporeal membrane oxygenation
- ICU, intensive care unit
- IVC, inferior vena cava
- LV, left ventricular
- MACE, major adverse cardiovascular events
- PA, pulmonary artery
- RV, right ventricular
- Right ventricular strain
Collapse
Affiliation(s)
| | - Max Ruge
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | | | - Stella B. Kyung
- Division of Cardiology, Loyola University Medical Center, Chicago, IL, United States of America
| | | | - Tisha M. Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Kim A. Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | | | - J. Alan Simmons
- Department of Research Core, Rush University Medical Center, Chicago, IL, United States of America
| | - Anupama K. Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| |
Collapse
|
16
|
Lankinen R, Hakamäki M, Hellman T, Koivuviita NS, Metsärinne K, Järvisalo MJ. Progression of Aortic Calcification in Stage 4-5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation. Kidney Blood Press Res 2021; 47:23-30. [PMID: 34818248 DOI: 10.1159/000518670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Abdominal aortic calcification (AAC) is common in chronic kidney disease (CKD) patients and associated with increased mortality. Comparative data on the AAC score progression in CKD patients transitioning from conservative treatment to different modalities of renal replacement therapy (RRT) are lacking and were examined. METHODS 150 study patients underwent lateral lumbar radiograph to study AAC in the beginning of the study before commencing RRT (AAC1) and at 3 years of follow-up (AAC2). We examined the associations between repeated laboratory tests taken every 3 months, echocardiographic and clinical variables and AAC increment per year (ΔAAC), and the association between ΔAAC and outcomes during follow-up. RESULTS At the time of AAC2 measurement, 39 patients were on hemodialysis, 39 on peritoneal dialysis, 39 had a transplant, and 33 were on conservative treatment. Median AAC1 was 4.8 (0.5-9.0) and median AAC2 8.0 (1.5-12.0) (p < 0.0001). ΔAAC was similar across the treatment groups (p = 0.19). ΔAAC was independently associated with mean left ventricular mass index (LVMI) (log LVMI: β = 0.97, p = 0.02) and mean phosphorus through follow-up (log phosphorus: β = 1.19, p = 0.02) in the multivariable model. Time to transplantation was associated with ΔAAC in transplant recipients (per month on the waiting list: β = 0.04, p = 0.001). ΔAAC was associated with mortality (HR 1.427, 95% confidence interval 1.044-1.950, p = 0.03). CONCLUSION AAC progresses rapidly in patients with CKD, and ΔAAC is similar across the CKD treatment groups including transplant recipients. The increment rate is associated with mortality and in transplant recipients with the time on the transplant waiting list.
Collapse
Affiliation(s)
- Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| |
Collapse
|
17
|
Frisoli A, Paes AT, Kimura AD, Azevedo E, Ambrosio V. Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study. Bone Rep 2021; 15:101134. [PMID: 34660851 PMCID: PMC8502712 DOI: 10.1016/j.bonr.2021.101134] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction In older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults. Aim To assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD. Methods We evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD). Results 43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion. Conclusion In the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults. Diagnosis of osteoporosis (OP) in the elderly with cardiovascular disease is challenging. We evaluated the sensitivity of distal forearm (DF) BMD vs. lumbar spine (LS) BMD. LS BMD did not diagnose OP in 27/100, and DF BMD in 9/100 (p = 0.001). LS BMD did not identify OP in 31/100, and DF BMD in 5/100 (p < 0.001) aged ≥80 years. DF BMD showed higher sensitivity for diagnosing osteoporosis, regardless of gender.
Collapse
Affiliation(s)
- Alberto Frisoli
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Angela T Paes
- Statistics Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda Diniz Kimura
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Elaine Azevedo
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Valdir Ambrosio
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| |
Collapse
|
18
|
Kim K, Song SH, Kim IJ, Jeon YK. Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease? Osteoporos Int 2021; 32:1859-1868. [PMID: 33598794 DOI: 10.1007/s00198-020-05670-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED Several patients with chronic kidney disease (CKD) have deteriorated bone status. Estimation of bone status using DXA has limitations especially in patients with CKD accompanying aortic calcifications. Quantitative CT and the trabecular bone score could be more accurate methods to estimate bone status for patients with CKD and vascular calcifications. INTRODUCTION It remains unclear whether dual-energy absorptiometry (DXA) is appropriate for the assessment of bone status in patients with chronic kidney disease (CKD), a disease that impacts bone health. The aims of this study were to compare DXA and central quantitative computed tomography (cQCT) and to evaluate bone status in patients with pre-dialysis CKD. METHODS This retrospective study included 363 healthy control subjects whose bone mineral density (BMD) was evaluated with DXA and 117 CKD patients whose BMD was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine (LS) and femur neck (FN) from DXA or between two modalities. The trabecular bone score (TBS) was extracted from DXA images. The volume of abdominal aortic calcification (AAC) was calculated using CT images from cQCT. RESULTS Using LS DXA T-score, osteoporosis was less common in the CKD group than in controls. Patients with normal LS BMD using DXA were reclassified into osteopenia or osteoporosis using cQCT in CKD patients. Among discordant subjects between FN and LS in DXA, a higher BMD of LS was more common in CKD patients than in controls. CKD patients had lower TBS than controls despite having the same diagnosis using DXA. AAC volume negatively correlated with BMD from cQCT and with TBS but not with BMD from DXA. CONCLUSIONS TBS and cQCT could accurately assess bone status in CKD patients since DXA may overestimate LS BMD, likely due to an increased AAC volume.
Collapse
Affiliation(s)
- K Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - S H Song
- Division of Nephrology, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - I-J Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan, 602-739, South Korea
| | - Y K Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan, 602-739, South Korea.
| |
Collapse
|
19
|
Özhan A, Baştopcu M, Karakaya C, Güler E, Şahin S, Memetoğlu ME, Ketenci B, Demirtaş MM. The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:166-73. [PMID: 34104510 DOI: 10.5606/tgkdc.dergisi.2021.21285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
Background
In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting.
Methods
A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data.
Results
Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042).
Conclusion
Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.
Collapse
|
20
|
Ramírez-Vélez R, García-Hermoso A, Correa-Rodríguez M, Lobelo F, González-Ruiz K, Izquierdo M. Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age. Nutr Metab Cardiovasc Dis 2021; 31:1035-1043. [PMID: 33573921 DOI: 10.1016/j.numecd.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/10/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults. METHODS AND RESULTS The analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013-2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1-L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64-0.84) and (women OR = 0.58, CI95%, 0.47-0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women. CONCLUSION Lower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.
Collapse
Affiliation(s)
- Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, 7500618, Chile.
| | - María Correa-Rodríguez
- Faculty of Health Science, Department of Nursing, University of Granada, Av. Ilustración, 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria, IBS, Avda, de Madrid, 15, Pabellón de consultas externas 2, 2(a) planta, 18012, Granada, Spain.
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Exercise is Medicine Global Research and Collaboration Center, Atlanta, GA, USA.
| | - Katherine González-Ruiz
- Grupo de Ejercicio Físico y Deportes, Vicerrectoría de Investigaciones, Universidad Manuela Beltrán, Bogotá, 110231, Colombia.
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
21
|
Kimura T, Inaka K. Arterial medial calcification (Mönckeberg's sclerosis) with chronic renal disease in a zoo-kept Southern tamandua ( Tamandua tetradactyla). Int J Vet Sci Med 2021; 9:1-6. [PMID: 33869623 PMCID: PMC8008936 DOI: 10.1080/23144599.2021.1899408] [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] [Indexed: 12/02/2022] Open
Abstract
Arterial medial calcification observed in animals is equivalent to Mönckeberg’s sclerosis in human beings. This lesion is rarely reported in domestic animals. In addition, little information is available concerning the occurrence of arterial medial calcification in zoo animals. The aim of the current work was to report arterial medial calcification incidentally encountered in a Southern tamandua (Tamandua tetradactyla). This paper described the clinical findings, haematological and serum biochemical profiles, and histopathological results. Haematological examinations showed decreases in white blood cell counts, erythrocytic parameters and platelets. In serum biochemical examinations, both of the creatinine and blood urea nitrogen levels markedly increased in this study. Glucose concentrations dramatically declined from the normal levels to the critical conditions. There was electrolytic imbalance which was not accompanied by increases in calcium and inorganic phosphorus concentrations. Enzyme activities (ALP, AST, ALP, γ-GT, LDH and CK) remarkably increased just before the animal died. Histopathological examinations revealed that this marked and thickened calcification extended linearly around the circumference of the vessels. The calcified deposits were located entirely within the medial layer of the arterial wall. The lesions showed involvement of the internal elastic lamina with calcification. Severe calcification was observed in the glomerular capsules, indicating serious chronic kidney disease. We concluded that arterial medial calcification in the Southern tamandua arose with progressing chronic kidney failure.
