scholarly journals Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox

ISRN Obesity ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Kongkiat Chaikriangkrai ◽  
Mahwash Kassi ◽  
Sayf Khaleel bala ◽  
Faisal Nabi ◽  
Su Min Chang
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Cardiac Ct ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Acute Chest Pain ◽  
Coronary Calcification ◽  
Obesity Paradox ◽  
Asymptomatic Subjects

Obesity paradox has been described in various populations of coronary artery disease, mainly asymptomatic subjects. However, relationship between obesity and coronary artery calcification detected by cardiac CT in symptomatic patients has rarely been demonstrated. This study seeks to investigate whether the paradoxical relationship between obesity and coronary artery calcification exists in patients with acute chest pain. A final cohort of 1030 chest pain patients presenting at our emergency department who underwent coronary evaluation by multidetector cardiac CT were examined. With absent-to-mild coronary calcification (CAC score < 100) as a referent, multivariable analysis showed that presence of obesity (OR 0.564; 95% CI 0.395, 0.806; P 0.002), body mass index (OR 0.945; 95% CI 0.920, 0.971; P<0.001), body weight (OR 0.987; 95% CI 0.979, 0.995; P 0.001), and body surface area (OR 0.582; 95% CI 0.369, 0.920; P 0.020) were inversely associated with moderate-to-severe coronary calcification (CAC score ≥ 100). This study extends the concept of obesity paradox to symptomatic patients undergoing coronary artery calcium score assessment. However, biological explanation(s) of this paradox remains unanswered.

scholarly journals Correlation between Osteoprotegerin Serum Level and Coronary Calcification Using Coronary Artery Calcium Score in Patient with Moderate–Severe Cardiovascular Risk Factor

2017 ◽  
Vol 26 (04) ◽  
pp. 234-237 ◽  
Author(s):  
Widorini Widorini ◽  
J. Nugroho
Keyword(s):  
Computed Tomography ◽  
Risk Factor ◽  
Coronary Artery ◽  
Serum Level ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcification ◽  
Calcium Score ◽  
Coronary Calcification ◽  
Cross Sectional ◽  
The Mean

AbstractCoronary artery calcification is a part of atherosclerosis process associated with coronary heart disease. Recently, coronary artery calcification assessment using computed tomography (CT) is still the best noninvasive imaging with high sensitivity and specificity. Osteoprotegerin (OPG) is one of vascular calcification marker that through its role to bind receptor activator of nuclear factor-κβ ligand and inhibit osteoclastogenesis is suspected of playing a role for coronary calcification in atherosclerosis process. The objective of this study was to prove a positive correlation between OPG serum level and coronary calcification using coronary artery calcium (CAC) score in patient with moderate–severe cardiovascular (CV) risk factor. This is a cross-sectional study with purposive sampling technique. Thirty-three subjects participate in this research and each subject underwent a multislice computed tomography (MSCT) examination to assess coronary calcification and their blood samples were collected for OPG measurement. This study is analyzed with Spearman's correlation test. The mean of OPG serum level in this study was 5.89 ± 2.1 pmol/L for moderate-risk Framingham risk score (FRS) and the mean of OPG serum level for high-risk FRS was 7.27 ± 3.4. There was a positive, moderate, and significant correlation between OPG serum level and coronary calcification using CAC score in patient with moderate–severe CV risk factor (r = 0.694; p < 0.001).

Abstract 1900: Coronary MDCT based Detection of Coronary Stenosis and Plaque in the Assessment of Patients with Acute Chest Pain: Update from ROMICAT I

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Udo Hoffmann ◽  
Fabian Bamberg ◽  
Sujith Seneviratne ◽  
Ian S Rogers ◽  
Quynh A Truong ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Atherosclerotic Plaque ◽  
Cardiac Ct ◽  
Coronary Artery Stenosis ◽  
Acute Chest Pain ◽  
Artery Stenosis ◽  
Significant Coronary Artery Stenosis ◽  
Coronary Syndrome ◽  
Coronary Atherosclerotic Plaque