Collapse
Affiliation(s)
- Tohru Kimura
- Laboratory Animal Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kengo Inaka
- Laboratory Animal Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| |
Collapse
|
22
|
Lankinen R, Hakamäki M, Metsärinne K, Koivuviita N, Pärkkä JP, Saarenhovi M, Hellman T, Järvisalo MJ. Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease. BMC Nephrol 2021; 22:50. [PMID: 33541279 PMCID: PMC7863467 DOI: 10.1186/s12882-021-02251-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/09/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied. Methods One hundred seventy-four CKD 4–5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments. Results The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e’ and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β = − 0.09, p = 0.02), AAC (β = − 1.67, p < 0.0001) and diabetes (β = − 11.7, p < 0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectively. Conclusions TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD. Trial registration http://www.ClinicalTrials.gov NCT04223726. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02251-y.
Collapse
Affiliation(s)
- Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Pärkkä
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland. .,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland. .,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Building 18, TG3B, Hämeentie 11, FIN-20520, Turku, Finland.
| |
Collapse
|
23
|
Zhang J, Gaffey AC, Jackson B. Hepatorenal bypass resulting in dialysis independence in case of acute renal failure. J Vasc Surg Cases Innov Tech 2021; 7:113-116. [PMID: 33718679 PMCID: PMC7921180 DOI: 10.1016/j.jvscit.2020.12.013] [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] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
In the present case report, we have described a patient with bilateral renal artery occlusion resulting in the acute onset of refractory hypertension and renal failure requiring hemodialysis. Endovascular stenting of the renal arteries was not feasible owing to extensive aortic and renal orifice calcification. After consultation with nephrology and medical optimization, the patient underwent unilateral hepatorenal bypass, with subsequent improvement in renal function and sustained freedom from dialysis. Although percutaneous revascularization has become the preferred option for surgical management of renal artery occlusion, the findings from the present case have demonstrated that hepatorenal bypass remains a viable alternative for more complex cases.
Collapse
Affiliation(s)
- Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Ann C Gaffey
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Benjamin Jackson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
24
|
Hirose K, Kodera S, Daimon M, Komuro I. Time-Dependent Changes in Porcelain Aorta and Aortic Stenosis in a Patient with Systemic Lupus Erythematosus. Int Heart J 2020; 61:1294-1297. [PMID: 33191339 DOI: 10.1536/ihj.20-050] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Porcelain aorta, defined as extensive calcification of the ascending aorta or aortic arch, is a reported risk factor for embolic stroke during cardiac surgery. However, the time course of the progression of aortic calcification leading to porcelain aorta has not been elucidated. We herein describe a 70-year-old woman who was followed up for systemic lupus erythematosus and antiphospholipid syndrome for approximately 20 years. A routine computed tomography scan revealed progression of ascending aortic calcification to porcelain aorta. The calcification was absent during the preceding 12 years, partial 6 years later, and total after another 3 years. Computed tomography also demonstrated aortic and mitral valve calcification in the development of porcelain aorta. During the 3 years prior to the last admission, annual echocardiography examinations showed progression of calcific aortic stenosis with symptoms. The patient was admitted to our institution for aortic valve replacement. Considering the high risk of perioperative stroke associated with porcelain aorta, transcatheter aortic valve implantation was performed. Postoperative transthoracic echocardiography revealed improvement of the aortic stenosis with no symptoms. The present case revealed aortic calcific progression to porcelain aorta during an approximately 10-year period with deterioration of aortic stenosis within a short time. The aortic and valvular calcification could be attributed to the inflammatory process of systemic lupus erythematosus and antiphospholipid syndrome. The presence of aortic and mitral annular calcification in the serial imaging can provide information on aortic and valvular atherosclerotic progression, which may be modifiable by early steroid-lowering therapy.
Collapse
Affiliation(s)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masao Daimon
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
25
|
Cai G, Keen HI, Host LV, Aitken D, Laslett LL, Winzenberg T, Wluka AE, Black D, Jones G. Once-yearly zoledronic acid and change in abdominal aortic calcification over 3 years in postmenopausal women with osteoporosis: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int 2020; 31:1741-1747. [PMID: 32361951 DOI: 10.1007/s00198-020-05430-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Abstract
UNLABELLED This study evaluated whether zoledronic acid (ZA) inhibited the progression of abdominal aortic calcification (AAC) over 3 years in 502 postmenopausal women with osteoporosis. AAC progressed in a similar proportion of participants in the ZA (29%) and placebo (31%) groups, suggesting no effect of ZA on AAC progression. INTRODUCTION Bisphosphonate use is associated with reduced risk of all-cause mortality and cardiovascular events. The underlying mechanisms are uncertain but may include effects on vascular calcification. This study aimed to evaluate the effect of zoledronic acid (ZA) on abdominal aortic calcification (AAC) in postmenopausal women with osteoporosis. METHODS This was a post hoc analysis of the HORIZON Pivotal Fracture Trial that included 502 postmenopausal women (mean age 72.5 years) with osteoporosis (234 received ZA and 268 placebo). AAC scores (range, 0-8) were assessed from paired spine X-rays at baseline and after 3 years. Progression of AAC was defined as any increase in AAC score. The association between change in hip and femoral neck bone mineral density and change in AAC score was also assessed. RESULTS At baseline, 292 (58.2%) participants had AAC (i.e., AAC score > 0), with AAC scores similar in the two intervention groups (median [interquartile range], 1 [0 to 2] for both; p = 0.98). Over 3 years, AAC progressed in a similar proportion of participants in both groups (ZA 29% and placebo 31%; p = 0.64). Change in bone mineral density and change in AAC score were not correlated. CONCLUSION Once-yearly zoledronic acid did not affect progression of AAC over 3 years in postmenopausal women with osteoporosis. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00049829.
Collapse
Affiliation(s)
- G Cai
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - H I Keen
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Australia
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - L V Host
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Australia
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Australia
| | - D Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia.
| |
Collapse
|
26
|
Lankinen R, Hakamäki M, Metsärinne K, Koivuviita NS, Pärkkä JP, Hellman T, Kartiosuo N, Raitakari OT, Järvisalo MJ. Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease. Am J Nephrol 2020; 51:726-735. [PMID: 32777781 DOI: 10.1159/000509582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study. METHODS One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients. RESULTS The duration of follow-up was 42 ± 17 months (range 134-2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e' ratio, and albumin. CONCLUSION Stress ergometry performance, abdominal aortic calcification score, E/e' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
Collapse
Affiliation(s)
- Roosa Lankinen
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland,
| | - Kaj Metsärinne
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Pärkkä
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Noora Kartiosuo
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| |
Collapse
|
27
|
Iwakawa N, Tanaka A, Ishii H, Kataoka T, Niwa K, Hitora Y, Tashiro H, Mitsuda T, Kojima H, Hirayama K, Furusawa K, Yoshida R, Suzuki S, Murohara T. Impact of Diabetes Mellitus on the Aortic Wall Changes as Atherosclerosis Progresses: Aortic Dilatation and Calcification. J Atheroscler Thromb 2020; 27:509-515. [PMID: 31554764 PMCID: PMC7355097 DOI: 10.5551/jat.50930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/11/2022] Open
Abstract
Aim: An inverse association between diabetes mellitus (DM) and aortic dilatation has recently been reported. However, little is known about the association between DM and the progression of aortic dilatation/calcification as atherosclerosis progresses. Methods: We identified 216 patients who had undergone percutaneous coronary intervention (PCI) and abdominal computed tomography (CT) during the PCI and follow-up phases. The patients were classified into two groups: those with DM (DM+ group; n = 107) and those without DM (DM− group; n = 109). The infrarenal aortic diameter and aortic calcification index (ACI) were measured, and annual changes were calculated using measurement results obtained during the PCI and follow-up phases. Results: Infrarenal aortic diameters were significantly shorter in the DM+ group than in the DM− group during the PCI phase, and no significant ACI differences were observed between the DM+ and DM− groups. The median duration between the PCI and follow-up phase CT was 3.0 years. The growth rate of the infrarenal aortic dilatation from the PCI phase in the DM+ group was similar to that in the DM− group. Annual ACI changes were significantly larger in the DM+ group than in the DM− group. Multivariate logistic regression analysis indicated that the prevalence of DM was an independent predictor of rapid aortic calcification progression (odds ratio: 2.51; 95% confidence interval: 1.23–5.14; p = 0.01). Conclusion: Our findings suggest that DM negatively affects aortic dilatation during an earlier phase of atherosclerosis progression and positively affects the progression of aortic calcification in a later phase.
Collapse
Affiliation(s)
- Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yusuke Hitora
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| |
Collapse
|
28
|
Horbal SR, Rossman AH, Brown E, Shah NV, Ross BE, Bidulescu A, Sullivan JA, Su GL, Wang SC. Morphomic calcification score from clinical CT scans: A proxy for coronary artery calcium. Clin Imaging 2020; 66:57-63. [PMID: 32450484 DOI: 10.1016/j.clinimag.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening of cardiovascular risk is essential in preventing cardiac events and quantifying asymptomatic risk. Coronary artery calcium (CAC) scores are a well-established in predicting cardiovascular risk, but require specialized computed tomography (CT) scans. Given the relationship of aortic calcification with cardiovascular risk, we sought to determine whether aortic calcification measures from incidental CT scans may approximate CAC. STUDY DESIGN Retrospective CT scans and corresponding volumetric CAC scores were obtained from patients at the University of Michigan. Aortic calcifications were measured in 166 scans. Correlations between a novel morphomic calcium (MC) percent score and CAC score were evaluated using Kendall's correlation coefficients. Comparison of receiver operating characteristic (ROC) curves based on MC at different vertebral levels showed the highest predictive values for measures taken at L4. RESULTS MC at L4 shows promise in predicting CAC (AUC 0.90 in non-contrast scans, 0.70 in post-contrast scans). Proposed MC threshold are (4.21% for best sensitivity, B 12.93% for balance, C = 19.26% for specificity) in scans without contrast enhancement and (D = 7.31 for sensitivity, E 8.06 for specificity) in scans with contrast enhancement. CONCLUSION The MC score demonstrates promising potential in approximating CAC, particularly at the L4 level. The utilization of MC from incidental CT scans may be useful for assessment of cardiovascular risk. The ability to extract MC from contrast scans makes it especially valuable to patients receiving additional medical or surgical care. Recognition of high-risk patients would allow the use of indicated preventative strategies to avoid hard cardiovascular events in at risk patients.
Collapse
Affiliation(s)
- Steven R Horbal
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Andrea H Rossman
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Edward Brown
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Nidhi V Shah
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian E Ross
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | | | - June A Sullivan
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Grace L Su
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Stewart C Wang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
29
|
Knol WG, Bogers AJJC, Braun LMM, van Rosmalen J, Bekker MWA, Krestin GP, Budde RPJ. Aortic calcifications on routine preoperative chest X-ray and perioperative stroke during cardiac surgery: a nested matched case-control study. Interact Cardiovasc Thorac Surg 2020; 30:507-514. [PMID: 31828332 DOI: 10.1093/icvts/ivz295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/22/2019] [Accepted: 11/14/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Perioperative stroke in cardiac surgery is most often embolic in origin. Preoperative chest X-ray (CXR) is routinely used amongst others to screen for relevant aortic calcification, a potential source of embolic stroke. We performed a nested matched case-control study to examine the relationship between aortic calcifications on CXR and the occurrence of embolic stroke. METHODS Among all consecutive patients undergoing cardiac surgery in our hospital between January 2014 and July 2017, we selected all patients with perioperative embolic stroke (cases). Controls, all patients without perioperative stroke, were matched on age, sex and type of surgery. All preoperative CXRs were scored for aortic calcifications (none, mild, severe) in the ascending aorta, arch, aortic knob and descending aorta. RESULTS Out of the 3038 eligible patients, 27 cases were detected and 78 controls were selected. In the stroke group, mild-to-severe calcifications were found least often in the ascending aorta [9% of patients, 95% confidence interval (CI) 1-29%] and most frequently in the aortic knob (63% of patients, 95% CI 44-78%). The distribution of aortic calcification was comparable in cases versus controls. CONCLUSIONS Calcification burden was comparable between the cases and their matched controls. In our study population, CXR findings on aortic calcification were not related to the risk of embolic stroke. In these patients, the correlation between findings on the preoperative CXR and the risk of stroke might, therefore, be too weak to use the CXR directly for the assessment of the safety of manipulating the ascending aorta during surgery.
Collapse
Affiliation(s)
- Wiebe G Knol
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Loes M M Braun
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Margreet W A Bekker
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gabriel P Krestin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
30
|
Ekser B, Balci D. Invited Commentary on "The relationship between aortic calcification and anastomotic leak following gastrointestinal resection: A systematic review". Int J Surg 2020; 74:76-77. [PMID: 31926323 DOI: 10.1016/j.ijsu.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Deniz Balci
- Department of Surgery and Transplantation, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
31
|
Ohishi T, Fujita T, Nishida T, Asukai M, Suzuki D, Sugiura K, Matsuyama Y. Factors Influencing Serum Homocysteine Levels in Postmenopausal Osteoporotic Females - Comparison to Urinary Collagen Crosslinks. Endocr Res 2019; 44:117-125. [PMID: 30760054 DOI: 10.1080/07435800.2019.1577892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose: The correlation between serum levels of homocysteine and bone mineral density remains controversial. The aim of this study was to identify the potential factors associated with the levels of serum total homocysteine (S-Hcy) and urinary N-terminal telopeptide of type I collagen (U-NTX) in female osteoporotic patients. Materials and Methods: This cross-sectional study included 163 female osteoporotic patients, aged between 48 and 91 years, who had never been treated with anti-osteoporosis therapy. Background data including spine and hip bone mineral density, ongoing therapy for the metabolic disease, aortic calcification score as evaluated by lateral lumbar X-ray film, and recent fragility fracture history were obtained. S-Hcy, U-NTX levels, and creatinine clearance were measured. Results: Multiple linear regression analysis revealed a significant correlation between S-Hcy levels and aortic calcification score (p = 0.022), creatinine clearance (p = 0.004), and recent fracture history (within 1 year after fracture) (p = 0.028); conversely, U-NTX levels correlated significantly with total hip bone mineral density (p < 0.0001) and recent fracture history (p = 0.0007). Conclusions: S-Hcy levels had no correlation with bone mineral density, but were associated with the degree of aortic calcification, renal function, and fracture events. These confounding factors should be taken into consideration when the relationship between S-Hcy and bone mineral density is discussed.