Objective : To determine CT angiographic patterns of coronary plaque and stenosis and diagnostic test characteristics of these findings to predict ACS in patients presenting with acute chest pain to the emergency department (ED). Methods : We conducted a blinded, prospective, observational cohort study in patients presenting with acute chest pain to the ED between May 2005 and July 2006, who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice cardiac CT was performed immediately before admission and caregivers were blinded to the cardiac CT results. An expert panel determined the presence or absence of ACS (unstable angina pectoris [UAP], Non-ST-Elevation Myocardial Infarction [MI] according to AHA/ACC criteria). Two independent observers evaluated cardiac CT data sets for the presence of (1) coronary atherosclerotic plaque, and (2) significant coronary artery stenosis (>50%). Results: Of 221 consecutive patients (44% female, mean age 55±12 years), 31 patients had ACS (10 NSTEMI, 21 UAP). The presence of any coronary atherosclerotic plaque could be excluded in 82 patients (37%). None of these subjects was determined to have ACS (Sensitivity and NPV: 100%, (95% CI: 0.91–1.00 and 0.96–1.00; respectively). The presence of a significant coronary artery stenosis could be excluded in 152 subjects (69%). Overall, three of these patients had ACS during the index hospitalization (NPV, 98 %; 95% CI: 0.94–1.00). In 69 patients (31%), a significant stenosis was either detected or could not be completely excluded. Among them were 28/31 patients with ACS (specificity: 78%, 95% CI: 0.72– 0.84; PPV: 41% 95% CI: 0.29 – 0.53). Conclusions : These data extend initial observations that nearly 40% and 70% of patients with acute chest pain demonstrate no detectable CAD or no significant coronary artery stenosis on cardiac MDCT, respectively. Randomized diagnostic trials are warranted to determine how this information will be used by ED physicians and whether it will decrease the number of unnecessary admissions.

Abstract 224: Obesity Paradox in Coronary Artery Disease in Patients With Acute Chest Pain

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Mahwash Kassi ◽  
Sayf Khaleel bala ◽  
Su Min Chang
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Acute Chest Pain ◽  
P Value ◽  
Artery Disease ◽  
Severe Calcification

Introduction Obesity has been inconsistently linked with coronary artery calcium score (CACS) as a surrogate of coronary artery disease (CAD) in asymptomatic subjects. Our aim was to examine whether there is relationship between obesity defined by BMI≥30kg/m 2 and presence and severity of CAD defined by CACS in patients with acute chest pain. Methods In this cross-sectional study, 1030 consecutive patients without reported history of coronary artery disease who presented with acute chest pain were included. CACS by non-contrast CT scan and BMI were collected. Patients were categorized by CACS classifications and BMI. Results The population with mean age of 54±13 years, 33% (338 of 1030) of patients being overweight and 46% (477 of 1030) being obese consisted of 60.6% (624 of 1030) patients with zero CACS, 21.7% (223 of 1030) with mild calcification (0<CACS<100) and 17.8% (183 of 1030) with moderate-to-severe calcification (CACS≥100). Compared to non-overweight/non-obese group, obese group had less patients with moderate-to-severe calcification (69 of 477; 14.5% VS 50 of 215; 22.6% p-value=0.016) despite more patients with hypertension (311 of 477; 65.2% VS 98 of 215; 45.6% p-value<0.001), diabetes (98 of 477; 20.5% VS 11 of 215; 5.1% p-value<0.001) and hyperlipidemia(174 of 477; 36.5% VS 57 of 215; 26.5% p-value=0.010). Obesity is INVERSELY associated with presence of CACS and moderate-to-severe calcification in multivariable logistic regression analysis (table 1). Conclusion Obesity defined by body mass index ≥ 30kg/m 2 is INVERSELY associated with presence and severity of coronary artery disease defined by coronary artery calcium score in patients with acute chest pain.

scholarly journals Analysis of Correlation Between Coronary Tortuosity and Calcification Score

2021 ◽  
Author(s):  
Min Li ◽  
Zhen-Wei Wang ◽  
Li-Juan Fang ◽  
Shou-Quan Cheng ◽  
Xin Wang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Multivariable Analysis ◽  
Vascular Anatomy ◽  
Density Lipoprotein ◽  
Calcium Score ◽  
Cross Sectional ◽  
Calcification Score ◽  
Multivariable Regression ◽  
Coronary Tortuosity