Collapse
Affiliation(s)
- Tsuyoshi Ohishi
- a Department of Orthopedic Surgery , Enshu Hospital , Hamamatsu, Shizuoka , Japan
| | - Tomotada Fujita
- a Department of Orthopedic Surgery , Enshu Hospital , Hamamatsu, Shizuoka , Japan
| | - Tatsuya Nishida
- a Department of Orthopedic Surgery , Enshu Hospital , Hamamatsu, Shizuoka , Japan
| | - Mitsuru Asukai
- b Department of Orthopedic Surgery , Shizuoka Municipal Hospital , Shizuoka , Japan
| | - Daisuke Suzuki
- c Suzuki Orthopedic Sports Clinic , Hamamatsu, Shizuoka , Japan
| | - Kaori Sugiura
- d Department of Orthopedic Surgery , Hamamatsu University School of Medicine , Hamamatsu, Shizuoka , Japan
| | - Yukihiro Matsuyama
- d Department of Orthopedic Surgery , Hamamatsu University School of Medicine , Hamamatsu, Shizuoka , Japan
| |
Collapse
|
32
|
Cecelja M, Moore A, Fogelman I, Frost ML, Blake GM, Chowienczyk P. Evaluation of aortic 18F-NaF tracer uptake using PET/CT as a predictor of aortic calcification in postmenopausal women: A longitudinal study. JRSM Cardiovasc Dis 2019; 8:2048004019848870. [PMID: 31105936 PMCID: PMC6506920 DOI: 10.1177/2048004019848870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/28/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Aortic calcification as detected by computed tomography is associated with
arterial stiffening and is an important predictor of cardiovascular
morbidity and mortality. Uptake of 18F-sodium fluoride
(18F-NaF) in the aortic wall reflects metabolically active
areas of calcification. The aim of this study was to determine if
18F-NaF uptake in the aorta is associated with calcification
and progression of calcification as detected by computed tomography. Methods Twenty-one postmenopausal women (mean age 62 ± 6 years) underwent assessment
of aortic 18F-NaF uptake using positron emission
tomography/computer tomography at baseline and a repeat computed tomography
scan after a mean follow-up of 3.8 ± 1.3 years. Tracer uptake was quantified
by calculating the target-to-background (TBR) ratios at baseline and
follow-up. Calcification was assessed at baseline and follow-up using
computed tomography. Results Over the follow-up period, aortic calcium volume increased from 0.46 ± 0.62
to 0.71 ± 0.93 cm3 (P < 0.05). However, the
change in calcium volume did not correlate with baseline TBR either
unadjusted (r = 0.00, P = 1.00) or
adjusted for age and baseline calcium volume (beta coefficient = −0.18,
P = 0.42). TBR at baseline did not differ between
participants with (n = 16) compared to those without
(n = 5) progression in calcium volume (2.43 ± 0.46 vs.
2.31 ± 0.38, P = 0.58). In aortic segments identified to
have the highest tracer uptake at baseline, calcium volume did not
significantly change over the follow-up period
(P = 0.41). Conclusion In a cohort of postmenopausal women, 18F-NaF uptake as measured by
TBR in the lumbar aorta did not predict progression of aortic calcification
as detected by computed tomography over a four-year follow-up.
Collapse
Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, Department of Clinical Pharmacology, St Thomas' Hospital
| | - Amelia Moore
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Ignac Fogelman
- Department of Nuclear Medicine, King's College London, Guy's Campus, London, UK
| | - Michelle L Frost
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Glen M Blake
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, Department of Clinical Pharmacology, St Thomas' Hospital
| |
Collapse
|
33
|
Tamura T, Unagami K, Okazaki M, Komatsu M, Nitta K. Serum Magnesium Levels and Mortality in Japanese Maintenance Hemodialysis Patients. Blood Purif 2019; 47 Suppl 2:88-94. [PMID: 30943488 DOI: 10.1159/000496659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Although hypomagnesemia was found to be a risk for cardiovascular diseases in the general population, the relationship between serum magnesium (Mg) levels and prognosis of patients on maintenance hemodialysis (MHD) has not been extensively studied. This study sought to determine the relationship of serum Mg levels with aortic arch calcification (AoAC) and mortality in Japanese MHD patients. METHODS We measured serum Mg levels in a cohort of 392 patients on MHD, classified the patients into 3 groups according to these levels, and followed their course for 4 years. AoAC was assessed using chest-X-rays. RESULTS During follow-up, there were 117 deaths. Kaplan-Meier analyses showed that the high serum Mg group tended to have better survival rates than the low and middle serum Mg groups but this did not reach statistical significance. We also found that patients in the high serum Mg group had better nutritional status associated with higher serum albumin, triglyceride, and phosphate levels and had a significantly lower serum C-reactive protein level. In total, 83 patients (59.3%) in the high serum Mg group had been prescribed Mg oxide (MgO). CONCLUSIONS Hypermagnesemia tended to be associated with better survival and a higher prescription rate of MgO. Interventional studies are needed to clarify whether Mg supplementation is beneficial for improving patient prognosis.
Collapse
Affiliation(s)
- Tomomi Tamura
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kohei Unagami
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Mizuki Komatsu
- Department of Nephrology, Jyoban Hospital, Fukushima, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan,
| |
Collapse
|
34
|
Bristow SM, Gamble GD, Horne AM, Reid IR. Longitudinal changes in bone mineral density, bone mineral content and bone area at the lumbar spine and hip in postmenopausal women, and the influence of abdominal aortic calcification. Bone Rep 2019; 10:100190. [PMID: 30766896 PMCID: PMC6360344 DOI: 10.1016/j.bonr.2018.100190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 11/17/2022] Open
Abstract
Longitudinal studies often report that spine bone mineral density (BMD), measured by DXA, is stable in older adults, which has been attributed to osteophyte development and the presence of aortic calcification. A decline in projected spine area as a result of loss of intervertebral disc height might also contribute to higher BMD. We utilised data from 297 postmenopausal women (mean 73 years) who had DXA measurements of the lumbar spine, total hip and femoral neck 5 years apart, and abdominal aortic calcification scoring from vertebral morphometry. BMD declined by -4.4% at the total hip and -3.9% at the femoral neck (p < 0.001), but did not change at the spine (-0.5%, p = 0.12). In contrast, bone mineral content (BMC) declined by -4.0% at the total hip, -2.5% at the femoral neck and -1.7% at the spine (all p < 0.001). Bone area increased by 0.5% at the hip and 1.6% at the femoral neck but declined by -1.2% at the spine (all p < 0.001). 43% of the cohort had abdominal aortic calcification (AAC) present at baseline. The presence of AAC at baseline was not related to changes in BMD or BMC at the total hip or femoral neck, nor to BMD at the spine. However, women with AAC present had a smaller loss of BMC at the spine than those without (-0.8% versus -2.4%, p = 0.03). AAC score increased more over 5 years among those with AAC at baseline than those without (0.28 versus 0.16, p = 0.036). Thus, the stability of spine BMD is the result of both a loss of projected bone area (as a result of intervertebral disc changes and/or a decrease in projected area of the vertebral bodies) and the effects of aortic calcification. Future clinical trials should consider assessing changes in spine BMC as a more informative index of spine mineral status.
Collapse
Affiliation(s)
- Sarah M Bristow
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Greg D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Anne M Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.,Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
35
|
Rodríguez AJ, Lewis JR, Scott DS, Kiel DP, Schousboe JT, Ebeling PR, Prince RL. Aortic Calcification is Associated with Five-Year Decline in Handgrip Strength in Older Women. Calcif Tissue Int 2018; 103:589-598. [PMID: 30039226 DOI: 10.1007/s00223-018-0458-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/14/2018] [Indexed: 12/19/2022]
Abstract
The objective of the study was to determine the association between AAC and neuromuscular function over 5 years. Participants in this study were ambulant women over 70 years old residing in Perth, Western Australia who participated in the Calcium Intake Fracture Outcomes Study, a randomised controlled trial of calcium supplementation. 1046 women (mean age = 74.9 ± 2.6 years; BMI = 27.1 ± 4.4 kg/m2) were included. Lateral spine images captured during bone density testing were scored for AAC (AAC24; 0-24) at baseline. Severe AAC (AACsev) was defined using established cut points (AAC24 ≥ 6). At baseline and follow-up, isometric grip strength was assessed using a dynamometer. Mobility was assessed by the Timed-Up-and-Go (TUG) test. Using pre-defined criteria, muscle weakness was considered as grip strength < 22 kg and poor mobility defined as TUG > 10.2 s. A subset of women had appendicular lean mass (ALM) determined by dual-energy X-ray absorptiometry at baseline and follow-up (n = 261). AACsev was evident in 193 (18.5%) women. Average decline in grip strength after 5 years was greater in those with AACsev than those without (3.6 ± 3.7 vs. 2.9 ± 4.2 kg; p = 0.034). This remained significant after adjustment for age, treatment allocation, diabetes, smoking history, renal function, medical record-derived prevalent vascular disease, BMI and physical activity (β = - 0.184; 95% confidence interval: - 0.361, - 0.008; p = 0.040). AACsev was not associated with 5-year changes in TUG or ALM in univariable or multivariable analyses (all p > 0.05). In older women, severe aortic calcification was associated with greater 5-year decline in muscle strength, but not TUG or ALM. These findings support the concept that vascular disease may have an effect on the loss of muscular strength.
Collapse
Affiliation(s)
- Alexander J Rodríguez
- Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
- Bone and Muscle Health Research Group, Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3146, Australia.
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital Unit, Medical School, University of Western Australia, Nedlands, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - David S Scott
- Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Australian Institute for Musculoskeletal Science, Melbourne Medical School-Western Campus, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc., Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Peter R Ebeling
- Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Australian Institute for Musculoskeletal Science, Melbourne Medical School-Western Campus, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Richard L Prince
- Sir Charles Gairdner Hospital Unit, Medical School, University of Western Australia, Nedlands, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| |
Collapse
|
36
|
Elseweidy MM, Mohamed HE, Elrashidy RA, Atteia HH, Elnagar GM, Ali AEM. Potential therapeutic roles of 10-dehydrogingerdione and/or pentoxifylline against calcium deposition in aortic tissues of high dietary cholesterol-fed rabbits. Mol Cell Biochem 2018; 453:131-142. [PMID: 30173373 DOI: 10.1007/s11010-018-3438-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/24/2018] [Indexed: 02/08/2023]
Abstract
The present study aimed to investigate the inhibitory effects of 10-dehydrogingerdione (10-DHGD) and pentoxifylline (PTX) either individually or in combined form on calcium deposition in high cholesterol diet (HCD)-fed rabbits as compared to atorvastatin (ATOR), and to clarify the underlying mechanisms. Three-months-old male New Zealand white rabbits received either normal chow or HCD for 12 weeks. The latter group was subdivided into five groups and concurrently treated either with vehicle (dyslipidemic control), ATOR, 10-DHGD, PTX or combined 10-DHGD and PTX. Blood samples and aortic tissue were collected for biochemical and histological analyses. HCD-fed rabbits displayed dyslipidemia, inflammation, atherosclerotic lesions, and calcium deposition in aortas as compared to normal group. This was associated with up-regulation of bone morphogenetic protein-2 (BMP-2), wingless-type MMTV integration site family 3A (Wnt3a) mRNA levels and osteopontin expression in their aortic tissue, along with higher serum alkaline phosphatase and osteocalcin levels. Furthermore, a marked decrease in osteoprotegerin, along with a significant increase in receptor activator of NF-κB(RANK) levels, was found in aortic tissue of dyslipidemic rabbits. 10-DHGD and PTX monotherapy significantly modulated the afore-mentioned calcification markers and attenuated aortic calcification to greater extent than ATOR. Combination of 10-DHGD and PTX exerted more anti-calcifying effect than either individual drug. Our findings suggested therapeutic roles of 10-DHGD and PTX against aortic calcium deposition in dyslipidemic rabbits, likely mediated by HDL-raising effect and attenuation of associated inflammation. Combination of 10-DHGD and PTX may represent a promising therapeutic strategy for aortic calcification associated with atherosclerosis.
Collapse
Affiliation(s)
- Mohamed M Elseweidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
| | - Hoda E Mohamed
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Rania A Elrashidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Hebatallah H Atteia
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Gehad M Elnagar
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Abd El-Monem Ali
- Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| |
Collapse
|
37
|
Lee SM, Lee HW, Son YK, Kim SE, An WS. Abdominal aortic calcification score among several vascular calcification scores of plain radiograph is the most reliable predictor of severe coronary artery calcification in dialysis patients. Ren Fail 2018; 39:729-735. [PMID: 29157086 PMCID: PMC6446146 DOI: 10.1080/0886022x.2017.1398666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: Coronary artery calcification (CAC) score on computed tomography (CT) or vascular calcification (VC) scores on plain radiographs are associated with cardiovascular events and fracture. We investigated which VC score among several VC scores on plain radiographs is predictor of CAC, and whether VC scores are related with bone mineral density (BMD) in dialysis patients. Methods: We checked several plain radiographs (hands and pelvis [HP], feet and lateral lumbar spine), BMD and multidetector CT scans of 55 patients maintaining dialysis in this cross-sectional study. We analyzed data to find predictors for severe CAC which was defined as CAC scores >400 on CT. Results: Patients with severe CAC on CT had a higher proportion of abdominal aortic calcification (AAC) score ≥5, HP score ≥3 and feet ≥1 than those without severe CAC. The CAC score on CT was positively correlated with all VC scores on plain radiographs. The AAC and CAC scores were negatively correlated with T-scores for the BMD at the forearm and positively correlated with osteoprotegerin levels. Among several VC scores on plain radiographs, the AAC ≥5 were independently associated with severe CAC on CT. Conclusions: Several plain radiographs evaluating VC scores, including a lateral lumbar spine view at the very least, can replace CT checking CAC score in dialysis patients. The AAC score ≥5 may not only reveal severe CAC but also give a hint of low bone mass at the forearm.
Collapse
Affiliation(s)
- Su Mi Lee
- a Department of Internal Medicine , Dong-A University , Busan , Republic of Korea
| | - Hye Won Lee
- a Department of Internal Medicine , Dong-A University , Busan , Republic of Korea
| | - Young Ki Son
- a Department of Internal Medicine , Dong-A University , Busan , Republic of Korea
| | - Seong Eun Kim
- a Department of Internal Medicine , Dong-A University , Busan , Republic of Korea
| | - Won Suk An
- a Department of Internal Medicine , Dong-A University , Busan , Republic of Korea
| |
Collapse
|
38
|
Sato M, Hanafusa N, Kawaguchi H, Tsuchiya K, Nitta K. A Prospective Cohort Study Showing No Association Between Serum Sclerostin Level and Mortality in Maintenance Hemodialysis Patients. Kidney Blood Press Res 2018; 43:1023-1033. [PMID: 29940587 DOI: 10.1159/000490824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Potential relationships between serum sclerostin levels and the levels of bone metabolic markers in maintenance hemodialysis (MHD) patients have yet to be evaluated. This study sought to determine whether serum sclerostin levels are associated with mortality in MHD patients. METHODS We measured serum sclerostin levels in a Japanese MHD cohort, classified the patients into tertiles according to these levels, and followed their course for a 42-month period. RESULTS The cohort consisted of 389 MHD patients and there were 75 deaths. Kaplan-Meier analyses showed that the tertile of serum sclerostin was not associated with mortality risk. Cox analyses showed that there were no significant associations between serum sclerostin level and mortality. CONCLUSION Serum sclerostin level was not an independent predictor of mortality in MHD patients after adjustment for several confounders. However, whether clinical interventions to modulate serum sclerostin levels in MHD patients would improve their survival remains to be determined.