Abstract Background: Coronary artery tortuosity (CAT) is regarded as a variation of vascular anatomy, and its relationship with coronary artery calcification (CAC) score is still not well clarified. Studying the correlation between coronary artery calcification scores and CAT to determine specific prevention and intervention populations seems to have more meaningful.Methods: The study is a cross-sectional retrospective study, including 1280 patients with tortuous coronary artery. CAT is defined as the presence of at least three consecutive curvatures of more than 45°measured during systole or diastole of a major epicardial coronary artery. Multivariable regression analysis was used to adjust the clinical parameters directly affecting CAT.Results: Of these individuals, 445 (35%) were evaluated having CAT, of which females are higher than males (59.1% vs. 40.9%). Moderate CAC score (101-400) (odds ratio (OR) 1.49, 95% confidence interval [95%CI] 1.05-2.10, P=0.025) revealed significantly associated with CAT on univariable analysis. However, multivariable analysis after adjusting for confounding factors only indicated that CAT was positively correlated with female (OR 1.60, 95%CI 1.22-2.10, P=0.001), hypertension (OR 1.34, 95% CI 1.03-1.74, P=0.028), and age (OR 1.04, 95% CI 1.01-1.03, P=0.001), while was negatively associated with body mass index (BMI) > 28 (OR 0.48, 95% CI 0.32-0.70, P<0.0001). Further analysis stratified by gender showed that compared with non-CAT, CAT was significantly linked with moderate CAC score (OR 1.79, 95% CI 1.00-3.20, P=0.048), hypertension (OR 1.54, 95% CI 1.07-2.22, P=0.021), and high-density lipoprotein (HDL) (OR 1.86, 95% CI 1.07-3.24, P=0.028), while was negatively related to BMI > 28 (OR 0.51, 95% CI 0.31-0.84, P<0.008) in female patients.Conclusions: CAT is more likely to be found in females, connected with hypertension, age, and BMI. No significant correlation is found between the presence of tortuosity and calcium score or diameter stenosis on multivariable analysis. Whereas the CAT is associated with moderate CAC score in correlation analysis when women are selected as the main group.

Incorporating coronary calcification by computed tomography into CHA2DS2-VASc score: impact on cardiovascular outcomes in patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Nicholas Chan ◽  
Paul C Cremer ◽  
Mohamed Kanj ◽  
Bryan Baranowski ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Cardiac Computed Tomography ◽  
Multivariable Analysis ◽  
Coronary Calcification ◽  
Major Adverse Cardiovascular Events ◽  
Anticoagulation Management ◽  
Disease Parameter

Abstract Aims CHA2DS2-VASc score is widely utilized for risk stratification and guiding anticoagulation in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed for pulmonary vein isolation (PVI) can also identify coronary artery calcifications (CAC). We evaluated the frequency and outcomes of incorporating CAC into the CHA2DS2-VASc score in AF patients undergoing PVI. Methods and results Consecutive patients in a prospective PVI registry during 2014–18 having CCT within 1 year of PVI were studied. Reclassification of CHA2DS2-VASc score and associations between CAC as a binary variable detected on CCT with clinical characteristics, stroke as primary endpoint, death, myocardial infarction, and major adverse cardiovascular events (MACE) were analysed. Amongst 3604 AF patients, 2238 (62.1%) had CAC detected on CCT and was associated with most traditional cardiovascular risk factors. Coronary artery calcification was independently associated with all pre-specified endpoints adjusting for clinical parameters in multivariable analysis. Adjusting for CHA2DS2-VASc score, CAC was associated with stroke (hazards ratio 3.64, 95% confidence interval 1.25–10.6, P = 0.018), death (2.26, 1.29–3.98, P = 0.006), and MACE (2.08, 1.36–3.16, P = 0.001) during 2.8 ± 1.6-year follow-up. Incorporating CAC as a vascular disease parameter of CHA2DS2-VASc score, anticoagulation decision-making would be revised in 723 (20.1%) patients, including an additional 488 (13.5%) patients where anticoagulation would be now indicated. Conclusion Coronary artery calcification is prevalent in AF patients undergoing PVI and independently associated stroke, death and MACE even when adjusted for traditional CHA2DS2-VASc score. Adding CAC as vascular component to the CHA2DS2-VASc score requires further research as it potentially modified the anticoagulation management in 20% of our AF cohort.

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