Collapse
Affiliation(s)
- Madoka Sato
- Department of Nephrology, Jyoban Hospital, Fukushima, Japan
| | - Norio Hanafusa
- Departments of Blood Purification Tokyo Women's Medical University, Tokyo, Japan
| | | | - Ken Tsuchiya
- Departments of Blood Purification Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan,
| |
Collapse
|
39
|
Krishnasamy R, Tan SJ, Hawley CM, Johnson DW, Stanton T, Lee K, Mudge DW, Campbell S, Elder GJ, Toussaint ND, Isbel NM. Progression of arterial stiffness is associated with changes in bone mineral markers in advanced CKD. BMC Nephrol 2017; 18:281. [PMID: 28870151 PMCID: PMC5584006 DOI: 10.1186/s12882-017-0705-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/22/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022] Open
Abstract
Background Arterial stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with chronic kidney disease (CKD). There are limited prospective data however on progression of arterial stiffness in CKD, including evaluating associations with bone mineral markers such as fibroblast growth factor 23 (FGF23) and soluble α-klotho (sKl). Methods In this prospective, single-center, observational study, arterial stiffness [measured by pulse wave velocity (PWV)] and hormones influencing mineral homeostasis, including serum FGF23 and sKl, were compared between non-dialysis CKD stages 4/5 and healthy controls at baseline and 12 months (12 m). Abdominal aortic calcification (AAC) was quantitated using lateral lumbar radiography at baseline. Results Forty patients with CKD [mean estimated glomerular filtration rate (eGFR) 19.5 ± 6.7 mL/min/1.73m2] and 42 controls (mean eGFR 88.6 ± 12.9 mL/min/1.73m2) completed follow-up. There were no differences in age, gender and body mass index between groups. A significant increase in FGF23 [240.6 (141.9–1129.8) to 396.8 (160.3–997.7) pg/mL, p = 0.001] was observed in the CKD group but serum phosphate, corrected calcium, parathyroid hormone and sKl did not change significantly over 12 m. At baseline, CKD subjects had higher AAC prevalence [83.8% versus (vs.) 43.6%, p = 0.002] and higher aortic PWV [9.7(7.6–11.7) vs. 8.1 (7.2–9.7) m/s, p = 0.047] compared to controls. At 12 m, aortic PWV increased by 1.3 m/s (95% confidence interval, 0.56 to 2.08, p < 0.001) in the CKD cohort, with 30% of subjects showing progression from normal aortic elasticity to stiffening (PWV > 10 m/s). Serum FGF23 was associated with AAC, abnormal PWV and progression of PWV at 12 m. Conclusions Arterial stiffness and serum FGF23, both of which are associated with increased cardiovascular risk, increased over one year in individuals with CKD. Additionally, a significant association was found between serum FGF23 and arterial calcification and stiffness. Larger clinical studies and further experimental work are warranted to delineate the temporal relationship as well as the pathological mechanisms linking FGF23 and vascular disease. Electronic supplementary material The online version of this article (10.1186/s12882-017-0705-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, PO Box 5340, Sunshine Coast, Birtinya, MC QLD, 4560, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Sven-Jean Tan
- Department of Nephrology, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Carmel M Hawley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Tony Stanton
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Australia
| | - Kevin Lee
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Mudge
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Nicole M Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
40
|
Rodríguez AJ, Scott D, Hodge A, English DR, Giles GG, Ebeling PR. Associations between hip bone mineral density, aortic calcification and cardiac workload in community-dwelling older Australians. Osteoporos Int 2017; 28:2239-2245. [PMID: 28378290 DOI: 10.1007/s00198-017-4024-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED In older adults, lower bone density in the proximal femur was associated with increased heart burden, and this association was linked to calcification in the aorta. These results were seen in women but not in men. PURPOSE To determine whether there is an association between lower bone mineral density (BMD) and increased cardiac workload in older adults, and if this association was independent of abdominal aortic calcification (AAC). METHODS Three hundred thirty-seven participants [mean ± SD age = 70 ± 5 years and BMI = 28 ± 5 kg/m2, 61% females] had BMD determined by dual-energy X-ray absorptiometry and AAC determined by radiography. Aortic calcification score (ACS) was determined visually in the L1-L4 vertebrae (range 0-24). Systolic blood pressure (BP) and heart rate (HR) were measured. The rate pressure product (RPP), a measure of cardiac workload, was determined by multiplying BP and HR. RESULTS AAC was present in 205 (61%) participants. Mean ± SD RPP was 9120 ± 1823; range was 5424-18,537. In all participants, ACS was positively associated with log-transformed RPP [LnRPP] (β = 0.011, p < 0.001), and severe calcification was positively associated with LnRPP (β = 0.083, p = 0.004 relative to no calcification). In sex-stratified analyses, these associations were significant only in females. Lower odds of any AAC were observed per 1 g/cm2 increment in femoral neck BMD (OR = 0.08, 95% CI 0.01-0.95). A similar trend was evident in women separately (OR = 0.05, 95% CI 0-1.17) but not men. In all participants, femoral neck (β = -0.20, p = 0.04) and total hip BMD (β = -0.17, p = 0.04) were inversely associated with LnRPP after multivariate adjustment. Adjusting additionally for AAC reduced the strength of the association in femoral neck (β = -0.19, p = 0.05) but not total hip BMD (β = -0.17, p = 0.04). CONCLUSION Lower BMD was marginally, but significantly with increased LnRPP, and this relationship was partially mediated by AAC suggesting that older adults, particularly females, with osteoporosis may have an increased cardiovascular risk.
Collapse
Affiliation(s)
- A J Rodríguez
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3146, Australia.
| | - D Scott
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3146, Australia
- Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Australia
| | - A Hodge
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3052, Australia
| | - D R English
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3052, Australia
| | - G G Giles
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3052, Australia
| | - P R Ebeling
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3146, Australia
- Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Australia
| |
Collapse
|
41
|
Disthabanchong S, Boongird S. Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease. World J Nephrol 2017; 6:100-110. [PMID: 28540199 PMCID: PMC5424431 DOI: 10.5527/wjn.v6.i3.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/27/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Vascular calcification (VC) is common among patients with chronic kidney disease (CKD). The severity of VC is associated with increased risk of cardiovascular events and mortality. Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load. VC is observed in arteries of all sizes from small arterioles to aorta, both in the intima and the media of arterial wall. Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC. Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods. Mammography, especially useful among women, offers a unique way to study breast arterial calcification, which is largely a medial-type calcification. Ultrasonography is suitable for calcification in superficial arteries. Analyses of wall thickness and lumen size are also possible. Computed tomography (CT) scan, the gold standard, is the most sensitive technique for evaluation of VC. CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.
Collapse
|
42
|
Tanaka T, Hatakeyama S, Yamamoto H, Narita T, Hamano I, Matsumoto T, Soma O, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Takahashi I, Nakaji S, Terayama Y, Funyu T, Ohyama C. Clinical relevance of aortic calcification in urolithiasis patients. BMC Urol 2017; 17:25. [PMID: 28376750 PMCID: PMC5379761 DOI: 10.1186/s12894-017-0218-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 07/11/2016] [Accepted: 03/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background The aim of the present study is to investigate the clinical relevance of aortic calcification in urolithiasis patients. Methods Between January 2010 and September 2014, 1221 patients with urolithiasis were treated in Oyokyo Kidney Research Institute and Hirosaki University Hospital. Among these, 287 patients (Stone group) on whom adequate data were available were included in this retrospective study. We also selected 148 subjects with early stage (pT1N0M0) renal cell carcinoma from 607 renal cell carcinoma patients who underwent radical nephrectomy at Hirosaki University Hospital (Non-stone group) as control subjects. Validity of the Non-stone group was evaluated by comparison with pair-matched 296 volunteers from 1166 subjects who participated in the Iwaki Health Promotion Project in 2014. Thereafter, age, body mass index, aortic calcification index (ACI), renal function, serum uric acid concentrations, and comorbidities (diabetes, hypertension, or cardiovascular disease) were compared between the Non-stone and Stone groups. Independent factors for higher ACI and impaired renal function were assessed using multivariate logistic regression analysis. Results We confirmed relevance of Non-stone group patients as a control subject by comparing the pair-matched community-dwelling volunteers. Backgrounds of patients between the Non-stone and Stone groups were not significantly different except for the presence of hypertension in the Stone group. ACI was not significantly high in the Stone group compared with the Non-stone group. However, age-adjusted ACI was greater in the Stone group than the Non-stone group. Among urolithiasis patients, ACI was significantly higher in uric acid containing stone patients. The number of patients with stage 3B chronic kidney disease (CKD) was significantly higher in the Stone group than in the Non-stone group (12% vs. 4%, P = 0.008). Multivariate logistic regression analysis showed higher aortic calcification index (>13%), and being a stone former were independent factors for stage 3B CKD at the time of diagnosis. Conclusion Aortic calcification and being a stone former had harmful influence on renal function. This study was registered as a clinical trial: UMIN: UMIN000022962.
Collapse
Affiliation(s)
- Toshikazu Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Teppei Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Yuriko Terayama
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Tomihisa Funyu
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
43
|
Venkatesh S, Sanyukta J, Jain S, Prabhu SS, Kulkarni S. Aortic and pulmonary artery calcification: An unusual manifestation of twin-to-twin transfusion syndrome. Ann Pediatr Cardiol 2017; 10:75-77. [PMID: 28163434 PMCID: PMC5241851 DOI: 10.4103/0974-2069.197059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Twin-to-twin transfusion syndrome (TTTS) at times complicates monochorionic twin gestations, resulting in conditions ranging from discordant sizes to fetal demise of one baby. Various types of cardiac defects have been described in the recipient twin of this syndrome. Isolated great artery calcification, i.e. aortic and pulmonary artery calcification is one such uncommon condition associated with TTTS. Calcification of the walls of great vessels may be due to chronic vascular injury sustained as a result of circulatory volume overload in the recipient twin. It may also cause severe systemic hypertension and cardiomyopathy. An accurate diagnosis is important for an optimal follow-up and appropriate genetic counseling. We report a case of aortic and pulmonary artery calcification in association with TTTS.
Collapse
Affiliation(s)
- Sumitra Venkatesh
- Division of Pediatric Cardiology, Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - J Sanyukta
- Division of Pediatric Cardiology, Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - S Jain
- Division of Pediatric Cardiology, Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - S S Prabhu
- Division of Pediatric Cardiology, Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - S Kulkarni
- Division of Pediatric Cardiology, Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| |
Collapse
|
44
|
Fukushi K, Hatakeyama S, Yamamoto H, Tobisawa Y, Yoneyama T, Soma O, Matsumoto T, Hamano I, Narita T, Imai A, Yoneyama T, Hashimoto Y, Koie T, Terayama Y, Funyu T, Ohyama C. Aortic calcification burden predicts deterioration of renal function after radical nephrectomy. BMC Urol 2017; 17:13. [PMID: 28166753 PMCID: PMC5294895 DOI: 10.1186/s12894-017-0202-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/15/2016] [Accepted: 01/30/2017] [Indexed: 01/04/2023] Open
Abstract
Background Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic kidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before surgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of renal function in patients undergoing radical nephrectomy. Methods Between January 1995 and December 2012, we performed 511 consecutive radical nephrectomies for patients with RCC. We retrospectively studied data from 109 patients who had regular postoperative follow-up of renal function for at least five years. The patients were divided into non-CKD and pre-CKD based on a preoperative estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 or <60 mL/min/1.73 m2, respectively. The ACI was quantitatively measured by abdominal computed tomography before surgery. The patients in each group were stratified between low and high ACIs. Variables such as age, sex, comorbidities, and pre- and postoperative renal function were compared between patients with a low or high ACI in each group. Renal function deterioration-free interval rates were evaluated by Kaplan-Meier analysis. Factors independently associated with deterioration of renal function were determined using multivariate analysis. Results The median age, preoperative eGFR, and ACI in this cohort were 65 years, 68 mL/min/1.73 m2, and 8.3%, respectively. Higher ACI (≥8.3%) was significantly associated with eGFR decline in both non-CKD and pre-CKD groups. Renal function deterioration-free interval rates were significantly lower in the ACI-high than ACI-low strata in both of the non-CKD and pre-CKD groups. Multivariate analysis showed that higher ACI was an independent risk factor for deterioration of renal function at 5 years after radical nephrectomy. Conclusions Aortic calcification burden is a potential predictor of deterioration of renal function after radical nephrectomy. Trial registration This study was registered as a clinical trial: UMIN000023577 Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0202-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ken Fukushi
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Teppei Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yuriko Terayama
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Tomihisa Funyu
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
45
|
Abstract
OBJECTIVE The objective of this meta-analysis was to systematically assess the association between aortic calcification (AC) and fractures. METHOD Relevant studies were identified through searching PubMed, EMBASE and Cochrane databases before August 2014. Two investigators extracted data independently from the included studies. A random-effects model was derived to composite the pooled HRs or ORs for association of aortic calcification with fractures. RESULTS A total of 15 articles (21927 subjects) were included in the final meta-analyses. Comparing with non-calcification subjects, patients with aortic calcification were associated with increased risk of fractures (OR = 2.97, 95% CI: 1.98-4.42). Stratified analysis indicated that patients with aortic calcification showed a higher risk of fractures in hemodialysis patients (OR = 1.89, 95% CI: 1.33-2.67; I2 = 0.0%, p= 0.781) and general population (OR = 2.90, 95% CI: 1.80-4.80; I2 = 33.0%, p= 0.225), respectively. Similar significant association between severe aortic calcification and fractures were also observed. CONCLUSIONS Patients with aortic calcification or severe aortic calcification were associated with higher risk of fractures.
Collapse
Affiliation(s)
- Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunxian Yu
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
46
|
Pereira RMR, Figueiredo CP, Cha CC, Caparbo VF, Oliveira RM, Franco AS, Menezes PR, de Castro I, Onuchic LF. Associations between OPG and RANKL polymorphisms, vertebral fractures, and abdominal aortic calcification in community-dwelling older subjects: the Sao Paulo Ageing & Health Study (SPAH). Osteoporos Int 2016; 27:3319-3329. [PMID: 27311721 DOI: 10.1007/s00198-016-3664-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/08/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED This is the first study analyzing concomitantly osteoprotegerin (OPG)/receptor activator of nuclear factor kappa B ligand (RANKL) polymorphisms and OPG/RANKL serum levels and their association with bone mineral density (BMD), vertebral fractures, and vascular aortic calcification in a cohort of 800 subjects in community-dwelling older individuals. INTRODUCTION Osteoprotegerin (OPG) and RANKL play an important role in osteoclast activation and differentiation as well as in vascular calcification. At present, there are no studies of OPG or RANKL gene polymorphisms in Brazilian older populations. The aim of this study was to evaluate OPG/RANKL polymorphism and their association with vertebral fractures (VFs) and aortic calcification. METHODS Eight hundred subjects (497 women/303 men) were genotyped for the OPG 1181G>C (rs2073618), 163C>T (rs3102735), 245T>G (rs3134069), and 209G>A (rs3134070) and RANKL A>G (rs2277438) single-nucleotide polymorphisms (SNPs). VFs were evaluated by spine radiography (Genant's method). Aortic calcification was quantified using Kauppila's method. RESULTS The isolated genotype analyses and single-allele frequency data showed association of OPG 163C, 245G, and 209A alleles with presence of VFs (P < 0.05). Multiple logistic regression of subjects with absence of VFs vs. those with VFs (grades II/III) revealed only OPG 209A homozygosity as a risk factor for higher-grade VFs (odds ratio (OR) = 4.17, 95 % CI 1.03-16.93, P = 0.046). Regarding aortic calcification, the isolated genotype analysis frequency data revealed a significant association of OPG 1181G, 163C, 245G, and 209A alleles with absent aortic calcification (P < 0.05). Multiple logistic regression data confirmed that the OPG 209A allele was protective for aortic calcification (OR = 0.63, 95 % CI 0.45-0.88, P = 0.007) and the OPG 1181C allele was a risk factor for aortic calcification (OR = 1.26, 95 % CI 1.00-1.58, P = 0.046). CONCLUSION This study showed that the OPG 209AA genotype was a risk factor for higher-grade VFs, the OPG 209A allele was protective for aortic calcification, and the OPG 1181C was a risk factor for aortic calcification, supporting the involvement of OPG polymorphisms in the analyzed phenotypes and the concept that the related pathogenesis is multifactorial.
Collapse
Affiliation(s)
- R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av, Dr Arnaldo, 455, 3° andar Reumatologia, sala 3193, São Paulo, SP, 01246-903, Brazil.
| | - C P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av, Dr Arnaldo, 455, 3° andar Reumatologia, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - C C Cha
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av, Dr Arnaldo, 455, 3° andar Reumatologia, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av, Dr Arnaldo, 455, 3° andar Reumatologia, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - R M Oliveira
- RDO Diagnosticos Medicos, São Paulo, São Paulo, Brazil
| | - A S Franco
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av, Dr Arnaldo, 455, 3° andar Reumatologia, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - P R Menezes
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - I de Castro
- Molecular Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L F Onuchic
- Divisions of Nephrology and Molecular Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
47
|
Rodríguez AJ, Scott D, Khan B, Khan N, Hodge A, English DR, Giles GG, Ebeling PR. Low Relative Lean Mass is Associated with Increased Likelihood of Abdominal Aortic Calcification in Community-Dwelling Older Australians. Calcif Tissue Int 2016; 99:340-9. [PMID: 27272030 DOI: 10.1007/s00223-016-0157-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/26/2016] [Indexed: 11/26/2022]
Abstract
Age-related loss of skeletal muscle is associated with increased risk of functional limitation and cardiovascular (CV) mortality. In the elderly abdominal aortic calcification (AAC) can increase CV risk by altering aortic properties which may raise blood pressure and increase cardiac workload. This study investigated the association between low muscle mass and AAC in community-dwelling older Australians. Data for this cross-sectional analysis were drawn from a 2010 sub-study of the Melbourne Collaborative Cohort Study in the setting of community-dwelling older adults. Three hundred and twenty-seven participants [mean age = 71 ± 6 years; mean BMI = 28 ± 5 kg/m(2); females n = 199 (62 %)] had body composition determined by dual-energy x-ray absorptiometry (DXA) and AAC determined by radiography. Participants were stratified into tertiles of sex-specific BMI-normalised appendicular lean mass (ALM). Those in the lowest tertile were considered to have low relative muscle mass. Aortic calcification score (ACS) was determined visually as the extent of calcification on the aortic walls between L1 and L4 vertebrae (range: 0-24). Severe AAC was defined as ACS ≥ 6. Prevalence of any AAC was highest in participants with low relative muscle mass (74 %) compared to the middle (65 %) and upper (53 %) tertiles (p trend = 0.006). The lower ALM/BMI tertile had increased odds (Odds ratio = 2.3; 95 % confidence interval: 1.1-4.6; p = 0.021) of having any AAC; and having more severe AAC (2.2; 1.2-4.0; p = 0.009) independent of CV risk factors, serum calcium and physical activity. AAC is more prevalent and severe in community-dwelling older adults with low relative muscle mass. Maintaining muscle mass could form part of a broader primary prevention strategy in reducing AAC.
Collapse
Affiliation(s)
- Alexander J Rodríguez
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, Australia.
| | - David Scott
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, Australia
- Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Australia
| | - Belal Khan
- Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia
- Department of Medicine, Max Super Specialty Hospital, Patparganj, Delhi, India
| | - Nayab Khan
- Department of Radiology, Diwan Chand Satyapal Aggarwaal Diagnostic Imaging Research Centre, New Delhi, India
| | - Allison Hodge
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Dallas R English
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Peter R Ebeling
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, Australia
- Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Australia
| |
Collapse
|
48
|
Okamoto K, Fukui T. Bilateral axillary artery cannulation for severely calcified aorta and branches: a case report. J Cardiothorac Surg 2016; 11:98. [PMID: 27390936 PMCID: PMC4939062 DOI: 10.1186/s13019-016-0492-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/10/2016] [Accepted: 06/24/2016] [Indexed: 02/07/2023] Open
Abstract
Background Aortic valve surgery in patients with severely calcified aortas is technically challenging. Additionally, the choice of arterial cannulation site and whether to perform an aortic clamp to prevent neurological complications are poorly defined. Case presentation We describe a patient with a severely calcified aorta and stenosis of its side branches. He successfully underwent aortic valve replacement with bilateral axillary artery cannulation and short-term moderate hypothermic circulatory arrest for cross-clamping of a severely calcified aorta to prevent neurological complications. Conclusions Bilateral axillary artery cannulation and short-term moderate hypothermic circulatory arrest for cross-clamping of the porcelain aorta is a suitable option to prevent neurological complications in patients with a severely calcified aorta and stenosis of its side branches who need aortic valve replacement.
Collapse
Affiliation(s)
- Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| |
Collapse
|
49
|
NasrAllah MM, Nassef A, Elshaboni TH, Morise F, Osman NA, Sharaf El Din UA. Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification. Int J Cardiol 2016; 220:884-9. [PMID: 27400189 DOI: 10.1016/j.ijcard.2016.06.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/19/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is no consensus on the most appropriate technique to diagnose vascular calcification in chronic kidney disease. This is primarily because of the absence of direct comparisons of predictive values of the various calcification scores, especially outside the coronary vascular beds, to detect clinical outcomes. METHODS We included 93 haemodialysis patients and performed 6 vascular calcification scores: two scores utilised simple X-rays of abdominal aorta and peripheral vessels. CT scans of the thoracic, upper abdominal and lower abdominal aorta were performed to calculate the aortic calcification index and CT of the pelvis for calcification of iliac vessels. Patients were followed for 63months (mean 46.8months) for first major cardiovascular events and mortality. RESULTS Nineteen cardiovascular events and 28 deaths occurred. Calcification was detected more sensitively in central and peripheral beds using CT scans compared to X-rays (p<0.001). CT scans detected calcification more frequently in distal than proximal vascular beds (p<0.001). Calcification of the pelvic vessels and lower abdominal aorta were most predictive of events including pre-existing cardiovascular disease O.R. 6.5 (95% C.I. 2-22; p=0.001) and O.R. 3 (95% C.I. 1.1-9; p=0.035); new major cardiovascular events H.R. 4.2 (95% C.I. 1.5-11; p=0.006) and H.R. 2 (95% C.I. 0.8-5.3; p=0.1) as well as mortality H.R. 2.8 (95% C.I. 1.3-6; p=0.01) and H.R. 2.2 (95% C.I. 1.04-5; p=0.04) respectively. CONCLUSIONS CT based techniques are more sensitive than plain X-rays at detecting peripheral and aortic vascular calcifications. Distal CT scans of the aorta and pelvic vessels have the highest predictive value for cardiovascular events and mortality.
Collapse
Affiliation(s)
- Mohamed M NasrAllah
- Kasr AlAiny School of Medicine, Cairo University, Nephrology, Saray Street, Manial, Cairo, Egypt.
| | - Amr Nassef
- Kasr AlAiny School of Medicine, Cairo University, Radiology, Cairo, Egypt
| | - Tarik H Elshaboni
- Kasr AlAiny School of Medicine, Cairo University, Nephrology, Saray Street, Manial, Cairo, Egypt
| | - Fadia Morise
- Kasr AlAiny School of Medicine, Cairo University, Nephrology, Saray Street, Manial, Cairo, Egypt
| | - Noha A Osman
- Kasr AlAiny School of Medicine, Cairo University, Nephrology, Saray Street, Manial, Cairo, Egypt
| | - Usama A Sharaf El Din
- Kasr AlAiny School of Medicine, Cairo University, Nephrology, Saray Street, Manial, Cairo, Egypt
| |
Collapse
|
50
|
Eveno C, Latrasse V, Gayat É, Lo Dico R, Dohan A, Pocard M. Colorectal anastomotic leakage can be predicted by abdominal aortic calcification on preoperative CT scans: A pilot study. J Visc Surg 2016; 153:253-7. [PMID: 27118170 DOI: 10.1016/j.jviscsurg.2016.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There have been no solid data regarding whether patients with aortic calcification (AC) who have undergone colorectal surgery are at increased risk for anastomotic leakage. Our study aim to investigate the impact of AC on anastomotic leakage (AL) and postoperative morbidity after colorectal resection. METHODS This was a cohort study of 60 patients who were prospectively registered in a database. We evaluated the relationship between an aortic calcification score (ACS), measured on preoperative computed tomography (CT) imaging, and surgical complications in patients undergoing colorectal surgery. RESULTS ACS was strongly correlated with mortality rate. All three of the deceased patients were in the ACS-2 group (5%; P=0.021). The rate of AL was positively correlated with ACS; no leakage was found cases of ACS-0, with a rate of 18% in cases of ACS-1 and 44% in cases of ACS-2 (P=0.022). The consequences of AL were more serious according to the grade of ACS. DISCUSSION This study suggested that aortic calcification score is correlated with surgical outcomes, particularly anastomosis leakage, after colorectal surgery. These findings could provide useful tools for adapting surgical strategies by delaying colorectal anastomosis in high-risk patients.
Collapse
Affiliation(s)
- C Eveno
- Surgical oncologic and digestive unit, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Université Paris-Diderot, Sorbonne Paris Cité, 10, rue de Verdun, 75010 Paris, France; Inserm U965, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - V Latrasse
- Surgical oncologic and digestive unit, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - É Gayat
- Department of intensive care and anaesthesiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - R Lo Dico
- Surgical oncologic and digestive unit, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Dohan
- Université Paris-Diderot, Sorbonne Paris Cité, 10, rue de Verdun, 75010 Paris, France; Inserm U965, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Department of abdominal and interventional imaging, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; McGill university health center, department of radiology, McGill university health center, 1650, Cedar avenue, C5 118 Montreal, QC, Canada
| | - M Pocard
- Surgical oncologic and digestive unit, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Université Paris-Diderot, Sorbonne Paris Cité, 10, rue de Verdun, 75010 Paris, France; Inserm U965, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| |
Collapse
|